Respect your elders: effects of ageing on intracranial pressure monitor use in traumatic brain injury

Schüpper, Alexander J.; Berndtson, Allison E.; Smith, Alan; Godat, Laura N; Costantini, Todd W.

doi:10.1136/tsaco-2019-000306

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…27 In a similar fashion, Schupper et al found age disparities with regard to adherence to the Brain Trauma Foundation guidelines among blunt TBI patients presenting with a GCS score of 3-8. 28 The differential effect of ICP monitoring and age on short-and long-term outcomes following severe TBI certainly merits further investigation and remains to be determined in future research. Furthermore, whether ICP monitoring contributes to lower mortality rates in severe TBI remains an area of contention among the scientific community, with the literature demonstrating conflicting results.…”

Section: Discussionmentioning

confidence: 98%

Morbidity and mortality in elderly patients undergoing evacuation of acute traumatic subdural hematoma

Kerezoudis

Goyal

Puffer

et al. 2020

Neurosurgical Focus

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OBJECTIVEAcute traumatic subdural hematoma (atSDH) can be a life-threatening neurosurgical emergency that necessitates immediate evacuation. The elderly population can be particularly vulnerable to tearing bridging veins. The aim of this study was to evaluate inpatient morbidity and mortality, as well as predictors of inpatient mortality, in a national trauma database.METHODSThe authors queried the 2016–2017 National Trauma Data Bank registry for patients aged 65 years and older who had undergone evacuation of atSDH. Patients were categorized into three age groups: 65–74, 75–84, and 85+ years. A multivariable logistic regression model was fitted for inpatient mortality adjusting for age group, sex, race, presenting Glasgow Coma Scale (GCS) category (3–8, 9–12, and 13–15), Injury Severity Score, presence of coagulopathy, presence of additional hemorrhages (epidural hematoma [EDH], intraparenchymal hematoma [IPH], and subarachnoid hemorrhage [SAH]), presence of midline shift > 5 mm, and pupillary reactivity (both, one, or none).RESULTSA total of 2508 patients (35% females) were analyzed. Age distribution was as follows: 990 patients at 65–74 years, 1096 at 75–84, and 422 at 85+. Midline shift > 5 mm was present in 72% of cases. With regard to additional hemorrhages, SAH was present in 21%, IPH in 10%, and EDH in 2%. Bilaterally reactive pupils were noted in 90% of patients. A major complication was observed in 14.4% of patients, and the overall mortality rate was 18.3%. In the multivariable analysis, the presenting GCS category was found to be the strongest predictor of postoperative inpatient mortality (3–8 vs 13–15: OR 3.63, 95% CI 2.68–4.92, p < 0.001; 9–12 vs 13–15: OR 2.64, 95% CI 1.79–3.90, p < 0.001; 30% of overall variation), followed by the presence of SAH (OR 2.86, 95% CI 2.21–3.70, p < 0.001; 25% of overall variation) and the presence of midline shift > 5 mm (OR 2.40, 95% CI 1.74–3.32, p < 0.001; 11% of overall variation). Model discrimination was excellent (c-index 0.81). Broken down by age decile group, mortality increased from 8.0% to 15.4% for GCS 13–15 to around 36% for GCS 9–12 to almost as high as 60% for GCS 3–8, particularly in those aged 85 years and older.CONCLUSIONSThe present results from a national trauma database will, the authors hope, assist surgeons in preoperative discussions with patients and their families with regard to expected postoperative outcomes following surgical evacuation of an atSDH.

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Section: Discussionmentioning

confidence: 98%

Morbidity and mortality in elderly patients undergoing evacuation of acute traumatic subdural hematoma

Kerezoudis

Goyal

Puffer

et al. 2020

Neurosurgical Focus

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“… 31 There already exists age disparities in following BTF guidelines. 32 Our findings suggest this age disparity, or systematic bias, might be even more profound because the guidelines are based on a definition of severe TBI using GCS 3–8. Older adults with a true severe TBI may be underrepresented because their presenting ED GCS score may not reflect the severity of their injuries; conversely, younger adults may be overrepresented in severe TBI management guidelines, in that their TBI does not result in neurosurgical intervention or poor morbidity or mortality.…”

Section: Discussionmentioning

confidence: 80%

Incorporating age improves the Glasgow Coma Scale score for predicting mortality from traumatic brain injury

Salottolo

Panchal²,

Madayag

et al. 2021

Trauma Surg Acute Care Open

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BackgroundThe Glasgow Coma Scale (GCS) score has been adapted into categories of severity (mild, moderate, and severe) and are ubiquitous in the trauma setting. This study sought to revise the GCS categories to account for an interaction by age and to determine the discrimination of the revised categories compared with the standard GCS categories.MethodsThe American College of Surgeons National Trauma Data Bank registry was used to identify patients with traumatic brain injury (TBI; ICD-9 codes 850–854.19) who were admitted to participating trauma centers from 2010 to 2015. The primary exposure variables were GCS score and age, categorized by decade (teens, 20s, 30s…, 80s). In-hospital mortality was the primary outcome for examining TBI severity/prognostication. Logistic regression was used to calculate the conditional probability of death by age decade and GCS in a development dataset (75% of patients). These probabilities were used to create a points-based revision of the GCS, categorized as low (mild), moderate, and high (severe). Performance of the revised versus standard GCS categories was compared in the validation dataset using area under the receiver operating characteristic (AUC) curves.ResultsThe final population included 539,032 patients with TBI. Age modified the performance of the GCS, resulting in a novel categorization schema for each age decile. For patients in their 50s, performance of the revised GCS categories mirrored the standard GCS categorization (3–8, 9–12, 13–15); all other revised GCS categories were heavily modified by age. Model validation demonstrated the revised GCS categories statistically significantly outperformed the standard GCS categories at predicting mortality (AUC: 0.800 vs 0.755, p<0.001). The revised GCS categorization also outperformed the standard GCS categories for mortality within pre-specified subpopulations: blunt mechanism, isolated TBI, falls, non-transferred patients.DiscussionWe propose the revised age-adjusted GCS categories will improve severity assessment and provide a more uniform early prognostic indicator of mortality following traumatic brain injury.Level of evidenceIII epidemiologic/prognostic.

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“…1 The volume increase of the contents in the cranial cavity makes the ICP continue to exceed 20 mm Hg, which leads to a series of symptoms and signs. 2 The continuous increase of ICP will lead to a decrease of cerebral blood flow (CBF), cerebral ischemia, and even brain death. 3 Therefore, the accurate monitoring of ICP becomes very important for the diagnosis, treatment, and prognosis of patients with craniocerebral diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Increased intracranial pressure (ICP) often occurs in patients with craniocerebral injury, cerebral hemorrhage, brain edema, brain tumor, and other neurosurgical diseases 1 . The volume increase of the contents in the cranial cavity makes the ICP continue to exceed 20 mm Hg, which leads to a series of symptoms and signs 2 . The continuous increase of ICP will lead to a decrease of cerebral blood flow (CBF), cerebral ischemia, and even brain death 3 .…”

Section: Introductionmentioning

confidence: 99%

Relationship between reduced scattering coefficient and intracranial pressure in clinical patients under different brain edema states

Wang

Chen

Liu

et al. 2023

Int J Imaging Syst Tech

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There is a lack of a safe and effective technology to monitor intracranial pressure accurately and non‐destructively. In this paper, the relationship between reduced scattering coefficient and intracranial pressure in clinical patients under different brain edema states was studied. First, the brain edema MC simulation model was constructed based on different types of brain edema. The results laid a foundation for clinical ICP detection. Second, the changes of ICP and reduced scattering coefficient caused by brain edema were studied in clinical application. It was found that when the patient developed brain edema, the reduced scattering coefficient and ICP showed corresponding changes. Finally, the mathematical model of invasive ICP and reduced scattering coefficient was established. It was found that the sensitivity of 834 nm light to brain tissue changes was higher than that of 692 nm light, which could be used to reflect the changes of brain tissue physiological state.

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Respect your elders: effects of ageing on intracranial pressure monitor use in traumatic brain injury

Cited by 8 publications

References 21 publications

Morbidity and mortality in elderly patients undergoing evacuation of acute traumatic subdural hematoma

Morbidity and mortality in elderly patients undergoing evacuation of acute traumatic subdural hematoma

Incorporating age improves the Glasgow Coma Scale score for predicting mortality from traumatic brain injury

Relationship between reduced scattering coefficient and intracranial pressure in clinical patients under different brain edema states

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