Prognostication in critically ill patients with severe traumatic brain injury: the TBI-Prognosis multicentre feasibility study

被引：20

作者：

Turgeon, Alexis F. ^{[1
,2
]}

Lauzier, Francois ^{[1
,2
]}

Zarychanski, Ryan ^{[3
]}

Fergusson, Dean A. ^{[4
]}

Leger, Caroline ^{[1
]}

McIntyre, Lauralyn A. ^{[4
,5
]}

Bernard, Francis ^{[6
]}

Rigamonti, Andrea ^{[7
]}

Burns, Karen ^{[7
]}

Griesdale, Donald E. ^{[8
]}

Green, Robert ^{[9
]}

Scales, Damon C. ^{[10
]}

Meade, Maureen O. ^{[11
]}

Savard, Martin ^{[2
,12
]}

Shemilt, Michele ^{[1
]}

Paquet, Jerome ^{[13
,14
]}

Gariepy, Jean-Luc ^{[14
]}

Lavoie, Andre ^{[1
]}

Reddy, Kesh ^{[15
]}

Jichici, Draga ^{[11
]}

Pagliarello, Giuseppe ^{[5
]}

Zygun, David ^{[16
]}

Moore, Lynne ^{[1
,17
]}

机构：

[1] Univ Laval, Res Ctr, CHU Quebec, Populat Hlth & Optimal Hlth Practices Res Unit Tr, Quebec City, PQ, Canada

[2] Univ Laval, Dept Anesthesiol & Crit Care Med, Div Crit Care Med, Quebec City, PQ, Canada

[3] Univ Manitoba, Dept Internal Med, Sect Crit Care & Haematol & Med Oncol, Winnipeg, MB, Canada

[4] Univ Ottawa, Ottawa Hlth Res Inst, Clin Epidemiol Unit, Ctr Transfus & Crit Care Res, Ottawa, ON, Canada

[5] Univ Ottawa, Ottawa Hosp, Dept Crit Care Med, Ottawa, ON, Canada

[6] Univ Montreal, Dept Med, Montreal, PQ, Canada

[7] Univ Toronto, St Michaels Hosp, Interdepat Div Crit Care Med, Toronto, ON, Canada

[8] Univ British Columbia, Dept Anesthesiol Pharmacol & Therapeut, Vancouver, BC, Canada

[9] Dalhousie Univ, Dept Emergency Med, Dept Crit Care Med, Halifax, NS, Canada

[10] Univ Toronto, Sunnybrook Hosp, Interdept Div Crit Care Med, Toronto, ON, Canada

[11] McMaster Univ, Div Crit Care Med, Dept Med, Hamilton, ON, Canada

[12] Univ Laval, Div Neurol, Dept Med, Quebec City, PQ, Canada

[13] Univ Laval, Div Neurosurg, Dept Surg, Quebec City, PQ, Canada

[14] Univ Laval, Dept Radiol & Nucl Med, Quebec City, PQ, Canada

[15] McMaster Univ, Div Neurosurg, Dept Surg, Hamilton, ON, Canada

[16] Univ Alberta, Dept Crit Care Med, Edmonton, AB, Canada

[17] Univ Laval, Dept Prevent & Social Med, Quebec City, PQ, Canada

来源：

BMJ OPEN | 2017年 / 7卷 / 04期

基金：

加拿大健康研究院;

关键词：

SEVERE HEAD-INJURY; RANDOMIZED CONTROLLED-TRIAL; LIFE-SUSTAINING THERAPY; NEUROCRITICAL CARE; DECISION-MAKING; WITHDRAWAL; PREDICTION; MANAGEMENT; MORTALITY; SUPPORT;

D O I：

10.1136/bmjopen-2016-013779

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective: Severe traumatic brain injury is a significant cause of morbidity and mortality in young adults. Assessing long-term neurological outcome after such injury is difficult and often characterised by uncertainty. The objective of this feasibility study was to establish the feasibility of conducting a large, multicentre prospective study to develop a prognostic model of long-term neurological outcome in critically ill patients with severe traumatic brain injury. Design: A prospective cohort study. Setting: 9 Canadian intensive care units enrolled patients suffering from acute severe traumatic brain injury. Clinical, biological, radiological and electrophysiological data were systematically collected during the first week in the intensive care unit. Mortality and functional outcome (Glasgow Outcome Scale extended) were assessed on hospital discharge, and then 3, 6 and 12 months following injury. Outcomes: The compliance to protocolised test procedures was the primary outcome. Secondary outcomes were enrolment rate and compliance to follow-up. Results: We successfully enrolled 50 patients over a 12-month period. Most patients were male (80%), with a median age of 45 years (IQR 29.0-60.0), a median Injury Severity Score of 38 (IQR 25-50) and a Glasgow Coma Scale of 6 (IQR 3-7). Mortality was 38% (19/50) and most deaths occurred following a decision to withdraw life-sustaining therapies (18/19). The main reasons for non-enrolment were the time window for inclusion being after regular working hours (35%, n=23) and oversight (24%, n=16). Compliance with protocolised test procedures ranged from 92% to 100% and enrolment rate was 43%. No patients were lost to follow-up at 6 months and 2 were at 12 months. Conclusions: In this multicentre prospective feasibility study, we achieved feasibility objectives pertaining to compliance to test, enrolment and follow-up. We conclude that the TBI-Prognosis prospective multicentre study in severe traumatic brain injury patients in Canada is feasible.

引用

页数：7

共 43 条

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