Prediction of Early Intracranial Hypertension After Severe Traumatic Brain Injury: A Prospective Study

被引:14
|
作者
Martin, Mathieu [1 ]
Lobo, David [1 ]
Bitot, Valerie [1 ]
Couffin, Severine [1 ]
Escalard, Simon [2 ,3 ]
Mounier, Roman [1 ]
Cook, Fabrice [1 ]
机构
[1] Paris Est Creteil Univ, Surg Intens Care Unit, Trauma Ctr, Dept Anaesthesiol & Crit Care Med, Creteil, France
[2] Paris Est Creteil Univ, Dept Neuroradiol, Creteil, France
[3] Henri Mondor Univ Hosp, AP HP, Creteil, France
关键词
Computed tomography; Intracranial pressure; Optic nerve sheath diameter; Transcranial Doppler; Traumatic brain injury; OPTIC-NERVE SHEATH; PRESSURE; MANAGEMENT; DIAMETER; ULTRASONOGRAPHY; GUIDELINES; CARE;
D O I
10.1016/j.wneu.2019.04.121
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: This study aimed to assess the reliability of clinical features, noninvasive transcranial Doppler-related pulsatility index (PI) calculation, and optic nerve sheath diameter (ONSD) measured by ultrasound (US) and initial computed tomography (CT) scan (Marshall CT scan classification) in predicting the occurrence of early (<24 hours) high intracranial pressure (EHICP) (>20 mm Hg) after severe traumatic brain injury (TBI). METHODS: We conducted an observational prospective study in a level 1 trauma center. Patients were measured simultaneously for PI and US ONSD in the triage zone. Patients were categorized into 2 groups: those who had EHICP after TBI (EHICP+) and those who did not (EHICP-). RESULTS: Fifty-four patients were included; 32 were categorized as EHICP+ and 22 as EHICP-. PI >1.4 did not correlate with EHICP+ patients (69% vs. 46%, P = 0.09). US ONSD measurement was higher in the EHICP+ group (6.25; range, 6-6.95 vs. 5.7; range, 5.2-6.4; P = 0.005). The area under the receiver operating characteristic curve for US ONSD as a predictor of developing EHICP was 0.73 (95% confidence interval [CI], 0.59-0.86). CT ONSD measurement was higher in the EHICP+ group (6.71; range, 6.35-7.87 vs. 6.25; range, 5.8-6.93; P = 0.04). The area under the receiver operating characteristic curve for CT ONSD measurement as a predictor for EHICP+ was 0.67 (95% CI, 0.53-0.81). The diffuse injury III and IV categories in the Marshall CT scan classification were associated with the occurrence of EHICP (P = 0.004). CONCLUSIONS: None of the clinical features or noninvasive tools assessed in this study enabled clinicians to strictly ascertain EHICP. Further studies are needed to establish their potential role before intracranial pressure probe insertion.
引用
收藏
页码:E1242 / E1248
页数:7
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