title: Isolated traumatic brain injury in patients with cirrhosis: do different treatment paradigms result in increased mortality?
abstract: BACKGROUND
  Cirrhosis is associated with increased mortality in trauma, yet its effects on outcomes after traumatic brain injury (TBI) are unclear. We hypothesized that cirrhosis adversely effects mortality and increases complications after TBI.
  
  
  METHODS
  Cirrhotic patients with isolated TBI were matched with noncirrhotic TBI patients in a 3:1 ratio based on age, sex, injury mechanism, and injury severity score at our academic, level 1 trauma center.
  
  
  RESULTS
  Of the 8,748 patients with isolated TBI, 65 patients had concurrent cirrhosis. Cirrhotic patients had increased mortality compared with matched controls (31% vs 17%, P = .03) and were less likely to undergo emergent neurosurgical operation (12% vs 25%, P = .03). There was no difference in admission Glasgow Coma Score, type of intracranial hemorrhage, length of stay, or complications between the groups.
  
  
  CONCLUSIONS
  Cirrhotic patients have increased mortality after TBI and were less likely to undergo operative intervention. New treatment paradigms may be needed to improve outcomes for cirrhotic patients suffering TBI.
authors.affiliation: Department of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, 200 W. Arbor Dr, #8220, San Diego, CA 92103, USA.
authors.forename: Simone
authors.initials: S
authors.lastname: Langness
authors.affiliation: Department of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, 200 W. Arbor Dr, #8220, San Diego, CA 92103, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Costantini
authors.affiliation: Department of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, 200 W. Arbor Dr, #8220, San Diego, CA 92103, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Smith
authors.affiliation: Department of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, 200 W. Arbor Dr, #8220, San Diego, CA 92103, USA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Bansal
authors.affiliation: Department of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, 200 W. Arbor Dr, #8220, San Diego, CA 92103, USA. Electronic address: rcoimbra@ucsd.edu.
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
mesh_terms: D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D016022:Case-Control Studies; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Liver cirrhosis; Model for end-stage liver disease; Neurosurgical operation; Traumatic brain injury