Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome.
BACKGROUND
Medical complications after severe traumatic brain injury (S-TBI) may delay or prevent transfer to rehabilitation units and impact on long-term outcome.


OBJECTIVE
Mapping of medical complications in the subacute period after S-TBI and the impact of these complications on 1-year outcome to inform healthcare planning and discussion of prognosis with relatives.


METHODS
Prospective multicentre observational study. Recruitment from 6 neurosurgical centres in Sweden and Iceland.
Patients aged 18-65 years with S-TBI and acute Glasgow Coma Scale 3-8, who were admitted to neurointensive care. Assessment of medical complications 3 weeks and 3 months after injury. Follow-up to 1 year. 114 patients recruited with follow-up at 1 year as follows: 100 assessed, 7 dead and 7 dropped out.


METHODS
Glasgow Outcome Scale Extended.


RESULTS
68 patients had ≥1 complication 3 weeks after injury. 3 weeks after injury, factors associated with unfavourable outcome at 1 year were: tracheostomy, assisted ventilation, on-going infection, epilepsy and nutrition via nasogastric tube or percutaneous endoscopic gastroscopy (PEG) tube (univariate logistic regression analyses). Multivariate analysis demonstrated that tracheostomy and epilepsy retained significance even after incorporating acute injury severity into the model. 3 months after injury, factors associated with unfavourable outcome were tracheostomy and heterotopic ossification (Fisher's test), infection, hydrocephalus, autonomic instability, PEG feeding and weight loss (univariate logistic regression). PEG feeding and weight loss at 3 months were retained in a multivariate model.


CONCLUSIONS
Subacute complications occurred in two-thirds of patients. Presence of a tracheostomy or epilepsy at 3 weeks, and of PEG feeding and weight loss at 3 months, had robust associations with unfavourable outcome that were incompletely explained by acute injury severity.
Department of Clinical Sciences, Karolinska Institutet and University Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, Stockholm, Sweden Department of Rehabilitation Medicine, University Hospital Uppsala and Uppsala University, Sweden.
Alison K
AK
Godbolt
Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
Maud
M
Stenberg
National Respiratory Centre at the Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
Jan
J
Jakobsson
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Kimmo
K
Sorjonen
Department of Clinical Sciences, Karolinska Institutet and University Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, Stockholm, Sweden.
Karolina
K
Krakau
Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
Britt-Marie
BM
Stålnacke
Department of Clinical Sciences, Karolinska Institutet and University Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, Stockholm, Sweden.
Catharina
C
Nygren DeBoussard
D000293:Adolescent; D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology / Q000534:rehabilitation*; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000453:epidemiology*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology; D007055:Iceland; D007239:Infections / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D013548:Sweden; D014139:Tracheostomy / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D015431:Weight Loss; D055815:Young Adult
REHABILITATION MEDICINE; TRAUMA MANAGEMENT