Influencing factor screening for poor prognosis in patients with ultra ⁃ severe traumatic brain injury

Objective To screen the influencing factors for the poor prognosis in patients with ultra⁃ severe traumatic brain injury (TBI). Methods Total 133 patients with ultra⁃severe TBI [Glasgow Coma Scale (GCS) score 3-5] which admitted to the 909th Hospital of Joint Logistic Support Force; Dongnan Hospital of Xiamen University from January 2012 to June 2017 were included. All cases underwent hematoma removal with either standard craniotomy decompression or oversized craniotomy decompression, even combined with internal decompression. Glasgow Outcome Scale (GOS) was used to evaluate prognosis 6 months after surgery. Univariate and multivariate Logistic regression analyses were adopted to screen the influencing factors for poor prognosis in patients with ultra⁃severe TBI. Results Total 133 patients were divided into favourable prognosis group (GOS score ≥ 4, n = 12) and poor prognosis group (GOS score < 4, n = 121). Logistic regression analysis showed bilateral pupils dilated (OR = 1.779, 95%CI: 1.698-4.531; P = 0.004), postoperative high intracranial pressure (ICP; OR = 12.629, 95%CI: 2.313-68.949, P = 0.007) and volume of secondly cerebral infarction > 75 ml (OR = 2.147, 95%CI: 1.894-5.156; P = 0.009) were the risk factors for poor prognosis, while injury subtyping of isolated epidural hematoma was the protective factor for favourable prognosis (OR = 0.172, 95%CI: 0.032-0.915; P = 0.002). Conclusions GCS score is not reliable in solely predicting the prognosis of patients with ultra ⁃severe TBI. Preoperative bilateral pupil dilation, postoperative high ICP and volume of secondly cerebral infarction > 75 ml were risk factors for poor prognosis of patients with ultra⁃severe TBI, while injury subtyping of isolated epidural hematoma was the protective factor for favourable prognosis.