Ortega ZJM, Lomillos PN, Choque CB, Sierra RM, Poveda NP, Tamarit DM, López SMR, Zamorano FJ, del Piñal ÁBG

Language: Spanish
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Page: 1-23
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ABSTRACT

Objective: Determine the main clinical and neuroimaging factors associated to the prognosis of patients with moderate traumatic brain injury.
Methods: A retrospective study was conducted of patients aged over 14 years with moderate traumatic brain injury cared for at Getafe University Hospital in Madrid between the years 2005 and 2015. The sample was composed of 66 patients. Based on the Glasgow coma scale, groups were formed to describe the clinical and neuroimaging variables associated to short-term prognosis. Determination was made of means and percentages, and bivariate analysis was performed. A clinical management scheme was designed on the basis of the factors analyzed.
Results: Among the patients studied there was a predominance of male individuals with moderate traumatic brain injury (57 patients). Road accidents were the most significant cause (33 patients). Clinical neurological damage is more common among patients with diffuse axonal injury associated to cerebral edema and multiple bilateral contusions. In the multivariate linear regression analysis the existence or non-existence of neurological focality (regression coefficient 0.884), control computed tomography findings (regression coefficient 0.499), initial computed tomography findings (regression coefficient 0.174) and age (regression coefficient 0.033) were significant (p<0.001) in relation to final evolution. The Glasgow coma scale revealed prognostic differences between the patients with scores 11 and 12 and those who obtained scores of 9 and 10. However, the overall coma score was not directly related to the evolution of patients with moderate traumatic brain injury.
Conclusions: The following factors were found to be associated to the prognosis of patients with moderate traumatic brain injury: abnormal computed tomography findings, neurological focality, clinical neurological damage, advanced age, and control computed tomography findings. The main causes were traffic collisions, falls and direct impact. In our view, hospitalization is always necessary, considering the clinical status and the presence of pathological computed tomography findings.