Document Detail


Automated measurement of "pressure times time dose" of intracranial hypertension best predicts outcome after severe traumatic brain injury.
MedLine Citation:
PMID:  20038855     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Earlier, more accurate assessment of secondary brain injury is essential in management of patients with traumatic brain injury (TBI). We assessed the accuracy and utility of high-resolution automated intracranial pressure (ICP) and cerebral perfusion pressure (CPP) recording and their analysis in patients with severe TBI. METHODS: ICP and CPP data for 30 severe TBI patients were collected automatically at 6-second intervals. The degree and duration of ICP and CPP above and below treatment thresholds were calculated as "pressure times time dose" (PTD; mm Hg . h) using automated recordings (PTDa) or manual recordings (PTDm) for early stage (trauma resuscitation unit [TRU]) and total monitoring time (TRU and intensive care unit). RESULTS: Bland-Altman plots showed lack of agreement between PTDa and PTDm. For ICP >20 mm Hg and CPP <60 mm Hg, PTDa, but not PTDm, was significantly higher in patients with unfavorable outcome (Extended Glasgow Outcome Scale score <or=4) than in patients with favorable outcome (Extended Glasgow Outcome Scale score >4). Total PTDa for ICP >20 mm Hg and CPP <60 mm Hg had high predictive power for functional outcome (area under the receiver operating characteristics curve: 0.92 +/- 0.05 and 0.82 +/- 0.08, respectively) and inhospital mortality (0.76 +/- 0.15 and 0.79 +/- 0.14, respectively) and were strongly correlated with length of intensive care unit stay (p = 0.009 and 0.007), length of hospital stay (p = 0.009 and 0.005), and discharge Glasgow Coma Scale scores (p = 0.008 and p = 0.038). PTDa of CPP >100 mm Hg during TRU monitoring and during the first 24 hours showed highest predictive power for mortality (area under the receiver operating characteristics curve: 0.72 +/- 0.18 and 0.85 +/- 0.13, respectively). PTDa was better than PTDm and the duration of episodes alone in predicting outcome. CONCLUSIONS: PTD calculation of high resolution ICP and CPP recording is a reliable and feasible way of monitoring severe TBI patients.
Authors:
Sibel Kahraman; Richard P Dutton; Peter Hu; Yan Xiao; Bizhan Aarabi; Deborah M Stein; Thomas M Scalea
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of trauma     Volume:  69     ISSN:  1529-8809     ISO Abbreviation:  J Trauma     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-12     Completed Date:  2010-08-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  United States    
Other Details:
Languages:  eng     Pagination:  110-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Brain Injuries / complications,  diagnosis,  physiopathology*
Female
Humans
Intensive Care / methods
Intracranial Hypertension / etiology*,  physiopathology
Length of Stay
Male
Monitoring, Physiologic / methods
Prognosis
Statistics, Nonparametric
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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