343 A New Computed Tomography-based Frontal Contusion Score for Patients with Traumatic Brain Injury

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 277-277
Author(s):  
Qiang Yuan
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Area Under The Curve ◽  
Neurological Deterioration ◽  
Stepwise Logistic Regression ◽  
Basal Cistern ◽  
Unit Increase ◽  
Acute Neurological Deterioration

Abstract INTRODUCTION Frontal contusions are characterized by gradually progressing hematoma/edema and rapid deterioration owing to central herniation, even if the patient is conscious at the time of admission. This study 1) examined how to better characterize frontal contusion in a series of traumatic brain injury (TBI) patients, and 2) developed and validated a new frontal contusion score (FCS) based on the shape of the frontal contusion to facilitate rapid, accurate assessment of the computed tomography (CT) findings of frontal contusion. METHODS This study retrospectively analyzed data from 206 consecutive patients with isolated frontal contusions. The new score is based mainly on the shape of the frontal brain contusion. Forward stepwise logistic regression was used to identify independent predictors of acute neurological deterioration and refractory intracranial hypertension. A receiver-operating characteristic (ROC) curve was then drawn based on the FCS. RESULTS >The incidence of acute neurological deterioration increased significantly as the FCS increased. FCS, obliteration of the basal cistern, and a serum sodium decrease of more than 10 mm ol/L within 24 hours were independent predictors of acute neurological deterioration. Each one-unit increase in FCS led to a 57% increase in the odds of acute neurological deterioration [odds ratio (OR), 1.57; 95% confidence interval (CI), 1.25 1.95]. The area under the curve (AUC) of the FCS that predicted acute neurological deterioration was 0.727 (95% CI 0.656 0.797). The incidence of refractory intracranial hypertension increased significantly with an increase in the FCS. Only FCS and obliteration of the basal cistern remained predictors of refractory intracranial hypertension. Each one-unit increase in FCS led to a 49% increase in the odds of refractory intracranial hypertension (OR, 1.49; 95% CI, 1.06 2.10). The area under the curve (AUC) of the FCS for predicting refractory intracranial hypertension was 0.647 (95% CI 0.532 0.763). The FCS was not an independent predictor of the 6-month mortality (OR, 0.87; 95% CI, 0.59 1.28) or 6-month unfavorable outcome (OR, 1.32; 95% CI, 0.93 1.87). CONCLUSION Therefore, the FCS is a valid evaluator of the character of frontal contusion. The clinical utility and generalizability of this score need to be validated in a large sample.

Relationship of “dose” of intracranial hypertension to outcome in severe traumatic brain injury

2008 ◽  
Vol 109 (4) ◽  
pp. 678-684 ◽  
Author(s):  
Anne Vik ◽  
Torbjørn Nag ◽  
Oddrun Anita Fredriksli ◽  
Toril Skandsen ◽  
Kent Gøran Moen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Scale Score ◽  
Severe Traumatic Brain Injury ◽  
Injury Severity ◽  
Area Under The Curve ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Scale Scores

Object It has recently been suggested that the degree of intracranial pressure (ICP) above the treatment goal can be estimated by the area under the curve (AUC) of ICP versus time in patients with severe traumatic brain injury (TBI). The objective of this study was to determine whether the calculated “ICP dose”—the ICP AUC—is related to mortality rate, outcome, and Marshall CT classification. Methods Of 135 patients (age range 1–82 years) with severe TBI treated during a 5-year period at the authors' institution, 113 patients underwent ICP monitoring (84%). Ninety-three patients with a monitoring time > 24 hours were included for analysis of ICP AUC calculated using the trapezoidal method. Computed tomography scans were assessed according to the Marshall TBI classification. Patients with Glasgow Outcome Scale scores at 6 months and > 3 years were separated into 2 groups based on outcome. Results Sixty patients (65%) had ICP values > 20 mm Hg, and 12 (13%) developed severe intracranial hypertension and died secondary to herniation. A multiple regression analysis adjusting for Glasgow Coma Scale score, age, pupillary abnormalities and Injury Severity Scale score demonstrated that the ICP AUC was a significant predictor of poor outcome at 6 months (p = 0.034) and of death (p = 0.035). However, it did not predict long-term outcome (p = 0.157). The ICP AUC was significantly higher in patients with Marshall head injury Categories 3 and 4 (24 patients) than in those with Category 2 (23 patients, p = 0.025) and Category 5 (46 patients, p = 0.021) TBIs using the worst CT scan obtained. Conclusions The authors found a significant relationship between the dose of ICP, the worst Marshall CT score, and patient outcome, suggesting that the AUC method may be useful in refining and improving the treatment of ICP in patients with TBI.

scholarly journals Evaluation of Intracranial Hypertension in Traumatic Brain Injury Patient: A Noninvasive Approach Based on Cranial Computed Tomography Features

2021 ◽  
Vol 10 (11) ◽  
pp. 2524
Author(s):  
Yingchi Shan ◽  
Yihua Li ◽  
Xuxu Xu ◽  
Junfeng Feng ◽  
Xiang Wu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Hounsfield Unit ◽  
Radiological Feature ◽  
Cranial Computed Tomography ◽  
Clinical Expertise ◽  
Midline Shift ◽  
Model Features

Background: Our purpose was to establish a noninvasive quantitative method for assessing intracranial pressure (ICP) levels in patients with traumatic brain injury (TBI) through investigating the Hounsfield unit (HU) features of computed tomography (CT) images. Methods: In this retrospective study, 47 patients with a closed TBI were recruited. Hounsfield unit features from the last cranial CT and the initial ICP value were collected. Three models were established to predict intracranial hypertension with Hounsfield unit (HU model), midline shift (MLS model), and clinical expertise (CE model) features. Results: The HU model had the highest ability to predict intracranial hypertension. In 34 patients with unilateral injury, the HU model displayed the highest performance. In three classifications of intracranial hypertension (ICP ≤ 22, 23–29, and ≥30 mmHg), the HU model achieved the highest F1 score. Conclusions: This radiological feature-based noninvasive quantitative approach showed better performance compared with conventional methods, such as the degree of midline shift and clinical expertise. The results show its potential in clinical practice and further research.

A review of external lumbar drainage for the management of intracranial hypertension in traumatic brain injury

2021 ◽  
Author(s):  
Elizabeth E Ginalis ◽  
Laura L Fernández ◽  
Juan P Ávila ◽  
Sarita Aristizabal ◽  
Andres M Rubiano
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Lumbar Drainage ◽  
External Lumbar Drainage

Flushing in relation to a possible rise in intracranial pressure: documentation of an unusual clinical sign

2000 ◽  
Vol 92 (6) ◽  
pp. 1040-1044 ◽  
Author(s):  
Gregory W. Hornig
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intraventricular Hemorrhage ◽  
Pneumococcal Meningitis ◽  
Clinical Importance ◽  
Neurological Deterioration ◽  
Content Type ◽  
Transient Nature ◽  
Fine Print

✓ This report documents clinical features in five children who developed transient reddening of the skin (epidermal flushing) in association with acute elevations in intracranial pressure (ICP). Four boys and one girl (ages 9–15 years) deteriorated acutely secondary to intracranial hypertension ranging from 30 to 80 mm Hg in the four documented cases. Two patients suffered from ventriculoperitoneal shunt malfunctions, one had diffuse cerebral edema secondary to traumatic brain injury, one was found to have pneumococcal meningitis and hydrocephalus, and one suffered an intraventricular hemorrhage and hydrocephalus intraoperatively. All patients were noted to have developed epidermal flushing involving either the upper chest, face, or arms during their period of neurological deterioration. The response was transient, typically lasting 5 to 15 minutes, and dissipated quickly. The flushing reaction is postulated to be a centrally mediated response to sudden elevations in ICP. Several potential mechanisms are discussed. Flushing has clinical importance because it may indicate significant elevations in ICP when it is associated with neurological deterioration. Because of its transient nature, the importance of epidermal flushing is often unrecognized; its presence confirms the need for urgent treatment.

scholarly journals Experimental model of intracranial hypertension with continuous multiparametric monitoring in swine

2013 ◽  
Vol 71 (10) ◽  
pp. 802-806 ◽  
Author(s):  
Almir Ferreira de Andrade ◽  
Matheus Schmidt Soares ◽  
Gustavo Cartaxo Patriota ◽  
Alessandro Rodrigo Belon ◽  
Wellingson Silva Paiva ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Animal Model ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Severe Traumatic Brain Injury ◽  
Transcranial Doppler ◽  
Porcine Model ◽  
Cerebral Oximetry ◽  
Suitable Animal Model

Objective Intracranial hypertension (IH) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, IH was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). Results None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.

Sign in / Sign up

Export Citation Format

Share Document