Effect of antiplatelet and anticoagulant medication use on injury severity and mortality in patients with traumatic brain injury treated in the intensive care unit

Characteristics and outcome of patients requiring Decompressive Craniectomy for Traumatic Brain Injury: a retrospective analysis

Brain swelling after Traumatic Brain Injury (TBI) can elevate intracranial pressure, necessitating Decompressive Craniectomy (DC) as the preferred surgical intervention. This study aimed to analyze a large institutional database to identify clinical characteristics of patients requiring primary DC and their outcomes. We reviewed TBI patients admitted to our center from 2015 to 2021, utilizing a prospectively maintained registry. Data collected included demographics, injury mechanisms, admission findings, neuroimaging results, DC necessity, procedures during hospitalization, and functional outcomes at discharge and six-month follow-up. A total of 4,011 patients were analyzed, with 506 undergoing primary DC. Factors such as International Normalized Ratio, activated Partial Thromboplastin Time, subdural hematoma, midline shift, epidural hematoma, intracerebral hemorrhage, and the presence of compressed or absent basal cisterns were independently linked to the need for DC. Additionally, the requirement for DC correlated with an increased likelihood of tracheostomy. For patients requiring DC, older age, lower hemoglobin levels, higher Rotterdam scores, and the presence of compressed or absent basal cisterns were associated with unfavorable outcomes in mild to moderate TBI cases. In severe TBI patients, lower Glasgow Coma Scale scores and fixed pupils were linked to poor outcomes. This study represents one of the most comprehensive analyses of primary DC requirements and outcomes, revealing that the need for DC is associated with worse outcomes in TBI patients and identifying several independent predictors of outcomes across varying severity levels.

Risk Factors Analysis for 90-Day Mortality of Adult Patients with Mild Traumatic Brain Injury in an Italian Emergency Department

Purpose: The most prominent risk factors for mortality after mild traumatic brain injury (TBI) have not been established. This study aimed to establish risk factors related to 90-day mortality after a traumatic event. Methods: A retrospective cohort study on adult patients entering the Emergency Department of the University Hospital of Trieste for mild TBI from 1 January 2020 to 31 December 2020 was conducted. Results: The final population was 1221 patients (median age of 78 years). The 90-day mortality rate was 7% (90 patients). In the Cox regression model (likelihood ratio 110.9; p < 2 × 10-16), the variables that significantly correlated to 90-day mortality were age (less than 75 years old is a protective factor, HR 0.29 [95%CI 0.16-0.54]; p < 0.001); chronic liver disease (HR 4.59 [95%CI 2.56-8.24], p < 0.001); cognitive impairment (HR 2.76 [95%CI 1.78-4.27], p < 0.001); intracerebral haemorrhage (HR 15.38 [95%CI 6.13-38.63], p < 0.001); and hospitalization (HR 2.56 [95%CI 1.67-3.92], p < 0.001). Cardiovascular disease (47% vs. 11%; p < 0.001) and cognitive impairment (36% vs. 10%; p < 0.001) were more prevalent in patients over 75 years of age than the rest of the population. Conclusions: In our cohort of patients with mild TBI, 90-day mortality was low but not negligible. The risk factors associated with 90-day mortality included age, history of chronic liver disease, and cognitive impairment, as well as evidence of intracerebral hemorrhage and hospitalization. The mortality of the sub-population of older patients was likely to be linked to cardiovascular comorbidities and neurodegenerative diseases.