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Hyponatremia on Initial Presentation Correlates With Poor Outcomes in Traumatic Brain Injury FREE TO VIEW

Amy Pate; Srilakshmi Ponukumati; Akella Chendrasekhar
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Richmond University Medical Center, Staten Island, NY

Chest. 2014;146(4_MeetingAbstracts):221A. doi:10.1378/chest.1992549
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SESSION TITLE: Non Pulmonary Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Metabolic derangements often occur in the setting of acute cerebral insult. The objective of this study is to determine whether the presence of hyponatremia on initial presentation affects outcome in patients with acute traumatic brain injury (TBI).

METHODS: We performed a retrospective study of all subjects aged >13 years with acute TBI presenting to an urban level-I trauma center over the course of January 2012 to May 2013. Patients were identified via the trauma registry and stratified into two groups: hyponatremic (Na+ <135 mEq/L) and non-hyponatremic (Na+ >135 mEq/L). Medical records were reviewed for demographics, vital signs and laboratory results on initial presentation, injury severity score (ISS), head abbreviated injury scale (AIS-head), length of stay (LOS), intensive care unit length of stay (ICU-LOS), and survival to discharge. Statistical analysis was performed using chi-square analysis or t-test as appropriate.

RESULTS: A total of 151 patients (50 female, 101 male) with a mean age of 53 ± 3.8 years were included; hyponatremia was present in 44 patients (29.1%). Mean ISS was 22.6 ± 5.4, mean AIS-head was 3.9 ± 0.1, mean LOS was 7.8 ± 1.6 days, and mean ICU-LOS was 4.2 ± 0.9 days. Twenty-five patients expired (16.5%). Mean age, mean AIS-head, and mean LOS did not significantly vary between hyponatremic (mean Na+ 130.3 ± 0.9 mEq/L) and non-hyponatremic (mean Na+ 138.8 ± 0.6 mEq/L) patients. Mean ISS (32 ± 18.3 vs 18.7 ± 1.5, p=0.03) was higher and mean ICU-LOS (9.3 ± 4.2 vs 3.6 ± 0.8 days, p=0.03) was longer in hyponatremic patients. Hyponatremia was negatively correlated with survival to discharge (p<0.001); mean initial sodium was lower in patients who expired (130.6 ± 1.8 vs 137.5 ± 0.7 mEq/L, p<0.001).

CONCLUSIONS: Hyponatremia on initial presentation is correlated with mortality and longer ICU-LOS in patients with acute TBI. Further large-scale research involving measurements of plasma osmolarity would be necessary to determine whether our findings are indicative of a hypo-osmolar state.

CLINICAL IMPLICATIONS: Hyponatremia on initial presentation correlates with mortality and longer ICU-LOS in the setting of acute traumatic brain injury; physicians should note that sodium levels <135 mEq/L on arrival may aid in the identification of patients at risk for suboptimal outcomes.

DISCLOSURE: The following authors have nothing to disclose: Amy Pate, Srilakshmi Ponukumati, Akella Chendrasekhar

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