Outcome in polytraumatized patients with and without brain injury.
BACKGROUND
To investigate the long-term outcome in polytrauma victims with traumatic brain injury (TBI) and without traumatic brain injury (NTBI).


METHODS
Cohort study based on prospectively collected data. Evaluation of functional outcome and quality of life at least 2 years (median 2.5) following trauma in 111 survivors [39.5 ± 20.9 years; injury severity score (ISS) 27.9 ± 8.2; TBI: n = 45; NTBI: n = 66] out of a total of 211 consecutive multiply-injured patients with an ISS > 16, all primarily admitted to the intensive care unit.


RESULTS
Significantly fewer TBI patients lived independently compared with NTBI patients (71% vs. 95%; P < 0.001). TBI patients showed a higher decrease in their capacity to work compared with NTBI patients (P < 0.002). Both study groups experienced a significantly reduced long-term outcome in comparison with pre-injury level in all dimensions of the short form (SF)-36. Following stepwise logistic regression, the mental sum component of the SF-36 and the Nottingham Health Profile discriminated independently between TBI and NTBI patients (R(2) = 0.219; P < 0.001).


CONCLUSIONS
More than 2 years after injury, polytraumatized patients with and without TBI suffer from a reduction in functional outcome and quality of life, but TBI patients are doing importantly worse. Any comparison of trauma patient cohorts should consider these differences between TBI and NTBI patients. Given their discriminatory potential, the sensitivity of self-reported measures needs further affirmation with neuropsychological assessments.
Computer Assisted Radiology & Surgery Switzerland, University Hospital Basel, Switzerland. thomas.gross@ksa.ch
T
T
Gross
M
M
Schüepp
C
C
Attenberger
H
H
Pargger
F
F
Amsler
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000523:psychology / Q000628:therapy*; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012050:Rehabilitation, Vocational; D016019:Survival Analysis; D015599:Trauma Severity Indices; D016896:Treatment Outcome