Mila M. Paul (Würzburg / DE), Hannah Mieden (Würzburg / DE), Rolf Lefering (Witten/Herdecke / DE), Eva K. Kupczyk (Würzburg / DE), Martin C. Jordan (Würzburg / DE), Fabian Gilbert (Munich / DE), Rainer H. Meffert (Würzburg / DE), Anna-Leena Sirén (Würzburg / DE), Stefanie Hoelscher-Doht (Würzburg / DE)
Abstract text (incl. references and figure legends)
Introduction: Traumatic brain injury (TBI) is the leading cause of death and disability in polytrauma and is often accompanied by concomitant injuries [1,2]. We analyzed the impact of a concomitant femoral fracture on outcome and mortality of TBI patients [3].
Material & Methods: We conducted a retrospective matched-pair analysis of data from the multicenter trauma database TraumaRegister DGU®. Data from a 10-year period were analyzed regarding the influence of a concomitant femoral fracture on outcome and mortality of TBI patients. We included adult patients (≥ 16 years) with moderate to critical TBI (AIS 2-5). Patients with isolated TBI were compared to patients with combined TBI and femoral fracture. Matching criteria were TBI severity, ASA risk classification, initial GCS, age and gender. The chi-square test was used to evaluate categorical variables and statistical significance was defined as a p-value < 0.05.
Results: 4508 patients were included. Patients suffering combined TBI and femoral fracture showed a higher mortality rate overall, within < 6h and < 24h after injury (Figure 1). They presented with less favorable Glasgow Outcome Scale (GOS) at the time of discharge, a higher rate of multi-organ failure and of neurosurgical intervention than patients with isolated TBI. Interestingly, patients with moderate TBI (AISHead=2) showed an increased in-hospital mortality when presenting with a concomitant femoral fracture (p = 0.037, Figure 2). In addition, mortality was similar in patients receiving early total care of the femoral fracture and those treated with damage control orthopedics.
Conclusions: Patients with combined TBI and femoral fracture have a higher mortality, more in-hospital complications, an increased need for neurosurgical intervention and inferior GOS at the time of discharge.
References:
[1] Maas et al. Lancet 2008
[2] van Leeuwen et al. Neurosurgery 2012
[3] Suto et al. J Trauma Acute Care Surg 2018
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No