|
Abstract
|
OBJECT: Induced hypernatremia is frequently used to reduce intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI). This technique is controversial, and some studies have independently associated hypernatremia with worse outcomes following TBI. We sought to investigate this potential association in a large health care database.
METHODS: The Nationwide Inpatient Sample (NIS) was used to obtain data on all adults who were discharged between 2002 and 2011 with a primary diagnosis of TBI who required mechanical ventilation, ICP monitoring, or craniotomy/craniectomy. Patients with diabetes insipidus were excluded. Patients with hypernatremia were assigned to the hypernatremia group, and the rest were assigned to the control group. The primary outcome was in-hospital mortality, and secondary outcomes included length of stay (LOS), non-routine hospital discharge, total hospital charges, tracheostomy, and gastrostomy placement.
RESULTS: A total of 85,579 patients without a diagnosis of hypernatremia (control group) and 4,542 patients with a diagnosis of hypernatremia (hypernatremia group) were identified. When controlling for age, comorbidities, gender, and cerebral edema, hypernatremia was associated with an increased rate of in-hospital mortality (OR 1.51; 95% CI 1.39 - 1.65), longer mean LOS (23.65 vs. 12.12 days, p < 0.001), increased rate of non-routine hospital discharge (OR 2.58; 95% CI 2.28 - 2.92), and greater mean total hospital cost ($227,112 vs. $112,507, p < 0.001). Hypernatremic patients also had higher rates of tracheostomy and gastrostomy placement.
CONCLUSION: Hypernatremia was associated with poorer outcomes in patients with severe TBI. This warrants further investigation in a prospective, randomized study.
Copyright © 2018 Elsevier Inc. All rights reserved.
Language: en |