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dc.contributor.authorRoberts, D.J.
dc.contributor.authorLeonard, S.D.
dc.contributor.authorStein, D.M.
dc.date.accessioned2019-03-29T14:42:02Z
dc.date.available2019-03-29T14:42:02Z
dc.date.issued2019
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85062029230&doi=10.1136%2ftsaco-2018-000229&partnerID=40&md5=22c999036b2418ec48f5c23ff416395c
dc.identifier.urihttp://hdl.handle.net/10713/8601
dc.description.abstractBackground: Although many patients with traumatic brain injury (TBI) are admitted to trauma intensive care units (ICUs), some question whether outcomes would improve if their care was provided in neurocritical care units. We sought to compare characteristics and outcomes of patients with TBI admitted to and cared for in a trauma versus neuroscience ICU. Methods: We conducted a prospective cohort study of adult (≥18 years of age) blunt trauma patients with TBI admitted to a trauma versus neuroscience ICU between May 2015 and December 2016. We used multivariable logistic regression to estimate an adjusted odds ratio (OR) comparing 30-day mortality between cohorts. Results: In total, 548 patients were included in the study, including 207 (38%) who were admitted to the trauma ICU and 341 (62%) to the neuroscience ICU. When compared with neuroscience ICU admissions, patients admitted to the trauma ICU were more likely to have sustained their injuries from a high-speed mechanism (71% vs. 34%) and had a higher Injury Severity Score (ISS) (median 25 vs. 16) despite a similar head Abbreviated Injury Scale score (3 vs. 3, p=0.47) (all p<0.05). Trauma ICU patients also had a lower initial Glasgow Coma Scale score (5 vs. 15) and systolic blood pressure (128 mm Hg vs. 136 mm Hg) and were more likely to have fixed or unequal pupils at admission (13% vs. 8%) (all p<0.05). After adjusting for age, ISS, a high-speed mechanism of injury, fixed or unequal pupils at admission, and field intubation, the odds of 30-day mortality was 70% lower among patients admitted to the trauma versus neuroscience ICU (adjusted OR=0.30, 95% CI 0.11 to 0.82). Conclusions: Despite a higher injury burden and worse neurological examination and hemodynamics at presentation, patients admitted to the trauma ICU had a lower adjusted 30-day mortality. This finding may relate to improved care of associated injuries in trauma versus neuroscience ICUs. Level of evidence Prospective comparative study, level II. Copyright 2019 Author(s) (or their employer(s)).en_US
dc.description.urihttps://dx.doi.org/10.1136/tsaco-2018-000229en_US
dc.language.isoen_USen_US
dc.publisherBMJ Publishing Groupen_US
dc.relation.ispartofTrauma Surgery and Acute Care Open
dc.subjectintensive care uniten_US
dc.subjectneurocritical careen_US
dc.subjectpolytraumaen_US
dc.subjecttrauma intensive care uniten_US
dc.subjecttraumatic brain injuryen_US
dc.titleCan trauma surgeons keep up? A prospective cohort study comparing outcomes between patients with traumatic brain injury cared for in a trauma versus neuroscience intensive care uniten_US
dc.typeArticleen_US
dc.identifier.doi10.1136/tsaco-2018-000229


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