SESSION TITLE: Outcomes/Quality Control Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Severe head injury is thought to be associated with hyper-metabolism and subsequent organ dysfunction. Little data exist on the timing of this hyper-metabolism and organ dysfunction and its association with mortality. Pre-albumin level is a good short-term marker of nutritional status. Lower Albumin level after injury is a marker of hyper-metabolism and its normalization is a marker of abatement of the hyper-metabolic rate. Elevated initial serum creatinine is a marker of renal insufficiency.
METHODS: We performed a retrospective data analysis on 251 severe head injured trauma patients [abbreviated injury score (AIS) ≥ 3] seen at our level 1 trauma center. Patients with length of stay ≤ 1 day and pediatric patients with age < 16 years were excluded. We collected demographic data and data on the presence and absence of infection, survival to discharge from the hospital, injury severity score [ISS], revised trauma score [RTS], hospital and ICU length of stay. The data were analyzed by one-way analysis of variance [ANOVA]
RESULTS: We analyzed 147 severe closed head injured patients. Initial albumin level was higher in survivors [3.80 ± 0.06 versus 3.34 ± 0.12 g/dl, p=0.001]; initial pre-albumin was also higher in survivors [16.7 ± 0.7 versus 11.3 ± 1.4 mg/dl, p=0.001]. Surprisingly initial serum creatinine was lower in survivors [0.99 ± 0.08 versus 2.00 ± 0.18]. ICU and hospital length of stay were equivalent for both survivors and non-survivors. Infection was associated with a lower survival [63.2 ± 5.5% versus 91.7 ± 3.2%, p=0.0001] as well as longer ICU length of stay [8.4 ± 0.8 versus 2.7 ± 0.5 days, p=0.0001] and hospital length of stay [13.4 ± 1.5 versus 5.8 ± 0.9 days, p=0.0001]. The type of infection did not affect survival. Infection was associated with worse injury [higher ISS, AIS head and lower RTS]. The ability to correct albumin level was associated with improved survival [87.7 ± 3.2% versus 68.0 ± 7.2%, p=0.01].
CONCLUSIONS: pre-albumin and albumin demonstrate abnormally low levels early after head injury. The ability to correct albumin is an independent marker of survival. The elevated creatinine is suggestive of renal insufficiency manifesting at entry into the ER. Infection in head injury is associated with higher morbidity and mortality.
CLINICAL IMPLICATIONS: head injured patients that demonstrate lower nutritional or metabolic response parameters or infection need to be watched closely as the risk to morbidity and mortality is significant
DISCLOSURE: The following authors have nothing to disclose: Benita Panigrahi, Shannon LaBoy, Roman Prosniak, Armaiti Mody, Akella Chendrasekhar
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