Outcome of Patients with Traumatic Brain Injury Admitted to ICU UKMMC: A 5-Year Retrospective Study
Outcome of Patients with TBI Admitted to ICU UKMMC
Abstract
Traumatic brain injury (TBI) has led to significant morbidity and mortality worldwide, imposing a substantial burden socioeconomically. Development and adherence to management guidelines has shown promising results in improving the outcomes of patients with TBI, in both mortality as well as functionality. Nevertheless, a protocolised management guideline remains lacking in many centres in Malaysia. This single-centre retrospective study aimed to determine the outcomes of patients with TBI admitted to Intensive Care Unit (ICU) and the associated risk factors. Additional work had been done to follow up on the employment status of these patients. ICU registry was screened for eligible patients with TBI admitted 2015-2019, and relevant information were extracted. Logistic regression was used to determine risk factors. McNemar test was used to analyse post-traumatic employment status of patients. A total of 173 patients were studied, and all-cause mortality of 16.2% was reported. Increasing age, occurrence of hypoxaemia and hypotension respectively during the first 24-hour in ICU, and higher lactate level were independent risk factors to mortality. As many as 40.9% of patients who were employed or was a student prior to TBI, did not return to work/school. We concluded that the in-hospital mortality for patients admitted to ICU for TBI was high. Unemployment after TBI is high, however, it is not directly attributed by functional disability following the injury.
Keywords :
Brain injuries; functional status; intensive care units; mortality; risk factors; employment; traumatic ,
Abstrak
Kecederaan otak traumatis (TBI) telah menyebabkan morbiditi dan kematian yang signifikan di seluruh dunia, serta telah memberikan beban yang besar dari segi sosioekonomi. Pembangunan dan pematuhan terhadap garis panduan pengurusan telah menunjukkan hasil yang memberangsangkan dalam meningkatkan hasil rawatan pesakit dengan TBI, sama ada dari segi mortaliti mahupun fungsi. Walau bagaimanapun, garis panduan pengurusan yang teratur masih kurang di kebanyakan pusat rawatan di Malaysia. Kajian retrospektif tunggal di pusat ini bertujuan untuk menentukan hasil rawatan pesakit dengan TBI yang dirawat di Unit Rawatan Rapi (ICU) dan faktor risiko yang berkaitan. Kerja tambahan telah dilakukan untuk memantau status pekerjaan pesakit-pesakit ini. Pendaftaran ICU telah disaring untuk pesakit mengalami TBI yang dirawat dari tahun 2015 hingga 2019, dan maklumat yang berkaitan telah diekstrak. Regresi logistik telah digunakan untuk menentukan faktor risiko. Ujian McNemar telah digunakan untuk menganalisis status pekerjaan pasca-trauma pesakit-pesakit ini. Sejumlah 173 pesakit telah dikaji, dan kadar mortaliti tanpa mengira sebab adalah sebanyak 16.2%. Peningkatan usia, kejadian hipoksia dan hipotensi masing-masing dalam 24 jam pertama di ICU, dan tahap laktat yang lebih tinggi adalah faktor risiko bebas terhadap mortaliti. Sebanyak 40.9% pesakit yang bekerja atau merupakan pelajar sebelum TBI, tidak kembali bekerja/sekolah. Kami menyimpulkan bahawa mortaliti di hospital bagi pesakit yang dimasukkan di ICU disebabkan TBI adalah tinggi. Pengangguran selepas TBI juga tinggi, namun ia tidak secara langsung dikaitkan dengan kecacatan fungsi selepas kecederaan tersebut.
Kata Kunci :
Faktor risiko; kecederaan otak; kematian; pekerjaan; status fungsi,
traumatik; unit rawatan rapi,
Correspondance Address
Loo Wing Hoh. Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +60162090766 Email: wing_hoh88@hotmail.com
