Functional status and quality of life in patients suffering severe cranioencephalic trauma at the time of discharge from the intensive care unit and 1 year after

Introduction

Results obtained after management of cranioencephalic trauma (CET) are referred only in terms of morbimortality. Our objective is to analyze physical and functional status after being discharged from the ICU, and the quality of life 1 year later.

Methods

Cohort study with adult patients admitted to the ICU from 2004 to 2008 with severe CET. Demographic, epidemiologic and clinical data were recorded. Validated measure scales used were GCS, GOS, ISS and the quality-of-life questionnaire PAEEC (Project for the Epidemiological Analysis of Critical Patients). Multivariate analysis identified predictor factors of mortality.

Results

We included 323 patients with a median age of 32 years old, 79.6% males, who suffered severe CET secondary to traffic (57.6%) or falling (29.8%) accidents. Cranial computed tomography (CT) scan most frequent findings were diffuse injury III (30%) in Marshall classification; ISS first median was 33; APACHE II, 19; length of stay, 6 days (10 days if we take away those who died very soon); days on mechanical ventilator, 8. Total GCS at admission/discharge was 5/10 (P = 0.001). GOS 4 to 5 at discharge from the ICU was 14.4% and 1 year later was 54.1% (P = 0.001). Mortality in the ICU was 33.1%. Predictors of mortality were the length of stay (P = 0.0001), GCS at admission (P = 0.05), CT findings type III, IV and V (P = 0.014, 0.001 and 0.028, respectively), complications (P = 0.0001), tracheotomy (P = 0.028), days on ventilator (P = 0.0001) and APACHE II (P = 0.025). One year after discharge, 159 from 216 patients answered the questionnaire (73.6%): severe physiologic dysfunction, great dependence in activities of daily living and emotional disturbances were detected when leaving the ICU and marked as 59.3%, 88.6% and 70.1%, while 1 year after they were 18.9%, 32.1% and 35.8%, respectively (P = 0.0001).

Conclusions

Severe CET was usually caused by traffic accidents, affected young adults and the mortality was over 33% in the ICU. Factors independently associated with increased mortality were coma level, type of findings in CT, complications, prolonged mechanical ventilation, length of stay, APACHE II, and the need for a tracheotomy. One year later, survivors showed a better GOS and physiologic capacity.