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Paper Information

Journal:   BULLETIN OF EMERGENCY AND TRAUMA BEAT   2014 , Volume 2 , Number 2; Page(s) 65 To 71.
 
Paper: 

EFFECTS OF GLYCEMIC LEVEL ON OUTCOME OF PATIENTS WITH TRAUMATIC BRAIN INJURY: A RETROSPECTIVE COHORT STUDY

 
 
Author(s):  ALVIS MIRANDA HERNANDO RAPHAEL, NAVAS MARRUGO SANDY ZULEICA, VELASQUEZ LOPERENA ROBERT ANDRES, ADIE VILLAFANE RICHARD JOSE, VELASQUEZ LOPERENA DUFFAY, CASTELLAR LEONES SANDRA MILENA, ALCALA CERRA GABRIEL, PULIDO GUTIERREZ JUAN CAMILO, RODRIGUEZ CONDE JAVIER RICARDO, MORENO MORENO MARIA FERNANDA, RUBIANO ANDRES M., MOSCOTE SALAZAR LUIS RAFAEL*
 
* DEPARTMENT OF NEUROSURGERY, UNIVERSITY OF CARTAGENA, CARTAGENA DE INDIAS, COLOMBIA, SOUTH AMERICA
 
Abstract: 

Objective: To determine the effects of glycemic level on outcome patients with traumatic brain injury.
Methods: From September 2010 to December 2012, all medical records of adult patients with TBI admitted to the Emergency Room of Laura Daniela Clinic in Valledupar City, Colombia, South America were enrolled.
Both genders between 18 and 85 years who referred during the first 48 hours after trauma, and their glucose level was determined in the first 24 hours of admission were included. Adults older than 85 years, with absence of Glasgow Coma Scale (GCS) score and a brain Computerized Tomography (CT) scans were excluded. The cut-off value was considered 200 mg/dL to define hyperglycemia. Final GCS, hospital admission duration and complications were compared between normoglycemic and hyperglycemic patients.
Results: Totally 217 patients were identified with TBI. Considering exclusion criteria, 89 patients remained for analysis. The mean age was 43.0±19.6 years, the mean time of remission was 5.9±9.4 hours, the mean GCS on admission was 10.5±3.6 and the mean blood glucose level in the first 24 hours was 138.1±59.4 mg/dL. Hyperglycemia was present in 13.5% of patients. The most common lesions presented by patients with TBI were fractures (22.5%), hematoma (18.3%), cerebral edema (18.3%) and cerebral contusion (16.2%). Most of patients without a high glucose level at admission were managed only medically, whereas surgical treatment was more frequent in patients with hyperglycemia (p=0.042). Hyperglycemia was associated with higher complication (p=0.019) and mortality rate (p=0.039). GCS was negatively associated with on admission glucose level (r=0.11; p=0.46).
Conclusion: Hyperglycemia in the first 24-hours of TBI is associated with higher rate of surgical intervention, higher complication and mortality rates. So hyperglycemia handling is critical to the outcome of patients with traumatic brain injury.

 
Keyword(s): TRAUMATIC BRAIN INJURY, HYPERGLYCEMIA, POLYTRAUMA
 
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