![]() ![]() We sought to identify risks of mortality in critically ill patients with TBI using time-varying covariates. Mortality risks after Traumatic Brain Injury (TBI) are understudied in critical illness. In the setting of stroke or trauma, the clinical finding of BFDP should not be solely relied on as an indicator of futility. The literature suggests a rate of favorable recovery approaching 17% following decompressive surgery in patients with transtentorial herniation and BFDP, secondary to space-occupying lesions. Given the methodological limitations, the prognostic value of age, GCS, and time to surgery could not be determined. Among survivors, 50.5% had severe disability (GOS 2-3), while 49.5% had good outcome (GOS 4-5), representing 17% of the whole population. Mean follow-up was 7 months (range 1-40). Nearly two-thirds (66.9%) underwent surgical decompression within 2 hours of pupillary changes. Median preoperative Glasgow coma score (GCS) was 3 (range 3-6). Nearly two-thirds of patients (67.7%) were male. Study designs were: prospective cohort (n=1), retrospective cohort (n=15), case report (n=6). Twenty-two studies totaling 503 patients were included. Individual patient data were extracted, pooled, and analyzed. Systematic review of MEDLINE, EMBASE, Cochrane, and Google Scholar databases, using a combination of 15 prespecified keywords, according to PRISMA methodology. We sought to determine survival rate and functional outcomes in patients with transtentorial herniation and BFDP following emergency decompressive surgery. As a result, such patients may be denied life-saving decompressive surgery, resulting in very high mortality rates. The predictive value of the GCS, GCS-P, and MS-P scales was demonstrated, thus contributing to its external validation in low- to middle-income country.īilaterally fixed and dilated pupils (BFDP) in the setting of transtentorial herniation due to a space-occupying lesion have traditionally been considered a sign of futility. Both scores were good predictors of LHS (r ² = 0.084 × 0.079 × 0.072 ). For hospital mortality, MS-P demonstrated better discrimination than GCS (AUC, 0.750 × 0.682 P < 0.001) and higher AUC than GCS-P (0.750 × 0.714 P = 0.027). MS-P demonstrated better discriminative ability than GCS to predict mortality (AUC 0.736 × 0.658 P < 0.001) and higher AUC than GCS-P (0.736 × 0.704, respectively P = 0.073). Predictive values of the GCS, GCS-P, and MS-P were evaluated and compared for 14 day and in-hospital mortality outcomes and length of hospital stay (LHS). This is a prospective cohort of patients with TBI in a tertiary trauma reference center in Brazil. The objective of this study is to validate the admission Glasgow coma scale (GCS) associated with pupil response (GCS-P) to predict traumatic brain injury (TBI) patient’s outcomes in a low- to middle-income country and to compare its performance with that of a simplified model combining the better motor response of the GCS and the pupilar response (MS-P). Pupil reactivity together with the GCS motor component performed best in predicting death. The best predictive accuracy for presence of TBI was obtained using the GCS components. Good outcome (Glasgow Outcome Scale score 4 or more) was documented for only 1929 patients (8.0 per cent) showing fixed and bilateral dilated pupils. Patients displaying both unequal pupils and fixed pupils were most likely to have TBI (95.1 per cent of 283 patients). Pupil reactivity and size were significantly correlated (r(s) = 0.56, P < 0.001). The combination of pupil reactivity and GCS motor component (AUROC 0.822, 0.814 to 0.830) outmatched the predictive accuracy of GCS alone (AUROC 0.808, 0.800 to 0.815). Best accuracy for outcome prediction was found for pupil reactivity (AUROC 0.770, 95 per cent confidence interval 0.761 to 0.779) and GCS motor component (AUROC 0.797, 0.788 to 0.805), with less accuracy for GCS eye and verbal components. Some 24 115 patients fulfilled the study inclusion criteria. The unadjusted predictive roles of GCS components and pupil parameters, alone or in combination, were modelled using area under the receiver operating characteristic (AUROC) curve analyses and multivariable logistic regression regarding presence of TBI and death. Only directly admitted patients alive on admission and with complete data on GCS, pupil size and pupil reactivity were included. This study evaluated the predictive accuracy of Glasgow Coma Scale (GCS) verbal, motor and eye components alone, or in addition to pupil size and reactivity, for TBI.Ī retrospective cohort analysis of data from 51 425 severely injured patients registered in the Trauma Registry of the German Society for Trauma Surgery from 1993 to 2009 was undertaken. Early diagnosis and prediction of traumatic brain injury (TBI) is essential for determining treatment strategies and allocating resources. ![]()
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