Impact of Immediate Treatment Within Four Days on Prognosis in Severe Traumatic Brain Injury Patients Without Vasospasm

Abstract

Background and objectives: Traumatic brain injury (TBI) is associated with high mortality rate and long-term disability. Application of the Brain Trauma Foundation's ＂Guidelines for the management of severe traumatic brain injury＂ would reduce the prevalence of morbidity and mortality. However, the prevalence of some predictors of TBI have not been studied well with respect to the guidelines, for example, vasospasm. This study evaluated the correlation between the prognostic factors and outcome in patients without vasospasm. Materials and Methods: All patients were treated as per the aforementioned guidelines. Ten patients were prospectively recruited and nine were examined by computed tomography angiography (CTA). The cerebral perfusion pressure (CPP) was measured before and on the fourth postoperative day and was maintained at ≥ 60 mmHg. The results of Glasgow outcome scale (GOS) and Glasgow coma scale (GCS) were collected after four weeks, three months, one year, and two years after admission. Results: There was no vasospasm noted in any of the assessed patients. Current results showed that the elderly (≥ 65 years) had poor GOS (5/6, 83.3%), whereas the younger group had better GOS (3/3, 100%) (p ＜ 0.05). Lower GCS was associated with lower GOS. The subgroup with GCS ≤ 6 (p ＜ 0.05) had a lower GOS. We also observed a better outcome when GCS was higher than 9 (≥ 10) (5/5, 100%) on the fourth postoperative day (p ＜ 0.05). Conclusions: The use of CTA to evaluate vasospasm could be a reference while following the guidelines to manage patients with severe TBI. Aggressive treatment within the first four days could help in obtaining better brain resuscitation in severe TBI patients.