Neurointensive care of traumatic brain injury in the elderly—age-specific secondary insult levels and optimal physiological levels to target need to be defined

Abstract Background Elderly patients with traumatic brain injury increase. Current targets and secondary insult definitions during neurointensive care (NIC) are mostly based on younger patients. The aim was therefore to study the occurrence of predefined secondary insults and the impact on outcome in different ages with particular focus on elderly. Methods Patients admitted to Uppsala 2008–2014 were included. Patient characteristics, NIC management, monitoring data, and outcome were analyzed. The percentage of monitoring time for ICP, CPP, MAP, and SBP above-/below-predefined thresholds was calculated. Results Five hundred seventy patients were included, 151 elderly ≥ 65 years and 419 younger 16–64 years. Age ≥ 65 had significantly higher percentage of CPP > 100, MAP > 120, and SBP > 180 and age 16–64 had higher percentage of ICP ≥ 20, CPP ≤ 60, and MAP ≤ 80. Age ≥ 65 contributed independently to the different secondary insult patterens. When patients in all ages were analyzed, low percentage of CPP > 100 and SBP > 180, respectively, was significant predictors of favorable outcome and high percentage of ICP ≥ 20, CPP > 100, SBP ≤ 100, and SBP > 180, respectively, was predictors of death. Analysis of age interaction showed that patients ≥ 65 differed and had a higher odds for favorable outcome with large proportion of good monitoring time with SBP > 180. Conclusions Elderly ≥ 65 have different patterns of secondary insults/physiological variables, which is independently associated to age. The finding that SBP > 180 increased the odds of favorable outcome in the elderly but decreased the odds in younger patients may indicate that blood pressure should be treated differently depending on age.

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The Use of Nurse Checklists in a Bedside Computer-Based Information System to Focus on Avoiding Secondary Insults in Neurointensive Care

ISRN Neurology ◽

10.5402/2012/903954 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Lena Nyholm ◽

Anders Lewén ◽

Camilla Fröjd ◽

Tim Howells ◽

Pelle Nilsson ◽

...

Keyword(s):

Information System ◽

Perfusion Pressure ◽

Neurointensive Care ◽

Neurointensive Care Unit ◽

Secondary Insults ◽

Secondary Insult ◽

Monitoring Time ◽

Working Shift ◽

Computer Based ◽

Sensitivity Specificity

The feasibility and accuracy of using checklists after every working shift in a bedside computer-based information system for documentation of secondary insults in the neurointensive care unit were evaluated. The ultimate goal was to get maximal attention to avoid secondary insults. Feasibility was investigated by assessing if the checklists were filled in as prescribed. Accuracy was evaluated by comparing the checklists with recorded minute-by-minute monitoring data for intracranial pressure-ICP, cerebral perfusion pressure CPP, systolic blood pressure SBP, and temperature. The total number of checklist assessments was 2,184. In 85% of the shifts, the checklists were filled in. There was significantly longer duration of monitoring time at insult level when Yes was filled in regarding ICP (mean 134 versus 30 min), CPP (mean 125 versus 26 min) and temperature (mean 315 versus 120 min). When a secondary insult was defined as >5% of monitoring time spent at insult level, the sensitivity/specificity for the checklist assessments was 31%/100% for ICP, 38%/99% for CPP, and 66%/88% for temperature. Checklists were feasible and appeared relatively accurate. Checklists may elevate the alertness for avoiding secondary insults and help in the evaluation of the patients. This concept may be the next step towards tomorrow critical care.

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Anemia and Blood Transfusion in Patients with Isolated Traumatic Brain Injury

Critical Care Research and Practice ◽

10.1155/2015/672639 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Hasan M. Al-Dorzi ◽

Waleed Al-Humaid ◽

Hani M. Tamim ◽

Samir Haddad ◽

Ahmad Aljabbary ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Blood Transfusion ◽

Hospital Mortality ◽

Injury Severity ◽

Tertiary Care ◽

Hemoglobin Level ◽

Secondary Insult ◽

The Impact ◽

Present On Admission

Rationale. By reducing cerebral oxygen delivery, anemia may aggravate traumatic brain injury (TBI) secondary insult. This study evaluated the impact of anemia and blood transfusion on TBI outcomes.Methods. This was a retrospective cohort study of adult patients with isolated TBI at a tertiary-care intensive care unit from 1/1/2000 to 31/12/2011. Daily hemoglobin level and packed red blood cell (PRBC) transfusion were recorded. Patients with hemoglobin < 10 g/dL during ICU stay (anemic group) were compared with other patients.Results. Anemia was present on admission in two (2%) patients and developed in 48% during the first week with hemoglobin < 7 g/dL occurring in 3.0%. Anemic patients had higher admission Injury Severity Score and underwent more craniotomy (50% versus 13%,p<0.001). Forty percent of them received PRBC transfusion (2.8 ± 1.5 units per patient, median pretransfusion hemoglobin = 8.8 g/dL). Higher hospital mortality was associated with anemia (25% versus 6% for nonanemic patients,p=0.01) and PRBC transfusion (38% versus 9% for nontransfused patients,p=0.003). On multivariate analysis, only PRBC transfusion independently predicted hospital mortality (odds ratio: 6.8; 95% confidence interval: 1.1–42.3).Conclusions. Anemia occurred frequently after isolated TBI, but only PRBC transfusion independently predicted mortality.

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Prevention of Secondary Insults in Neurointensive Care of Traumatic Brain Injury

European Journal of Trauma ◽

10.1007/s00068-003-1273-9 ◽

2003 ◽

Vol 29 (2) ◽

pp. 74-80 ◽

Cited By ~ 15

Author(s):

Per Enblad ◽

Kristin Elf ◽

Pelle Nilsson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Neurointensive Care ◽

Secondary Insults

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Introduction of the Uppsala Traumatic Brain Injury register for regular surveillance of patient characteristics and neurointensive care management including secondary insult quantification and clinical outcome

Upsala Journal of Medical Sciences ◽

10.3109/03009734.2013.806616 ◽

2013 ◽

Vol 118 (3) ◽

pp. 169-180 ◽

Cited By ~ 15

Author(s):

Lena Nyholm ◽

Tim Howells ◽

Per Enblad ◽

Anders Lewén

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Clinical Outcome ◽

Care Management ◽

Patient Characteristics ◽

Neurointensive Care ◽

Secondary Insult

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Age-related differences in the impact of coagulopathy in patients with isolated traumatic brain injury: an observational cohort study

10.21203/rs.2.19876/v1 ◽

2020 ◽

Author(s):

Wataru Takayama ◽

Akira Endo ◽

Hazuki Koguchi ◽

Kiyoshi Murata ◽

Yasuhiro Otomo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

The Elderly ◽

International Normalized Ratio ◽

Elderly Group ◽

Age Related ◽

Correlation Degree ◽

Observational Cohort ◽

The Impact

Abstract Background Although age and trauma-induced coagulopathy (TIC) are well-known predictors of poor outcome after traumatic brain injury (TBI), the interaction effect of these two predictors remains unclear.Objectives We assessed age-related differences in the impact of TIC on the outcome following isolated TBI.Methods We conducted a retrospective observational study in two tertiary emergency critical care medical centers in Japan from 2013 to 2018. A total of 1036 patients with isolated TBI [head abbreviated injury scale (AIS) ≥3, and other AIS <3] were selected, and divided into the non-elderly (n = 501, 16-64 years) and elderly group (n = 535, age ≥65 years). We further evaluated the impact of coagulopathy (international normalized ratio ≥1.2, and/or platelet count <120 × 10 9 /L, and/or fibrinogen ≤150 mg/dL) on TBI outcomes [Glasgow Outcome Scale-Extended (GOS-E) scores, in-hospital mortality, and ventilation-free days (VFD)] in both groups using univariate and multivariate models. Further, we conducted an age-based assessment of the impact of coagulopathy on GOS-E using a generalized additive model.Results The multivariate model showed a significant association of age and coagulopathy with lower GOS-E scores, in-hospital mortality, and shorter VFD in the non-elderly group; however, significant impact of coagulopathy was not observed for all the outcomes in the elderly group. There was a decrease in the correlation degree between coagulopathy and GOS-E scores decreased with age over 65 years old.Conclusions There was a low impact of coagulopathy on functional and survival outcomes in geriatric patients with isolated TBI.

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Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care*

Critical Care Medicine ◽

10.1097/00003246-200209000-00029 ◽

2002 ◽

Vol 30 (9) ◽

pp. 2129-2134 ◽

Cited By ~ 182

Author(s):

Kristin Elf ◽

Pelle Nilsson ◽

Per Enblad

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Neurointensive Care ◽

Secondary Insult

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Traumatic brain injury in the presence of Aβ pathology affects neuronal survival, glial activation and autophagy

Scientific Reports ◽

10.1038/s41598-021-02371-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Linn Streubel-Gallasch ◽

Marlena Zyśk ◽

Chiara Beretta ◽

Anna Erlandsson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Calcium Binding ◽

Amyloid Β ◽

The Elderly ◽

Epidemiological Studies ◽

Cellular Level ◽

Glial Activation ◽

Acute Injury ◽

The Impact

AbstractTraumatic brain injury (TBI) presents a widespread health problem in the elderly population. In addition to the acute injury, epidemiological studies have observed an increased probability and earlier onset of dementias in the elderly following TBI. However, the underlying mechanisms of the connection between TBI and Alzheimer’s disease in the aged brain and potential exacerbating factors is still evolving. The aim of this study was to investigate cellular injury-induced processes in the presence of amyloid β (Aβ) pathology. For this purpose, a co-culture system of cortical stem-cell derived astrocytes, neurons and oligodendrocytes were exposed to Aβ42 protofibrils prior to a mechanically induced scratch injury. Cellular responses, including neurodegeneration, glial activation and autophagy was assessed by immunoblotting, immunocytochemistry, ELISA and transmission electron microscopy. Our results demonstrate that the combined burden of Aβ exposure and experimental TBI causes a decline in the number of neurons, the differential expression of the key astrocytic markers glial fibrillary acidic protein and S100 calcium-binding protein beta, mitochondrial alterations and prevents the upregulation of autophagy. Our study provides valuable information about the impact of TBI sustained in the presence of Aβ deposits and helps to advance the understanding of geriatric TBI on the cellular level.

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