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Critical Care Research and Practice
Volume 2018, Article ID 3769418, 7 pages
https://doi.org/10.1155/2018/3769418
Research Article

Outcome in Patients with Isolated Moderate to Severe Traumatic Brain Injury

1Department of Trauma, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3585 GA Utrecht, Netherlands
2Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3585 GA Utrecht, Netherlands
3Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3585 GA Utrecht, Netherlands
4Department of Neurology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3585 GA Utrecht, Netherlands
5Department of Intensive Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3585 GA Utrecht, Netherlands

Correspondence should be addressed to D. Jochems; ln.thcertucmu@3-smehcoj.d

Received 8 May 2018; Revised 16 July 2018; Accepted 14 August 2018; Published 23 September 2018

Academic Editor: Thomas J. Esposito

Copyright © 2018 D. Jochems et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Traumatic brain injury (TBI) remains a major cause of death. Withdrawal of life-sustaining treatment (WLST) can be initiated if there is little anticipated chance of recovery to an acceptable quality of life. The aim of this study was firstly to investigate WLST rates in patients with moderate to severe isolated TBI and secondly to assess outcome data in the survivor group. Material and Methods. A retrospective cohort study was performed. Patients aged ≥ 18 years with moderate or severe isolated TBI admitted to the ICU of a single academic hospital between 2011 and 2015 were included. Exclusion criteria were isolated spinal cord injury and referrals to and from other hospitals. Gathered data included demographics, mortality, cause of death, WLST, and Glasgow Outcome Scale (GOS) score after three months. Good functional outcome was defined as GOS > 3. Results. Of 367 patients, 179 patients were included after applying inclusion and exclusion criteria. 55 died during admission (33%), of whom 45 (82%) after WLST. Patients undergoing WLST were older, had worse neurological performance at presentation, and had more radiological abnormalities than patients without WLST. The decision to withdraw life-sustaining treatment was made on the day of admission in 40% of patients. In 33% of these patients, this decision was made while the patient was in the Emergency Department. 71% of survivors had a good functional outcome after three months. No patient left hospital with an unresponsive wakefulness syndrome (UWS) or suffered from UWS after three months. One patient died within three months of discharge. Conclusion. In-hospital mortality in isolated brain injured patients was 33%. The vast majority died after a decision to withdraw life-sustaining treatment. None of the patients were discharged with an unresponsive wakefulness syndrome.