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

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

John K Yue  1   2 , Gabriela G Satris  1   2 , Cecilia L Dalle Ore  1   2 , J Russell Huie  1   2 , Hansen Deng  3 , Ethan A Winkler  1   2 , Young M Lee  1   2 , Mary J Vassar  1   2 , Sabrina R Taylor  1   2 , David M Schnyer  4 , Hester F Lingsma  5 , Ava M Puccio  3 , Esther L Yuh  2   6 , Pratik Mukherjee  2   6 , Alex B Valadka  7 , Adam R Ferguson  1   2 , Amy J Markowitz  2 , David O Okonkwo  3 , Geoffrey T Manley  1   2
Affiliations

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

John K Yue et al. Neurotrauma Rep. .

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.

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Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Flowchart of included patients.
FIG. 2.
FIG. 2.
(A,B) Distribution of GOSE at 3 and 6 months between TBI patients with and without polytrauma. In general, the TBI+Polytrauma group had worse GOSE scores at 3 and 6 months compared with the Isolated TBI group. (C) Distribution of patients who declined, stayed the same, and improved in GOSE from 3 to 6 months. In the TBI+Polytrauma group, a statistically significantly greater proportion of patients declined and a smaller proportion of patients improved. GOSE, Glasgow Outcome Scale-Extended; TBI, traumatic brain injury.
FIG. 3.
FIG. 3.
Polytrauma: univariate and multi-variable odds for poorer outcome. Odds ratios are shown for different known GOSE clinical cutoffs at 3 and 6 months for TBI+polytrauma (comparison group, with odds ratios shown) compared with Isolated TBI (reference group). Univariate logistic regressions are shown for GOSE <8 (any deficit vs. less than full recovery), GOSE <7 (moderate disability or worse vs. good recovery), and GOSE <5 (death/severe disability vs. moderate disability or better). Univariate ordinal regressions showed odds of worse outcome on the GOSE as an ordinal measure at 3 and 6 months. The multi-variable ordinal odds ratio controls are for known predictors of TBI outcome (age, sex, education, race, baseline psychiatric history, mechanism of injury, GCS score, and Marshall CT score). General trends were the same across all comparisons. Statistically significant odds ratios for worse outcome are associated with the TBI+Polytrauma group across all clinical cutoffs at 3 months, as well as for GOSE <7, GOSE <5, and univariate and multi-variable ordinal regressions. CT, computed tomography; GCS, Glasgow Coma Scale; GOSE, Glasgow Outcome Scale-Extended; TBI, traumatic brain injury.
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