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[PMID]: | 29229352 | [Au] Autor: | Bonow RH; Barber J; Temkin NR; Videtta W; Rondina C; Petroni G; Lujan S; Alanis V; La Fuente G; Lavadenz A; Merida R; Jibaja M; Gonzáles L; Falcao A; Romero R; Dikmen S; Pridgeon J; Chesnut RM; Global Neurotrauma Research Group |
[Ad] Address: | Department of Neurological Surgery, University of Washington, Seattle, Washington, USA. Electronic address: rbonow@uw.edu. | [Ti] Title: | The Outcome of Severe Traumatic Brain Injury in Latin America. | [So] Source: | World Neurosurg;111:e82-e90, 2018 Mar. | [Is] ISSN: | 1878-8769 | [Cp] Country of publication: | United States | [La] Language: | eng | [Ab] Abstract: | BACKGROUND: Traumatic brain injury (TBI) disproportionately affects lower- and middle-income countries (LMIC). The factors influencing outcomes in LMIC have not been examined as rigorously as in higher-income countries. METHODS: This study was conducted to examine clinical and demographic factors influencing TBI outcomes in Latin American LMIC. Data were prospectively collected during a randomized trial of intracranial pressure monitoring in severe TBI and a companion observational study. Participants were aged ≥13 years and admitted to study hospitals with Glasgow Coma Scale score ≤8. The primary outcome was Glasgow Outcome Scale, Extended (GOS-E) score at 6 months. Predictors were analyzed using a multivariable proportional odds model created by forward stepwise selection. RESULTS: A total of 550 patients were identified. Six-month outcomes were available for 88%, of whom 37% had died and 44% had achieved a GOS-E score of 5-8. In multivariable proportional odds modeling, higher Glasgow Coma Scale motor score (odds ratio [OR], 1.41 per point; 95% confidence interval [CI], 1.23-1.61) and epidural hematoma (OR, 1.83; 95% CI, 1.17-2.86) were significant predictors of higher GOS-E score, whereas advanced age (OR, 0.65 per 10 years; 95% CI, 0.57-0.73) and cisternal effacement (P < 0.001) were associated with lower GOS-E score. Study site (P < 0.001) and race (P = 0.004) significantly predicted outcome, outweighing clinical variables such as hypotension and pupillary examination. CONCLUSIONS: Mortality from severe TBI is high in Latin American LMIC, although the rate of favorable recovery is similar to that of high-income countries. Demographic factors such as race and study site played an outsized role in predicting outcome; further research is required to understand these associations. | [Pt] Publication type: | JOURNAL ARTICLE | [Em] Entry month: | 1712 | [Cu] Class update date: |
180303 | [Lr] Last revision date: | 180303 | [St] Status: | In-Data-Review |
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