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Prognostication in critically ill patients with severe traumatic brain injury: the TBI-Prognosis multicentre feasibility study
  1. Alexis F Turgeon1,2,
  2. François Lauzier1,2,
  3. Ryan Zarychanski3,
  4. Dean A Fergusson4,
  5. Caroline Léger1,
  6. Lauralyn A McIntyre4,5,
  7. Francis Bernard6,
  8. Andrea Rigamonti7,
  9. Karen Burns7,
  10. Donald E Griesdale8,
  11. Robert Green9,
  12. Damon C Scales10,
  13. Maureen O Meade11,
  14. Martin Savard12,
  15. Michèle Shemilt1,
  16. Jérôme Paquet13,14,
  17. Jean-Luc Gariépy14,
  18. André Lavoie1,
  19. Kesh Reddy15,
  20. Draga Jichici11,
  21. Giuseppe Pagliarello5,
  22. David Zygun16,
  23. Lynne Moore1,17
  24. for the TBI-Prognosis Study Team and the Canadian Critical Care Trials Group
  1. 1Population Health and Optimal Health Practices Research Unit (Trauma—Emergency—Critical Care Medicine), CHU de Québec—Université Laval Research Centre, Québec City, Québec, Canada
  2. 2Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
  3. 3Department of Internal Medicine, Section of Critical Care and of Haematology and Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
  4. 4Clinical Epidemiology Unit, Center for Transfusion and Critical Care Research, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  5. 5Department of Critical Care Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
  6. 6Department of Medicine, Université de Montréal, Montréal, Québec, Canada
  7. 7Interdepartmental Division of Critical Care Medicine, St-Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  8. 8Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
  9. 9Department of Critical Care Medicine, Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  10. 10Interdepartmental Division of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
  11. 11Department of Medicine, Division of Critical Care Medicine, McMaster University, Hamilton, Ontario, Canada
  12. 12Department of Medicine, Division of Neurology, Université Laval, Québec, Québec, Canada
  13. 13Department of Surgery, Division of Neurosurgery, Université Laval, Québec, Québec, Canada
  14. 14Department Radiology and Nuclear Medicine, Université Laval, Québec, Québec, Canada
  15. 15Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
  16. 16Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
  17. 17Department of Preventive and Social Medicine, Université Laval, Québec, Québec, Canada
  1. Correspondence to Alexis F Turgeon; alexis.turgeon{at}fmed.ulaval.ca

Abstract

Objective Severe traumatic brain injury is a significant cause of morbidity and mortality in young adults. Assessing long-term neurological outcome after such injury is difficult and often characterised by uncertainty. The objective of this feasibility study was to establish the feasibility of conducting a large, multicentre prospective study to develop a prognostic model of long-term neurological outcome in critically ill patients with severe traumatic brain injury.

Design A prospective cohort study.

Setting 9 Canadian intensive care units enrolled patients suffering from acute severe traumatic brain injury. Clinical, biological, radiological and electrophysiological data were systematically collected during the first week in the intensive care unit. Mortality and functional outcome (Glasgow Outcome Scale extended) were assessed on hospital discharge, and then 3, 6 and 12 months following injury.

Outcomes The compliance to protocolised test procedures was the primary outcome. Secondary outcomes were enrolment rate and compliance to follow-up.

Results We successfully enrolled 50 patients over a 12-month period. Most patients were male (80%), with a median age of 45 years (IQR 29.0–60.0), a median Injury Severity Score of 38 (IQR 25–50) and a Glasgow Coma Scale of 6 (IQR 3–7). Mortality was 38% (19/50) and most deaths occurred following a decision to withdraw life-sustaining therapies (18/19). The main reasons for non-enrolment were the time window for inclusion being after regular working hours (35%, n=23) and oversight (24%, n=16). Compliance with protocolised test procedures ranged from 92% to 100% and enrolment rate was 43%. No patients were lost to follow-up at 6 months and 2 were at 12 months.

Conclusions In this multicentre prospective feasibility study, we achieved feasibility objectives pertaining to compliance to test, enrolment and follow-up. We conclude that the TBI-Prognosis prospective multicentre study in severe traumatic brain injury patients in Canada is feasible.

  • Traumatic brain injury
  • Pilot study
  • Prognosis
  • Outcome

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors AFT, FL, RZ, DAF, LAM, FB, AR, KB, DG, RG, DCS, MOM, MS, JP, J-LG, AL, KR, GP, DZ and LM were involved in conception and design. AFT, FL, RZ, DAF, CL, LAM, FB, AR, KB, DG, RG, DCS, MOM, MS, MSh, JP, J-LG, AL, KR, DJ, GP, DZ and LM were involved in the acquisition and interpretation of data. AFT, CL and MSh drafted the manuscript. AFT, FL, RZ, DAF, CL, LAM, FB, AR, KB, DG, RG, DCS, MOM, MS, MSh, JP, J-LG, AL, KR, DJ, GP, DZ and LM were involved in revising the manuscript and approved the version published.

  • Funding This study was funded by the Fonds de la Recherche du Québec—Santé (FRQS) (grant #5888) and the Canadian Intensive Care Foundation (CICF). AFT is the Canada Research Chair in Critical Care Neurology and Trauma. LM, LAM, AFT and RZ are or were recipients of New Investigator Awards from the Canadian Institutes of Health Research (CIHR) during the conduction of the study. AFT and FL are supported by the Traumatology Research Consortium of the FRQS. FL is a recipient of a salary support Award from the FRQS.

  • Competing interests None declared.

  • Ethics approval Centre Hospitalier Affilié Universitaire de Québec (CHAUQ) Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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