Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury
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Published:2024-03-08
Issue:3
Volume:7
Page:e241556
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Zheng Jiang1, Ouyang Yufang1, Zhang Ke1, Wang Zhixing1, Younsi Alexander2, Alhalabi Obada2, Fu Hong1, , Rosand Jonathan3, Correia Marta3, Gagliardo Pablo3, Vespa Paul M.3, Stevens Robert3, Furmanov Alex3, Brazinova Alexandra3, Ghuysen Alexandre3, Lagares Alfonso3, Kowark Ana3, Castaño-León Ana M.3, Negru Ancuta3, Radoi Andreea3, Piippo-Karjalainen Anna3, Antoni Anna3, Belli Antonio3, Ragauskas Arminas3, Chieregato Arturo3, Lejeune Aurelie3, Depreitere Bart3, Bellander Bo-Michael3, Jacobs Bram3, Brorsson Camilla3, McMahon Catherine3, Rosenlund Christina3, Tolias Christos3, Dahyot‑Fizelier Claire3, Martino Costanza3, Tudora Cristina Maria3, Kondziella Daniel3, Đilvesi Đula3, Valeinis Egils3, Schwendenwein Elisabeth3, Vega Emmanuel3, Johnson Faye3, Grossi Francesca3, Della Corte Francesco3, Audibert Gérard3, Chevallard Giorgio3, Carbayo Lozano Guillermo3, Schoonman Guus3, Rosenthal Guy3, Dulière Guy_x001E_-Loup3, Clusmann Hans3, Ples Horia3, den Boogert Hugo3, Maréchal Hugues3, Haitsma Iain3, Golubovic Jagoš3, Payen Jean_x001E_-François3, Rhodes Jonathan3, van der Naalt Joukje3, Sahuquillo Juan3, Koskinen Lars_x001E_-Owe 3, Giga Lelde3, Levi Leon3, Beretta Luigi3, Rambadagalla Malinka3, Azzolini Maria Luisa3, Calvi Maria Rosa3, Coburn Mark Steven3, Thomas Matt3, Karan Mladen3, Sundström Nina3, Barzó Pál3, Persona Paolo3, Dark Paul3, Gomez Pedro A.3, Vulekovic Petar3, Vajkoczy Peter3, Raj Rahul3, Helbok Raimund3, Vilcinis Rimantas3, Lightfoot Roger3, Bartels Ronald3, Beer Ronny3, Rossi Sandra3, Rocka Saulius3, Frisvold Shirin3, Cavallo Simona3, Jankowski Stefan3, Tamosuitis Tomas3, Skandsen Toril3, Zelinkova Veronika3, Vámos Zoltán3, Theadom Alice3, Čović Amra3, Mikolic Ana3, Melegh Béla3, Glocker Ben3, Gravesteijn Benjamin3, Ao Braden Te3, van Heugten Caroline3, Sewalt Charlie3, Nieboer Daan3, Pisica Dana3, Rueckert Daniel3, Voormolen Daphne3, Tibboel Dick3, Donoghue Emma3, Stamatakis Emmanuel3, van Veen Ernest3, Kompanje Erwin3, Wiegers Eveline3, Zeiler Frederick A.3, Manley Geoffrey3, Van der Steen Gregory3, Gao Guoyi3, Williams Guy3, Dawes Helen3, Helmrich Isabel Retel3, Verheyden Jan3, Sandor Janos3, Rosenfeld Jeffrey V.3, Huijben Jilske3, Jiang Ji_x001E_-yao3, Brooker Joanne3, Gratz Johannes3, Haagsma Juanita A.3, Jones Kelly3, Wang Kevin K.W.3, Velt Kimberley3, Horton Lindsay3, Wilson Lindsay3, Maegele Marc3, Majdan Marek3, Timmers Marjolein3, Taylor Mark Steven3, Rusnák Martin3, Oresic Matej3, van der Jagt Mathieu3, Pirinen Matti3, Jarrett Mike3, Schäfer Nadine3, Perera Natascha3, Curry Nicola3, von Steinbüchel Nicole3, Esser Patrick3, Bragge Peter3, Cameron Peter3, Ylén Peter3, Azouvi Philippe3, George Pradeep3, Lefering Rolf3, Beauvais Romuald3, Ripatti Samuli3, Stanworth Simon3, Polinder Suzanne3, Richardson Sylvia3, Feigin Valery L.3, Rehorčíková Veronika3, Brinck Vibeke3, Stewart William3, Van Hecke Wim3, Yang Zhihui3, Sorinola Abayomi3, Dixit Abhishek3, Vargiolu Alessia3, Caccioppola Alessio3, Buki Andras3, Unterberg Andreas3, Kolias Angelos G.3, Ercole Ari3, Thibaut Aurore3, Misset Benoit3, Roe Cecilie3, Galanaud Damien3, Whitehouse Daniel3, Nelson David3, Ledoux Didier3, Van Praag Dominique3, Helseth Eirik3, Calappi Emiliana3, Czeiter Endre3, Ezer Erzsébet3, Kornaropoulos Evgenios3, Ortolano Fabrizio3, Benali Habib3, Adams Hadie3, van Erp Inge A.M.3, Cooper Jamie D.3, Dreier Jens3, van Dijck Jeroen T.J.M.3, Coles Jonathan3, Nyirádi József3, Posti Jussi P.3, Foks Kelly3, Lanyon Linda3, Puybasset Louis3, Carbonara Marco3, Czosnyka Marek3, Fabricius Martin3, Blaabjerg Morten3, Kovács Noémi3, Tenovuo Olli3, Olubukola Otesile3, Parizel Paul M.3, Smielewski Peter3, Hutchinson Peter J.3, Singh Ranjit D.3, Sanchez_x001E_-Porras Renan3, Schou Rico Frederik3, Takala Riikka3, van Wijk Roel P. J.3, Richter Sophie3, Wolf Stefan3, Laureys Steven3, Vande Vyvere Thijs3, van Essen Thomas A.3, Menovsky Tomas3, Zoerle Tommaso3, De Keyser Véronique3, Volovici Victor3, Tamás Viktória3, Degos Vincent3, Perlbarg Vincent3, Newcombe Virginia3, Sakowitz Oliver3, Palotie Aarno3, Roise Olav3, Maas Andrew I.R.3, Schoechl Herbert3, Cabeleira Manuel3, Bullinger Monika3, Gruen Russell L.3, Gupta Deepak3, Rossaint Rolf3, Ziverte Agate3, Manara Alex3, Pomposo Inigo3, Berardino Maurizio3, Mattern Julia3, Schmidt Silke3, Legrand Valerie3, Muraleedharan Visakh3, Anke Audny3, Åkerlund Cecilia3, Amrein Krisztina3, Andreassen Lasse3, Andelic Nada3, Menon David3, Stocchetti Nino3, Peul Wilco3, Lecky Fiona3, Citerio Giuseppe3, Steyerberg Ewout W.3, Lingsma Hester3, Gantner Dashiell3, Murray Lynnette3, Vallance Shirley3, Trapani Tony3, Vik Anne3, Winzeck Stefan3
Affiliation:
1. Department of Anesthesiology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China 2. Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany 3. for the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants
Abstract
ImportanceThe optimal timing for fixation of extremity fractures after traumatic brain injury (TBI) remains controversial.ObjectiveTo investigate whether patients who underwent extremity fixation within 24 hours of TBI experienced worse outcomes than those who had the procedure 24 hours or more after TBI.Design, Setting, and ParticipantsThis cohort study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients 16 years or older with TBI who underwent internal extremity fixation met inclusion criteria. To compare outcomes, patients who underwent the procedure within 24 hours were propensity score matched with those who underwent it 24 hours or later. Patients were treated from December 9, 2014, to December 17, 2017. Data analysis was conducted between August 1, 2022, and December 25, 2023.Main Outcomes and MeasuresThe primary outcome was an unfavorable functional status at 6 months (Glasgow Outcome Scale–Extended [GOSE] score ≤4).ResultsA total of 253 patients were included in this study. The median age was 41 (IQR, 27-57) years, and 184 patients (72.7%) were male. The median Injury Severity Score (ISS) was 41 (IQR, 27-49). Approximately half of the patients (122 [48.2%]) had a mild TBI while 120 (47.4%) had moderate to severe TBI. Seventy-four patients (29.2%) underwent an internal extremity fixation within 24 hours, while 179 (70.8%) had the procedure 24 hours or later. At 6 months, 86 patients (34.0%) had an unfavorable functional outcome. After propensity score matching, there were no statistically significant differences in unfavorable functional outcomes at 6 months (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77) in patients with TBI of any severity. Similar results were observed in patients with mild TBI (OR, 0.71 [95% CI, 0.22-2.29]; P = .56) and moderate to severe TBI (OR, 1.08 [95% CI, 0.32-3.70]; P = .90).Conclusions and RelevanceThe outcomes of extremity fracture fixation performed within 24 hours after TBI appear not to be worse than those of procedures performed 24 hours or later. This finding suggests that early fixation after TBI could be considered in patients with mild head injuries.
Publisher
American Medical Association (AMA)
Cited by
1 articles.
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