• Madeline E Greil, James Pan, Jason K Barber, Nancy R Temkin, Robert H Bonow, Walter Videtta, VegaManuel JibajaMJHospital Eugenio Espejo, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador., Silvia Lujan, Gustavo Petroni, Randall M Chesnut, and Global Neurotrauma Research Group Collaborators.
• Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
• World Neurosurg. 2024 Oct 1; 190: e424e434e424-e434.

IntroductionExtracranial complications occur commonly in patients with traumatic brain injury (TBI) and can have implications for patient outcome. Patient-specific risk factors for developing these complications are not well studied, particularly in low and middle-income countries (LMIC). The study objective was to determine patient-specific risk factors for development of extracranial complications in TBI.MethodsWe assessed the relationship between patient demographic and injury factors and incidence of extracranial complications using data collected September 2008-October 2011 from the BEST TRIP trial, a randomized controlled trial assessing TBI management protocolized on intracranial pressure (ICP) monitoring versus imaging and clinical exam, and a companion observational patient cohort.ResultsExtracranial infections (55%), respiratory complications (19%), hyponatremia (27%), hypernatremia (27%), hospital acquired pressure ulcers (6%), coagulopathy (9%), cardiac arrest (10%), and shock (5%) occurred at a rate of ≥5% in our study population; overall combined rate of these complications was 82.3%. Tracheostomy in the intensive care unit (P < 0.001), tracheostomy timing (P = 0.025), mannitol and hypertonic saline doses (P < 0.001), brain-specific therapy days and brain-specific therapy intensity (P < 0.001), extracranial surgery (P < 0.001), and neuroworsening with pupil asymmetry (P = 0.038) were all significantly related to the development of one of these complications by univariable analysis. Multivariable analysis revealed ICP monitor use and brain-specific therapy intensity to be the most common factors associated with individual complications.ConclusionsExtracranial complications are common following TBI. ICP monitoring and treatment are related to extra-cranial complications. This supports the need for reassessing the risk-benefit balance of our current management approaches in the interest of improving outcome.Copyright © 2024. Published by Elsevier Inc.

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