title: Twenty-Eight-Day Mortality of Blunt Traumatic Brain Injury and Co-Injuries Requiring Mechanical Ventilation.
abstract: OBJECTIVE
  This paper aims to assess the impact of co-injuries and consequent emergency surgical interventions and nosocomial pneumonia on the 28-day mortality of patients with severe traumatic brain injuries (TBIs).
  
  
  METHODS
  One hundred and seventy-seven patients with TBI admitted to the emergency trauma intensive care unit at the Clinical Center of Serbia for more than 48 h were studied over a 1-year period. On admission, the Glasgow Coma Scale (GCS), Injury Severity Score (ISS) and Acute Physiology and Chronic Health Evaluation II score (APACHE II) were calculated. At admission, an isolated TBI was recorded in 45 of the patients, while 44 had three or more co-injuries.
  
  
  RESULTS
  Of the 177 patients, 78 (44.1%) died by the end of the 28-day follow-up period. They had a significantly higher ISS score (25 vs. 20; p = 0.024) and more severe head (p = 0.034) and chest (p = 0.013) injuries compared to those who survived. Nonsurvivors had spent more days on mechanical ventilation (9.5 vs. 8; p = 0.041) and had a significantly higher incidence of ventilator-associated pneumonia (VAP) than survivors (67.9 vs. 40.4%; p < 0.001). A high Rotterdam CT score (OR 2.062; p < 0.001) and a high APACHE II score (OR 1.219; p < 0.001) were identified as independent predictors of early TBI-related mortality.
  
  
  CONCLUSIONS
  Patients who had TBI with a high Rotterdam score and a high APACHE II score were at higher risk of 28-day mortality. VAP was a very common complication of TBI and was associated with an early death and higher mortality in the subgroup of patients with a GCS ≤8.
authors.affiliation: Institute of Epidemiology, University of Belgrade, Belgrade, Serbia.
authors.forename: Bojan
authors.initials: B
authors.lastname: Jovanovic
authors.forename: Zoka
authors.initials: Z
authors.lastname: Milan
authors.forename: Olivera
authors.initials: O
authors.lastname: Djuric
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Markovic-Denic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Karamarkovic
authors.forename: Pavle
authors.initials: P
authors.lastname: Gregoric
authors.forename: Krstina
authors.initials: K
authors.lastname: Doklestic
authors.forename: Jovana
authors.initials: J
authors.lastname: Avramovic
authors.forename: Jelena
authors.initials: J
authors.lastname: Velickovic
authors.forename: Vesna
authors.initials: V
authors.lastname: Bumbasirevic
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology*; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012307:Risk Factors; D055771:Serbia / Q000453:epidemiology; D015599:Trauma Severity Indices; D055815:Young Adult