title: Effects of Glycemic Level on Outcome of Patients with Traumatic Brain Injury: A Retrospective Cohort Study.
abstract: OBJECTIVE
  To determine the effects of glycemic level on outcome patients with traumatic brain injury.
  
  
  METHODS
  From September 2010 to December 2012, all medical records of adult patients with TBI admitted to the Emergency Room of Laura Daniela Clinic in Valledupar City, Colombia, South America were enrolled. Both genders between 18 and 85 years who referred during the first 48 hours after trauma, and their glucose level was determined in the first 24 hours of admission were included. Adults older than 85 years, with absence of Glasgow Coma Scale (GCS) score and a brain Computerized Tomography (CT) scans were excluded. The cut-off value was considered 200 mg/dL to define hyperglycemia. Final GCS, hospital admission duration and complications were compared between normoglycemic and hyperglycemic patients.
  
  
  RESULTS
  Totally 217 patients were identified with TBI. Considering exclusion criteria, 89 patients remained for analysis. The mean age was 43.0±19.6 years, the mean time of remission was 5.9±9.4 hours, the mean GCS on admission was 10.5±3.6 and the mean blood glucose level in the first 24 hours was 138.1±59.4 mg/dL. Hyperglycemia was present in 13.5% of patients. The most common lesions presented by patients with TBI were fractures (22.5%), hematoma (18.3%), cerebral edema (18.3%) and cerebral contusion (16.2%). Most of patients without a high glucose level at admission were managed only medically, whereas surgical treatment was more frequent in patients with hyperglycemia (p=0.042). Hyperglycemia was associated with higher complication (p=0.019) and mortality rate (p=0.039). GCS was negatively associated with on admission glucose level (r=0.11; p=0.46).
  
  
  CONCLUSIONS
  Hyperglycemia in the first 24-hours of TBI is associated with higher rate of surgical intervention, higher complication and mortality rates. So hyperglycemia handling is critical to the outcome of patients with traumatic brain injury.
authors.affiliation: Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia, South America.
authors.forename: Hernando Raphael
authors.initials: HR
authors.lastname: Alvis-Miranda
authors.affiliation: Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia, South America.
authors.forename: Sandy Zuleica
authors.initials: SZ
authors.lastname: Navas-Marrugo
authors.affiliation: Department of Medicine, University of Magdalena, Colombia, South America.
authors.forename: Robert Andrés
authors.initials: RA
authors.lastname: Velasquez-Loperena
authors.affiliation: Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia, South America.
authors.forename: Richard José
authors.initials: RJ
authors.lastname: Adie-Villafañe
authors.affiliation: Department of Medicine, University of Magdalena, Colombia, South America.
authors.forename: Duffay
authors.initials: D
authors.lastname: Velasquez-Loperena
authors.affiliation: Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia, South America.
authors.forename: Sandra Milena
authors.initials: SM
authors.lastname: Castellar-Leones
authors.affiliation: Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia, South America.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Alcala-Cerra
authors.affiliation: National University of Colombia, Bogota, Colombia.
authors.forename: Juan Camilo
authors.initials: JC
authors.lastname: Pulido-Gutiérrez
authors.affiliation: National University of Colombia, Bogota, Colombia.
authors.forename: Javier Ricardo
authors.initials: JR
authors.lastname: Rodríguez-Conde
authors.affiliation: National University of Colombia, Bogota, Colombia.
authors.forename: María Fernanda
authors.initials: MF
authors.lastname: Moreno-Moreno
authors.affiliation: Hospital Universitario de Neiva, Huila, Colombia.
authors.forename: Andrés
authors.initials: A
authors.lastname: M Rubiano
authors.affiliation: Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia, South America.
authors.forename: Luis Rafael
authors.initials: LR
authors.lastname: Moscote-Salazar
keywords: Hyperglycemia; Polytrauma; Traumatic brain injury