Encarnacion Manuel*, Peralta Ismael, Paulino Jeffrey, Renat Nurmukhametov, Rossi Evelyn Barrientos
Introduction: This is the first prospective study that evaluates the functional outcome after a surgical procedure secondary to a traumatic brain injury, in a single centre, in the Dominican Republic.
Objective: To determine the functional status of surgically treated patients 6 months after trauma and to establish the association of functional status with the predictive variables of the International Mission for Prognosis and Analysis of Critical Trials in TBI (IMPACT), determining the relative risk of worse prognosis according to those variables.
Material and method: A prospective, longitudinal study was conducted in a cohort of 22 patients who were surgically treated for a traumatic intracranial injury at Dr Ney Arias Lora Hospital in the Dominican Republic. We applied the IMPACT calculator, (pupillary response, Hg, hypoxia, age, motor response, CT lesion, hypotension, etc.) previous to surgery and the Extended Glasgow Outcome Scale (GOS-E) 6 months after surgery to determine the functional outcome. Our team modified the IMPACT form by adding The Glasgow level, pre-surgical time and rehabilitation therapy. The SPSS database (15.0 version, Chicago Il.) was used. Central tendency measures and Fisher's test were applied. A p ≤ 0.05 with a 95% confidence interval was considered statistically significant. Results: The only predictive variable associated with a poor prognosis was the motor response (p=0.01), hypoxia and hypotension (p=0.05). Patients who had any alterations in Motor response had a worse prognosis and higher mortality in this subgroup (RR: 10, 95% CI: 3-22). Normal flexion was found in all patients with good high recovery (p= 0.04).
Conclusion: 67% of patients had a favourable outcome (moderate disability and good recovery). Mortality was 23%. Motor response and Hypoxia, previous to surgery, were powerful outcome prognostic factors.