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Clinical and laboratory parameter effects on traumatic brain injury patients
NEUROSURGERY Clinical and laboratory parameter effects on traumatic brain injury patients Azedine Medhkour, MD, FACS, Justin Baum, Pouya Entezami, MD University of Toledo College of Medicine, Toledo, OH INTRODUCTION: The purpose of this study was to retrospectively evaluate patients treated for traumatic brain injuries (TBI) in an effort to determine how certain clinical and laboratory parameters affect outcome. METHODS: A single institution retrospective review of all patients diagnosed with TBI at a level I trauma center from 2000-2014 was conducted. Clinical outcome was based on Glasgow Outcome Scale (GOS) at hospital discharge. Parameters analyzed were age, sex, Glasgow Coma Scale (GCS) at presentation to emergency department, Injury Severity Score (ISS), length of stay (LOS), intracranial pressure (ICP), cerebral perfusion pressure (CPP), ICP monitor duration, central venous pressure (CVP), pO2, blood lactate, and blood sodium. Initial, minimum, and maximum values of all pressures and laboratory parameters were recorded during hospital stay. Regression analysis was conducted using SPSS 21. RESULTS: There were 409 patients reviewed. Majority of patients were male (73%), average age was 46y (16-94), average GCS was 7, and 71% had severe TBI (GCS<9). Thirty percent of patients had poor outcome (GOS¼1-2) Regression analysis indicated age (OR¼0.947, p<0.001), GCS (OR¼1.161, p¼0.041), max sodium (OR¼0.847, p¼0.001), max ICP (OR¼0.967, p¼0.05), and LOS (OR¼1.193, p<0.001) as significant predictors of outcome. Hyponatremia (Na<135 mEq/L) and blood lactate levels were not significant predictors. CONCLUSIONS: Age, GCS, maximum ICP predicted outcome as hypothesized, but maximum blood sodium levels measured via venous sampling were significant as well. These results emphasize the need for attention to laboratory detail in the management of TBI patients.
ª 2015 by the American College of Surgeons Published by Elsevier Inc.
Oligodendroglioma prognosis varies significantly with age: a population based clinical outcomes study involving 4,601 patients from the Surveillance Epidemiology and End Results (SEER) database (1973e2010) Christine SM Lau, MD, Krishnaraj Mahendraraj, MD, Ronald S Chamberlain, MD, MPA, FACS St Barnabas Medical Center, Livingston, NJ INTRODUCTION: Oligodendrogliomas (OD)account for <20% of intracranial tumors and is rare amongst children and the elderly. This study examines a large cohort of OD patients to examine clinical factors associated with prognosis. METHODS: Data on 4,601 OD patients was abstracted from the SEER database (1973e2010). Pediatric patients were defined as 19 years old, adultsage 20-64, and elderly age65. Standard statistical methodology was used. RESULTS: Among 4,601 OD patients, 8.2% were pediatric, 81.9% adult and 9.9%elderly. ODs were more common amongst males; however, the elderly had almost equal gender distribution. ODs were more common amongst Caucasians (78.4%); however, OD in African Americans occurredmore oftenin children(10.6% vs 3.9% and 2.9%) and OD in Hispanics was more common among children and adults (11.7% and 11.5% vs 7.3%). The most common location was the temporal lobe in children, and frontal lobes in other groups. The most common treatment modality in children and adults wassurgerywhile combination surgery/radiation was more common in the elderly. Surgical resection resulted in improved survival in all patients. Overall and cancer specific mortality increased significantly with age, p<0.001. Multivariate analysis identified radiation therapy as independently associated with increased mortality, while female gender conferred survival advantage, p<0.01. CONCLUSIONS: ODs most often presents in adult Caucasian males in their fifth decade of life as moderately differentiated tumors >4cm. Surgical resection confers the greatest survival, especially in children. OD has worsening prognosis with increasing age, and older patients should be considered for clinical trial accrual to improve outcomes.
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http://dx.doi.org/10.1016/j.jamcollsurg.2015.08.191 ISSN 1072-7515/15
ª 2015 by the American College of Surgeons Published by Elsevier Inc.
Oligodendroglioma prognosis varies significantly with age: a population based clinical outcomes study involving 4,601 patients from the Surveillance Epidemiology and End Results (SEER) database (1973e2010) Christine SM Lau, MD, Krishnaraj Mahendraraj, MD, Ronald S Chamberlain, MD, MPA, FACS St Barnabas Medical Center, Livingston, NJ INTRODUCTION: Oligodendrogliomas (OD)account for <20% of intracranial tumors and is rare amongst children and the elderly. This study examines a large cohort of OD patients to examine clinical factors associated with prognosis. METHODS: Data on 4,601 OD patients was abstracted from the SEER database (1973e2010). Pediatric patients were defined as 19 years old, adultsage 20-64, and elderly age65. Standard statistical methodology was used. RESULTS: Among 4,601 OD patients, 8.2% were pediatric, 81.9% adult and 9.9%elderly. ODs were more common amongst males; however, the elderly had almost equal gender distribution. ODs were more common amongst Caucasians (78.4%); however, OD in African Americans occurredmore oftenin children(10.6% vs 3.9% and 2.9%) and OD in Hispanics was more common among children and adults (11.7% and 11.5% vs 7.3%). The most common location was the temporal lobe in children, and frontal lobes in other groups. The most common treatment modality in children and adults wassurgerywhile combination surgery/radiation was more common in the elderly. Surgical resection resulted in improved survival in all patients. Overall and cancer specific mortality increased significantly with age, p<0.001. Multivariate analysis identified radiation therapy as independently associated with increased mortality, while female gender conferred survival advantage, p<0.01. CONCLUSIONS: ODs most often presents in adult Caucasian males in their fifth decade of life as moderately differentiated tumors >4cm. Surgical resection confers the greatest survival, especially in children. OD has worsening prognosis with increasing age, and older patients should be considered for clinical trial accrual to improve outcomes.
e110
http://dx.doi.org/10.1016/j.jamcollsurg.2015.08.191 ISSN 1072-7515/15