OTA 2006 Posters

Scientific Poster #4 Polytrauma

Cognitive Effects in Multiple Trauma Patients
William T. Obremskey, MD, MPH (a-Synthes, EBI); Rebecca Bauer, MD (*); James Jackson, PhD (n); Bryan A Cotton, MD (n); Wes Ely, MD (n);
Vanderbilt University Medical Center, Nashville, Tennessee, USA

Purpose: The purpose of this study was to assess the incidence of long-term cognitive deficits in severely injured multiple trauma patients. In addition, we hoped to identify potential predictors of long-term cognitive deficits in terms of patient demographics, injury, and treatment with careful attention to the effect of intramedullary nailing of femur fractures. A reamed intramedullary nail has been associated with increasing inflammatory mediators, cerebral emboli, and cerebral fat embolism syndrome.

Methods: Following IRB approval, a query of the American College of Surgeons trauma registry identified 100 adult patients with ISS >25 and no closed head injury as determined by negative CT scan at the time of admission. 58 patients were able to be contacted, gave informed consent, and underwent chart review of demographics, injury, and treatment. The patients were also given an extensive battery of neuropsychological testing to assess for long-term cognitive deficits, posttraumatic stress disorder (PTSD), and depression. The patient's mean age was 45 ± 14 years (range, 20-72). Education level was a mean of 12.7 years ± 2.3 (range, 6-18). 39 of the patients were male and 19 patients were female; 51 patients were white, 5 black, and 1 Hispanic. ISS mean was 33 ± 6.8 (range, 26-51).

Results: The patients had no significant incidence of pre-existing dementia. SF-36 scores were significantly decreased in all domains except social function compared to general population norms. 57% of the patients were noted to have significant cognitive impairment compared to general population norms; 28% had moderate to severe depression scores and 38% tested positive for PTSD. Long-term cognitive impairment and posttraumatic stress disorder was not predicted by age, sex, race, ISS, blood loss, ventilatory days, or intramedullary nailing of long-bone fracture. 81% of the patients with skull fracture or concussion had long-term cognitive impairment. A skull fracture or concussion was significantly correlated (P = 0.0064) (Fisher's exact test) with long-term cognitive impairment.

Conclusion: This cohort of patients had no evidence of closed head injury at the time of admission, but had a high incidence of long-term cognitive impairment, posttraumatic stress disorder, and depression.

Significance: 70% of severely injured patients have long-term follow-up with orthopaedic surgeons due to their musculoskeletal injuries. Orthopaedic surgeons need to be aware of the high incidence of cognitive problems, especially in patients who may have had loss of consciousness or skull fractures. Because these patients routinely follow-up with orthopaedic surgeons for a long period of time, surgeons can steer patients toward appropriate rehabilitative services.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.