Prognostic significance of prolonged corrected QT interval in cerebral contusion

Abstract

Background & objectives: Cerebral contusion (CC) results in a release of catecholamines, autonomic dysfunction and neural stimulation that can lead to a number of cardiac adverse events, so it is critical to determine these. So the objective of this study was to investigate the prognostic significance of electrocardiographic changes, particularly the effects of a prolonged corrected QT (QTc) interval in CC. Methods: In this retrospective cohort study, 110 patients with CC were evaluated. Age, sex, concomitant diseases, Glasgow Coma Scale on admission, radiological assessment of the contusion (location, size, course and presence of cerebral oedema), need for surgical intervention, length of hospital stay and the extended Glasgow Outcome Scale (GOS-E) were statistically analysed within the QTc interval by routine electrocardiography (ECG) on admission. Results: The prolonged QTc interval was found to be associated with a higher incidence of cerebral oedema and a significantly higher risk of needing surgery. Patients with a prolonged QTc interval had a significantly larger contusion volume, greater midline shift and longer hospital stay, so their GOS-E score was significantly lower. A prolonged QTc interval on admission resulted in a hospital stay of more than eight days (sensitivity: 0.97 and specificity: 0.86), a higher risk of midline shift of more than 0.45 cm (P=0.006, sensitivity: 0.80 and specificity: 0.99) and a GOS-E score of <7 (sensitivity: 0.97 and specificity: 0.85). Interpretation & conclusions: ECG changes on admission showing a prolonged QTc interval have prognostic significance in CC. This simple and easily applicable information should be taken into consideration at the time of clinical decision making which may prevent an adverse events survivor.