Management and perioperative outcomes of traumatic brain injury: retrospective study
Cranioencephalic traumatism (CET) is a cause of mortality and morbidity in the surgical patient. However, the perioperative management of this entity has not been evaluated in the country's health institutions, despite its high disease burden and potential adverse clinical outcomes.
To evaluate the clinical characteristics of surgical TBI and perioperative outcomes.
Descriptive study of historical review conducted at the Hospital San Vicente Fundación, Medellín, Colombia. Data were collected from the medical records of patients over 13 years of age diagnosed with moderate-severe TBI between 2011 and 2014. Clinical variables, perioperative management, and clinical outcomes up to discharge were analyzed. An exploratory analysis was performed between perioperative management and postoperative mortality or neurological dysfunction.
CET was most common in the young male population (89.3%). Severe trauma occurred in 71.1% of patients. Perioperative mortality was 16%, and 54% presented neurological disability at discharge. A strong association was found between mortality or neurological dysfunction and severity of injury and perioperative hypotension.
The study found that surgical CET was a high morbidity and perioperative mortality event, highly related to the severity of the injury and the hemodynamic stability of the patient. Despite this, intraoperative hemodynamic and metabolic monitoring remains limited in more than 50% of these patients' surgical procedures.
2. Álvarez D, Cuartas M, Gil A, et al. Manejo del trauma craneoencefálico de la población adulta en el ámbito prehospitalario. Degree thesis Medellín: CES University; 2009.
3. Guzmán F. Physiopathology of traumatic brain injury. Colomb Méd 2008;29 (suppl 3):78-84.
4. Losiniecki A, Shutter L. Management of traumatic brain injury. Curr Treat Options Neurol 2010;12:142-154.
5. Sharma D, Vavilala MS. Perioperative management of adult traumatic brain injury. Anesthesiol Clin 2012;30:333-346.
6. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975;1:480-484.
7. Dash HH, Chavali S. Management of traumatic brain injury patients. Korean J Anesthesiol 2018;71:12-21.
8. Heegaard W, Biros M. Traumatic brain injury. Emerg Med Clin North Am 2007;25:655-678.
9. Jiang J-Y, Gao G-Y, Li W-P, et al. Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 2002;19:869-874.
10. Moreno SL. Datos para la Vida 2016. Inst Nac Med Leg For Sci 2016;18:649.
11. Hendrickson P, Pridgeon J, Temkin NR, et al. Development of a severe traumatic brain injury consensus-based treatment protocol conference in Latin America. World Neurosurg 2018;110:e952-e957.
12. Hirschi R, Rommel C, Letsinger J, et al. Brain trauma foundation guideline compliance: results of a multidisciplinary, international survey. World Neurosurg 2018;116:e399-e405.
13. Tsang KK-T, Whitfield PC. Traumatic brain injury: review of current management strategies. Br J Oral Maxillofac Surg 2012; 50:298-308.
14. Steiner LA, Johnston AJ, Czosnyka M, et al. Direct comparison of cerebrovascular effects of norepinephrine and dopamine in headinjured patients. Crit Care Med 2004;32:1049-1054.
15. Talving P, Benfield R, Hadjizacharia P, et al. Coagulopathy in severe traumatic brain injury: a prospective study. J Trauma 2009;66:55-61. discussion 61-62.
16. Shakur H, Roberts I, Bautista R, et al. CRASH-2 Trial Collaborators Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2): a randomized, placebo-controlled trial. Lancet 2010;376:23-32.
17. Liu-DeRyke X, Collingridge DS, Orme J, et al. Clinical impact of early hyperglycemia during acute phase of traumatic brain injury. Neurocrit Care 2009;11:151-157.
18. Pendem S, Rana S, Manno EM, et al. A review of red cell transfusion in the neurological intensive care unit. Neurocrit Care 2006;4:63-67.
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