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Risk Factors and Neurological Outcomes Associated With Circulatory Shock After Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study.

Publication ,  Journal Article
Toro, C; Hatfield, J; Temkin, N; Barber, J; Manley, G; Ohnuma, T; Komisarow, J; Foreman, B; Korley, FK; Vavilala, MS; Laskowitz, DT; James, ML ...
Published in: Neurosurgery
September 1, 2022

BACKGROUND: Extracranial multisystem organ failure is a common sequela of severe traumatic brain injury (TBI). Risk factors for developing circulatory shock and long-term functional outcomes of this patient subset are poorly understood. OBJECTIVE: To identify emergency department predictors of circulatory shock after moderate-severe TBI and examine long-term functional outcomes in patients with moderate-severe TBI who developed circulatory shock. METHODS: We conducted a retrospective cohort study using the Transforming Clinical Research and Knowledge in TBI database for adult patients with moderate-severe TBI, defined as a Glasgow Coma Scale (GCS) score of <13 and stratified by the development of circulatory shock within 72 hours of hospital admission (Sequential Organ Failure Assessment score ≥2). Demographic and clinical data were assessed with descriptive statistics. A forward selection regression model examined risk factors for the development of circulatory shock. Functional outcomes were examined using multivariable regression models. RESULTS: Of our moderate-severe TBI population (n = 407), 168 (41.2%) developed circulatory shock. Our predictive model suggested that race, computed tomography Rotterdam scores <3, GCS in the emergency department, and development of hypotension in the emergency department were associated with developing circulatory shock. Those who developed shock had less favorable 6-month functional outcomes measured by the 6-month GCS-Extended (odds ratio 0.36, P = .002) and 6-month Disability Rating Scale score (Diff. in means 3.86, P = .002) and a longer length of hospital stay (Diff. in means 11.0 days, P < .001). CONCLUSION: We report potential risk factors for circulatory shock after moderate-severe TBI. Our study suggests that developing circulatory shock after moderate-severe TBI is associated with poor long-term functional outcomes.

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Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

September 1, 2022

Volume

91

Issue

3

Start / End Page

427 / 436

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Humans
  • Glasgow Coma Scale
  • Brain Injuries, Traumatic
  • Brain Injuries
  • Adult
  • 5202 Biological psychology
  • 3209 Neurosciences
 

Citation

APA
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MLA
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Toro, C., Hatfield, J., Temkin, N., Barber, J., Manley, G., Ohnuma, T., … TRACK-TBI Investigators. (2022). Risk Factors and Neurological Outcomes Associated With Circulatory Shock After Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study. Neurosurgery, 91(3), 427–436. https://doi.org/10.1227/neu.0000000000002042
Toro, Camilo, Jordan Hatfield, Nancy Temkin, Jason Barber, Geoffrey Manley, Tetsu Ohnuma, Jordan Komisarow, et al. “Risk Factors and Neurological Outcomes Associated With Circulatory Shock After Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study.Neurosurgery 91, no. 3 (September 1, 2022): 427–36. https://doi.org/10.1227/neu.0000000000002042.
Toro C, Hatfield J, Temkin N, Barber J, Manley G, Ohnuma T, et al. Risk Factors and Neurological Outcomes Associated With Circulatory Shock After Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study. Neurosurgery. 2022 Sep 1;91(3):427–36.
Toro, Camilo, et al. “Risk Factors and Neurological Outcomes Associated With Circulatory Shock After Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study.Neurosurgery, vol. 91, no. 3, Sept. 2022, pp. 427–36. Pubmed, doi:10.1227/neu.0000000000002042.
Toro C, Hatfield J, Temkin N, Barber J, Manley G, Ohnuma T, Komisarow J, Foreman B, Korley FK, Vavilala MS, Laskowitz DT, Mathew JP, Hernandez A, Sampson J, James ML, Raghunathan K, Goldstein BA, Markowitz AJ, Krishnamoorthy V, TRACK-TBI Investigators. Risk Factors and Neurological Outcomes Associated With Circulatory Shock After Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study. Neurosurgery. 2022 Sep 1;91(3):427–436.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

September 1, 2022

Volume

91

Issue

3

Start / End Page

427 / 436

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Humans
  • Glasgow Coma Scale
  • Brain Injuries, Traumatic
  • Brain Injuries
  • Adult
  • 5202 Biological psychology
  • 3209 Neurosciences