Are Initial Radiographic and Clinical Scales Associated With Subsequent Intracranial Pressure and Brain Oxygen Levels After Severe Traumatic Brain Injury
Katsnelson M et al. – Following severe traumatic brain injury (TBI), factors associated with outcome may not always predict a patient's intensive care unit (ICU) course and, in particular, intracranial physiology.Methods
- One hundred one patients (median age, 41.0 years; interquartile range [26-55]) with severe TBI who had ICP and PbtO2 monitoring were identified.
- The relationship between admission GCS, ISS, APACHE II, Marshall and Rotterdam scores and ICP, PbtO2, and outcome was examined by using mixed-effects models and logistic regression.
- Median (25%–75% interquartile range) admission GCS and APACHE II without GCS scores were 3.0 (3-7) and 11.0 (8-13), respectively.
- Marshall and Rotterdam scores were 3.0 (3-5) and 4.0 (4-5).
- Mean ICP and PbtO2 during the patients' ICU course were 15.5 ± 10.7 mm Hg and 29.9 ± 10.8 mm Hg, respectively.
- Three-month mortality was 37.6%.
- Admission GCS was not associated with mortality.
- APACHE II (P=.003), APACHE-non-GCS (P=.004), Marshall (P<.001), and Rotterdam scores (P < .001) were associated with mortality.
- No relationship between GCS, ISS, Marshall, or Rotterdam scores and subsequent ICP or PbtO2 was observed.
- The APACHE II score was inversely associated with median PbtO2 (P=.03) and minimum PbtO2 (P=.008) and had a stronger correlation with amount of time of reduced PbtO2.