Polytrauma Is Associated with Increased Three- and Six-Month Disability after Traumatic Brain Injury: A TRACK-TBI Pilot Study

John K Yue; Gabriela G Satris; Cecilia L Dalle Ore; J Russell Huie; Hansen Deng; Ethan A Winkler; Young M Lee; Mary J Vassar; Sabrina R Taylor; David M Schnyer; Hester F Lingsma; Ava M Puccio; Esther L Yuh; Pratik Mukherjee; Alex B Valadka; Adam R Ferguson; Amy J Markowitz; David O Okonkwo; Geoffrey T Manley

doi:10.1089/neur.2020.0004

Polytrauma Is Associated with Increased Three- and Six-Month Disability after Traumatic Brain Injury: A TRACK-TBI Pilot Study

Neurotrauma Rep. 2020 Jul 23;1(1):32-41. doi: 10.1089/neur.2020.0004. eCollection 2020.

Authors

John K Yue^{1

2}, Gabriela G Satris^{1

2}, Cecilia L Dalle Ore^{1

2}, J Russell Huie^{1

2}, Hansen Deng³, Ethan A Winkler^{1

2}, Young M Lee^{1

2}, Mary J Vassar^{1

2}, Sabrina R Taylor^{1

2}, David M Schnyer⁴, Hester F Lingsma⁵, Ava M Puccio³, Esther L Yuh^{2

6}, Pratik Mukherjee^{2

6}, Alex B Valadka⁷, Adam R Ferguson^{1

2}, Amy J Markowitz², David O Okonkwo³, Geoffrey T Manley^{1

2}

Affiliations

¹ Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
² Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
³ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
⁴ Department of Psychology, University of Texas, Austin, Texas, USA.
⁵ Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
⁶ Department of Radiology, University of California San Francisco, San Francisco, California, USA.
⁷ Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.

Abstract

Polytrauma and traumatic brain injury (TBI) frequently co-occur and outcomes are routinely measured by the Glasgow Outcome Scale-Extended (GOSE). Polytrauma may confound GOSE measurement of TBI-specific outcomes. Adult patients with TBI from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study had presented to a Level 1 trauma center after injury, received head computed tomography (CT) within 24 h, and completed the GOSE at 3 months and 6 months post-injury. Polytrauma was defined as an Abbreviated Injury Score (AIS) ≥3 in any extracranial region. Univariate regressions were performed using known GOSE clinical cutoffs. Multi-variable regressions were performed for the 3- and 6-month GOSE, controlling for known demographic and injury predictors. Of 361 subjects (age 44.9 ± 18.9 years, 69.8% male), 69 (19.1%) suffered polytrauma. By Glasgow Coma Scale (GCS) assessment, 80.1% had mild, 5.8% moderate, and 14.1% severe TBI. On univariate logistic regression, polytrauma was associated with increased odds of moderate disability or worse (GOSE ≤6; 3 month odds ratio [OR] = 2.57 [95% confidence interval (CI): 1.50-4.41; 6 month OR = 1.70 [95% CI: 1.01-2.88]) and death/severe disability (GOSE ≤4; 3 month OR = 3.80 [95% CI: 2.03-7.11]; 6 month OR = 3.33 [95% CI: 1.71-6.46]). Compared with patients with isolated TBI, more polytrauma patients experienced a decline in GOSE from 3 to 6 months (37.7 vs. 24.7%), and fewer improved (11.6 vs. 22.6%). Polytrauma was associated with greater univariate ordinal odds for poorer GOSE (3 month OR = 2.79 [95% CI: 1.73-4.49]; 6 month OR = 1.73 [95% CI: 1.07-2.79]), which was conserved on multi-variable ordinal regression (3 month OR = 3.05 [95% CI: 1.76-5.26]; 6 month OR = 2.04 [95% CI: 1.18-3.42]). Patients with TBI with polytrauma are at greater risk for 3- and 6-month disability compared with those with isolated TBI. Methodological improvements in assessing TBI-specific disability, versus disability attributable to all systemic injuries, will generate better TBI outcomes assessment tools.

Keywords: disability; functional outcome; outcome measure; polytrauma; traumatic brain injury.

Abstract

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