Preditores clínicos de mortalidade Intra-Hospitalar em pacientes com traumatismo Cranioencefálico grave no Hospital de Urgências de Sergipe / Clinical predictors of in-hospital mortality in patients with severe traumatic brain injuries at the Hospital de Urgências de Sergipe

Authors

  • Otávio Santiago Rocha
  • João Victor Santos Melo
  • Diego Henrique Gois Pereira
  • Thaís Cristina de Souza Melo
  • José Nolasco de Carvalho Neto
  • Arthur Maynart Pereira Oliveira
  • Bruno Fernandes de Oliveira Santos

DOI:

https://doi.org/10.34119/bjhrv5n3-232

Keywords:

ferimentos craniofaciais, sobrevida, traumatismo cranioencefálico.

Abstract

INTRODUÇÃO: O trauma cranioencefálico (TCE) é um sério problema de saúde pública responsável por milhões de mortes e casos de incapacidade mundialmente. O objetivo do presente trabalho é portanto identificar preditores clínicos de mortalidade intra-hospitalar em pacientes admitidos por TCE severo no Hospital de Urgências de Sergipe.   METODOLOGIA: Trata-se um estudo de coorte retrospectivo com análise da sobrevida de 228 pacientes com trauma cranioencefálico severo. O método utilizado para estimar a sobrevida do paciente foi a regressão de Cox, sendo considerados significativos os valores de p < 0,05. RESULTADOS: A idade mediana dos 228 incluídos no estudo foi de 31 anos (14-94) anos , sendo 201 (88,2%) do sexo masculino. Sessenta pacientes (27,5%) tiveram como desfecho o óbito durante o internamento, sendo que a maioria dos óbitos (42, 60%) ocorreu nos primeiros 15 dias. Foi constatada uma letalidade de 21,9% nos primeiros 30 dias. O único preditor clínico independente para morte intra-hospitalar foi ausência do reflexo fotomotor direto (RFD ausente) (RR 3,4 e IC 95% 1,9-6,0). CONCLUSÃO: Foi constatada uma letalidade de 21,9% nos primeiros 30 dias e somente RFD ausente foi preditor clínico independente de mortalidade intra-hospitalar nos pacientes com TCE grave.

References

Moorin R, Miller TR, Hendrie D. Population-based incidence and 5-year survival for hospital-admitted traumatic brain and spinal cord injury, Western Australia, 2003–2008. Journal of Neurology. 2014;261(9):1726-1734. doi:10.1007/s00415-014-7411-y

Rodrigues M de S. Epidemiologia de traumatismo craniencefálico em um hospital. 2018:4.

Soares de Souza R, Pessoa Pinheiro P, Ferreira de Lima Silva JM, Leite Rolim Neto M, Machado Filho JA. Traumatic brain injury (TBI): morbidity, mortality and economic implications. International Archives of Medicine. 2015. doi:10.3823/1672

Harrison-Felix C, Kolakowsky-Hayner SA, Hammond FM, et al. Mortality After Surviving Traumatic Brain Injury: Risks Based on Age Groups. Journal of Head Trauma Rehabilitation. 2012;27(6):E45-E56. doi:10.1097/HTR.0b013e31827340ba

Brown AW, Leibson CL, Mandrekar J, Ransom JE, Malec JF. Long-Term Survival After Traumatic Brain Injury: A Population-Based Analysis Controlled for Nonhead Trauma. Journal of Head Trauma Rehabilitation. 2014;29(1):E1-E8. doi:10.1097/HTR.0b013e318280d3e6

Cooper DJ, Rosenfeld JV, Murray L, et al. Decompressive Craniectomy in Diffuse Traumatic Brain Injury. New England Journal of Medicine. 2011;364(16):1493-1502. doi:10.1056/NEJMoa1102077

Shackelford SA, Bell R, Becker T, Gurney J, McCafferty R, Marion DW. Association of time to craniectomy with survival in patients with severe combat-related brain injury. Neurosurg Focus. 2018;45:9.

Strnad M, Borovnik Lesjak V, Vujanović V, Križmarić M. Predictors of mortality in patients with isolated severe traumatic brain injury. Wiener klinische Wochenschrift. 2017;129(3-4):110-114. doi:10.1007/s00508-016-0974-0

Volpi PC, Robba C, Rota M, Vargiolu A, Citerio G. Trajectories of early secondary insults correlate to outcomes of traumatic brain injury: results from a large, single centre, observational study. BMC Emergency Medicine. 2018;18(1). doi:10.1186/s12873-018-0197-y

Fuller GW, Ransom J, Mandrekar J, Brown AW. Long-Term Survival Following Traumatic Brain Injury: A Population-Based Parametric Survival Analysis. Neuroepidemiology. 2016;47(1):1-10. doi:10.1159/000445997

Jacobs B, Beems T, van der Vliet TM, et al. Outcome Prediction in Moderate and Severe Traumatic Brain Injury: A Focus on Computed Tomography Variables. Neurocritical Care. 2013;19(1):79-89. doi:10.1007/s12028-012-9795-9

Bellaviti, Gianluca, et al. “Influence of Systemic Infection and Comorbidities on Rehabilitation Outcomes in Severe Acquired Brain Injury”. European Journal of Physical and Rehabilitation Medicine, vol. 57, no 1, fevereiro de 2021, p. 69–77. PubMed, doi:10.23736/S1973-9087.20.05939-0.

Boltzmann, Melanie, et al. “The Influence of the CRS-R Score on Functional Outcome in Patients with Severe Brain Injury Receiving Early Rehabilitation”. BMC Neurology, vol. 21, no 1, janeiro de 2021, p. 44. PubMed, doi:10.1186/s12883-021-02063-5.

Jin, Tao, et al. “Effect of Combination Invasive Intracranial Pressure (ICP) Monitoring and Transcranial Doppler in the Treatment of Severe Craniocerebral Injury Patients with Decompressive Craniectomy”. Annals of Palliative Medicine, vol. 10, no 4, abril de 2021, p. 4472–78. PubMed, doi:10.21037/apm-21-504.

Okazaki, Tomoya, et al. “Hospital-Level Intracranial Pressure Monitoring Utilization and Functional Outcome in Severe Traumatic Brain Injury: A Post Hoc Analysis of Prospective Multicenter Observational Study”. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, vol. 29, no 1, janeiro de 2021, p. 5. PubMed, doi:10.1186/s13049-020-00825-7.

Qu, Xingguang, et al. “Selective Sphingosine-1-Phosphate Receptor 1 Modulation Ameliorates TBI-Induced Neurological Deficit after CCI”. Neuroscience Letters, vol. 750, abril de 2021, p. 135748. DOI.org (Crossref), doi:10.1016/j.neulet.2021.135748.

Roberts, Ian, et al. “Tranexamic Acid to Reduce Head Injury Death in People with Traumatic Brain Injury: The CRASH-3 International RCT”. Health Technology Assessment (Winchester, England), vol. 25, no 26, abril de 2021, p. 1–76. PubMed, doi:10.3310/hta25260.

Wang, Zhong, et al. “[Application of continuous monitoring of intracranial pressure and brain oxygen partial pressure in the treatment of patients with severe craniocerebral injury]”. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, vol. 33, no 4, abril de 2021, p. 449–54. PubMed, doi:10.3760/cma.j.cn121430-20201106-00700.

Whyte, John, et al. “Brain Injury Functional Outcome Measure (BI-FOM): A Single Archives of Physical Medicine and Rehabilitation, vol. 102, no 1, janeiro de 2021, p. 87–96. PubMed, doi:10.1016/j.apmr.2020.09.377.

Yin, W., et al. “[GCS score combined with CT score and serum S100B protein level Can evaluate severity and early prognosis of acute traumatic brain injury]”. Nan Fang Yi Ke Da Xue Xue Bao = Journal of Southern Medical University, vol. 41, no 4, abril de 2021, p. 543–48. PubMed, doi:10.12122/j.issn.1673-4254.2021.04.09.

Zhao, Shibing, et al. “[Clinical efficacy of restrictive fluid management in patients with severe traumatic brain injury]”. Nan Fang Yi Ke Da Xue Xue Bao = Journal of Southern Medical University, vol. 41, no 1, janeiro de 2021, p. 111–15. PubMed, doi:10.12122/j.issn.1673-4254.2021.01.16.

Wiegers EJA, Trapani T, Gabbe BJ, Gantner D, Lecky F, Maas AIR, et al. Characteristics, management and outcomes of patients with severe traumatic brain injury in Victoria, Australia compared to United Kingdom and Europe: A comparison between two harmonised prospective cohort studies. Injury. setembro de 2021;52(9):2576–87.

Whiteneck GG, Ketchum JM, Almeida EJ, Goldstein R, Brown AW, Corrigan JD, et al. Developing an Index of Medical Conditions Associated with Outcomes after Moderate-to-Severe Traumatic Brain Injury. Journal of Neurotrauma. 1o de março de 2021;38(5):593–603.

Tverdal C, Andelic N, Helseth E, Brunborg C, Rønning P, Hellstrøm T, et al. In the Aftermath of Acute Hospitalization for Traumatic Brain Injury: Factors Associated with the Direct Pathway into Specialized Rehabilitation. JCM. 14 de agosto de 2021;10(16):3577.

the IATR study group, Rauch S, Marzolo M, Cappello TD, Ströhle M, Mair P, et al. Severe traumatic brain injury and hypotension is a frequent and lethal combination in multiple trauma patients in mountain areas – an analysis of the prospective international Alpine Trauma Registry. Scand J Trauma Resusc Emerg Med. dezembro de 2021;29(1):61.

Shibahashi K, Hoda H, Okura Y, Hamabe Y. Acceptable Blood Pressure Levels in the Prehospital Setting for Patients with Traumatic Brain Injury: A Multicenter Observational Study. World Neurosurgery. maio de 2021;149:e504–11.

Rubiano AM, Griswold DP, Jibaja M, Rabinstein AA, Godoy DA. Management of severe traumatic brain injury in regions with limited resources. Brain Inj. 19 de setembro de 2021;35(11):1317–25.

Rubiano AM, Griswold DP, Jibaja M, Rabinstein AA, Godoy DA. Management of severe traumatic brain injury in regions with limited resources. Brain Inj. 19 de setembro de 2021;35(11):1317–25.

Roquilly A, Moyer JD, Huet O, Lasocki S, Cohen B, Dahyot-Fizelier C, et al. Effect of Continuous Infusion of Hypertonic Saline vs Standard Care on 6-Month Neurological Outcomes in Patients With Traumatic Brain Injury: The COBI Randomized Clinical Trial. JAMA. 25 de maio de 2021;325(20):2056.

Roberts I, Shakur-Still H, Aeron-Thomas A, Beaumont D, Belli A, Brenner A, et al. Tranexamic acid to reduce head injury death in people with traumatic brain injury: the CRASH-3 international RCT. Health Technol Assess. abril de 2021;25(26):1–76.

Robba C, Graziano F, Rebora P, Elli F, Giussani C, Oddo M, et al. Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study. The Lancet Neurology. julho de 2021;20(7):548–58.

Ponsford J, Harrison-Felix C, Ketchum JM, Spitz G, Miller AC, Corrigan JD. Outcomes 1 and 2 Years After Moderate to Severe Traumatic Brain Injury: An International Comparative Study. Archives of Physical Medicine and Rehabilitation. março de 2021;102(3):371–7.

Neumane S, Câmara-Costa H, Francillette L, Toure H, Brugel D, Laurent-Vannier A, et al. Functional status 1 year after severe childhood traumatic brain injury predicts 7-year outcome: Results of the TGE study. Annals of Physical and Rehabilitation Medicine. setembro de 2022;65(5):101627.

Nelson LD, Magnus BE, Temkin NR, Dikmen S, Balsis S. Functional Status Examination Yields Higher Measurement Precision than the Glasgow Outcome Scale-Extended after Moderate-to-Severe Traumatic Brain Injury. Journal of Neurotrauma. 1o de dezembro de 2021;38(23):3288–94.

Mostert CQB, Singh RD, Gerritsen M, Kompanje EJO, Ribbers GM, Peul WC, et al. Long-term outcome after severe traumatic brain injury: a systematic literature review. Acta Neurochir [Internet]. 31 de janeiro de 2022 [citado 8 de março de 2022]; Disponível em: https://link.springer.com/10.1007/s00701-021-05086-6

Moorthy DSRK, Rajesh K, Priya S, Abhinov T, Devendra Prasad K. Prediction of outcome based on trauma and injury severity score, IMPACT and CRASH prognostic models in moderate-to-severe traumatic brain injury in the elderly. Asian J Neurosurg. 2021;16(3):500.

Mollayeva T, Bordignon C, Ishtiaq M, Colquhoun H, D’Souza A, Archambault P, et al. Knowledge of sex and gender and related information needs in patients with traumatic brain injury: in-depth interview study. Disability and Rehabilitation. 19 de junho de 2021;43(13):1872–82.

Lenstra J-J, Kuznecova-Keppel Hesselink L, la Bastide-van Gemert S, Jacobs B, Nijsten MWN, van der Horst ICC, et al. The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury. Front Neurol. 8 de janeiro de 2021;11:597737.

Kow CY, Harley B, Li C, Romo P, Gkolia P, Lu K-Y, et al. Escalating Mean Arterial Pressure in Severe Traumatic Brain Injury: A Prospective, Observational Study. Journal of Neurotrauma. 15 de julho de 2021;38(14):1995–2002.

Jakob DA, Lewis M, Benjamin ER, Demetriades D. Isolated traumatic brain injury: Routine intubation for Glasgow Coma Scale 7 or 8 may be harmful! J Trauma Acute Care Surg. 1o de maio de 2021;90(5):874–9.

Gómez PA, Castaño Leon AM, Lora D, Cepeda S, Lagares A. Final outcome trends in severe traumatic brain injury: a 25-year analysis of single center data. Acta Neurochir. dezembro de 2018;160(12):2291–302.

Gaitanidis A, Breen KA, Maurer LR, Saillant NN, Kaafarani HMA, Velmahos GC, et al. Systolic Blood Pressure <110 mm Hg as a Threshold of Hypotension in Patients with Isolated Traumatic Brain Injuries. J Neurotrauma. 1o de abril de 2021;38(7):879–85.

Erickson SL, Killien EY, Wainwright M, Mills B, Vavilala MS. Mean Arterial Pressure and Discharge Outcomes in Severe Pediatric Traumatic Brain Injury. Neurocrit Care. junho de 2021;34(3):1017–25.

Dijkland SA, Helmrich IRAR, Nieboer D, van der Jagt M, Dippel DWJ, Menon DK, et al. Outcome Prediction after Moderate and Severe Traumatic Brain Injury: External Validation of Two Established Prognostic Models in 1742 European Patients. Journal of Neurotrauma. 15 de maio de 2021;38(10):1377–88.

Deeb A, Phelos HM, Peitzman AB, Billiar TR, Sperry JL, Brown JB. The Whole is Greater Than the Sum of its Parts: GCS Versus GCS-Motor for Triage in Geriatric Trauma. Journal of Surgical Research. maio de 2021;261:385–93.

Chen P, Deng Y, Yu X, Huang T, Huang J. Analysis of Clinical Characteristics and Prognosis of Traumatic Brain Injury in Papua New Guinea. Comput Math Methods Med. 2021;2021:4948664.

Bruns N, Kamp O, Lange KM, Lefering R, Felderhoff-Muser U, Dudda M, et al. Functional short-term outcomes and mortality in children with severe traumatic brain injury - comparing decompressive craniectomy and medical management. Journal of Neurotrauma. 8 de dezembro de 2021;neu.2021.0378.

Brooks JC, Shavelle RM, Strauss DJ, Hammond FM, Harrison-Felix CL. Life Expectancy of 1-Year Survivors of Traumatic Brain Injury, 1988-2019: Updated Results From the TBI Model Systems. Arch Phys Med Rehabil. janeiro de 2022;103(1):176–9.

Brennan PM, Murray GD, Teasdale GM. Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity. Journal of Neurosurgery. junho de 2018;128(6):1612–20.

Bonds B, Dhanda A, Wade C, Diaz C, Massetti J, Stein DM. Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better? J Neurotrauma. 15 de abril de 2021;38(8):1168–76.

Balakrishnan B, VanDongen-Trimmer H, Kim I, Hanson SJ, Zhang L, Simpson PM, et al. GCS-Pupil Score Has a Stronger Association with Mortality and Poor Functional Outcome than GCS Alone in Pediatric Severe Traumatic Brain Injury. Pediatr Neurosurg. 2021;56(5):432–9.

Ali Ali B, Brinck T, Handolin L, Belzunegui Otano T. Severe head injury in elderly: 6-year comparison of treatment and outcome between southern Finland and Navarra (Spain). Eur J Trauma Emerg Surg. outubro de 2021;47(5):1429–36.

Published

2022-06-01

How to Cite

ROCHA, O. S.; MELO, J. V. S.; PEREIRA, D. H. G.; MELO, T. C. de S.; NETO, J. N. de C.; OLIVEIRA, A. M. P.; SANTOS, B. F. de O. Preditores clínicos de mortalidade Intra-Hospitalar em pacientes com traumatismo Cranioencefálico grave no Hospital de Urgências de Sergipe / Clinical predictors of in-hospital mortality in patients with severe traumatic brain injuries at the Hospital de Urgências de Sergipe. Brazilian Journal of Health Review, [S. l.], v. 5, n. 3, p. 10751–10763, 2022. DOI: 10.34119/bjhrv5n3-232. Disponível em: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/48848. Acesso em: 29 mar. 2024.

Issue

Section

Original Papers