Objective: To explore the factors determining the prognosis of acute traumatic brain injury (TBI) by retrospectively analysing the clinical data.
Methods: During the last 5 years, 2500 acute TBI cases were admitted into our department. We analysed the survival and mortality rates to evaluate the therapeutic outcome, the effect of emergency operation and the effect of intracranial pressure monitoring (ICPM) on the mortality of severe TBI.
Results: The mortalities of TBI in the severe (GCS<or=8), moderate (GCS=9-12) and slight (GCS=13-15) groups were 39, 12 and 0%, respectively. The clinical course could be classified into three different phases: the acute phase (<1 week), the subacute phase or transition period (1-3 weeks) and the chronic phase (>3 weeks). Of all the patients who became deceased in this study, approximately 80% was due to intractable intracranial hypertension during the acute phase, nearly 20% was due to multiple organ failure (including the lungs, kidneys, and heart), and <2% was due to chronic body consumption. A different therapeutic focus must be emphasized in each of the three phases. Emergency operation and ICPM could decrease the mortality to 32 and 36%, respectively.
Conclusion: Recognition of clinical features during different phases is the key for the neurosurgeon to establish an early and appropriate treatment (including emergency operation and ICPM) to reduce the mortality.