Jugular bulb oxygen saturation correlates with Full Outline of Responsiveness score in severe traumatic brain injury patients

Abstract

BackgroundMaintaining brain oxygenation status is the main goal of treatment in severe traumatic brain injury (TBI). Jugular venous oxygen saturation (SjvO2) monitoring is a technique to estimate global balance between cerebral oxygen supply and its metabolic requirement. Full Outline of Responsiveness (FOUR) score, a new consciousness measurement scoring, is expected to become an alternative for Glasgow Coma Scale (GCS) in evaluating neurologic status of patients with severe traumatic head injury, especially for those under mechanical ventilation.MethodsA total of 63 patients with severe TBI admitted to emergency department (ED) were included in this study. SjvO2 sampling was taken every 24 hours, until 72 hours after arrival. The assessment of FOUR score was conducted directly after each blood sample for SjvO2 was taken. Spearman’s rank correlation was used to determine the correlation between SjvO2 and FOUR score. Regression analysis was used to determine mortality predictors.ResultsFrom the 63 patients, a weak positive correlation between SjvO2 and FOUR score (r=0.246, p=0.052) was found upon admission. Meanwhile, strong and moderate negative correlation values were found in 48 hours (r=−0.751, p<0.001) and 72 hours (r=−0.49, p=0.002) after admission. Both FOUR score (p<0.001) and SjvO2 (p=0.04) were found to be independent mortality predictors in severe TBI.ConclusionThere was a negative correlation between the value of SjvO2 and FOUR score at 48 and 72 hours after admission. Both SjvO2 and FOUR score are independent mortality predictors in severe TBI.

The Relationship of the FOUR Score to Patient Outcome: A Systematic Review

“…Of these studies, 25 described in-hospital mortality 7,14,23,24,29,33,35,36,38–41,15,42,45–47,49,16–22 as the end point, 5 investigated mortality only up to 2 weeks post-event, 25,26,28,37,38 and 11 studies explored longer-term mortality up to 3–6 months. 14,25,52,26,30–32,34,42,44,45 The mortality rate between included studies varied widely—from 7.8% 36 to 70% 28 —among studies where FOUR score was assessed within 24 h of admission. Studies using later time points of FOUR score assessment reported mortality within the above range (Supplementary Table S3).…”

“…Seventeen studies used logistic regression to model dependence of survival on FOUR score 7,14,37,41,42,45–47,49,16,17,19,21,22,24,35,36 ; one with overall low risk of bias 14 and five studies are deemed high risk, 16,17,21,37,42 whereas the 11 remaining studies have moderate risk of bias. These studies identified that for every 1-point increase in total FOUR score, the unadjusted odds ratio of in-hospital mortality ranged between 0.93 42 and 0.59, 19 indicating reduction in odds of mortality by 7% to 41% per 1-point increase in FOUR score. Two studies utilized 3-month mortality as the dependent variable and demonstrated odds of 3-month mortality per increase in total FOUR score of 0.69 in one unadjusted model 45 and 0.64 in another model after adjustment for age, sex, blood pressures, respiration rate, alcohol, hypoglycemia, and trauma.…”

<p>Hyperbaric oxygen therapy attenuates neuronal apoptosis induced by traumatic brain injury via Akt/GSK3&beta;/&beta;-catenin pathway</p>

“…Traumatic brain injury (TBI) is a growing public health problem in the world and the leading cause of death in Chinese adults aged <40 years 1. Oxygen supply to the brain is often insufficient after TBI, and then results in decreased energy production, which leads to neuronal apoptosis 2. Therefore, maintaining brain-oxygenation status is the main goal of treatment for TBI 3.…”

Efficacy of Simultaneous Administration of Nimodipine, Progesterone, and Magnesium Sulfate in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial

“…SjvO2 in TBI has been shown to be a determinant in outcome. Previously, strong positive correlation between SjvO2 and prognosis and GCS was shown [36, 37], similarly, negative correlation with Full Outline of Responsiveness score has been revealed [35]. Although Aslan et al .…”

“…Vasospasm, hyperventilation, fever, seizure, reduced cerebral perfusion pressure and increased cerebral metabolic requirement of oxygen are among causes to decrease SjvO2 values. On the other hand, decreased cerebral metabolism requirement (due to cell death or mitochondrial dysfunction), hyperemia condition, and microvascular shunting due to oxygen extraction and diffusion disturbance on the damaged brain tissue can increase SjvO2 [34, 35]. SjvO2 in TBI has been shown to be a determinant in outcome.…”