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 Study of the Long-Term Results of Decompressive Craniectomy after Severe Traumatic Brain Injury Based on a Series of 60 Consecutive Cases

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Gaétane Gouello ◽  
Olivier Hamel ◽  
Karim Asehnoune ◽  
Eric Bord ◽  
Roger Robert ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Favourable Outcome ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome

Background. Decompressive craniectomy can be proposed in the management of severe traumatic brain injury. Current studies report mixed results, preventing any clear conclusions on the place of decompressive craniectomy in traumatology.Methods. The objective of this retrospective study was to evaluate the results of all decompressive craniectomies performed between 2005 and 2011 for refractory intracranial hypertension after severe traumatic brain injury. Sixty patients were included. Clinical parameters (Glasgow scale, pupillary examination) and radiological findings (Marshall CT scale) were analysed. Complications, clinical outcome, and early and long-term Glasgow Outcome Scale (GOS) were evaluated after surgery. Finally, the predictive value of preoperative parameters to guide the clinician’s decision to perform craniectomy was studied.Results. Craniectomy was unilateral in 58 cases and the mean bone flap area was 100 cm2. Surgical complications were observed in 6.7% of cases. Mean followup was 30 months and a favourable outcome was obtained in 50% of cases. The initial Glasgow Scale was the only statistically significant predictive factor for long-term outcome.Conclusion. Despite the discordant results in the literature, this study demonstrates that decompressive craniectomy is useful for the management of refractory intracranial hypertension after severe traumatic brain injury.

scholarly journals Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

2020 ◽  
Vol 9 (6) ◽  
pp. 2000
Author(s):  
Shannon Cooper ◽  
Cino Bendinelli ◽  
Andrew Bivard ◽  
Mark Parsons ◽  
Zsolt J. Balogh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Severe Traumatic Brain Injury ◽  
Injury Severity ◽  
Intervention Group ◽  
Small Sample ◽  
Perfusion Computed Tomography ◽  
Group I ◽  
Second Tier

The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients.

The Influence of Cultural Background on Experiences and Beliefs about Traumatic Brain Injury and their Association with Outcome

2008 ◽  
Vol 9 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Helen Saltapidas ◽  
Jennie Ponsford
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Emotional Adjustment ◽  
Illness Perception ◽  
Emotional Reactions ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Illness Perception Questionnaire ◽  
English Speaking

AbstractThe aim of the study was to compare beliefs and experiences of traumatic brain injury (TBI) in patients with TBI from the dominant English-speaking culture in Australia versus those from minority culturally and linguistically diverse (CALD) backgrounds and examine the relative influence of beliefs, acculturation, along with demographic and injury-related variables on outcome. The primary measures included the Illness Perception Questionnaire-Revised (IPQ-R), and the Craig Handicap Assessment and Reporting Technique (CHART). Participants were 70 individuals with mild to severe TBI, including 38 of English-speaking background (ESB) and 32 from CALD backgrounds. Although similar to the ESB participants in education, preinjury employment status, injury severity and experience of TBI, the CALD participants differed significantly from ESB participants on acculturation variables. CALD participants also experienced greater negative emotions and were less likely to have internal locus of control causal beliefs than ESB participants. Regression analyses indicated that describing one's value system as other than Australian, poorer understanding of TBI and greater negative emotional reactions, along with fewer years of education were associated with poorer outcomes on the CHART. Thus, in treating patients from different cultural backgrounds it is important for health professionals to understand beliefs about and responses to TBI, as they could potentially impact on coping, emotional adjustment and long-term outcome.

Detection of neurofilament-H in serum as a diagnostic tool to predict injury severity in patients who have suffered mild traumatic brain injury

2014 ◽  
Vol 121 (5) ◽  
pp. 1232-1238 ◽  
Author(s):  
Joshua W. Gatson ◽  
Jennifer Barillas ◽  
Linda S. Hynan ◽  
Ramon Diaz-Arrastia ◽  
Steven E. Wolf ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Injury Severity ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Clinical Findings ◽  
Ct Scans ◽  
Healthy Controls ◽  
Scale Scores

Object In previous studies of traumatic brain injury (TBI), neural biomarkers of injury correlate with injury severity and predict neurological outcome. The object of this paper was to characterize neurofilament-H (NFL-H) as a predictor of injury severity in patients who have suffered mild TBI (mTBI). Thus, the authors hypothesized that phosphorylated NFL-H (pNFL-H) levels are higher in mTBI patients than in healthy controls and identify which subjects experienced a more severe injury such as skull fractures, intracranial hemorrhaging, and/or contusions as detected by CT scans. Methods In this prospective clinical study, blood (8 ml) was collected from subjects (n = 34) suffering from mTBI (as defined by the American Congress of Rehabilitation and Glasgow Coma Scale scores between 13 and 15) at Parkland Hospital, Dallas, Texas, on Days 1 and 3 after injury). Additional clinical findings from the CT scans were also used to categorize the TBI patients into those with and those without clinical findings on the scans (CT+ and CTgroups, respectively). The serum levels of pNFL-H were measured using the enzyme-linked immunosorbent assay. Results Compared with healthy controls, the mTBI patients exhibited a significant increase in the serum levels of pNFL-H on Days 1 (p = 0.00001) and 3 (p = 0.0001) after TBI. An inverse correlation was observed between pNFL-H serum levels and Glasgow Coma Scale scores, which was significant. Additionally, using receiver operating characteristic curve analysis to compare the mTBI cases with controls to determine sensitivity and specificity, an area under the curve of 100% was achieved for both (p = 0.0001 for both). pNFL-H serum levels were only significantly higher on Day 1 in mTBI patients in the CT+ group (p < 0.008) compared with the CT− group. The area under the curve (82.5%) for the CT+ group versus the CT− group was significant (p = 0.021) with a sensitivity of 87.5% and a specificity of 70%, using a cutoff of 1071 pg/ml of pNFL-H in serum. Conclusions This study describes the serum profile of pNFL-H in patients suffering from mTBI with and without CT findings on Days 1 and 3 after injury. These results suggest that detection of pNFL-H may be useful in determining which individuals require CT imaging to assess the severity of their injury.

scholarly journals Long term outcome in survivors of decompressive craniectomy following severe traumatic brain injury

2019 ◽  
Vol 14 (1) ◽  
pp. 52
Author(s):  
Ashish Bindra ◽  
Ashutosh Kaushal ◽  
Abhyuday Kumar ◽  
Keshav Goyal ◽  
Niraj Kumar ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Intracranial pressure–based barbiturate coma treatment in children with refractory intracranial hypertension due to traumatic brain injury

2020 ◽  
Vol 25 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Fartein Velle ◽  
Anders Lewén ◽  
Timothy Howells ◽  
Per Enblad ◽  
Pelle Nilsson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Scale Score ◽  
Effective Means ◽  
Physiological Data ◽  
Barbiturate Coma ◽  
Severe Condition ◽  
Long Term Outcome

OBJECTIVERefractory intracranial pressure (ICP) hypertension following traumatic brain injury (TBI) is a severe condition that requires potentially harmful treatment strategies such as barbiturate coma. However, the use of barbiturates may be restricted due to concerns about inducing multiorgan system complications related to the therapy. The purpose of this study was to evaluate the outcome and occurrence of treatment-related complications to barbiturate coma treatment in children with refractory intracranial hypertension (RICH) due to TBI in a modern multimodality neurointensive care unit (NICU).METHODSThe authors conducted a retrospective cohort study of 21 children ≤ 16 years old who were treated in their NICU between 2005 and 2015 with barbiturate coma for RICH following TBI. Demographic and clinical data were acquired from patient records and physiological data from digital monitoring system files.RESULTSThe median age of these 21 children was 14 years (range 2–16 years) and at admission the median Glasgow Coma Scale score was 7 (range 4–8). Barbiturate coma treatment was added due to RICH at a median of 46 hours from trauma and had a median duration of 107 hours. The onset of barbiturate coma resulted in lower ICP values, lower pulse amplitudes on the ICP curve, and decreased amount of A-waves. No major disturbances in blood gases, liver and kidney function, or secondary insults were observed during this period. Outcome 1 year later revealed a median Glasgow Outcome Scale score of 5 (good recovery), however on the King’s Outcome Scale for Childhood Head Injury, the median was 4a (moderate disability).CONCLUSIONSThe results of this study indicate that barbiturate coma, when used in a modern NICU, is an effective means of lowering ICP without causing concomitant severe side effects in children with RICH and was compatible with good long-term outcome.

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