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 Citations (Scopus)

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

Fingerprint

Glasgow Coma Scale
APACHE
Intracranial Pressure
Oxygen
Injury Severity Score
Brain
Intensive Care Units
Mortality
Patient Care
Coma
Traumatic Brain Injury
Logistic Models
Tomography
carbosulfan

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

Are initial radiographic and clinical scales associated with subsequent intracranial pressure and brain oxygen levels after severe traumatic brain injury? / Katsnelson, Michael; MacKenzie, Larami; Frangos, Suzanne; Oddo, Mauro; Levine, Joshua M.; Pukenas, Bryan; Faerber, Jennifer; Dong, Chuanhui; Andrew Kofke, W.; Le Roux, Peter D.

In: Neurosurgery, Vol. 70, No. 5, 01.05.2012, p. 1095-1105.

Research output: Contribution to journalArticle

Katsnelson, M, MacKenzie, L, Frangos, S, Oddo, M, Levine, JM, Pukenas, B, Faerber, J, Dong, C, Andrew Kofke, W & Le Roux, PD 2012, 'Are initial radiographic and clinical scales associated with subsequent intracranial pressure and brain oxygen levels after severe traumatic brain injury?', Neurosurgery, vol. 70, no. 5, pp. 1095-1105. https://doi.org/10.1227/NEU.0b013e318240c1ed
Katsnelson, Michael ; MacKenzie, Larami ; Frangos, Suzanne ; Oddo, Mauro ; Levine, Joshua M. ; Pukenas, Bryan ; Faerber, Jennifer ; Dong, Chuanhui ; Andrew Kofke, W. ; Le Roux, Peter D. / Are initial radiographic and clinical scales associated with subsequent intracranial pressure and brain oxygen levels after severe traumatic brain injury?. In: Neurosurgery. 2012 ; Vol. 70, No. 5. pp. 1095-1105.
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AU - MacKenzie, Larami

AU - Frangos, Suzanne

AU - Oddo, Mauro

AU - Levine, Joshua M.

AU - Pukenas, Bryan

AU - Faerber, Jennifer

AU - Dong, Chuanhui

AU - Andrew Kofke, W.

AU - Le Roux, Peter D.

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N2 - 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.

AB - 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.

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