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Association of Early Multiple Organ Dysfunction With Clinical and Functional Outcomes Over the Year Following Traumatic Brain Injury: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study.

Publication ,  Journal Article
Krishnamoorthy, V; Temkin, N; Barber, J; Foreman, B; Komisarow, J; Korley, FK; Laskowitz, DT; Mathew, JP; Hernandez, A; Sampson, J; James, ML ...
Published in: Critical care medicine
October 2021

Traumatic brain injury is a leading cause of death and disability in the United States. While the impact of early multiple organ dysfunction syndrome has been studied in many critical care paradigms, the clinical impact of early multiple organ dysfunction syndrome in traumatic brain injury is poorly understood. We examined the incidence and impact of early multiple organ dysfunction syndrome on clinical, functional, and disability outcomes over the year following traumatic brain injury.Retrospective cohort study.Patients enrolled in the Transforming Clinical Research and Knowledge in Traumatic Brain Injury study, an 18-center prospective cohort study of traumatic brain injury patients evaluated in participating level 1 trauma centers.Adult (age > 17 yr) patients with moderate-severe traumatic brain injury (Glasgow Coma Scale < 13). We excluded patients with major extracranial injury (Abbreviated Injury Scale score ≥ 3).Development of early multiple organ dysfunction syndrome, defined as a maximum modified Sequential Organ Failure Assessment score greater than 7 during the initial 72 hours following admission.The main outcomes were: hospital mortality, length of stay, 6-month functional and disability domains (Glasgow Outcome Scale-Extended and Disability Rating Scale), and 1-year mortality. Secondary outcomes included: ICU length of stay, 3-month Glasgow Outcome Scale-Extended, 3-month Disability Rating Scale, 1-year Glasgow Outcome Scale-Extended, and 1-year Disability Rating Scale. We examined 373 subjects with moderate-severe traumatic brain injury. The mean (sd) Glasgow Coma Scale in the emergency department was 5.8 (3.2), with 280 subjects (75%) classified as severe traumatic brain injury (Glasgow Coma Scale 3-8). Among subjects with moderate-severe traumatic brain injury, 252 (68%) developed early multiple organ dysfunction syndrome. Subjects that developed early multiple organ dysfunction syndrome had a 75% decreased odds of a favorable outcome (Glasgow Outcome Scale-Extended 5-8) at 6 months (adjusted odds ratio, 0.25; 95% CI, 0.12-0.51) and increased disability (higher Disability Rating Scale score) at 6 months (adjusted mean difference, 2.04; 95% CI, 0.92-3.17). Subjects that developed early multiple organ dysfunction syndrome experienced an increased hospital length of stay (adjusted mean difference, 11.4 d; 95% CI, 7.1-15.8), with a nonsignificantly decreased survival to hospital discharge (odds ratio, 0.47; 95% CI, 0.18-1.2).Early multiple organ dysfunction following moderate-severe traumatic brain injury is common and independently impacts multiple domains (mortality, function, and disability) over the year following injury. Further research is necessary to understand underlying mechanisms, improve early recognition, and optimize management strategies.

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Published In

Critical care medicine

DOI

EISSN

1530-0293

ISSN

0090-3493

Publication Date

October 2021

Volume

49

Issue

10

Start / End Page

1769 / 1778

Related Subject Headings

  • Retrospective Studies
  • Prospective Studies
  • Proportional Hazards Models
  • Organ Dysfunction Scores
  • Multiple Organ Failure
  • Male
  • Humans
  • Glasgow Outcome Scale
  • Glasgow Coma Scale
  • Functional Status
 

Citation

APA
Chicago
ICMJE
MLA
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Krishnamoorthy, V., Temkin, N., Barber, J., Foreman, B., Komisarow, J., Korley, F. K., … and the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) Investigators, . (2021). Association of Early Multiple Organ Dysfunction With Clinical and Functional Outcomes Over the Year Following Traumatic Brain Injury: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study. Critical Care Medicine, 49(10), 1769–1778. https://doi.org/10.1097/ccm.0000000000005055
Krishnamoorthy, Vijay, Nancy Temkin, Jason Barber, Brandon Foreman, Jordan Komisarow, Fred K. Korley, Daniel T. Laskowitz, et al. “Association of Early Multiple Organ Dysfunction With Clinical and Functional Outcomes Over the Year Following Traumatic Brain Injury: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study.Critical Care Medicine 49, no. 10 (October 2021): 1769–78. https://doi.org/10.1097/ccm.0000000000005055.
Krishnamoorthy, Vijay, et al. “Association of Early Multiple Organ Dysfunction With Clinical and Functional Outcomes Over the Year Following Traumatic Brain Injury: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study.Critical Care Medicine, vol. 49, no. 10, Oct. 2021, pp. 1769–78. Epmc, doi:10.1097/ccm.0000000000005055.
Krishnamoorthy V, Temkin N, Barber J, Foreman B, Komisarow J, Korley FK, Laskowitz DT, Mathew JP, Hernandez A, Sampson J, James ML, Bartz R, Raghunathan K, Goldstein BA, Markowitz AJ, Vavilala MS, and the Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) Investigators. Association of Early Multiple Organ Dysfunction With Clinical and Functional Outcomes Over the Year Following Traumatic Brain Injury: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study. Critical care medicine. 2021 Oct;49(10):1769–1778.

Published In

Critical care medicine

DOI

EISSN

1530-0293

ISSN

0090-3493

Publication Date

October 2021

Volume

49

Issue

10

Start / End Page

1769 / 1778

Related Subject Headings

  • Retrospective Studies
  • Prospective Studies
  • Proportional Hazards Models
  • Organ Dysfunction Scores
  • Multiple Organ Failure
  • Male
  • Humans
  • Glasgow Outcome Scale
  • Glasgow Coma Scale
  • Functional Status