Outcomes and prognostic factors in patients with combined severe traumatic brain injury and abdominal trauma: a retrospective observational study.

Abstract

Purpose: Severe traumatic brain injury (TBI) is a leading cause of death and disability. Approximately one-third to one-half of cases of TBI are associated with severe extracranial injuries, particularly abdominal trauma. This combination is associated with high mortality rates. However, studies describing the outcomes and prognostic factors of patients with combined severe head and abdominal trauma are lacking. Therefore, this study aimed to compare the clinical characteristics and outcomes and identify prognostic factors in this patient population.

Methods: This single-centre, retrospective observational study included patients with major trauma, TBI, and abdominal injury admitted to a Level 1 trauma centre from 2016 to 2020. The inclusion criteria were TBI with an Abbreviated Injury Scale (AIS) score ≥ 3 and abdominal injury with an AIS score ≥ 3. The primary outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores at discharge.

Results: Of 4,554 patients screened, 160 met the inclusion criteria. The in-hospital mortality rate was 20.6%, and 63.1% of the patients had favourable functional outcomes. Multivariate analysis identified factors associated with increased mortality: lower initial mean arterial pressure (OR: 0.95, 95% CI: 0.91-0.98, p = 0.006), higher base deficit (OR: 1.22, 95% CI: 1.03-1.45, p = 0.022), lower initial Glasgow Coma Scale (GCS) score (OR: 0.75, 95% CI: 0.62-0.91, p = 0.004), prolonged activated partial thromboplastin time (OR: 1.03, 95% CI: 1.00-1.05, p = 0.029), lower platelet count (OR: 0.99, 95% CI: 0.98-1.00, p = 0.008), and lower fibrinogen level (OR: 1.01, 95% CI: 1.00-1.01, p = 0.014). For unfavorable functional outcomes, independent predictors included lower initial GCS score (OR: 0.86, 95% CI: 0.78-0.95, p = 0.002), head AIS score of 5 (OR: 3.52, 95% CI: 1.32-9.40, p = 0.012), lower platelet count (OR: 0.99, 95% CI: 0.99-1.00, p = 0.012), and massive transfusion requirement (OR: 2.92, 95% CI: 1.23-6.95, p = 0.015).

Conclusion: This study demonstrates a 20.6% mortality rate in patients with combined severe head and abdominal injuries. The findings identified key prognostic factors, including initial GCS score and platelet count. These results suggest that platelet dysfunction plays a crucial role in both mortality and functional outcomes. Early recognition and management of these factors are crucial for improving outcomes in critically injured patients.

Clinical trial number: Not applicable.