Early Pupillometry Assessment in Traumatic Brain Injury Patients: A Retrospective Study

Background: The aim of this study was to evaluate whether the early assessment of neurological pupil index (NPi) values derived from automated pupillometry could predict neurological outcome after traumatic brain injury (TBI). Methods: Retrospective observational study including adult (>18 years) TBI patients admitted from January 2018 to December 2020, with available NPi on admission. Abnormal NPi was considered if <3. Unfavorable neurological outcome (UO) at hospital discharge was considered for a Glasgow Outcome Scale of 1–3. Results: 100 patients were included over the study period (median age 48 (34–69) years and median GCS on admission 11 (6–15)); 49 (49%) patients had UO. On admission, 20 (20%) patients had an abnormal NPi (NPi < 3); median worst (i.e., from both eyes) NPi was 4.2 (3.2–4.5). Median worst and mean NPi on admission were significantly lower in the UO group than others (3.9 (1.7–4.4) vs. 4.4 (3.7–4.6); p = 0.005–4.0 (2.6–4.5) vs. 4.5 (3.9–4.7); p = 0.002, respectively). The ROC curve for the worst and mean NPi showed a moderate accuracy to predict UO (AUC 0.66 (0.56–0.77); p = 0.005 and 0.68 (0.57–0.78); p = 0.002). However, in a generalized linear model, the prognostic role of NPi on admission was limited. Conclusions: Low NPi on admission has limited prognostic value in TBI.

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Prognostic Role of Proton Magnetic Resonance Spectroscopy in Acute Traumatic Brain Injury

Journal of Head Trauma Rehabilitation ◽

10.1097/00001199-200607000-00005 ◽

2006 ◽

Vol 21 (4) ◽

pp. 334-349 ◽

Cited By ~ 33

Author(s):

Lori Shutter ◽

Karen A. Tong ◽

Ann Lee ◽

Barbara A. Holshouser

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Magnetic Resonance ◽

Magnetic Resonance Spectroscopy ◽

Proton Magnetic Resonance ◽

Proton Magnetic Resonance Spectroscopy ◽

Resonance Spectroscopy ◽

Prognostic Role ◽

Acute Traumatic Brain Injury

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Prognostic value of admission serum glucose-phosphate ratio in predicting the 6-month outcome of patients with severe traumatic brain injury: A retrospective study

Clinica Chimica Acta ◽

10.1016/j.cca.2020.08.038 ◽

2020 ◽

Vol 510 ◽

pp. 659-664

Author(s):

Shen-Zhong Qiu ◽

Guan-Rong Zheng ◽

Bin Chen ◽

Jian-Jun Huang ◽

Jia Shen ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Retrospective Study ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Prognostic Value ◽

Serum Glucose ◽

Glucose Phosphate

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External Validation of the International Mission for Prognosis and Analysis of Clinical Trials Model and the Role of Markers of Coagulation

Neurosurgery ◽

10.1227/01.neu.0000430326.40763.ec ◽

2013 ◽

Vol 73 (2) ◽

pp. 305-311 ◽

Cited By ~ 23

Author(s):

Rahul Raj ◽

Jari Siironen ◽

Riku Kivisaari ◽

Juha Hernesniemi ◽

Päivi Tanskanen ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Clinical Trials ◽

Brain Injury ◽

Neurological Outcome ◽

Injury Severity ◽

External Validation ◽

Impact Model ◽

Impact Risk ◽

The Impact

Abstract BACKGROUND: Markers of coagulation have shown to have important value in predicting traumatic brain injury outcome. OBJECTIVE: To externally validate and investigate the role of markers of coagulation for outcome prediction by using the International Mission for Prognosis and Analysis of Clinical Trials (IMPACT) model while adjusting for overall injury severity. METHODS: A retrospective chart analysis of traumatic brain injury patients admitted to Helsinki University Central Hospital between 2009 and 2010 was performed. Outcome was estimated by using the criteria of the IMPACT model. Admission international normalized ratio (INR) and platelet count were used as markers of coagulation. Overall injury severity was categorized with the injury severity score (ISS). Variables were added to the calculated IMPACT risk, generating new models. Model performance was assessed by analyzing and comparing the area under the curve (AUC) of the models. RESULTS: For 342 included patients, 6-month mortality was 32% and unfavorable neurological outcome was 36%. Patients with a poor outcome had lower platelets and higher INR and ISS than those with good outcome (P < .001). The IMPACT model had an AUC of 0.85 for predicting mortality and 0.81 for neurological outcome. Addition of INR but not ISS or platelets to the IMPACT predicted risk improved the predictive validity for mortality ([INCREMENT]AUC 0.02, P = .034) but not neurological outcome ([INCREMENT]AUC 0.00, P = .401). In multivariate analysis, INR remained significant for mortality but not for neurological outcome when adjusting for IMPACT risk and ISS (P = .012). CONCLUSION: The IMPACT model showed excellent performance, and INR was an independent predictor for mortality, independent of overall injury severity.

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