Frequency and Impact of Intensive Care Unit Complications on Moderate-Severe Traumatic Brain Injury: Early Results of the Outcome Prognostication in Traumatic Brain Injury (OPTIMISM) Study

Background

Known predictors of adverse outcomes in patients with moderate-severe TBI (msTBI) explain only a relatively small proportion of patient-related outcomes. The frequency and impact of intensive care unit complications (ICU-COMPL) on msTBI-associated outcomes are poorly understood.

Methods

In 213 consecutive msTBI patients admitted to a Level I Trauma Center neuro trauma ICU, twenty-eight ICU-COMPL (21 medical and 7 neurological) were prospectively collected and adjudicated by group consensus, using pre-defined criteria. We determined frequencies, and explored associations of ICU-COMPL and hospital discharge outcomes using multivariable logistic regression.

Results

The average age of the study sample was 53 years, and the median presenting Glasgow Coma Scale and Injury Severity Scores were 5 and 27, respectively. Hyperglycemia (79 %), fever (62 %), systemic inflammatory response syndrome (60 %), and hypotension requiring vasopressors (42 %) were the four most common medical ICU-COMPL. Herniation (39 %), intracranial rebleed (39 %), and brain edema requiring osmotherapy (37 %) were the three most common neurological ICU-COMPL. After adjusting for admission variables, duration of ventilation, and ICU length-of-stay, patients with brain edema (OR 5.8; 95 % CI 2, 16.7) had a significantly increased odds for dying during hospitalization whereas patients with hospital-acquired urinary tract infection (UTI) had a decreased odds (OR 0.05; 95 % CI 0.005, 0.6). Sensitivity analysis revealed that UTI occurred later, suggesting a non-causal association with survival. Brain herniation (OR 15.7; 95 % CI 2.6, 95.4) was associated with an unfavorable functional status (GOS 1–3).

Conclusion

ICU-COMPL are very common after msTBI, have a considerable impact on short-term outcomes, and should be considered in the prognostication of these high risk patients. Survival associations of time-dependent complications warrant cautious interpretation.