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Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury
Background: In the acute resuscitation period after traumatic brain injury (TBI), one of the goals is to identify those at risk for secondary neurological decline (ND), represented by a constellation of clinical signs that can be identified as objective events related to secondary brain injury and i...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167472/ https://www.ncbi.nlm.nih.gov/pubmed/30319521 http://dx.doi.org/10.3389/fneur.2018.00761 |
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author | Melinosky, Christopher Yang, Shiming Hu, Peter Li, HsiaoChi Miller, Catriona H. T. Khan, Imad Mackenzie, Colin Chang, Wan-Tsu Parikh, Gunjan Stein, Deborah Badjatia, Neeraj |
author_facet | Melinosky, Christopher Yang, Shiming Hu, Peter Li, HsiaoChi Miller, Catriona H. T. Khan, Imad Mackenzie, Colin Chang, Wan-Tsu Parikh, Gunjan Stein, Deborah Badjatia, Neeraj |
author_sort | Melinosky, Christopher |
collection | PubMed |
description | Background: In the acute resuscitation period after traumatic brain injury (TBI), one of the goals is to identify those at risk for secondary neurological decline (ND), represented by a constellation of clinical signs that can be identified as objective events related to secondary brain injury and independently impact outcome. We investigated whether continuous vital sign variability and waveform analysis of the electrocardiogram (ECG) or photoplethysmogram (PPG) within the first hour of resuscitation may enhance the ability to predict ND in the initial 48 hours after traumatic brain injury (TBI). Methods: Retrospective analysis of ND in TBI patients enrolled in the prospective Oximetry and Noninvasive Predictors Of Intervention Need after Trauma (ONPOINT) study. ND was defined as any of the following occurring in the first 48 h: new asymmetric pupillary dilatation (>2 mm), 2 point GCS decline, interval worsening of CT scan as assessed by the Marshall score, or intervention for cerebral edema. Beat-to-beat variation of ECG or PPG, as well as waveform features during the first 15 and 60 min after arrival in the TRU were analyzed to determine physiologic parameters associated with future ND. Physiologic and admission clinical variables were combined in multivariable logistic regression models predicting ND and inpatient mortality. Results: There were 33 (17%) patients with ND among 191 patients (mean age 43 years old, GCS 13, ISS 12, 69% men) who met study criteria. ND was associated with ICU admission (P < 0.001) and inpatient mortality (P < 0.001). Both ECG (AUROC: 0.84, 95% CI: 0.76,0.93) and PPG (AUROC: 0.87, 95% CI: 0.80, 0.93) analyses during the first 15 min of resuscitation demonstrated a greater ability to predict ND then clinical characteristics alone (AUROC: 0.69, 95% CI: 0.59, 0.8). Age (P = 0.02), Marshall score (P = 0.001), penetrating injury (P = 0.02), and predictive probability for ND by PPG analysis at 15 min (P = 0.03) were independently associated with inpatient mortality. Conclusions: Analysis of variability and ECG or PPG waveform in the first minutes of resuscitation may represent a non-invasive early marker of future ND. |
format | Online Article Text |
id | pubmed-6167472 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-61674722018-10-12 Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury Melinosky, Christopher Yang, Shiming Hu, Peter Li, HsiaoChi Miller, Catriona H. T. Khan, Imad Mackenzie, Colin Chang, Wan-Tsu Parikh, Gunjan Stein, Deborah Badjatia, Neeraj Front Neurol Neurology Background: In the acute resuscitation period after traumatic brain injury (TBI), one of the goals is to identify those at risk for secondary neurological decline (ND), represented by a constellation of clinical signs that can be identified as objective events related to secondary brain injury and independently impact outcome. We investigated whether continuous vital sign variability and waveform analysis of the electrocardiogram (ECG) or photoplethysmogram (PPG) within the first hour of resuscitation may enhance the ability to predict ND in the initial 48 hours after traumatic brain injury (TBI). Methods: Retrospective analysis of ND in TBI patients enrolled in the prospective Oximetry and Noninvasive Predictors Of Intervention Need after Trauma (ONPOINT) study. ND was defined as any of the following occurring in the first 48 h: new asymmetric pupillary dilatation (>2 mm), 2 point GCS decline, interval worsening of CT scan as assessed by the Marshall score, or intervention for cerebral edema. Beat-to-beat variation of ECG or PPG, as well as waveform features during the first 15 and 60 min after arrival in the TRU were analyzed to determine physiologic parameters associated with future ND. Physiologic and admission clinical variables were combined in multivariable logistic regression models predicting ND and inpatient mortality. Results: There were 33 (17%) patients with ND among 191 patients (mean age 43 years old, GCS 13, ISS 12, 69% men) who met study criteria. ND was associated with ICU admission (P < 0.001) and inpatient mortality (P < 0.001). Both ECG (AUROC: 0.84, 95% CI: 0.76,0.93) and PPG (AUROC: 0.87, 95% CI: 0.80, 0.93) analyses during the first 15 min of resuscitation demonstrated a greater ability to predict ND then clinical characteristics alone (AUROC: 0.69, 95% CI: 0.59, 0.8). Age (P = 0.02), Marshall score (P = 0.001), penetrating injury (P = 0.02), and predictive probability for ND by PPG analysis at 15 min (P = 0.03) were independently associated with inpatient mortality. Conclusions: Analysis of variability and ECG or PPG waveform in the first minutes of resuscitation may represent a non-invasive early marker of future ND. Frontiers Media S.A. 2018-09-25 /pmc/articles/PMC6167472/ /pubmed/30319521 http://dx.doi.org/10.3389/fneur.2018.00761 Text en Copyright © 2018 Melinosky, Yang, Hu, Li, Miller, Khan, Mackenzie, Chang, Parikh, Stein and Badjatia. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Melinosky, Christopher Yang, Shiming Hu, Peter Li, HsiaoChi Miller, Catriona H. T. Khan, Imad Mackenzie, Colin Chang, Wan-Tsu Parikh, Gunjan Stein, Deborah Badjatia, Neeraj Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury |
title | Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury |
title_full | Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury |
title_fullStr | Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury |
title_full_unstemmed | Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury |
title_short | Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury |
title_sort | continuous vital sign analysis to predict secondary neurological decline after traumatic brain injury |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6167472/ https://www.ncbi.nlm.nih.gov/pubmed/30319521 http://dx.doi.org/10.3389/fneur.2018.00761 |
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