In:
Journal of Trauma and Acute Care Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 89, No. 1 ( 2020-7), p. 215-221
Abstract:
The incidence of early cognitive impairment (ECI) after traumatic brain injury (TBI) is unknown. We hypothesized ECI is common and can be predicted based on Glasgow Coma Scale (GCS) and Brain Injury Guideline (BIG) category. METHODS A single-center, retrospective review of adult trauma patients (2014–2016) with intracranial hemorrhage (ICH) and mild TBI (GCS score, 13–15) was performed. The primary outcome was ECI, defined as a Rancho Los Amigos score less than 8. Routine cognitive evaluation is performed on all ICH patients at our institution. Comparisons between ECI and no-ECI groups regarding demographic, cognitive, and clinical outcomes were evaluated using bivariate statistics. The odds of ECI were evaluated using a multivariable logistic regression. RESULTS There were 465 patients with mild TBI, 70.3% were male, and the average age was 53 ± 23 years. The most common mechanism of injury was fall (41.1%) followed by motor vehicle collision (15.9%). The incidence of ECI was 51.4% (n = 239). The incidence in patients with a GCS score of 15 was 42.9%, and BIG 1 category was 42.7%. There were no differences in demographics (age, sex, comorbidities), mechanism of injury, or imaging when comparing ECI patients with no-ECI patients. The GCS score was lower in the ECI group (14.4 vs. 14.7, p 〈 0.001). Patients with ECI were also less likely to be discharged home (58.2% vs. 78.3%, p 〈 0.001). Lower GCS-verbal, BIG category 3, and presence of pelvic/extremity fractures were strong risk factors for ECI in a logistic regression model adjusted for age, loss of consciousness, anticoagulants, narcotic administration, and Rotterdam score. CONCLUSION Half of all patients with ICH and mild TBI had ECI. Both lower initial GCS score and BIG category 3 were associated with increased likelihood of ECI. Therefore, we recommend all patients with ICH and mild TBI undergo cognitive evaluation. LEVEL OF EVIDENCE Prognostic Study, Level III.
Type of Medium:
Online Resource
ISSN:
2163-0763
,
2163-0755
DOI:
10.1097/TA.0000000000002641
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2020
detail.hit.zdb_id:
2651313-4
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