Low Glasgow Coma Score in Traumatic Intracranial Hemorrhage Predicts Development of Cerebral Vasospasm

Al‐Mufti, Fawaz; Amuluru, Krishna; Lander, Megan; Mathew, Melwin; El‐Ghanem, Mohammad; Nuoman, Rolla; Park, Seami; Patel, Vikas; Singh, Inder Paul; Gupta, Gaurav; Gandhi, Chirag D.

doi:10.1016/j.wneu.2018.07.143

Cited by 17 publications

(13 citation statements)

References 16 publications

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“…Three variables (i.e., Glasgow Coma Score, systolic blood pressure, and white blood cell count) are also ranked among the top five by the SAPS II model. The Glasgow Coma Score is used to assess the level of consciousness in patients [ 69 ], and patients with decreased levels of consciousness tend to have poor prognosis [ 70 , 71 ]. The independent capabilities of systolic blood pressure and white blood cell count in predicting the prognosis of ICU patients have also been verified by existing studies [ 72 , 73 ].…”

Section: Discussionmentioning

confidence: 99%

Predicting Prolonged Length of ICU Stay through Machine Learning

Lin

et al. 2021

Diagnostics

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This study aimed to construct machine learning (ML) models for predicting prolonged length of stay (pLOS) in intensive care units (ICU) among general ICU patients. A multicenter database called eICU (Collaborative Research Database) was used for model derivation and internal validation, and the Medical Information Mart for Intensive Care (MIMIC) III database was used for external validation. We used four different ML methods (random forest, support vector machine, deep learning, and gradient boosting decision tree (GBDT)) to develop prediction models. The prediction performance of the four models were compared with the customized simplified acute physiology score (SAPS) II. The area under the receiver operation characteristic curve (AUROC), area under the precision-recall curve (AUPRC), estimated calibration index (ECI), and Brier score were used to measure performance. In internal validation, the GBDT model achieved the best overall performance (Brier score, 0.164), discrimination (AUROC, 0.742; AUPRC, 0.537), and calibration (ECI, 8.224). In external validation, the GBDT model also achieved the best overall performance (Brier score, 0.166), discrimination (AUROC, 0.747; AUPRC, 0.536), and calibration (ECI, 8.294). External validation showed that the calibration curve of the GBDT model was an optimal fit, and four ML models outperformed the customized SAPS II model. The GBDT-based pLOS-ICU prediction model had the best prediction performance among the five models on both internal and external datasets. Furthermore, it has the potential to assist ICU physicians to identify patients with pLOS-ICU risk and provide appropriate clinical interventions to improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Predicting Prolonged Length of ICU Stay through Machine Learning

Lin

et al. 2021

Diagnostics

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“…Among these mechanisms, BCVI has been considered an independent risk factor for PTCI. [7][8][9][10] Previous studies showed that the probability of PTCI occurrence increases with age. 11,12 Borsotti reported that patients older than 50 years have a lower risk of PTCI and argued that elderly individuals are less prone to cerebral vasospasm since cerebral arteriosclerosis has already occurred, while a certain degree of brain atrophy alleviates brain compression, displacement, and edema.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Cerebral Infarction After Moderate or Severe Traumatic Brain Injury

Chao

Gao

et al. 2021

TCRM

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Purpose: Posttraumatic cerebral infarction (PTCI) is a common and relatively serious complication of traumatic brain injury (TBI) without a clear etiology. Evaluating risk factors in advance is particularly important to predict and avoid the occurrence of PTCI. Patients and Methods: We retrospectively analyzed 297 patients with moderate to severe TBI admitted to the Department of Neurosurgery in our hospital from January 2019 to September 2020 and evaluated the effects of various factors such as age, sex, admission Glasgow Coma Scale (GCS), skull base fracture, subarachnoid hemorrhage (SAH), brain herniation, hypotensive shock, and decompressive craniectomy on the incidence of PTCI. We also performed a multivariate logistics regression analysis on the relevant factors identified and evaluated the diagnostic value of each risk factor in advance by receiver operating characteristic (ROC) analyses. Results: Among the patients, 32 (10.77%) suffered PTCI. The incidence rates of PTCI in those with GCS scores of 3-8 and 9-12 were 15.87% (30/189) and 1.85% (2/108), respectively, while the rates were 18.84% (13/69), 15.03% (29/193), 18.57% (13/70), and 20.59% (14/68) in those with skull base fractures, traumatic SAH, brain herniation, and hypotensive shock, respectively, and 14.38% (23/160) in those who underwent decompressive craniectomy. These differences in PTCI incidence were statistically significant. However, the differences in PTCI incidence caused by patient age and sex were not statistically significant. Conclusion: Low GCS score, skull base fractures, traumatic SAH, brain herniation, hypotensive shock, and decompressive craniectomy are risk factors for the occurrence of PTCI, while age and sex are not significantly correlated with the occurrence of PTCI.

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“…Extensive research has been done in the past on post traumatic vasospasm, which affects 27–40% of patients with TBI. [ 1 , 2 , 4 , 11 , 17 , 22 ] Nevertheless, its pathophysiological mechanisms, the associated risk factors, and optimal therapy still largely remain unknown and data of the related reports are generally inconclusive. It may be caused, in part, by the complex design of clinical studies in cases of acute TBI, characterized by the significant heterogeneity of multiple variables reflecting the medical background of patients, mechanisms and severity of the trauma, types of brain injury, and treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Cerebral vasospasm and hypoperfusion after traumatic brain injury: Combined CT angiography and CT perfusion imaging study

Maegawa¹,

Sasahara²,

Ohbuchi³

et al. 2021

Surgical Neurology International

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Background: Timely identification of the cerebral perfusion abnormalities after traumatic brain injury (TBI) is highly important. The objective of this study was the evaluation of the post traumatic vasospasm and cerebral hypoperfusion with the serial combined CT angiography (CTA) and CT perfusion (CTP) imaging examinations. Methods: The case series comprised 25 adult patients with closed TBI accompanied by various types of intracranial hematoma. Emergency surgery was done in 15 cases (60%). Combined CTA and CTP were performed on days 0 (D0) and 7 ± 1 (D7) after trauma. Results: CTA on D0 did not demonstrate vasospasm in any case but revealed it on D7 in 9 patients (36%). In the multivariate analysis, only the presence of subarachnoid hemorrhage (SAH) on D7 had confirmed a significant association with the development of vasospasm (P = 0.0201). Cerebral hypoperfusion at least in one evaluated brain region was noted on D0 and D7 in 76% and 60% of patients, respectively, and showed highly variable spatial distribution and temporal development. Treatment results were not associated with the presence of vasospasm (P = 0.7337) or the number of brain regions affected by hypoperfusion on D0 (P = 0.2285), but the number of brain regions affected by hypoperfusion on D7 was significantly greater in cases of unfavorable outcome (P = 0.0187). Conclusion: Vasospasm is merely related to SAH sustained at the subacute stage of TBI, but its spatial and temporary interrelationships with the post traumatic cerebral hypoperfusion are complex. Serial combined CTA and CTP examinations may facilitate monitoring of perfusion abnormalities and treatment guidance.

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Low Glasgow Coma Score in Traumatic Intracranial Hemorrhage Predicts Development of Cerebral Vasospasm

Cited by 17 publications

References 16 publications

Predicting Prolonged Length of ICU Stay through Machine Learning

Predicting Prolonged Length of ICU Stay through Machine Learning

Risk Factors for Cerebral Infarction After Moderate or Severe Traumatic Brain Injury

Cerebral vasospasm and hypoperfusion after traumatic brain injury: Combined CT angiography and CT perfusion imaging study

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