Abstract
Background
Acute severe brain injury is associated with significant morbidity and mortality.
Patients and their families need accurate information regarding expected outcomes.
Few studies have reported the long-term functional outcome of patients with acute
severe brain injury treated in an Australian neurocritical care unit.
Objective
The objective of this study was to describe 12-month functional outcomes (using the
extended Glasgow Outcome Scale) of patients with acute severe brain injury treated
in an Australian neurocritical care unit.
Methods
This was a single-centre prospective cohort study. Patients with a diagnosis of traumatic
brain injury, subarachnoid haemorrhage or intracranial haemorrhage admitted between
2015 and 2019 were enrolled.
Results
In total, 915 participants were enrolled during the 51-month study period. Of the
cohort, 403 (44%) were admitted after traumatic brain injury, 274 (30%) after subarachnoid
haemorrhage and 238 (26%) after intracranial haemorrhage. The median duration of intensive
care admission was 5 days (interquartile range: 2–13), 458 (50%) received invasive
ventilation, 417 (46%) received vasopressor support and 286 (31%) received an external
ventricular drain. At discharge from intensive care, 150 of 915 (16.4%) had died,
and the in-hospital mortality was seen in 191 of 915 patients (20.9%). Favourable
functional outcome, as defined by an extended Glasgow Outcome Scale score of 5–8,
was reported in 358 of available 795 patients (45.0%) at six months and in 311 of
672 available patients (46.3%) at 12 months. Those with intracranial haemorrhage reported
the highest rates of unfavourable outcomes with 112 of 166 patients (67.4%) at 12
months.
Conclusions
In this selected population, admission to a neurocritical care unit was associated
with significant resource use. At 12 months after admission, almost half of those
admitted to an Australian neurocritical unit with traumatic brain injury, subarachnoid
haemorrhage and intracerebral haemorrhage report a good functional outcome.
Keywords
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References
- Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients.Crit Care Med. 2007; 35: 2025-2030
- Neurocritical care: why does it make a difference?.Curr Opin Crit Care. 2014; 20: 174-181
- Prognosis and clinical trial design in traumatic brain injury: the IMPACT study.J Neurotrauma. 2007; 24: 232-238
- SAHIT investigators—on the outcome of some subarachnoid hemorrhage clinical trials.Transl Stroke Res. 2013; 4: 286-296
- Decompressive craniectomy in diffuse traumatic brain injury.NEJM. 2011; 364: 1493-1502
- Saline or albumin for fluid resuscitation in patients with traumatic brain injury.NEJM. 2008; 357: 74-884
- Hypothermia for intracranial hypertension after traumatic brain injury.NEJM. 2015; 373: 2403-2412
- Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial.Lancet. 2018; 391: 2107-2115
- Effect of early sustained prophylactic hypothermia on neurologic outcomes among patients with severe traumatic brain injury: the POLAR randomized clinical trial.J Am Med Assoc. 2018; 320: 2211-2220
- Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial.Lancet. 2019; 394: 1713-1723
- IMPACT recommendations for improving the design and analysis of clinical trials in moderate to severe traumatic brain injury.Neurotherapeutics. 2020; 7: 127-134
- Assessment of outcome after severe brain damage.Lancet (London, England). 1975; 1: 480-484
- Measuring functional and quality of life outcomes following major head injury: common scales and checklists.Injury. 2011; 42: 281-287
- Impact of medical complications on outcome after subarachnoid hemorrhage.Critical Care Med. 2006; 34: 617-623
- Do neurocritical care units save lives? Measuring the impact of specialized ICUs.Neurocritical Care. 2011; 14: 329-333
- Impact of a neurointensivist on outcomes in critically ill stroke patients.Neurocritical Care. 2012; 16: 63-71
- The effect of secular trends and specialist neurocritical care on mortality for patients with intracerebral haemorrhage, myasthenia gravis and Guillain–Barré syndrome admitted to critical care.Intensive Care Med. 2013; 39: 1405-1412
- Recognizing the needs of family members of neuroscience patients in an intensive care setting.J Neurosci Nurs: journal of American Association of Neuroscience Nurses. 2010; 42: 274-279
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chron Dis. 1987; 40: 373-383
- The ICH score: a simple, reliable grading scale for intracerebral hemorrhage.Stroke. 2001; 32: 891-897
- Assessment of coma and impaired consciousness. A practical scale.Lancet. 1974; 2: 81-84
- The diagnosis of head injury requires a classification based on computed axial tomography.J Neurotrauma. 1992; 9: S287-S292
- A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies.J Neurol Neurosurg Psychiatry. 1988; 51: 1457
- Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited.Stroke. 2001; 32: 2012-2020
- Relation of cerebral vasospasm to subarachnoid hemorrhage visualised by computerized tomographic scanning.Neurosurgery. 1980; 6: 1-9
- The ABCs of measuring intracerebral hemorrhage volumes.Stroke. 1996; 27: 1304-1305
- Structured interviews for the glasgow outcome scale and the extended glasgow outcome scale: guidelines for their use.J Neurotrauma. 1998; 15: 573-585
- Emotional and cognitive consequences of head injury in relation to the glasgow outcome scale.J Neurol Neurosurg Psychiatry. 2000; 69: 204-209
- Comparative study of outcome measures and analysis methods for traumatic brain injury trials.J Neurotrauma. 2015; 32: 581-589
- Use of a global test for multiple outcomes in stroke trials with application to the National Institute of Neurological Disorders and Stroke t-PA Stroke Trial.Stroke. 1996; 27: 2136-2142
- The glasgow outcome scale - 40 years of application and refinement.Nat Rev Neurol. 2016; 12: 477-485
- Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research.Lancet Neurol. 2017; 16: 987-1048
- Predictors for good functional outcome after neurocritical care.Crit Care. 2010; 14 (R136)
- Quality of life after intensive care: a systematic review of the literature.Crit Care Med. 2010; 38: 2386-2400
Article Info
Publication History
Published online: July 29, 2020
Accepted:
March 25,
2020
Received in revised form:
March 17,
2020
Received:
October 22,
2019
Identification
Copyright
© 2020 Published by Elsevier Ltd on behalf of Australian College of Critical Care Nurses Ltd.
