• Camilo Toro, Jordan Hatfield, Nancy Temkin, Jason Barber, Geoffrey Manley, Tetsu Ohnuma, Jordan Komisarow, Brandon Foreman, Frederick K Korley, Monica S Vavilala, Daniel T Laskowitz, Joseph P Mathew, Adrian Hernandez, John Sampson, Michael L James, Karthik Raghunathan, Benjamin A Goldstein, Amy J Markowitz, Vijay Krishnamoorthy, and TRACK-TBI Investigators.
• Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, North Carolina, USA.
• Neurosurgery. 2022 Sep 1; 91 (3): 427436427-436.

BackgroundExtracranial multisystem organ failure is a common sequela of severe traumatic brain injury (TBI). Risk factors for developing circulatory shock and long-term functional outcomes of this patient subset are poorly understood.ObjectiveTo identify emergency department predictors of circulatory shock after moderate-severe TBI and examine long-term functional outcomes in patients with moderate-severe TBI who developed circulatory shock.MethodsWe conducted a retrospective cohort study using the Transforming Clinical Research and Knowledge in TBI database for adult patients with moderate-severe TBI, defined as a Glasgow Coma Scale (GCS) score of <13 and stratified by the development of circulatory shock within 72 hours of hospital admission (Sequential Organ Failure Assessment score ≥2). Demographic and clinical data were assessed with descriptive statistics. A forward selection regression model examined risk factors for the development of circulatory shock. Functional outcomes were examined using multivariable regression models.ResultsOf our moderate-severe TBI population (n = 407), 168 (41.2%) developed circulatory shock. Our predictive model suggested that race, computed tomography Rotterdam scores <3, GCS in the emergency department, and development of hypotension in the emergency department were associated with developing circulatory shock. Those who developed shock had less favorable 6-month functional outcomes measured by the 6-month GCS-Extended (odds ratio 0.36, P = .002) and 6-month Disability Rating Scale score (Diff. in means 3.86, P = .002) and a longer length of hospital stay (Diff. in means 11.0 days, P < .001).ConclusionWe report potential risk factors for circulatory shock after moderate-severe TBI. Our study suggests that developing circulatory shock after moderate-severe TBI is associated with poor long-term functional outcomes.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

20 keywords...

hide…