Neuroworsening from a normal Glasgow Coma Scale Motor Score in the emergency department is an early predictor of neurosurgical intervention, hospital outcomes, and longitudinal disability in traumatic brain injury: A TRACK-TBI Study
Rattachement africain : us, nl. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
OBJECTIVE: Neuroworsening portends poor outcomes after traumatic brain injury (TBI) and is protocolized in intensive care unit (ICU) settings. The utility of neuroworsening assessments in non-ICU settings for intervention and prognostication requires further understanding. This study assessed relationships among neuroworsening in the emergency department (ED), clinicoradiological injury, blood-based biomarkers, neurosurgical interventions, and outcomes in TBI patients without Glasgow Coma Scale-Motor Score (GCS-M) impairment at ED arrival. METHODS: Adult subjects from the 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI; ClinicalTrials.gov #NCT02119182) Study with ED arrival GCS-M = 6 and ED disposition GCS-M were analyzed. Neuroworsening was defined as ED disposition GCS-M < 6. Subjects received clinically-indicated head computed tomography (CT) scan within 24-hours (h) post-TBI. Clinical characteristics, acute plasma TBI biomarker levels (glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase-L1 (UCH-L1); pg/ml), neurosurgical procedural interventions, hospital outcomes, and 3- and 6-month outcomes (Glasgow Outcome Scale-Extended (GOSE)) were compared. Multivariable logistic regressions examined predictors of neurosurgical interventions and unfavorable outcomes (GOSE ≤ 4) using adjusted odds ratios (AOR [95 % confidence intervals (CI)]). Cox proportional hazards model examined hospital discharge rate over time using adjusted hazard ratios (AHR). RESULTS: In 1210 subjects, 36 (3.0 %) had ED neuroworsening. Neuroworsening was associated with features of more severe injuries, including ICU admission (91.7 % vs. 30.3 %, p < 0.0001), post-traumatic amnesia duration (>24 h: 26.7 % vs. 4.2 %, p < 0.0001), and traumatic intracranial injuries on CT (72.2 % vs. 39.7 %, p = 0.00020). Neuroworsening subjects had higher GFAP (median = 1400 [Q1-Q3:864-3663] vs. 306 [82-839], p < 0.0001) and UCH-L1 (median = 459 [287-1036] vs. 170 [94-322], p < 0.0001), neurosurgical procedural interventions (38.9 % vs. 2.1 %, p < 0.0001), in-hospital mortality (8.6 % vs. 1.0 %, p = 0.018), hospital length of stay (6.9 days [Q1-Q3:4.8-16.8] vs. 2.2 days [1.3-4.0], p < 0.0001), and 3- and 6-month unfavorable outcomes (26.1 % vs. 3.5 %, p = 0.00040; 26.1 % vs. 3.7 %, p = 0.00050). Neuroworsening independently predicted neurosurgical interventions (AOR = 18.7 [95 % CI: 7.9-44.1], p < 0.0001), lower discharge rate [AHR = 0.35 [0.24-0.50], p < 0.0001), 3-month unfavorable outcome (AOR = 9.8 [3.0-31.9], p = 0.00010), and 6-month unfavorable outcome (AOR = 11.0 [3.1-38.7], p = 0.00020). CONCLUSIONS: ED neuroworsening is an early indicator of clinicoradiological TBI severity, and predicted neurosurgical procedural interventions, longer hospitalizations, and 3- and 6-month unfavorable outcomes. Higher blood-based TBI biomarker levels were associated with ED neuroworsening, suggesting their potential role to aid in the assessment of TBI patients at high risk of neurological deterioration.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Neuroworsening from a normal Glasgow Coma Scale Motor Score in the emergency department is an early predictor of neurosurgical intervention, hospital outcomes, and longitudinal disability in traumatic brain injury: A TRACK-TBI Study
- Date Crossref
- 01/05/2026
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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San Francisco General Hospital pays non établi dans la noticeÉtablissement de santé
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University of California Department of Neurological Surgery pays non établi dans la noticeUniversité ou école supérieure
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Philip R. Lee Institute for Health Policy Studies pays non établi dans la noticeStructure de recherche
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New York University pays non établi dans la noticeUniversité ou école supérieure
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University of Pittsburgh Medical Center Department of Neurological Surgery pays non établi dans la noticeÉtablissement de santé
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Neurological Surgery pays non établi dans la noticeÉtablissement de santé
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University of Wisconsin–Madison pays non établi dans la noticeUniversité ou école supérieure
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Leiden University Medical Center pays non établi dans la noticeOrganisme public
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Medisch Centrum Haaglanden pays non établi dans la noticeÉtablissement de santé
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University of Pennsylvania Department of Neurology pays non établi dans la noticeUniversité ou école supérieure
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Touro University California pays non établi dans la noticeUniversité ou école supérieure
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Baylor College of Medicine Department of Neurological Surgery pays non établi dans la noticeUniversité ou école supérieure
San Francisco General Hospital, Department of Neurological Surgery — University of California et Philip R. Lee Institute for Health Policy Studies, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.