Brain Death After Severe Traumatic Brain Injury: The Role of Systemic Secondary Brain Insults

Sánchez-Olmedo, José Ignacio; Flores-Cordero, J.M.; Rincón-Ferrari, M.D.; Pérez-Alé, M.; Muñoz-Sánchez, M.Á.; Domínguez-Roldán, José María; Murillo-Cabezas, Francisco

doi:10.1016/j.transproceed.2005.03.048

Cited by 33 publications

(18 citation statements)

References 8 publications

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“…This relation was not observed in other studies, and assessment of platelet function is considered more relevant than the actual platelet count (Jacoby et al, 2001). Decreased Hb has also been shown to be associated with poorer outcome (Sanchez-Olmedo et al, 2005). The presence of hypotension is an important systemic secondary insult (Miller et al, 1978) and strongly related to poorer outcome (Chesnut et al, 1993;Schreiber et al, 2002;Manley et al, 2001), although the relative prognostic value of decreased Hb and platelet levels in relation to hypotension or to the actual levels of systolic blood pressure has not been reported.…”

Section: Introductionmentioning

confidence: 80%

“…Abnormally low Hb values were observed in a substantial number of patients (17%) and associated with other parameters (e.g., hypotension). Anemia is a common problem in critically ill patients and its association to poorer outcome documented for many disease entities (du Cheyron et al, 2005;Hebert et al, 1997) including TBI (Sanchez-Olmedo et al, 2005).…”

Section: Hemoglobinmentioning

confidence: 99%

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Prognostic Value of Admission Laboratory Parameters in Traumatic Brain Injury: Results from The IMPACT Study

Beek

Mushkudiani²,

Steyerberg³

et al. 2007

Journal of Neurotrauma

207

146

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Abnormalities in laboratory parameters are frequent following traumatic brain injury (TBI), but few studies have investigated their predictive value. We aimed to describe and quantify the relation between laboratory parameters that are routinely determined on admission and final outcome following TBI. Individual patient data were available in the IMPACT database from six Phase III randomized controlled trials and one observational study in TBI. We studied glucose (N = 4834), sodium ( N = 5270), pH ( N = 3398), hemoglobin (Hb, N = 3875), platelet count ( N = 1629), and prothrombin time (PT; N = 840) for their associations with outcome at 6 months (Glasgow Outcome Scale [GOS]). We used logistic regression models with linear, quadratic, and restricted cubic spline functions. The strength of the associations was expressed as an unadjusted odds ratio, calculated over the shift in outcome between the 25th and 75th percentiles. Proportional odds methodology was further applied to quantify the strength of the associations across the full range of the GOS. All parameters were consistently associated with outcome in a continuous relationship: glucose and prothrombin time showed a positive linear relation to outcome (i.e., increasing values associated with poorer outcome) and Hb, platelets, and pH an inverse linear relation (i.e., low values associated with poorer outcome). Sodium demonstrated a U-shaped relation to outcome, with low levels being more strongly related to poorer outcome. Effects were strongest for increasing levels of glucose (odds ratio 1.7; 95% CI 1.54-1.83) and decreasing levels of Hb (odds ratio 0.7; CI 0.60-0.78). Higher glucose values were associated with increasing age, but on adjusted analysis, the strength of the association with outcome remained. Whether treatment of abnormal values may improve outcome needs further rigorous study.

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Section: Introductionmentioning

confidence: 80%

Section: Hemoglobinmentioning

confidence: 99%

Prognostic Value of Admission Laboratory Parameters in Traumatic Brain Injury: Results from The IMPACT Study

Beek

Mushkudiani²,

Steyerberg³

et al. 2007

Journal of Neurotrauma

207

146

View full text Add to dashboard Cite

show abstract

“…Studies that analyzed the association of TBI patient characteristics with mortality identified the following factors independently associated with mortality: the Marshall classification in CT (42), severity of the injury measured by CT (43), diffuse head injuries II–IV (44), lower score on the GCS (44, 45), hypotension (43–45), hyperglycemia (45, 46), hypothermia (46), SBP (43, 47), SpO 2 (48), hypoxia (44, 45), shock (45), ICP monitoring (49), a score of 5 on MAIS-Head (47, 49), and a high score in the ISS (43, 45, 47, 49). …”

Section: Discussionmentioning

confidence: 99%

Diffuse Axonal Injury: Epidemiology, Outcome and Associated Risk Factors

et al. 2016

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Diffuse axonal injury (DAI), a type of traumatic injury, is known for its severe consequences. However, there are few studies describing the outcomes of DAI and the risk factors associated with it. This study aimed to describe the outcome for patients with a primary diagnosis of DAI 6 months after trauma and to identify sociodemographic and clinical factors associated with mortality and dependence at this time point. Seventy-eight patients with DAI were recruited from July 2013 to February 2014 in a prospective cohort study. Patient outcome was analyzed using the Extended Glasgow Outcome Scale (GOS-E) within 6 months of the traumatic injury. The mean Injury Severity Score was 35.0 (SD = 11.9), and the mean New Injury Severity Score (NISS) was 46.2 (SD = 15.9). Mild DAI was observed in 44.9% of the patients and severe DAI in 35.9%. Six months after trauma, 30.8% of the patients had died, and 45.1% had shown full recovery according to the GOS-E. In the logistic regression model, the severity variables – DAI with hypoxia, as measured by peripheral oxygen saturation, and hypotension with NISS value – had a statistically significant association with patient mortality; on the other hand, severity of DAI and length of hospital stay were the only significant predictors for dependence. Therefore, severity of DAI emerged as a risk factor for both mortality and dependence.

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“…Secondary insults, representing discrete events that may be monitored for and intervened upon, are predictable, potentially avoidable, and include systemic causes such as hypotension [93,94], hypocarbia, hypercarbia [78,79,95], hypoxia [11,96], hyperthermia [97], and hyperglycemia [98,99]. These insults result in secondary injuries which signify underlying neurological processes related to cellular and molecular mechanisms of injury/ death, including inflammatory responses, impairment of cerebral autoregulation, excitotoxicity, delayed cell death, and BBB breakdown [92].…”

Section: Secondary Insults and Injuriesmentioning

confidence: 99%

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

Udomphorn

Armstead

Vavilala

2008

Pediatric Neurology

132

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Traumatic brain injury is a global health concern and is the leading cause of traumatic morbidity and mortality in children. Despite a lower overall mortality than in adult traumatic brain injury, the cost to society from the sequelae of pediatric traumatic brain injury is very high. Predictors of poor outcome after traumatic brain injury include altered systemic and cerebral physiology, including altered cerebral hemodynamics. Cerebral autoregulation is often impaired following traumatic brain injury and may adversely impact poor outcome. Although altered cerebrovascular hemodynamics early after traumatic brain injury may contribute to disability in children, there is a paucity of information regarding changes in cerebral blood flow and cerebral autoregulation after pediatric traumatic brain injury. In this article, we discuss normal pediatric cerebral physiology and cerebrovascular pathophysiology following pediatric traumatic brain injury.

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Brain Death After Severe Traumatic Brain Injury: The Role of Systemic Secondary Brain Insults

Cited by 33 publications

References 8 publications

Prognostic Value of Admission Laboratory Parameters in Traumatic Brain Injury: Results from The IMPACT Study

Prognostic Value of Admission Laboratory Parameters in Traumatic Brain Injury: Results from The IMPACT Study

Diffuse Axonal Injury: Epidemiology, Outcome and Associated Risk Factors

Cerebral Blood Flow and Autoregulation After Pediatric Traumatic Brain Injury

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