title: Higher haemoglobin levels and dedicated trauma admission are associated with survival after severe traumatic brain injury.
abstract: BACKGROUND
  Prevention of secondary brain injury is a key component of acute management of patients with severe traumatic brain injury (TBI). Haemoglobin concentration may have an impact on optimization of cerebral oxygenation. Patients with TBI may best be served by an organized trauma service. The objective is to determine if haemoglobin concentration or dedicated trauma admission has an impact on outcomes after severe TBI.
  
  
  METHODS
  This study retrospectively analysed consecutive patients with severe TBI admitted to a level-I trauma centre over 3 years. Patients <16 years-old and with length of stay (LOS) <24 hours were excluded. Data were collected on demographics; injury severity; LOS; admission service; survival to discharge; and haemoglobin levels from hospital days 1-7. Data were also collected on number of transfusions of packed red blood cells. The sample was stratified based on admission service and survival to discharge.
  
  
  RESULTS
  Of 147 patients (age = 54.1 ± 3.7 years), overall mortality rate was 15.4% (n = 23). Overall, non-survivors had lower daily and 7-day mean haemoglobin levels (10.7 ± 0.9 vs. 12.9 ± 0.4 g dL(-1), p < 0.001). Non-surgical admissions had lower haemoglobin levels and a higher mortality rate (28.9% vs. 12.2%, p < 0.001) compared to dedicated trauma admissions.
  
  
  CONCLUSIONS
  Among patients with severe TBI, higher haemoglobin levels and maintenance as a dedicated trauma admission are associated with higher survival to discharge.
authors: State University of New York Downstate Medical Center , Brooklyn, NY , USA and.
authors: Gerard Anthony
authors: GA
authors: Baltazar
authors: Amy J
authors: AJ
authors: Pate
authors: Benita
authors: B
authors: Panigrahi
authors: Audrey
authors: A
authors: Sharp
authors: Michael
authors: M
authors: Smith
authors: Akella
authors: A
authors: Chendrasekhar
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000097:blood* / Q000453:epidemiology / Q000628:therapy; D004909:Erythrocyte Indices; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data
chemical_list: D006454:Hemoglobins
keywords: Acute care; head injury; outcome; surgery; trauma; traumatic brain injury