Analysis on Short-Term Outcomes for Cerebral Protection Treatment in Post Severe Traumatic Brain Injury Patients: A Single Neurosurgical Centre Study

• Published in: The Malaysian journal of medical sciences Vol. 31; no. 2; pp. 142 - 152
• Main Authors: Mustafa, Ahmad Fikri Muhammad, Ab Mukmin, Laila, Mazlan, Mohd Zulfakar, Ghani, Abdul Rahman Izaini, Wan Hassan, Wan Mohd Nazaruddin, Hassan, Mohamad Hasyizan
• Format: Journal Article
• Language: English
• Published: Malaysia Universiti Sains Malaysia Press 01-04-2024; Penerbit Universiti Sains Malaysia
• Subjects: Anesthesia; Disability; Glasgow Coma Scale; Intensive care; Mortality; Original; Patients; Surgery; Trauma; Traumatic brain injury; traumatic brain injury; Glasgow Outcome Scale; Glasgow Coma Scale; cerebral protection; neurocritical care
• ISSN: 1394-195X; 2180-4303
• DOI: 10.21315/mjms2024.31.2.12

Severe traumatic brain injury (TBI) is a leading cause of disability worldwide and cerebral protection (CP) management might determine the outcome of the patient. CP in severe TBI is to protect the brain from further insults, optimise cerebral metabolism and prevent secondary brain injury. This study aimed to analyse the short-term Glasgow Outcome Scale (GOS) at the intensive care unit (ICU) discharge and a month after ICU discharge of patients post CP and factors associated with the favourable outcome.
This is a prospective cohort study from January 2021 to January 2022. The short-term outcomes of patients were evaluated upon ICU discharge and 1 month after ICU discharge using GOS. Favourable outcome was defined as GOS 4 and 5. Generalised Estimation Equation (GEE) was adopted to conduct bivariate GEE and subsequently multivariate GEE to evaluate the factors associated with favourable outcome at ICU discharge and 1 month after discharge.
A total of 92 patients with severe TBI with GOS of 8 and below admitted to ICU received CP management. Proportion of death is 17% at ICU discharge and 0% after 1 month of ICU discharge. Proportion of favourable outcome is 26.1% at ICU discharge and 61.1% after 1 month of ICU discharge. Among factors evaluated, age (odds ratio [OR] = 0.96; 95% CI: 0.94, 0.99;
= 0.004), duration of CP (OR = 0.41; 95% CI: 0.20, 0.84;
= 0.014) and hyperosmolar therapy (OR = 0.41; CI 95%: 0.21, 0.83;
= 0.013) had significant association.
CP in younger age, longer duration of CP and patient not receiving hyperosmolar therapy are associated with favourable outcomes. We recommend further clinical trial to assess long term outcome of CP.