Are initial radiographic and clinical scales associated with subsequent intracranial pressure and brain oxygen levels after severe traumatic brain injury?

Michael Katsnelson, Larami MacKenzie, Suzanne Frangos, Mauro Oddo, Joshua M. Levine, Bryan Pukenas, Jennifer Faerber, Chuanhui Dong, W. Andrew Kofke, Peter D. Le Roux

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

BACKGROUND: Prediction of clinical course and outcome after severe traumatic brain injury (TBI) is important. OBJECTIVE: To examine whether clinical scales (Glasgow Coma Scale [GCS], Injury Severity Score [ISS], and Acute Physiology and Chronic Health Evaluation II [APACHE II]) or radiographic scales based on admission computed tomography (Marshall and Rotterdam) were associated with intensive care unit (ICU) physiology (intracranial pressure [ICP], brain tissue oxygen tension [PbtO2]), and clinical outcome after severe TBI. 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. RESULTS: 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. CONCLUSION: Following severe TBI, factors associated with outcome may not always predict a patient's ICU course and, in particular, intracranial physiology.

Original languageEnglish (US)
Pages (from-to)1095-1105
Number of pages11
JournalNeurosurgery
Volume70
Issue number5
DOIs
StatePublished - May 1 2012

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Keywords

  • Acute Physiology and Chronic Health Evaluation
  • Brain tissue oxygen tension
  • Computed tomography
  • Glasgow Coma Scale
  • Injury Severity Score
  • Intracranial pressure
  • Marshall CT classification
  • Rotterdam CT Score
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Katsnelson, M., MacKenzie, L., Frangos, S., Oddo, M., Levine, J. M., Pukenas, B., Faerber, J., Dong, C., Andrew Kofke, W., & Le Roux, P. D. (2012). Are initial radiographic and clinical scales associated with subsequent intracranial pressure and brain oxygen levels after severe traumatic brain injury? Neurosurgery, 70(5), 1095-1105. https://doi.org/10.1227/NEU.0b013e318240c1ed