Medical Student Vanderbilt University School of Medicine Nashville, Tennessee, United States
Introduction: Our aim was to examine the roles of systolic blood pressure (SBP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), heart rate (HR), and serum sodium level in predicting clinical outcomes for traumatic brain injury (TBI).
Methods: Patients treated for TBI (January 1–December 31, 2017) at a level 1 trauma center were retrospectively reviewed. The primary outcome measure was discharge Glasgow Coma Scale (GCS) score >13. Optimal cutoff points for continuous variables were determined using Euclidean distance analysis onto favorable discharge GCS. General linear multivariable models adjusted for confounders including age, sex, injury severity score, neurosurgical intervention, and admission GCS score were used.
Results: A total of 131 patients (male sex, 100 [76%]) with a mean (standard deviation [SD]) age of 49 (21) years were included in the analysis. After adjustment, admission HR ≥97 bpm (odds ratio [OR], 0.32 [95%CI, 0.10–0.95], p = 0.04), maximum MAP ≥134 mm Hg (OR, 0.26 [95%CI, 0.08–0.76], p = 0.02), and maximum serum sodium level ≥142 mmol/L (OR, 0.21 [95%CI, 0.06–0.68], p = 0.01) remained significant predictors of lower odds of good neurological outcome. In a subanalysis where thresholds were optimized for IPH, SDH, and SAH expansion, minimum MAP ≥65 mm Hg (OR, 0.33 [95%CI, 0.12–0.85], p = 0.03) was associated with lower odds of expansion, and minimum serum sodium level ≥139 mmol/L (OR, 3.88 [95%CI, 1.39–10.7], p = 0.01) and maximum MAP max ≥110 mm Hg (OR, 2.65 [95%CI, 1.03–7.44, p = 0.050) were associated with higher odds of expansion.
Conclusion : The results suggest that a narrower range of MAP value maintenance and a ceiling for serum sodium levels could promote more favorable functional outcomes in TBI. Admission HR could be a predictive parameter for risk stratification for future poor neurological outcome.
