Background: Secondary insults (SI), such as hypotension, hypoxia, and intracranial hypertension frequently occur\nafter traumatic brain injury (TBI), and have a strong impact on patientsâ?? clinical outcomes. The aim of this study is to\nexamine the trajectories of SI from the early phase of injury in the prehospital setting to hospital admission in a\ncohort of TBI patients.\nMethods: This is a retrospective, observational, single centre study on consecutive patients admitted from 1997 to\n2016 to the Neuro Intensive Care Unit (NICU) at San Gerardo Hospital, in Monza, Italy. Trajectories of SI from the\nprehospital to hospital settings were defined as â??sustainedâ?, â??resolvedâ?, â??new eventâ?, and â??noneâ?. Univariate and\nmultivariate logistic regression analyses were performed to correlate SI trajectories to a 6-months outcome.\nResults: Nine hundred sixty-seven patients were enrolled in the final analysis. About 20% had hypoxic or\nhypotensive events and 30.7% of patients had pupillary abnormalities. Hypotension and hypoxia were associated\nwith an unfavourable outcome when â??sustainedâ? and â??resolvedâ?, while pupillary abnormalities were associated with\na poor outcome when â??sustainedâ? and as â??new eventsâ?. After adjusting for confounding factors, 6-month mortality\nstrongly correlated with â??sustainedâ? hypotension (OR 11.25, 95% CI, 3.52â??35.99), â??sustainedâ? pupillary abnormalities\n(OR 2.8, 95% CI, 1.51â??5.2) and â??new eventâ? pupillary abnormalities (OR 2.8, 95% CI, 1.16â??6.76).\nConclusions: After TBI, sustained hypotension and pupillary abnormalities are important determinants for patientsâ??\noutcomes. Early trajectories define the dynamics of SI and contribute to a better understanding of how early\nrecognition and treatments in emergency settings could impact on 6-month outcomes and mortality.
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