Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge

2016 ◽  
Vol 17 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Thomas M. O’Lynnger ◽  
Chevis N. Shannon ◽  
Truc M. Le ◽  
Amber Greeno ◽  
Dai Chung ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Critical Care ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Protocol Implementation ◽  
Discharge Disposition ◽  
Ordered Logistic Regression ◽  
Before And After ◽  
Severe Tbi

OBJECT The goal of critical care in treating traumatic brain injury (TBI) is to reduce secondary brain injury by limiting cerebral ischemia and optimizing cerebral blood flow. The authors compared short-term outcomes as defined by discharge disposition and Glasgow Outcome Scale scores in children with TBI before and after the implementation of a protocol that standardized decision-making and interventions among neurosurgeons and pediatric intensivists. METHODS The authors performed a retrospective pre- and postprotocol study of 128 pediatric patients with severe TBI, as defined by Glasgow Coma Scale (GCS) scores < 8, admitted to a tertiary care center pediatric critical care unit between April 1, 2008, and May 31, 2014. The preprotocol group included 99 patients, and the postprotocol group included 29 patients. The primary outcome of interest was discharge disposition before and after protocol implementation, which took place on April 1, 2013. Ordered logistic regression was used to assess outcomes while accounting for injury severity and clinical parameters. Favorable discharge disposition included discharge home. Unfavorable discharge disposition included discharge to an inpatient facility or death. RESULTS Demographics were similar between the treatment periods, as was injury severity as assessed by GCS score (mean 5.43 preprotocol, mean 5.28 postprotocol; p = 0.67). The ordered logistic regression model demonstrated an odds ratio of 4.0 of increasingly favorable outcome in the postprotocol cohort (p = 0.007). Prior to protocol implementation, 63 patients (64%) had unfavorable discharge disposition and 36 patients (36%) had favorable discharge disposition. After protocol implementation, 9 patients (31%) had unfavorable disposition, while 20 patients (69%) had favorable disposition (p = 0.002). In the preprotocol group, 31 patients (31%) died while 6 patients (21%) died after protocol implementation (p = 0.04). CONCLUSIONS Discharge disposition and mortality rates in pediatric patients with severe TBI improved after implementation of a standardized protocol among caregivers based on best-practice guidelines.

Self-awareness four years after severe traumatic brain injury: discordance between the patient’s and relative’s complaints. Results from the PariS-TBI study

2017 ◽  
Vol 32 (5) ◽  
pp. 692-704 ◽  
Author(s):  
Camille Chesnel ◽  
Claire Jourdan ◽  
Eleonore Bayen ◽  
Idir Ghout ◽  
Emmanuelle Darnoux ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Significant Relationship ◽  
Injury Severity ◽  
Chronic Phase ◽  
Functional Independence ◽  
Severe Tbi

Objective: To evaluate the patient’s awareness of his or her difficulties in the chronic phase of severe traumatic brain injury (TBI) and to determine the factors related to poor awareness. Design/Setting/Subjects: This study was part of a larger prospective inception cohort study of patients with severe TBI in the Parisian region (PariS-TBI study). Intervention/Main measures: Evaluation was carried out at four years and included the Brain Injury Complaint Questionnaire (BICoQ) completed by the patient and his or her relative as well as the evaluation of impairments, disability and quality of life. Results: A total of 90 patient-relative pairs were included. Lack of awareness was measured using the unawareness index that corresponded to the number of discordant results between the patient and relative in the direction of under evaluation of difficulties by the patient. The only significant relationship found with lack of awareness was the subjective burden perceived by the relative (Zarit Burden Inventory) ( r = 0.5; P < 0.00001). There was no significant relationship between lack of awareness and injury severity, pre-injury socio-demographic data, cognitive impairments, mood disorders, functional independence (Barthel index), global disability (Glasgow Outcome Scale), return to work at four years or quality of life (Quality Of Life after Brain Injury scale (QOLIBRI)). Conclusion: Lack of awareness four years post severe TBI was not related to the severity of the initial trauma, sociodemographic data, the severity of impairments, limitations of activity and participation, or the patient’s quality of life. However, poor awareness did significantly influence the weight of the burden perceived by the relative.

scholarly journals Moderate and severe traumatic brain injury: effect of blood alcohol concentration on Glasgow Coma Scale score and relation to computed tomography findings

2015 ◽  
Vol 122 (1) ◽  
pp. 211-218 ◽  
Author(s):  
Nils Petter Rundhaug ◽  
Kent Gøran Moen ◽  
Toril Skandsen ◽  
Kari Schirmer-Mikalsen ◽  
Stine B. Lund ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Dependent Manner ◽  
Blood Alcohol ◽  
Severe Tbi ◽  
Gcs Score ◽  
Dose Dependent

OBJECT The influence of alcohol is assumed to reduce consciousness in patients with traumatic brain injury (TBI), but research findings are divergent. The aim of this investigation was to study the effects of different levels of blood alcohol concentration (BAC) on the Glasgow Coma Scale (GCS) scores in patients with moderate and severe TBI and to relate the findings to brain injury severity based on the admission CT scan. METHODS In this cohort study, 265 patients (age range 16–70 years) who were admitted to St. Olavs University Hospital with moderate and severe TBI during a 7-year period were prospectively registered. Of these, 217 patients (82%) had measured BAC. Effects of 4 BAC groups on GCS score were examined with ordinal logistic regression analyses, and the GCS scores were inverted to give an OR > 1. The Rotterdam CT score based on admission CT scan was used to adjust for brain injury severity (best score 1 and worst score 6) by stratifying patients into 2 brain injury severity groups (Rotterdam CT scores of 1–3 and 4–6). RESULTS Of all patients with measured BAC, 91% had intracranial CT findings and 43% had BAC > 0 mg/dl. The median GCS score was lower in the alcohol-positive patients (6.5, interquartile range [IQR] 4–10) than in the alcohol-negative patients (9, IQR 6–13; p < 0.01). No significant differences were found between alcohol-positive and alcohol-negative patients regarding other injury severity variables. Increasing BAC was a significant predictor of lower GCS score in a dose-dependent manner in age-adjusted analyses, with OR 2.7 (range 1.4–5.0) and 3.2 (range 1.5–6.9) for the 2 highest BAC groups (p < 0.01). Subgroup analyses showed an increasing effect of BAC group on GCS scores in patients with Rotterdam CT scores of 1–3: OR 3.1 (range 1.4–6.6) and 6.7 (range 2.7–16.7) for the 2 highest BAC groups (p < 0.01). No such relationship was found in patients with Rotterdam CT scores of 4–6 (p = 0.14–0.75). CONCLUSIONS Influence of alcohol significantly reduced the GCS score in a dose-dependent manner in patients with moderate and severe TBI and with Rotterdam CT scores of 1–3. In patients with Rotterdam CT scores of 4–6, and therefore more CT findings indicating increased intracranial pressure, the brain injury itself seemed to overrun the depressing effect of the alcohol on the CNS. This finding is in agreement with the assumption of many clinicians in the emergency situation.

Abstract 230: Differential Effects of Prehospital Hypotension and Injury Severity in Isolated vs. Multisystem Major Traumatic Brain Injury

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Daniel W Spaite ◽  
Chengcheng Hu ◽  
Bentley J Bobrow ◽  
Bruce J Barnhart ◽  
Vatsal Chikani ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Treatment Effectiveness ◽  
Guideline Implementation ◽  
Body Region ◽  
Head Region ◽  
Differential Effects ◽  
Severe Tbi

Background: In hospital-based studies, hypotension (HT, SBP <90) is more likely to occur in multisystem traumatic brain injury (MTBI) than isolated (ITBI). However, there are few EMS studies on this issue. Hypothesis: Prehospital HT is associated with differential effects in MTBI and ITBI and these effects are influenced by the severity of primary brain injury. Methods: Inclusion: TBI cases in the EPIC Study (NIH 1R01NS071049) before TBI guideline implementation (1/07-3/14). ITBI: Major TBI cases (CDC Barell Matrix Type 1) that had no injury with ICD9-based Regional Severity Score [RSS (AIS equivalent)] ≥3 in any other body region. MTBI: Type 1 TBI plus at least one non-head region injury with RSS ≥3. Results: Included were 13,435 cases [Excl: age <10 (5.9%), missing data (6.2%)]. 10,374 (77.2%) were ITBI, 3061 (22.8%) MTBI. Mortality: ITBI: 7.7% (797/10,374), MTBI: 19.2% (587/3061, p<0.0001). Prehospital HT occurred 3.5 times more often in MTBI (14.8%, 453/3061 vs 4.2%, 437/10,374; p<0.0001). Among HT cases, 40.8% (185/453) with MTBI died vs 30.9% with ITBI (135/437; p<0.0001). In the hypotensive moderate/severe TBI cohort (RSS-Head 3/4), MTBI mortality was 2.4 times higher (17.2%, 40/232) than ITBI (7.1%, 17/240, p = 0.001). However, in the hypotensive very/extremely severe TBI group (RSS-Head 5/6), mortality was almost identical in MTBI (73.4%, 141/192) and ITBI (72.1%, 116/161, p = 0.864). Conclusion: Among major TBI patients with prehospital HT, those with MTBI were much more likely to die than those with ITBI. However, this association varied dramatically with TBI severity. In mod/severe TBI cases with HT, MTBI mortality was 2.4 times higher than in ITBI. In contrast, in very/extremely severe TBI with HT, there was no identifiable mortality difference. Thus, in cases with substantial potential to survive the primary brain injury (mod/severe), outcome is markedly worse in patients with multisystem injuries. However, in very/extremely severe TBI, non-head region injuries have no apparent association with mortality. This may be because the TBI is the primary factor leading to death in these cases. The main EPIC study is evaluating whether this severity-based difference in “effect” has implications for TBI guideline treatment effectiveness.

scholarly journals Critical Update on the Third Edition of the Guidelines for Managing Severe Traumatic Brain Injury in Children

2020 ◽  
Vol 29 (1) ◽  
pp. e13-e18
Author(s):  
Karin Reuter-Rice ◽  
Elise Christoferson
Keyword(s):  
Traumatic Brain Injury ◽  
Critical Care ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Current Evidence ◽  
Care Providers ◽  
The Third ◽  
Guideline Document ◽  
Severe Tbi ◽  
Pediatric Tbi

Background Severe traumatic brain injury (TBI) is associated with high rates of death and disability. As a result, the revised guidelines for the management of pediatric severe TBI address some of the previous gaps in pediatric TBI evidence and management strategies targeted to promote overall health outcomes. Objectives To provide highlights of the most important updates featured in the third edition of the guidelines for the management of pediatric severe TBI. These highlights can help critical care providers apply the most current and appropriate therapies for children with severe TBI. Methods and Results After a brief overview of the process behind identifying the evidence to support the third edition guidelines, both relevant and new recommendations from the guidelines are outlined to provide critical care providers with the most current management approaches needed for children with severe TBI. Recommendations for neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, ventilation therapies, temperature control/hypothermia, nutrition, and corticosteroids are provided. In addition, the complete guideline document and its accompanying algorithm for recommended therapies are available electronically and are referenced within this article. Conclusions The evidence base for treating pediatric TBI is increasing and provides the basis for high-quality care. This article provides critical care providers with a quick reference to the current evidence when caring for a child with a severe TBI. In addition, it provides direct access links to the comprehensive guideline document and algorithms developed to support critical care providers.

Effects of hypertonic saline on intracranial pressure and cerebral autoregulation in pediatric traumatic brain injury

2021 ◽  
pp. 1-7
Author(s):  
Julian Zipfel ◽  
Juliane Engel ◽  
Konstantin Hockel ◽  
Ellen Heimberg ◽  
Martin U. Schuhmann ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Primary Outcome Measure ◽  
Favorable Outcome ◽  
Outcome Group ◽  
Significant Difference

OBJECTIVE Hypertonic saline (HTS) is commonly used in children to lower intracranial pressure (ICP) after severe traumatic brain injury (sTBI). While ICP and cerebral perfusion pressure (CPP) correlate moderately to TBI outcome, indices of cerebrovascular autoregulation enhance the correlation of neuromonitoring data to neurological outcome. In this study, the authors sought to investigate the effect of HTS administration on ICP, CPP, and autoregulation in pediatric patients with sTBI. METHODS Twenty-eight pediatric patients with sTBI who were intubated and sedated were included. Blood pressure and ICP were actively managed according to the autoregulation index PRx (pressure relativity index to determine and maintain an optimal CPP [CPPopt]). In cases in which ICP was continuously > 20 mm Hg despite all other measures to decrease it, an infusion of 3% HTS was administered. The monitoring data of the first 6 hours after HTS administration were analyzed. The Glasgow Outcome Scale (GOS) score at the 3-month follow-up was used as the primary outcome measure, and patients were dichotomized into favorable (GOS score 4 or 5) and unfavorable (GOS score 1–3) groups. RESULTS The mean dose of HTS was 40 ml 3% NaCl. No significant difference in ICP and PRx was seen between groups at the HTS administration. ICP was lowered significantly in all children, with the effect lasting as long as 6 hours. The lowering of ICP was significantly greater and longer in children with a favorable outcome (p < 0.001); only this group showed significant improvement of autoregulatory capacity (p = 0.048). A newly established HTS response index clearly separated the outcome groups. CONCLUSIONS HTS significantly lowered ICP in all children after sTBI. This effect was significantly greater and longer-lasting in children with a favorable outcome. Moreover, HTS administration restored disturbed autoregulation only in the favorable outcome group. This highlights the role of a “rescuable” autoregulation regarding outcome, which might be a possible indicator of injury severity. The effect of HTS on autoregulation and other possible mechanisms should be further investigated.

White Matter Disruption in Pediatric Traumatic Brain Injury: Results from ENIGMA Pediatric Moderate to Severe Traumatic Brain Injury

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012222
Author(s):  
Emily L Dennis ◽  
Karen Caeyenberghs ◽  
Kristen R Hoskinson ◽  
Tricia L Merkley ◽  
Stacy J Suskauer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Behavioral Problems ◽  
Child Behavior Checklist ◽  
Injury Severity ◽  
Meta Analysis ◽  
Post Injury ◽  
Severe Tbi ◽  
Future Work

Objective:Our study addressed aims: (1) test the hypothesis that moderate-severe TBI in pediatric patients is associated with widespread white matter (WM) disruption; (2) test the hypothesis that age and sex impact WM organization after injury; and (3) examine associations between WM organization and neurobehavioral outcomes.Methods:Data from ten previously enrolled, existing cohorts recruited from local hospitals and clinics were shared with the ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric msTBI working group. We conducted a coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI processing pipeline.Results:Five hundred and seven children and adolescents (244 with complicated mild to severe TBI [msTBI] and 263 controls) were included. Patients were clustered into three post-injury intervals: acute/subacute - <2 months, post-acute - 2-6 months, chronic - 6+ months. Outcomes were dMRI metrics and post-injury behavioral problems as indexed by the Child Behavior Checklist (CBCL). Our analyses revealed altered WM diffusion metrics across multiple tracts and all post-injury intervals (effect sizes ranging between d=-0.5 to -1.3). Injury severity is a significant contributor to the extent of WM alterations but explained less variance in dMRI measures with increasing time post-injury. We observed a sex-by-group interaction: females with TBI had significantly lower fractional anisotropy in the uncinate fasciculus than controls (𝞫=0.043), which coincided with more parent-reported behavioral problems (𝞫=-0.0027).Conclusions:WM disruption after msTBI is widespread, persistent, and influenced by demographic and clinical variables. Future work will test techniques for harmonizing neurocognitive data, enabling more advanced analyses to identify symptom clusters and clinically-meaningful patient subtypes.

scholarly journals Severe Traumatic Brain Injury (TBI) Modulates the Kinetic Profile of the Inflammatory Response of Markers for Neuronal Damage

2020 ◽  
Vol 9 (6) ◽  
pp. 1667 ◽  
Author(s):  
Cora Rebecca Schindler ◽  
Thomas Lustenberger ◽  
Mathias Woschek ◽  
Philipp Störmann ◽  
Dirk Henrich ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Inflammatory Response ◽  
Calcium Binding ◽  
Injury Severity ◽  
Neuronal Damage ◽  
Severe Trauma ◽  
Multiple Injuries ◽  
Kinetic Profile ◽  
Severe Tbi

The inflammatory response plays an important role in the pathophysiology of multiple injuries. This study examines the effects of severe trauma and inflammatory response on markers of neuronal damage. A retrospective analysis of prospectively collected data in 445 trauma patients (Injury Severity Score (ISS) ≥ 16) is provided. Levels of neuronal biomarkers (calcium-binding Protein B (S100b), Enolase2 (NSE), glial fibrillary acidic protein (GFAP)) and Interleukins (IL-6, IL-10) in severely injured patients (with polytrauma (PT)) without traumatic brain injury (TBI) or with severe TBI (PT+TBI) and patients with isolated TBI (isTBI) were measured upon arrival until day 5. S100b, NSE, GFAP levels showed a time-dependent decrease in all cohorts. Their expression was higher after multiple injuries (p = 0.038) comparing isTBI. Positive correlation of marker level after concomitant TBI and isTBI (p = 0.001) was noted, while marker expression after PT appears to be independent. Highest levels of IL-6 and -10 were associated to PT und lowest to isTBI (p < 0.001). In all groups pro-inflammatory response (IL-6/-10 ratio) peaked on day 2 and at a lower level on day 4. Severe TBI modulates kinetic profile of inflammatory response by reducing interleukin expression following trauma. Potential markers for neuronal damage have a limited diagnostic value after severe trauma because undifferentiated increase.

Coagulopathy Predicts Mortality in Pediatric Patients with Traumatic Brain Injury

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2891-2891 ◽  
Author(s):  
Bhavya S. Doshi ◽  
Shannon L. Meeks ◽  
Jeanne E Hendrickson ◽  
Andrew Reisner ◽  
Traci Leong ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Morbidity And Mortality ◽  
P Value ◽  
Trauma Patients ◽  
Severity Scores ◽  
Pediatric Tbi

Abstract Trauma is the leading cause of death in children ages 1 to 21 years of age. Traumatic brain injury (TBI) poses a high risk of both morbidity and mortality within the subset of pediatric trauma patients. Numerous adult studies have shown that coagulopathy is commonly observed in patients who have sustained trauma and that the incidence is higher when there is TBI. Previously, it was thought that coagulopathy related to trauma was dilutional (i.e. due to replacement of red cells and platelets without plasma) but more recent studies show that the coagulopathy in trauma is early and likely independent of transfusion therapy. Additionally, abnormal coagulation studies (PT, PTT, INR, platelet count, fibrinogen, and D-dimer) following TBI are associated with increased morbidity and mortality in adults. Although coagulopathy after traumatic brain injury in adults is well documented, the pediatric literature is fairly sparse. A recent study by Hendrickson et al in 2008 demonstrated that coagulopathy is both underestimated and under-treated in pediatric trauma patients who required blood product replacements. Here we present the results of a retrospective pilot study designed to assess coagulopathy in the pediatric TBI population. We analyzed all children admitted to our facility with TBI from January 2012 to December 2013. Patients were excluded if they had underlying diseases of the hemostatic system. All patients had baseline characteristics measured including: age, sex, mechanism of injury, Glasgow Coma Scale (GCS), injury severity score (ISS), initial complete blood count, DIC profile, hematological treatments including transfusions, ICU and hospital length of stay, ventilator days and survival status. Coagulation studies were defined as "abnormal" when they fell outside the accepted reference range of the pediatric hospital laboratory (PT 12.6-15.9, PTT 23.6-42.1 seconds, fibrinogen < 180 mg/dL units, platelets < 185 103/mL and hemoglobin < 11.5 g/dL). Survival was measured as survival at 30 days from admission or last known status at hospital discharge. One hundred and twenty patients met the inclusion criteria of the study and all were included in outcome analysis. Twenty-three of the 120 patients died (19.2%). Logistic regression analysis was used to compare survivors and non-survivors and baseline demographic data showed no difference in age or weight between the two groups with p-values of 0.1635 and 0.1624, respectively. Non-survivors had a higher ISS (30.26 vs 20.92, p-value 0.0004) and lower GCS (3 vs 5.8, p-value 0.0002) compared to survivors. Univariate analysis of coagulation studies to mortality showed statistically significant odds-ratios for ISS (OR 1.09, 95% CI 1.04-1.15), PT (OR 5.91, 95% CI 1.86-18.73), PTT (OR 6.48, 95% CI 2.04-20.52) and platelets (OR 5.63, 95% CI 1.74 – 18.21). Abnormal fibrinogen levels were not predictive of mortality (OR 2.56, 95% CI 0.96-6.79). These results are summarized in Table 1. Our results demonstrate that, consistent with adult studies, abnormal coagulation studies are also associated with increased mortality in pediatric patients. Higher injury severity scores and lower GCS scores are also predictive of mortality. Taken together, these results suggest that possible early correction of coagulopathy in severe pediatric TBI patients could improve outcomes for these patients. Table 1. OR 95% CI p-value ISS 1.09 1.04—1.15 .0009 PT > 15.9 sec 5.91 1.86—18.73 0.0026 PTT > 42.1 sec 6.48 2.04—20.52 0.0015 Fibrinogen < 180 mg/dL 2.56 0.96—6.79 0.0597 Platelets < 185 x 103/mL 5.63 1.74—18.21 0.0040 Disclosures No relevant conflicts of interest to declare.

Behavioural Profiles and Injury Severity Following Childhood Traumatic Brain Injury

2007 ◽  
Vol 8 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Suzanne L. Barker-Collo
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Child Behavior Checklist ◽  
Injury Severity ◽  
Attention Problems ◽  
Normal Limits ◽  
Orthopaedic Injury ◽  
Severe Tbi ◽  
The Impact

AbstractTraumatic brain injury (TBI) is a leading cause of death and morbidity in children and can result in cognitive, behavioural, social and emotional difficulties that may impact quality of life. This study examined the impact of mild, moderate, and severe childhood TBI, when compared to severe orthopaedic injury, on behaviour as measured by the Child Behavior Checklist (CBCL) in a sample of 74 children with TBI and 13 with orthopaedic injury aged 4 to 13 years at the time of injury. Correlational analyses revealed that within the TBI sample increased anxiety/depression and somatisation were related to increased age at the time of injury and shorter inpatient hospital stay. Increased age was also related to increased parental reports of attention problems; while increased hospital stay was related to increased withdrawal and thought problems. Symptomatology was within normal limits for all groups, approaching the borderline clinical range in the moderate TBI group for somatic symptoms and in the severe TBI group for thought and attention problems. Those with severe TBI had more thought and attention problems, and to a lesser extent social problems, than those with mild or moderate TBI; while those with moderate TBI had the highest levels of somatic and anxious–depressed symptoms. The only scale where performance seemed to increase in relation to injury severity was the attention problems scale. It is suggested that the findings for those with moderate TBI reflect increased awareness of one's own vulnerability/mortality, with the implication that issues such as grief, loss, and mortality may need to be addressed therapeutically.

scholarly journals The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury

2021 ◽  
Vol 11 ◽  
Author(s):  
Jelmer-Joost Lenstra ◽  
Lidija Kuznecova-Keppel Hesselink ◽  
Sacha la Bastide-van Gemert ◽  
Bram Jacobs ◽  
Maarten Willem Nicolaas Nijsten ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Cardiac Arrhythmias ◽  
Injury Severity ◽  
Thoracic Injury ◽  
Diffuse Brain Injury ◽  
Severe Tbi ◽  
Ecg Abnormalities ◽  
Diffuse Brain

The aim of this study was to evaluate the frequency of electrocardiographic (ECG) abnormalities in the acute phase of severe traumatic brain injury (TBI) and the association with brain injury severity and outcome. In contrast to neurovascular diseases, sparse information is available on this issue. Data of adult patients with severe TBI admitted to the Intensive Care Unit (ICU) for intracranial pressure monitoring of a level-1 trauma center from 2002 till 2018 were analyzed. Patients with a cardiac history were excluded. An ECG recording was obtained within 24 h after ICU admission. Admission brain computerized tomography (CT)-scans were categorized by Marshall-criteria (diffuse vs. mass lesions) and for location of traumatic lesions. CT-characteristics and maximum Therapy Intensity Level (TILmax) were used as indicators for brain injury severity. We analyzed data of 198 patients, mean (SD) age of 40 ± 19 years, median GCS score 3 [interquartile range (IQR) 3–6], and 105 patients (53%) had thoracic injury. In-hospital mortality was 30%, with sudden death by cardiac arrest in four patients. The incidence of ECG abnormalities was 88% comprising ventricular repolarization disorders (57%) mostly with ST-segment abnormalities, conduction disorders (45%) mostly with QTc-prolongation, and arrhythmias (38%) mostly of supraventricular origin. More cardiac arrhythmias were observed with increased grading of diffuse brain injury (p = 0.042) or in patients treated with hyperosmolar therapy (TILmax) (65%, p = 0.022). No association was found between ECG abnormalities and location of brain lesions nor with thoracic injury. Multivariate analysis with baseline outcome predictors showed that cardiac arrhythmias were not independently associated with in-hospital mortality (p = 0.097). Only hypotension (p = 0.029) and diffuse brain injury (p = 0.017) were associated with in-hospital mortality. In conclusion, a high incidence of ECG abnormalities was observed in patients with severe TBI in the acute phase after injury. No association between ECG abnormalities and location of brain lesions or presence of thoracic injury was present. Cardiac arrhythmias were indicative for brain injury severity but not independently associated with in-hospital mortality. Therefore, our findings likely suggest that ECG abnormalities should be considered as cardiac mimicry representing the secondary effect of traumatic brain injury allowing for a more rationale use of neuroprotective measures.

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