Abstract Details

Title Pre-Hospital Neurological Deterioration Is Independent Predictor of Outcome in Traumatic Brain Injury: Analysis from National Trauma Data Bank (NTDB)

Topic Critical Care/Emergency Neurology/Trauma

Presentation(s) P01 - (-)

Poster/Presentation
Number 030

Objective

Background The prevalence and impact of PhND in patients with TBI have not been investigated.

Design/Methods Patients admitted with TBI were identified by ICD-9-CM codes from the National Trauma Data Bank(NTDB). NTDB represents one of the largest trauma databases and contains data from over 900 trauma centers across the United States. The initial GCS score ascertained at the scene by EMS was compared with the subsequent GCS score evaluation in the emergency department to identify neurological deterioration(defined as a decrease in GCS of =<2 points) Patients demographics, initial Injury Severity Score(ISS), admission GCS, and hospital outcome were compared between patients with PhND and patients without neurological deterioration.

Results A total of 22254 patients with PhND were identified which comprised 9% of all TBI patients. The mean age for patients with PhND was 2 years less than patients without PhND and neurological deterioration was more prevalent in men(72%). The mean of GCS score decrease was 5 points. Patients without PhND tended to have higher GCS recorded by EMS (mean of 12.69 versus 11.22, p<.0001). Admission ISS was significantly higher in patients with neurological deterioration(20.80 versus 14.15, p<.0001). TBI patients with PhND had significantly higher hospital length of stay, ICU days and ventilator days even after adjusting for baseline characteristics and EMS GCS score, and admission ISS(p<.0001). These patients had higher rate of in-hospital mortality after adjusting for age, gender, EMS GCS score, and admission ISS(OR; 95%CI: 1.17; 1.09-1.25).

Conclusions PhND occurs in 9% of TBI patients. It is more prevalent in men and associated with lower EMS GCS level and higher admission ISS. It appears that PhND is an independent predictor of worse hospital outcome in TBI patients.

Authors/Disclosures
Shahram Majidi, MD (Icahn School of Medicine at Mount Sinai) PRESENTER	Dr. Majidi has nothing to disclose.
Farhan Siddiq, MD	Dr. Siddiq has nothing to disclose.
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.
	No disclosure on file

��ɫ��

��ɫ��