Severe Traumatic Brain Injury at The Ottawa Hospital: A 2-Year Cohort Describing Epidemiology, Presentation, Management and Outcome
CCCF ePoster library. Tran A. Oct 3, 2017; 198201; 55
Alexandre Tran
Alexandre Tran
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Severe Traumatic Brain Injury at The Ottawa Hospital: A 2-Year Cohort Describing Epidemiology, Presentation, Management and Outcome

Alexandre Tran1, Victoria Saigle1, Neeraj Manhas1, Lauralyn McIntyre1,2, Alexis F. Turgeon3, François Lauzier3, Michaël Chassé4, Colleen Golka5, Scott J. Millington2, Kwadwo Kyeremanteng2, Diana Ghinda6, Sal Kanji7, Jennifer Fairbarn7, Tammy Lloyd7, Shane W. English1,2

 

1. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; 2. Department of Medicine (Critical Care), University of Ottawa, Ottawa, Canada; 3. Department of Anesthesiology and Critical Care Medicine, CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Unit, Laval, Canada; 4. Department of medicine (Critical Care), CHUM, Health Innovation and Evaluation Hub, crCHUM, Department of Medicine, Montreal University, Montreal, Canada; 5. Department of Nutrition and Food Sciences, The Ottawa Hospital, Ottawa, Canada; 6. Division of Neurosurgery, The Ottawa Hospital, Ottawa, Canada; 7. Department of Pharmacy, The Ottawa Hospital, Ottawa, Canada;


Introduction: Severe traumatic brain injury (sTBI) is associated with significant morbidity and mortality. Aggressive acute management of the initial injury, as well as prevention of secondary injuries and complications, are known to improve patient survival. Despite little level 1 evidence to guide management of these patients, the Brain Trauma Foundation has produced management guidelines since 1995 based on the best available evidence. As part of an internal practice audit, we present a 2-year cohort of patients with sTBI managed at the Ottawa Hospital (TOH) to better understand practices.


Objectives: This cohort provides a comprehensive overview of the epidemiology, clinical presentation, management considerations and clinical outcomes of patients with severe traumatic brain injuries at a single Canadian academic tertiary care hospital. 


Methods: This is a single-centre retrospective cohort of consecutive patients with sTBI admitted to the Ottawa Hospital between 1 January 2014 and 31 December 2015. Patients were identified using two existing datasets: the TOH Trauma Registry, and the Ottawa Hospital Data Warehouse (OHDW). We used database-specific criteria to capture potentially eligible patients. We screened patients from the Trauma Registry with an Abbreviated Injury Scale >2, admitted to ICU, length of stay >48 hours or died within 48 hours, as well as all patients from the OHDW with the ICD-10 diagnostic code S06 for head injury admitted to ICU, or died within 48 hours. From these merged samples, we included patients that: (a) were ≥ 16 years of age, (b) had blunt head injury, and (c) had a post-resuscitation Glasgow Coma Score (GCS) <9, or deteriorated to GCS <9 within 24h of presentation based on medical record review. Screening was performed by a single reviewer with a second reviewer completing a 10% sample audit in order to ensure agreement. For all included patients, we merged data from the TOH trauma database, the OHDW, and from primary chart review. Data points of interest included baseline characteristics, clinical presentation, hospitalization characteristics and interventions, and clinical outcomes.


Results: We identified 795 patient records (682 from the TOH trauma registry and 446 from the OHDW) and classified 187 patients as meeting criteria for inclusion following chart review. Of these, 39 (21%) patients were not captured by the S06 ICD-10 coding for traumatic brain injury. Median (Q1-Q3) age was 66 years (44 - 80), 131 (70%) patients were male, and median injury severity score was 26 (25 - 34). In this cohort, 179 (96%) required ICU admission with a median ICU length of stay 7 days (3 - 13). The remaining eight (4%) patients were admitted to the ward for palliation and died within 48 hours. There were 35 (19%) patients requiring immediate operative intervention at the time of admission and 7 (4%) underwent a craniectomy. Median hospital length of stay was 15 days (5 - 29). Thirty-four (18%) required a tracheostomy and 28 (15%) required a surgical or percutaneous endoscopic gastrostomy tube. In-hospital all-cause mortality was 32% (59/187).


Conclusion: This cohort provides an overview of patients with sTBI admitted to TOH during a two-year window and provides the results of a comprehensive approach to identify patients with this condition using available administrative data. Further work will be done to understand the treatment that these patients received as well as an opportunity to optimize quality of care.
 

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