Journal of Intensive Care Medicine最新文献

{"title":"Lung Ultrasound Score and Bronchiolitis: What can be Predicted in a Single Center Experience.","authors":"Matteo D'Alessandro, Tommaso Bellini, Marta Bustaffa, Benedetta Chianucci, Francesca Ridella, Daniele Franzone, Emanuela Piccotti","doi":"10.1177/08850666251344465","DOIUrl":"10.1177/08850666251344465","url":null,"abstract":"<p><p><b>Background:</b> Bronchiolitis is a viral respiratory illness affecting children younger than one year of age, and its accurate prognosis in the emergency department (ED) is often difficult. Lung ultrasound (LUS) has been shown to be useful in risk stratification with respect to the likelihood of being admitted to the hospital or high-intensity care units, receiving supplemental oxygen, or non-invasive ventilation (NIV). Our aim is to evaluate the predictive value of point-of-care lung ultrasound performed in a pediatric ED, especially regarding hospitalization, need for oxygen therapy and NIV. <b>Methods:</b> Observational prospective monocentric study including 109 patients with bronchiolitis younger than 12 months presenting to the ED. Both clinical and LUS scores were assigned at the time of medical examination, then main data regarding admission, need for oxygen supply and NIV were collected. <b>Results:</b> Comparing patient who required hospital care (admission, oxygen supply or NIV) or not, we found a higher median LUS score for patients requiring hospital care (4 <i>vs</i> 1 <i>p</i> < .001 for hospital admission, 4 <i>vs</i> 2 <i>p</i> < .001 for oxygen supply, 5 <i>vs</i> 3 <i>p</i> < .001 for NIV); furthermore, setting the threshold of LUS score at 3.5 as a predictive marker, the ROC AUC for hospital admission, need for oxygen supply or NIV was 0.78, 0.75 and 0.8, respectively. A logistic regression analysis evaluated the risk associated with LUS score: an increase in score affects the risk of hospital admission, need for oxygen supplementation and NIV (OR 1.4, 95%CI 1.04-1.78, <i>p</i> < .05; OR 1.4, 95%CI 1.10-1.78, <i>p</i> < .05; OR 1.6, 95%CI 1.17-2.06, <i>p</i> < .05, respectively). <b>Conclusions:</b> LUS has demonstrated to be a useful tool to help clinician in the process of risk stratification for bronchiolitis, although further (multicentric) studies would be advisable to strengthen this result.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1186-1192"},"PeriodicalIF":2.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12464352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality Predictors in Stroke Patients Requiring Mechanical Ventilation: A Multicenter Prospective Observational Study.","authors":"Vadim Ershov, Andrey Belkin, Vladimir Gorbachev, Alexey Gritsan, Igor Zabolotskikh, Konstantin Lebedinsky, Ilya Leiderman, Sergey Petrikov, Denis Protsenko, Alexander Solodov, Alexey Shchegolev, Victor Silkin, Alexey Dobrynin, Artem Kuzovlev, Michail Pisarev, Alexander Kulikov","doi":"10.1177/08850666251342731","DOIUrl":"10.1177/08850666251342731","url":null,"abstract":"<p><p><b>Background:</b> Patients with acute severe stroke requiring mechanical ventilation represent a significant clinical challenge. Identification of mortality predictors is necessary to improve outcomes. <b>Methods:</b> Fourteen hospitals located around Russia participated in this prospective multicenter observational clinical study. Patients admitted to ICU between November 1, 2017, and November 1, 2019 with confirmed cerebral stroke, aged 18 to 90 years, and requiring mechanical ventilation were included. The impact of various clinical factors on mortality during the 28-day period after stroke was assessed. <b>Results:</b> A total of 1289 patients were included in the registry, and 1144 met the study criteria. The 28-day mortality rate for stroke patients on mechanical ventilation was 64.3%. The most common indications for mechanical ventilation were impaired consciousness (75.7%) and hypoxemia (60.9%). In the cohort of strokes with NIHSS severity greater than 20 points, hypoxemia at the start of ventilation (OR 1.85 [1.21; 2.81], P = 0.004) and the use of hyperventilation mode (OR 1.46 [1.02; 2.06], P = 0.0336) were associated with increased mortality. Pressure-controlled mode as the primary ventilation method (OR 0.36 [0.21; 0.60], P < 0.001) and ICP monitoring (OR 0.23 [0.12; 0.44], P < 0.001) were associated with decreased mortality. Infectious complications were associated with longer mechanical ventilation and ICU stay (P < 0.001). The relationship between probable mortality and the severity of neurological deficit on the NIHSS scale at the start of mechanical ventilation is non-linear. A critical threshold was reached at 16 points NIHSS, where a trend of increasing probable mortality emerged. <b>Conclusion:</b> The identified predictors of mortality in stroke patients requiring mechanical ventilation are essential for decision-making in this cohort. They include hypoxemia, hyperventilation (used to control intracranial hypertension), volume-controlled (VC) versus pressure-controlled (PC) initial ventilation, and the use of clinical methods for monitoring ICP alone versus invasive monitoring.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1169-1176"},"PeriodicalIF":2.1,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144317087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Mortality After Convulsive Status Epilepticus: The Status Epilepticus M³A²S²H Score.","authors":"Fawaz Al-Mufti, Smit D Patel, Jonathan Ogulnick, Ariel Sacknovitz, Ankita Jain, Eris Spirollari, Keshav Raghavendran, Leah Blowes, Bridget Nolan, Jessica Bloomfield, Sanjana Marikunte, Galadu Subah, Eric Feldstein, Anaz Uddin, Rolla Nuoman, Jon Rosenberg, Andrew Bauerschmidt, Philip Overby, Venkat Ramani, Steven M Wolf, Tracey Milligan, Manisha Holmes, Chirag D Gandhi, Mill Etienne, Stephan A Mayer","doi":"10.1177/08850666251331925","DOIUrl":"10.1177/08850666251331925","url":null,"abstract":"<p><p>PurposeThis study aimed to investigate in-patient mortality and predictors of death associated with convulsive status epilepticus (CSE) in a large nationwide cohort and create a simplified predictive score for in-hospital mortality.MethodsRetrospective data from the National Inpatient Sample (NIS) database between 2007 and 2014 were analyzed, including 123,082 adults with CSE. Univariate logistic testing identified admission variables, neurological and medical complications associated with mortality. A simplified clinical prediction score, called M³A²S²H, was generated using variables that were frequent (>1%) and had a significant impact on mortality.ResultsThe overall hospital mortality rate was 3.5%. Univariate analysis revealed that older age, female gender, past medical history, and acute hospital conditions were related to mortality. After reclassification, a final multivariable model with 27 clinical variables was constructed, and the eight strongest predictors were included in the M³A²S²H score: hypoxic-ischemic encephalopathy/cardiac arrest (2 points); age >60 years, acute symptomatic CSE, invasive mechanical ventilation, sepsis, metastases, and chronic liver failure (all 1 point); and medication nonadherence (-1 point). The mortality rate among patients with ≤0, 1, 2, 3, 4, or ≥5 of these risk factors progressively increased from 0.2%, 2.1%, 7.8%, 20.3%, 31.9%, to 50.0% (P < 0.0001). Additionally, a similar stepwise trend was observed regarding discharge to a facility versus home without services (P < 0.0001).ConclusionsThis study demonstrates that mortality in CSE cases occurs in 3.5% of adult hospital admissions. Identification of specific acute and chronic conditions using the standardized M³A²S²H score can help predict the risk of death or disability even in hospitals without advanced brain monitoring.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1052-1059"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Review of Tracheal Intubation of Obstetrical Patients, Incidence and Associated Factors.","authors":"Ryan J Keneally, Laura M Roland, Eric R Heinz, Jonathan M Wainblat, Andrew B Canonico, Marshall Lawler, Bhiken I Naik, Mohamed Tiouririne, Michael A Mazzeffi","doi":"10.1177/08850666251339467","DOIUrl":"10.1177/08850666251339467","url":null,"abstract":"<p><p><b>Introduction:</b> Tracheal intubation (TI) of an obstetrical patient around the time of delivery can be an upsetting event for involved providers. It can also cause an unpredictable use of intensive care resources. Its incidence is currently poorly characterized in the literature. We analyzed the 2019 National Inpatient Sample (NIS) to assess the incidence rate and associated risk factors. <b>Methods:</b> Patients were identified by International Classification of Diseases, 10th edition codes for delivery of a child. Measured endpoints were the incidence of TI and factors associated. Categorical variables were compared using Chi squared or Fisher's Exact. Continuous variables were compared using the Student T-test or the Mann Whitney rank sum U-test. A logistic regression model was created to determine the odds for each variable contributing to TI. A P value of 0.05 was considered the minimum standard for significance. <b>Results:</b> There was a low rate of TI (0.03%). Mortality was rare (0.004%) and there was a higher rate of mortality among patients who underwent tracheal intubation (5.5% vs 0.003% among patients not intubated, <i>P</i> < .001). The majority of intubations occurred among patients who delivered via CD. Pneumonia, cardiomyopathy, eclampsia, and postpartum hemorrhage were all independently associated with increased odds for TI. <b>Conclusions:</b> There are risk factors which may increase the likelihood for tracheal intubation. The diagnosis of a cardiomyopathy was strongly associated with an increased odds for TI and may result from acute respiratory failure. PPH and eclampsia were also associated with a greater odds for intubation.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1077-1080"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Appropriateness of Care in the ICU: A Case-Based Application of the Fourfold Assessment.","authors":"Katerina Rusinova, Louis Voigt, Andrej Michalsen","doi":"10.1177/08850666251352456","DOIUrl":"10.1177/08850666251352456","url":null,"abstract":"<p><p>PurposeAppropriateness of care is a fundamental yet often underexamined aspect of critical care medicine. Drawing on Kant's notion of appropriateness as providing \"no more and no less than the matter requires,\" we explore how clinicians can align medical indication with patient or surrogate consent. Misalignments in this regard may result in overtreatment or undertreatment, contributing to moral distress, burnout, and dissatisfaction among families and clinicians.MethodsWe present a case report of an elderly patient whose clinical course in the intensive care unit (ICU) traverses all four quadrants of a proposed framework-the Fourfold Table of Appropriateness. This conceptual tool classifies medical interventions according to two dimensions: medical indication (yes/no) and patient or surrogate consent (yes/no). Each quadrant is associated with ethical and clinical implications and is color-coded like a traffic light to support real-time decision-making: green (appropriate), yellow (caution), red (stop).ResultsThe case illustrates how alignment between indication and consent fosters goal-concordant care. It also demonstrates how therapeutic obstinance, paternalism, or emotionally driven demands may lead to inappropriate care. Each episode reveals different challenges-physician biases, surrogate distress, unclear prognoses-and highlights the role of communication, shared decision-making, and clinical humility.ConclusionThe Fourfold Table provides a didactic framework to guide structured reflection among ICU clinicians. By naming and examining patterns of inappropriateness, it fosters ethical awareness and better communication practices. This case-based approach highlights the necessity of early recognition of misalignments, the importance of addressing emotional and cognitive biases, and the value of interventions such as time-limited trials and family-centered care. Ultimately, this framework contributes to more compassionate, appropriate, and goal-aligned critical care.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1096-1100"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Documenting Pediatric Delirium During Transitions of Care: A Single Site Observational Study.","authors":"Matthew S Hazle, Gabrielle Horner, Melissa Ross, Harlan McCaffery, Nasuh Malas, Erin F Carlton, Emily Jacobson","doi":"10.1177/08850666251339457","DOIUrl":"10.1177/08850666251339457","url":null,"abstract":"<p><p>BackgroundDelirium is a common complication of illness. Patients who experience delirium are at risk for worse outcomes during and after hospitalization. This study aims to describe rates of, and factors associated with, delirium documentation during care transitions for patients who screened positive for delirium in the pediatric intensive care unit (PICU) at transfer to the pediatric hospital medicine (PHM) service and discharge.MethodsDemographic and clinical characteristics were collected retrospectively on patients ages 0-21 years, without developmental delay, who screened positive via Cornell Assessment of Pediatric Delirium (CAPD) before transferring from PICU to PHM service of a tertiary-care children's hospital from 2016-2022. Primary outcomes were documentation of \"delirium\" at PICU transfer and hospital discharge. Statistical analysis included bivariate analysis and multivariate logistic regression.ResultsOf 337 encounters, 66 transfer (20%) and 62 discharge notes (18%) documented delirium. On bivariate analysis, older age, female sex, Hispanic ethnicity, prolonged and elevated CAPD scoring, longer PICU and hospital length of stay, mechanical ventilation (MV), and psychiatry consultation were associated with documentation at transfer. On logistic regression, Black race decreased odds (OR 0.275, 95% CI 0.08-0.84) while psychiatry consultation (OR 66.82, 24.45-212.25) and invasive MV (OR 6.495, 2.13-22.34) increased odds of documentation. Discharge documentation demonstrated similar associations, except sex and ethnicity were not associated, while neurology consultation was positively associated with documentation. On logistic regression, psychiatry consultation (OR 36.01, 14.51-100.71) and invasive MV (OR 2.96, 1.09-8.83) increased odds of documentation at discharge.ConclusionsDespite a validated screening tool, pediatric providers often fail to document delirium at PICU transfer and hospital discharge. Lack of documentation may leave patients and families at risk for worse outcomes.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1081-1088"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk Factors of Intensive Care Unit-acquired Weakness in Patients With COVID-19: A Systematic Review and Meta-analysis.","authors":"Ya-Chi Chuang, Sz-Iuan Shiu, Yu-Chun Lee, Yu-Lin Tsai, Yuan-Yang Cheng","doi":"10.1177/08850666241268437","DOIUrl":"10.1177/08850666241268437","url":null,"abstract":"<p><p>BackgroundIntensive care unit acquired weakness (ICUAW) is a common neuromuscular complication of critical illness, impacting patients' recovery and long-term outcomes. However, limited evidence is available on pooled prevalence and risk factors of ICUAW specifically in the COVID-19-infected population.MethodsWe searched on PubMed, Embase, Cochrane Library, Web of Science, PEDro, and EBSCOhost/CINAHL up to January 31, 2024. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and odds ratios with corresponding 95% confidence intervals was used to identify risk factors.ResultsThe pooled prevalence of ICUAW in COVID-19 patients was 55% in eight studies on 868 patients. Risk factors for developing ICUAW in these patients were: old age (WMD 4.78, 95% CI, 1.06-8.49), pre-existing hypertension (OR = 1.63, 95% CI, 1.02-2.61), medical intervention of prone position (OR = 5.21, 95% CI, 2.72-9.98), use of neuromuscular blocking agents (NMBA) (OR = 12.04, 95% CI, 6.20-23.39), needed tracheostomy (OR = 18.07, 95% CI, 5.64-57.92) and renal replacement therapy (RRT) (OR = 5.24, 95% CI = 2.36-11.63).ConclusionsThe prevalence of ICUAW in patients with COVID-19 was considered relatively high. Older age, pre-existing hypertension, medical intervention of prone position, NMBA use, needed tracheostomy and RRT were likely risk factors. In the future, interdisciplinary medical team should pay attention to high-risk groups for ICUAW prevention and early treatments.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1042-1051"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Part 2: Current Concepts in Radiologic Imaging & Intervention in Acute Biliary Tract Diseases.","authors":"Easton Neitzel, Owais Salahudeen, Peter R Mueller, Avinash Kambadakone, Shravya Srinivas-Rao, Eric vanSonnenberg","doi":"10.1177/08850666241259420","DOIUrl":"10.1177/08850666241259420","url":null,"abstract":"<p><p>Acute cholangitis is encountered commonly in critically ill, often elderly, patients. The most common causes of cholangitis include choledocholithiasis, biliary strictures, and infection from previous endoscopic, percutaneous, or surgical intervention of the biliary tract. Rare causes of acute cholangitis in the United States include sclerosing cholangitis and recurrent pyogenic cholangitis, the latter predominantly occurring in immigrants of Asian descent. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, gastroenterologists, endoscopists, and infectious disease physicians typically involved in the care of these patients. In this paper intended for intensivists predominantly, we will review the imaging findings and radiologic interventional management of critically ill patients with acute cholangitis, primary and secondary sclerosing cholangitis, and recurrent pyogenic cholangitis.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1003-1012"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Value of Hepcidin in Sepsis: A Systematic Review and Meta-Analysis.","authors":"Jingxiao Zhang, Zhifang Zheng, Lei Ren, Chenhong Wang, Yue Li, Xidan Hu, Jie Zhang, Xiaoqing Jing, Yuzi Jin","doi":"10.1177/08850666241267261","DOIUrl":"10.1177/08850666241267261","url":null,"abstract":"<p><p><b>Objectives:</b> To investigate the diagnostic value of hepcidin for sepsis diagnosis. <b>Methods:</b> The relevant literature on hepcidin for sepsis diagnosis published up to October 20, 2023, was systematically searched in the Web of Science, PubMed, Embase, and China Knowledge Network databases. Two researchers screened the literature and extracted relevant data according to the inclusion and exclusion criteria. Study quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis and calculation of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were performed using State16 and Review Manager 5.3 software. Furthermore, receiver operating characteristic curve (ROC) was plotted, and the respective area under the curve (AUC) was calculated to assess the accuracy of hepcidin. Publication bias was evaluated using Deeks' funnel plot asymmetry test. <b>Results:</b> Overall, 1047 patients from 8 studies were included (625 patients with sepsis and 422 controls). The quality of the literature was relatively moderate. Meta-analysis demonstrated the presence of heterogeneity in the data (<i>I</i>²<i> </i>> 50%, <i>P </i>< .05), and a randomized model was employed to combine the diagnostic indicators. Regarding its accuracy for sepsis diagnosis, hepcidin demonstrated a pooled sensitivity of 0.88 (95% confidence interval [CI]: 0.76-0.94) and specificity of 0.91 (95% CI: 0.76-0.97). The diagnostic odds ratio was 69.00 (95% CI: 19.00-253.00), and the ROC curve revealed an AUC of 0.95. Additionally, Deeks' funnel plot asymmetry test demonstrated absence of publication bias. <b>Conclusions:</b> Our meta-analysis suggested that hepcidin has a high diagnostic value in sepsis and may be a valuable diagnostic tool.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1023-1032"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Venous Thrombosis in Traumatic Brain Injury: A Population-Based Cross-Sectional Study of 640 Patients.","authors":"Ankita Jain, Michael Fortunato, Bridget Nolan, Sahdev S Baweja, Galadu Subah, Sima Vazquez, Candice Dyce, Andy Jiang, Eris Spirollari, Ariel Sacknovitz, Chirag D Gandhi, Fawaz Al-Mufti","doi":"10.1177/08850666251331522","DOIUrl":"10.1177/08850666251331522","url":null,"abstract":"<p><p>BackgroundCerebral venous thrombosis (CVT) is a rare but serious complication of traumatic brain injury (TBI), yet the implications of this association remain poorly understood. This study explores the demographics, risk factors, and clinical outcomes of patients with both TBI and CVT (CVT-TBI).MethodsThe National Inpatient Sample (NIS) was queried from 2016-2020 for adult patients with a primary diagnosis of TBI and concurrent CVT. Chi-squared tests and logistic regression were used to compare demographic, clinical, and outcome variables of CVT-TBI and TBI-only patients.ResultsOf the 1,583,915 TBI patients identified between 2016-2020, 640 (0.04%) had concurrent CVT. CVT-TBI patients were younger (47.94 vs 61.81; p < 0.001), more likely to have Medicaid (30.5% vs 14.1%; p < 0.001), less likely to be female (31.3% vs 39.0%; p < 0.001), and less likely to be Caucasian (60.9% vs 68.1%; p < 0.001). Multivariate analysis demonstrated age (OR = 0.98; p < 0.001), skull fracture (OR = 3.741; p < 0.001), epidural hematoma (OR = 1.407; p = 0.012), subdural hematoma (OR = 2.395; p < 0.001), and subarachnoid hemorrhage (OR = 1.415; p < 0.001) as CVT risk factors. CVT-TBI patients experienced more severe clinical courses involving mechanical ventilation (21.9% vs 10.4%; p < 0.001), cerebral herniation (6.3% vs 3.7%; p = 0.001), and being comatose (45.3% vs 30.7%; p < 0.001) and were more likely to undergo decompressive hemicraniectomy (4.7% vs 1.1%; p < 0.001), tracheostomy or percutaneous endoscopic gastrostomy tube placement (3.9% vs 1.5%; p < 0.001), and develop long-term sequelae, including seizures (10.9% vs 4.2%; p < 0.001) and hydrocephalus (7.0% vs 1.7%; p < 0.001). After matching, there was a significant difference in discharge home (OR = 1.806; p = 0.018), but no significant difference in discharge to a skilled nursing home (OR = 1.068; p = 0.449), short term rehabilitation facility (OR = 0.850; p = 0.500), or inpatient mortality (OR = 1.134; p = 0.500).ConclusionsThis population-based retrospective analysis unveils distinctive demographic and clinical features of CVT-TBI patients, emphasizing the need for tailored risk assessment and management strategies to improve outcomes for this subset of TBI patients.</p>","PeriodicalId":16307,"journal":{"name":"Journal of Intensive Care Medicine","volume":" ","pages":"1060-1066"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}