Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury

Reisner, Andrew; Chen, Xiaoxiao; Kumar, Kamal; Reifman, Jaques

doi:10.1089/neu.2013.3128

Cited by 13 publications

(10 citation statements)

References 33 publications

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“…Hence, the combination of pSBP and pHR could be helpful to predict LT-BI among patients without eye opening, as Reisner et al reported that patients with abnormal SBP, HR, and GCS in the prehospital setting were significantly more likely to have high mortality compared with the single parameter in TBI patients [12]. Our results showed that even subjects with the highest pSBP and lowest pHR had a positive predictive value of 0.61 and an adjusted odds ratio of only 4.77 versus the reference group.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, many investigators reported the prognostic factors or models in TBI patients at an early stage after injury using vital signs, including GCS or pupillary reaction [4, 5, 12, 14, 15]. Among them, either prehospital hypertension or prehospital hypotension were revealed to be associated with higher mortality due to possible intracranial hypertension or paroxysmal sympathetic hyperactivity and impaired cerebral blood flow [3–5, 12]. To the best of our knowledge, our investigation is the first to describe Cushing’s sign in the prehospital setting predicting a life-threatening condition in TBI patients.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Yumoto

Mitsuhashi

Yamakawa

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundCushing’s reflex usually results from intracranial hypertension. Although Cushing’s sign can implicate severe traumatic brain injury (TBI) in injured patients, no major investigations have been made. The purpose of this study was to assess the predictability of life-threatening brain injury requiring immediate neurosurgical intervention (LT-BI) among trauma patients with Cushing’s sign in the prehospital setting.MethodsThis was a retrospective study using data from the Japan Trauma Data Bank from the period of 2010 to 2014. Patients 16 years old or older with blunt mechanisms of injury who were transported directly from the scene and Glasgow Coma Scale for eye opening of one in the prehospital setting were included. LT-BI was defined as patients requiring burr hole evacuation or craniotomy within 24 h of hospital arrival and patients who were non-survivors due to isolated severe TBI. Prehospital systolic blood pressure (pSBP) and heart rate (pHR) were assessed using area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis to predict LT-BI.ResultsOf 6332 eligible patients, 1859 (29%) exhibited LT-BI. AUROC of LT-BI using pSBP and pHR was 0.666 (95% confidence interval (CI); 0.652–0.681, P < 0.001), and 0.578 (95% CI; 0.563–0.594, P < 0.001), respectively. AUROC of pSBP was the highest among the 60 ≤ pHR ≤ 99 subgroup, of which AUROC was 0.680 (95% CI; 0.662–0.699, P < 0.001).Multiple logistic regression analysis showed that the higher the pSBP and the lower the pHR, the more likely that the patients had LT-BI. In a group with pSBP ≥ 180 mmHg and pHR ≤ 59 beats/min, the odds ratio and 95% CI of LT-BI after adjusting for age, sex, and severity of injuries to other body regions was 4.77 (2.85–7.97), P < 0.001 was compared with the reference group, which was defined as patients with normal vital signs.DiscussionOur study has found that the combination of hypertension and bradycardia, which are the components of Cushing's sign without eye opening in the prehospital setting was a weak but a significant predictor of LT-BI, or death due to possible isolated severe TBI.ConclusionsPrehospital Cushing’s sign with disturbed level of consciousness in trauma patients was a weak but significant predictor of the need for immediate neurosurgical intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Yumoto

Mitsuhashi

Yamakawa

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…AIS) is the basis for assessing the severity of the head injury. Similarly, while the AIS value is low, the GCS is also low[12].…”

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confidence: 94%

The The Correlation of Hemodynamic Status and Oxygen Saturation with The Level of Consciousness in Head Injury Patients

2020

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Introduction: Head injury is a traumatic disorder caused by the mechanical strength of a blunt object or penetration that can cause temporary or permanent changes in tissue function and structure. The latest developing concept on poor prognosis among head injury patients was occur related to the secondary injuries, where there was an increase in intracranial, cerebral ischemia, and decreased consciousness. The important thing in the management of head injuries is to maintain hemodynamic stability and to prevent hypoxia by maintaining oxygen saturation >95%. The purpose of this study was to analyze the correlation of hemodynamic status and oxygen saturation with the level of consciousness in head injury patients at RSUD Mardi Waluyo, Blitar. Methods: The research used correlational analytical with a cross-sectional design. The sampling technique used consecutive sampling within a total sample of 30 respondents. Spearman's test was used for data analysis. Results: The results showed a correlation between mean arterial pressure (p-value = .004), respiratory rate (p-value = .000), body temperature (p-value = .017), and oxygen saturation (p-value = .000) with level of consciousness (GCS) respectively. Conclusion: It can be concluded that mean arterial pressure, respiratory rate, body temperature, and oxygen saturation can affect the level of consciousness (GCS). There was a need to improve hemodynamic and oxygen saturation monitoring to prevent the bad prognosis in head injury patients at RSUD Mardi Waluyo, Blitar.

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“…A patient's BP is useful when assessing for organ perfusion, identifying stroke risk, and diagnosing sepsis. 1 Studies suggest that it may also provide insight into patient outcome following trauma 2 and has prognostic value in patient mortality. 3 Abbreviations: ANOVA: analysis of variance BMI: body mass index BP: blood pressure EMR: electronic medical record EMS: Emergency Medical Services IA: intra-arterial ICP: intracranial pressure ICU: intensive care unit LAR: Legal Authorized Representative LOA: limits of agreement NIBP: non-invasive blood pressure RIBP: radial intra-arterial blood pressure SBP: systolic blood pressure Though it is recognized as a valuable component in the initial screening assessment, BP remains one of the most difficult vital signs to obtain accurately.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Non-Invasive Blood Pressure Measurement Strategies with Intra-Arterial Measurement

Rebesco

Pinkston

Smyrnios

et al. 2020

Prehosp. Disaster med.

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Introduction: It is difficult to obtain an accurate blood pressure (BP) measurement, especially in the prehospital environment. It is not known fully how various BP measurement techniques differ from one another. Study Objective: The study hypothesized that there are differences in the accuracy of various non-invasive blood pressure (NIBP) measurement strategies as compared to the gold standard of intra-arterial (IA) measurement. Methods: The study enrolled adult intensive care unit (ICU) patients with radial IA catheters placed to measure radial intra-arterial blood pressure (RIBP) as a part of their standard care at a large, urban, tertiary-care Level I trauma center. Systolic blood pressure (SBP) was taken by three different NIBP techniques (oscillometric, auscultated, and palpated) and compared to RIBP measurements. Data were analyzed using the paired t-test with dependent samples to detect differences between RIBP measurements and each NIBP method. The primary outcome was the difference in RIBP and NIBP measurement. There was also a predetermined subgroup analysis based on gender, body mass index (BMI), primary diagnosis requiring IA line placement, and current vasoactive medication use. Results: Forty-four patients were enrolled to detect a predetermined clinically significant difference of 5mmHg in SBP. The patient population was 63.6% male and 36.4% female with an average age of 58.4 years old. The most common primary diagnoses were septic shock (47.7%), stroke (13.6%), and increased intracranial pressure (ICP; 13.6%). Most patients were receiving some form of sedation (63.4%), while 50.0% were receiving vasopressor medication and 31.8% were receiving anti-hypertensive medication. When compared to RIBP values, only the palpated SBP values had a clinically significant difference (9.88mmHg less than RIBP; P < .001). When compared to RIBP, the oscillometric and auscultated SBP readings showed statistically but not clinically significant lower values. The palpated method also showed a clinically significant lower SBP reading than the oscillometric method (5.48mmHg; P < .001) and the auscultated method (5.06mmHg; P < .001). There was no significant difference between the oscillometric and auscultated methods (0.42mmHg; P = .73). Conclusion: Overall, NIBPs significantly under-estimated RIBP measurements. Palpated BP measurements were consistently lower than RIBP, which was statistically and clinically significant. These results raise concern about the accuracy of palpated BP and its pervasive use in prehospital care. The data also suggested that auscultated and oscillometric BP may provide similar measurements.

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Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury

Cited by 13 publications

References 33 publications

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

The The Correlation of Hemodynamic Status and Oxygen Saturation with The Level of Consciousness in Head Injury Patients

A Comparison of Non-Invasive Blood Pressure Measurement Strategies with Intra-Arterial Measurement

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