Predictors of Clinical Outcome and Overall Survival (OS) Following Neurosurgical Intervention in Severe Traumatic Brain Injury (TBI) with a Glasgow Coma Scale Score (GCS) of 3: A Multicentric Retrospective Study
Faisal S. Alqahtani1, Jumanah Qedair2, Ziyad Alqahtani2, Othman Bin-Alamer3, Waad Fudhah4, Sami Khairy5, Ahmed Alkhani6
1College of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia, 2College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, 35Department of Neurological Surgery, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA, 41College of Medicine, 1College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia, 5College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia., 6Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
Objective:
We aimed to evaluate the predictors of clinical outcomes and OS following neurosurgical intervention among patients with severe TBI who presented with a GCS score of 3.
Background:
Despite the high rate of TBI in Saudi Arabia and worldwide, the predictors of clinical outcome and survival following neurosurgical intervention among patients with TBI and a GCS score of 3 remain undetermined.
Design/Methods:
TBI registry data collected from two of the largest tertiary hospitals in Saudi Arabia was used in this study. The primary outcome measures were the Modified Rankin Scale (mRS) and OS in months. Patients were stratified into favorable (mRS = 0–2) and unfavorable (mRS = 3–6) outcome groups. A Cox proportional hazards model was created to identify potential predictors of survival.
Results:
Out of 2,443 patients with TBI, 150 met our inclusion criteria. The median age was 29 years, and 94% were males. The most common mechanism of injury was motor vehicle accident (MVA) 64%, and skull bone fracture was the most prevalent pathology 73.3%. The neurosurgical interventions were decompressive craniectomy 68%, hematoma evacuation 51.3%, and external ventricular drainage 24.7%. During a median follow-up time of two months, 26% of the patients died, with 84.6% of them not surviving beyond one month following neurosurgical intervention. Clinical outcomes were evaluated in 143 patients. The rate of unfavorable outcome was significantly higher in patients who aged 20-49 years (68.8%, p=0.01), had MVA (67%, p<0.001), and had one or both nonreactive pupils (p <0.001). Multivariable analysis revealed that the absence of reactivity in one pupil (HR: 10.1, 95% CI: 2.38–43.0, p=0.002) or both pupils (HR: 24.5, 95% CI: 7.30–82.0, p<0.001) was a significant predictor of reduced OS.
Conclusions:
The absence of preoperative pupillary reactivity is a significant predictor of OS following neurosurgical intervention, so a multidisciplinary approach with close postoperative monitoring is highly recommended.