Outcomes Following Concomitant Traumatic Brain Injury and Hemorrhagic Shock: a Secondary Analysis of the PROPPR Trial

• Activity Number: 417 - Contributed Poster Presentations: Section on Statistics in Epidemiology
• Type: Contributed
• Date/Time: Tuesday, August 1, 2017 : 2:00 PM to 3:50 PM
• Sponsor: Section on Statistics in Epidemiology
• Author(s): Savitri N. Appana* and Erin E Fox and Sarah Baraniuk and Patrick L Bosarge and Elieen M. Bulger and Rachael A. Callcut and Bryan A. Cotton and Michael Goodman and Kenji Inaba and Terence O'Keeffe and Martin A. Schreiber and Charles E. Wade and Thomas M. Scalea and John B. Holcomb and Deborah M. Stein and Samuel M. Galvagno Jr.
• Companies: The University of Texas Health Science Center at Houston and The University of Texas Health Science Center, Center for Translational Injury Research and The University of Texas Health Science Center at Houston and University of Alabama School of Medicine and University of Washington Department of Surgery and University of California San Francisco Division of General Surgery and The University of Texas Health Science Center at Houston and University of Cincinnati School of Medicine and University of Southern California Keck School of Medicine and University of Arizona School of Medicine and Oregon Health & Science University School of Medicine and The University of Texas Health Science Center, Center for Translational Injury Research and University of Maryland School of Medicine and The University of Texas Health Science Center at Houston and University of Maryland School of Medicine and University of Maryland School of Medicine
• Keywords: logistic regression ; generalized estimating equations (GEE) ; clinical trials ; traumatic brain injury ; hemorrhagic shock ; resuscitation

Abstract

This is a secondary analysis of the PROPPR trial. We hypothesized that patients with concomitant traumatic brain injury (TBI) and hemorrhagic shock (HS) (TBI+HS) had worse outcomes and required more intensive care versus patients with only one of these injuries. TBI was defined by a head abbreviated injury scale > 2 and HS as a base excess ? -4 and/or shock index ? 0.9. The primary outcome was mortality at 30 days. Logistic regression, using GEE to control for clustering by study center, was used to model categorical outcomes. Treatment assignment and TBI/HS group were included in all models and other covariates were chosen using purposeful selection and a p-value < 0.10. Regression diagnostics were performed. 670 patients were included. Unadjusted mortality was higher in the TBI+HS (51.6%) and TBI (50%) groups compared to the HS (17.5%) and neither group (7.7%). Adjusted odds of death in the TBI and TBI+HS groups were 8.2 (95% CI, 3.4-19.5) and 10.6 (4.8-23.2) times higher, respectively. TBI and not shock is the predominant predictor of death within 30 days. The addition of TBI to HS is associated with worse coagulopathy prior to resuscitation, and increased mortality.