Delayed detection of neurological worsening in the acute setting increases traumatic brain injury lethality

Introduction: Traumatic brain injury is a leading worldwide cause of death and disability in young people. Severity classification is based on Glasgow Coma Scale (GCS). However, the presence of Neurological Worsening in the Acute Setting is not always according to the initial severity, suggesting an underestimation of real magnitude of the injury. Objective: To study the correlation between the initial severity given by the GCS and the patient outcome, in the context of different clinical and tomographic variables. Materiales y methods: A retrospective cohort was conducted for patients with closed traumatic brain injury (n=490) in two tertiary centres in Barranquilla whom required a stay in the intensive care unit. Risk estimate was established by calculating the OR (95% CI). alpha = 0.05 is used as a significance level. Results: 41,0% of all patients required orotracheal intubation, being 51,2% initially classified as moderate, and 6,0% as mild traumas. Delay in time for aggressive management mainly affect moderate group, in whom the lethality increased to 100% when time to detection of neurological worsening and, therefore, to treat aggressively was delayed beyond 4 to 8 hours. Also, this group of patients showed lethality <20,0% when treated aggressively within the first hour. Conclusions: Risk of lethality in traumatic brain injury increases with the delayed detection of neurological worsening in the acute setting, especially when aggressive management is performed after the first hour postrauma.