Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study.

IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE
Christine E Ren, Anastasia Ternovskaia, Fatima Mikdashi, Hassan Syed, Isha Vashee, Vainavi Gambhir, Natalie Chao, Jessica V Downing, David Dreizin, Quincy K Tran
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引用次数: 0

Abstract

Background: Diffuse axonal injury (DAI), a feature seen in severe traumatic brain injury (TBI), is associated with substantial morbidity and mortality. Although blood pressure variability (BPV) has been shown to impact TBI outcomes overall, its relevance in DAI cases remains uncertain. We investigated whether 24-hour post-injury BPV and other clinical factors were linked to patient outcomes.

Methods: We conducted a retrospective analysis of Level I trauma center-admitted TBI patients with radiographic DAI diagnosis (computed tomography/magnetic resonance imaging). Hospital disposition (home, nursing facility, hospice/death) and Glasgow Coma Scale (GCS) on hospital day 5 (HD5GCS) were outcomes of interest. We assessed associations with clinical factors using ordinal logistic regression.

Results: Among 153 patients (mean age 49 ±20 years, 74% male), median admission GCS was 5.0 (3.0-12.5), HD5GCS was 8.0 (6.0-11), and median hospital stay was 25 (15.5-34.5) days. The BPV, measured as successive variation in systolic blood pressure (SBPSV) and standard deviation in systolic blood pressure (SBPSD), was not significantly associated with hospital disposition. SBPSV and SBPSD were also not associated with our secondary outcome of HD5GCS. Initial international normalized ratio (INR) (Coefficient -3.67, odds ratio [OR] 0.03, 95% confidence interval [CI] 0.00-0.70), cerebral contusion (Coeff -2.39, OR 0.09, 95% CI 0.01-0.75), and HD5GCS (Coeff 0.59, OR 1.80, 95% CI 1.30-2.49) were associated with increased odds of discharge to hospice or death. Administration of blood products (Coeff 1.06, OR 2.89, 95% CI 1.10-7.60), vasopressors (Coeff 1.40, OR 4.05, 95% CI 1.37-11.96), and hyperosmolar therapy (Coeff 1.23, OR 3.41, 95% CI 1.36-8.54), and concurrent intraventricular hemorrhage (Coeff 0.99, OR 2.70, 95% CI 0.86-6.49) were linked to poorer HD5GCS.

Conclusion: Blood pressure variability was not correlated with outcomes in patients with diffuse axonal injury. Low Glasgow Coma Score on hospital day 5, high initial INR, and concomitant cerebral contusion were associated with poorer outcomes.

外伤性脑损伤伴弥漫性轴索损伤患者的血压变异性和预后预测因素:一项回顾性队列研究。
背景:弥漫性轴索损伤(DAI)是严重创伤性脑损伤(TBI)的一个特征,与大量的发病率和死亡率相关。尽管血压变异性(BPV)总体上影响TBI的预后,但其与DAI病例的相关性仍不确定。我们调查了24小时损伤后BPV和其他临床因素是否与患者预后有关。方法:我们回顾性分析了创伤中心收治的一级创伤性脑损伤患者的影像学诊断(计算机断层扫描/磁共振成像)。医院处置(家庭、护理机构、临终关怀/死亡)和住院第5天的格拉斯哥昏迷量表(GCS) (HD5GCS)是感兴趣的结果。我们使用有序逻辑回归评估与临床因素的关联。结果153例患者(平均年龄49±20岁,男性占74%),入院GCS中位数为5.0 (3.0 ~ 12.5),HD5GCS中位数为8.0(6.0 ~ 11),住院时间中位数为25(15.5 ~ 34.5)天。收缩压的连续变化(SBPSV)和收缩压的标准偏差(SBPSD)测量的BPV与医院处置无显著相关。SBPSV和SBPSD也与我们的HD5GCS次要结局无关。初始国际标准化比(INR)(系数-3.67,优势比[OR] 0.03, 95%可信区间[CI] 0.00-0.70)、脑挫伤(Coeff -2.39, OR 0.09, 95% CI 0.01-0.75)和HD5GCS (Coeff 0.59, OR 1.80, 95% CI 1.30-2.49)与出院至临终护理或死亡的几率增加相关。血液制品(Coeff 1.06, OR 2.89, 95% CI 1.10-7.60)、血管加压药物(Coeff 1.40, OR 4.05, 95% CI 1.37-11.96)和高渗治疗(Coeff 1.23, OR 3.41, 95% CI 1.36-8.54)以及并发脑室内出血(Coeff 0.99, OR 2.70, 95% CI 0.86-6.49)与较差的HD5GCS相关。结论:弥漫性轴索损伤患者血压变异性与预后无关。住院第5天格拉斯哥昏迷评分低,初始INR高,并伴有脑挫伤与较差的预后相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Western Journal of Emergency Medicine
Western Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
5.30
自引率
3.20%
发文量
125
审稿时长
16 weeks
期刊介绍: WestJEM focuses on how the systems and delivery of emergency care affects health, health disparities, and health outcomes in communities and populations worldwide, including the impact of social conditions on the composition of patients seeking care in emergency departments.
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