Clinical course of mild traumatic brain injury in polytrauma patients admitted to intensive care.

Abstract

Mild traumatic brain injury (mTBI) accounts for the majority of TBI cases. In polytrauma patients admitted to intensive care units (ICUs), mTBI may be associated with more severe clinical profiles and a higher risk of intervention. However, the outcomes and characteristics of this population remain underdescribed. The authors conducted a retrospective study of adult patients with mTBI (Glasgow Coma Scale [GCS] score ≥ 13) admitted to the ICU of a level I trauma center from 2011 to 2017. Patients with secondary neurological deterioration prior to ICU admission were excluded. The authors specifically assessed the presence of intracranial lesions, need for neurosurgical interventions, and clinical outcomes including in-hospital mortality. Statistical analyses included descriptive statistics, univariate comparisons, and multivariate logistic regression models to identify factors independently associated with neurosurgical intervention and mortality. Among 244 patients (82% male, mean age 41.3 years), 82.8% had traumatic intracranial lesions. Neurosurgical intervention was required in 22.1% of cases, and the mortality rate was 3.3%. Subarachnoid hemorrhage, subdural hematoma, and epidural hematoma were the most common imaging findings. Independent predictors of neurosurgical intervention included epidural hematoma, midline shift > 5 mm, and assault-related trauma. Mortality was associated with age and hemorrhagic shock. Functional outcomes were favorable in most patients, but 24% had disability at discharge. In polytrauma patients admitted to the ICU, mTBI is often accompanied by intracranial injuries and a substantial need for surgical intervention, even when the GCS score is high.