Medical Student Vanderbilt University School of Medicine Nashville, Tennessee, United States
Introduction: Several patient characteristics at admission have been assessed as prognostic indicators for TBI. The prognostic value of SI has also been investigated, but its use has been limited to predicting specific outcomes rather than more generalized discharge status and neurological outcome. The purpose of the present study is to define SI cutoffs with favorable discharge outcomes in a diverse set of TBI patients in the form of a retrospective chart review at a high-volume quaternary center.
Methods: All patients who presented with TBI from January 1st-December 31st, 2017, at a Level 1 trauma center were retrospectively reviewed. Data that were analyzed included demographic information such as age, gender, race, and ethnicity, as well as functional outcomes such as admission Glasgow Coma Scale (GCS) score, whether a neurological intervention was performed, and injury severity score. The primary outcomes assessed included favorable discharge outcome, as defined by GCS greater than 13.
Results: A total of 130 patients were included in the analysis (GCS range 3 – 15). SI correlation to admission GCS as well as TBI severity exhibited no significant trend. Analysis across all TBI injuries revealed a significantly elevated SI (0.79) for patients with poor discharge GCS as compared to those with favorable discharge GCS (0.67) with a p value of 0.015. Optimal threshold analysis optimized for discharge GCS revealed significant cutoffs for SI >/= 0.7373 across all TBI injuries. In the sub-analysis for mild TBIs, the SI cutoff increased to >/= 1.0606, whereas analysis of severe TBIs yielded no significant cutoff value for SI.
Conclusion : Collectively, the findings of the present study and dearth of investigations into the prognostic value and associated impact on clinical management of SI in TBI warrant further investigation on these topics.
