Introduction: Secondary insults (SI) occur frequently after traumatic brain injury (TBI). Their presence is associated with a worse outcome. We examined the early trajectories of hypotension (SBP<90mmHg), hypoxia (SpO2<90%) and pupillary abnormalities from the prehospital settings to the Emergency Department (ED), and their relationship with 6-months outcome. Methods: In this retrospective, observational study we included all TBI patients admitted to our Neuro Intensive Care Unit (NICU) from January 1997 to December 2016. We defined the trajectories of SI: – "sustained" if present on the scene of accident and at hospital admission, – "resolved" if present on the scene but resolved in ED, – "new event" if absent on the scene and present in ED, – "none" if no insults were recorded. We investigated the association of SI trajectories with 6-months dichotomized outcome (Glasgow Outcome Scale (GOS); favorable=4-5; unfavorable=1-3). Results: 967 patients were enrolled in the final analysis. Hypoxia and hypotension were related with unfavourable outcome when sustained (70.6% and 78.8%) and resolved (59.3% and 58.8%) while pupillary abnormalities were associated with unfavourable outcome when sustained and new events (65% and 66.7%). Results are summarized in the two figures below. Conclusions: Trajectories could better define the dynamic and the burden of SI and their impact on outcome of TBI patients. Early treatments can influence evolution of SI and improve outcome.

Volpi, P., Robba, C., Rota, M., Vargiolu, A., Citerio, G. (2018). Trajectories of early secondary insults after traumatic brain injury: a new approach to evaluate impact on outcome. CRITICAL CARE, 22(Suppl 1).

Trajectories of early secondary insults after traumatic brain injury: a new approach to evaluate impact on outcome

Volpi, PC
Primo
;
Rota, M;Vargiolu, A
Penultimo
;
Citerio G
Ultimo
2018

Abstract

Introduction: Secondary insults (SI) occur frequently after traumatic brain injury (TBI). Their presence is associated with a worse outcome. We examined the early trajectories of hypotension (SBP<90mmHg), hypoxia (SpO2<90%) and pupillary abnormalities from the prehospital settings to the Emergency Department (ED), and their relationship with 6-months outcome. Methods: In this retrospective, observational study we included all TBI patients admitted to our Neuro Intensive Care Unit (NICU) from January 1997 to December 2016. We defined the trajectories of SI: – "sustained" if present on the scene of accident and at hospital admission, – "resolved" if present on the scene but resolved in ED, – "new event" if absent on the scene and present in ED, – "none" if no insults were recorded. We investigated the association of SI trajectories with 6-months dichotomized outcome (Glasgow Outcome Scale (GOS); favorable=4-5; unfavorable=1-3). Results: 967 patients were enrolled in the final analysis. Hypoxia and hypotension were related with unfavourable outcome when sustained (70.6% and 78.8%) and resolved (59.3% and 58.8%) while pupillary abnormalities were associated with unfavourable outcome when sustained and new events (65% and 66.7%). Results are summarized in the two figures below. Conclusions: Trajectories could better define the dynamic and the burden of SI and their impact on outcome of TBI patients. Early treatments can influence evolution of SI and improve outcome.
Abstract in rivista
traumatic brain injury; secondary insults; hypoxia; hypotension; outcome
English
21-mar-2018
2018
22
Suppl 1
P379
none
Volpi, P., Robba, C., Rota, M., Vargiolu, A., Citerio, G. (2018). Trajectories of early secondary insults after traumatic brain injury: a new approach to evaluate impact on outcome. CRITICAL CARE, 22(Suppl 1).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/193058
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