To study the effect of therapeutic hypothermia (TH) on outcomes after severe traumatic brain Injury (TBI) in real practice using the Nationwide Inpatient Sample (NIS) database in United States.

Therapeutic hypothermia has been reported beneficial in traumatic brain injuries. But it is poorly understood especially in the real practice.

The NIS database was used to obtain data on all adults who had been discharged from 2012 to 2014 with a diagnosis of TBI who required mechanical ventilation, intracranial pressure monitoring or craniotomy/craniectomy using the ICD diagnosis and procedure codes. The patients with TH were assigned to the TH group and the rest were assigned to the control group. The primary outcome was in-hospital mortality and the secondary outcomes included mean length of stay, non-routine hospital discharge and mean hospital charges. The outcomes “in-hospital mortality” and “non-routine discharge” were adjusted in multi-variable analysis using logistic regression.

A total of 7,79,735 with severe TBI patients did not undergo TH (control group) and 500 (0.06%) patients underwent TH. TH group was younger (49.2 versus 59.4 years, p <.0001), lower proportion of females (25.2% versus 39.3%, p= 0.003) and higher rate of in-hospital complications (myocardial infarction, pneumonia and DVT). After adjusting for age, gender, comorbidities, in-hospital complications, hospital characteristics and All Patients Refined Diagnosis Related Groups (APR DRG) disease severity, TH was associated with an increased rate of in-hospital mortality (odds ratio: 2.97; 95% confidence interval: 2.04-4.32), a longer mean length of stay (13.8 vs. 6.44 days; p<0.001) and a greater mean total hospital cost ($243784 vs. $79674.5; p<0.001).  There was no difference between the two groups in terms of non-routine discharge (odds ratio: 1.23; 95% confidence interval: 0.68-2.22).

Therapeutic hypothermia was associated with poorer outcomes in patients with severe TBI. This finding warrants further investigation through a prospective, randomized controlled study.