Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study
Background: Diffuse axonal injury (DAI), a feature seen in severe traumatic brain injury (TBI), is associated with substantial morbidity and mortality. Although blood pressure variability (BPV) has been shown to impact TBI outcomes overall, its relevance in DAI cases remains uncertain. We investigat...
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eScholarship Publishing, University of California
2024-12-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/27s1j3b9 |
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| author | Christine E. Ren Anastasia Ternovskaia Fatima Mikdashi Hassan Syed Isha Vashee Vainavi Gambhir Natalie Chao Jessica V. Downing David Dreizin Quincy K. Tran |
| author_facet | Christine E. Ren Anastasia Ternovskaia Fatima Mikdashi Hassan Syed Isha Vashee Vainavi Gambhir Natalie Chao Jessica V. Downing David Dreizin Quincy K. Tran |
| author_sort | Christine E. Ren |
| collection | DOAJ |
| description | Background: Diffuse axonal injury (DAI), a feature seen in severe traumatic brain injury (TBI), is associated with substantial morbidity and mortality. Although blood pressure variability (BPV) has been shown to impact TBI outcomes overall, its relevance in DAI cases remains uncertain. We investigated whether 24-hour post-injury BPV and other clinical factors were linked to patient outcomes. Methods: We conducted a retrospective analysis of Level I trauma center-admitted TBI patients with radiographic DAI diagnosis (computed tomography/magnetic resonance imaging). Hospital disposition (home, nursing facility, hospice/death) and Glasgow Coma Scale (GCS) on hospital day 5 (HD5GCS) were outcomes of interest. We assessed associations with clinical factors using ordinal logistic regression. Results: Among 153 patients (mean age 49 ±20 years, 74% male), median admission GCS was 5.0 (3.0-12.5), HD5GCS was 8.0 (6.0-11), and median hospital stay was 25 (15.5-34.5) days. The BPV, measured as successive variation in systolic blood pressure (SBPSV) and standard deviation in systolic blood pressure (SBPSD), was not significantly associated with hospital disposition. SBPSV and SBPSD were also not associated with our secondary outcome of HD5GCS. Initial international normalized ratio (INR) (Coefficient -3.67, odds ratio [OR] 0.03, 95% confidence interval [CI] 0.00-0.70), cerebral contusion (Coeff -2.39, OR 0.09, 95% CI 0.01-0.75), and HD5GCS (Coeff 0.59, OR 1.80, 95% CI 1.30-2.49) were associated with increased odds of discharge to hospice or death. Administration of blood products (Coeff 1.06, OR 2.89, 95% CI 1.10-7.60), vasopressors (Coeff 1.40, OR 4.05, 95% CI 1.37-11.96), and hyperosmolar therapy (Coeff 1.23, OR 3.41, 95% CI 1.36-8.54), and concurrent intraventricular hemorrhage (Coeff 0.99, OR 2.70, 95% CI 0.86-6.49) were linked to poorer HD5GCS. Conclusion: Blood pressure variability was not correlated with outcomes in patients with diffuse axonal injury. Low Glasgow Coma Score on hospital day 5, high initial INR, and concomitant cerebral contusion were associated with poorer outcomes. |
| format | Article |
| id | doaj-art-6213d3235f6649b2a4e668b857e3f86f |
| institution | Kabale University |
| issn | 1936-900X 1936-9018 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | eScholarship Publishing, University of California |
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| series | Western Journal of Emergency Medicine |
| spelling | doaj-art-6213d3235f6649b2a4e668b857e3f86f2025-08-20T03:42:22ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182024-12-0126236737710.5811/westjem.2034620346Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort StudyChristine E. Ren0Anastasia Ternovskaia1Fatima Mikdashi2Hassan Syed3Isha Vashee4Vainavi Gambhir5Natalie Chao6Jessica V. Downing7David Dreizin8Quincy K. Tran9R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Department of Emergency Medicine-Surgical Critical Care, Baltimore, MarylandUniversity of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, MarylandUniversity of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, MarylandUniversity of Maryland School of Medicine, Baltimore, MarylandUniversity of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, MarylandUniversity of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, MarylandUniversity of Maryland School of Medicine, Baltimore, MarylandUniversity of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, MarylandUniversity of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Imaging, Division of Emergency and Trauma Imaging, Baltimore, MarylandUniversity of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, MarylandBackground: Diffuse axonal injury (DAI), a feature seen in severe traumatic brain injury (TBI), is associated with substantial morbidity and mortality. Although blood pressure variability (BPV) has been shown to impact TBI outcomes overall, its relevance in DAI cases remains uncertain. We investigated whether 24-hour post-injury BPV and other clinical factors were linked to patient outcomes. Methods: We conducted a retrospective analysis of Level I trauma center-admitted TBI patients with radiographic DAI diagnosis (computed tomography/magnetic resonance imaging). Hospital disposition (home, nursing facility, hospice/death) and Glasgow Coma Scale (GCS) on hospital day 5 (HD5GCS) were outcomes of interest. We assessed associations with clinical factors using ordinal logistic regression. Results: Among 153 patients (mean age 49 ±20 years, 74% male), median admission GCS was 5.0 (3.0-12.5), HD5GCS was 8.0 (6.0-11), and median hospital stay was 25 (15.5-34.5) days. The BPV, measured as successive variation in systolic blood pressure (SBPSV) and standard deviation in systolic blood pressure (SBPSD), was not significantly associated with hospital disposition. SBPSV and SBPSD were also not associated with our secondary outcome of HD5GCS. Initial international normalized ratio (INR) (Coefficient -3.67, odds ratio [OR] 0.03, 95% confidence interval [CI] 0.00-0.70), cerebral contusion (Coeff -2.39, OR 0.09, 95% CI 0.01-0.75), and HD5GCS (Coeff 0.59, OR 1.80, 95% CI 1.30-2.49) were associated with increased odds of discharge to hospice or death. Administration of blood products (Coeff 1.06, OR 2.89, 95% CI 1.10-7.60), vasopressors (Coeff 1.40, OR 4.05, 95% CI 1.37-11.96), and hyperosmolar therapy (Coeff 1.23, OR 3.41, 95% CI 1.36-8.54), and concurrent intraventricular hemorrhage (Coeff 0.99, OR 2.70, 95% CI 0.86-6.49) were linked to poorer HD5GCS. Conclusion: Blood pressure variability was not correlated with outcomes in patients with diffuse axonal injury. Low Glasgow Coma Score on hospital day 5, high initial INR, and concomitant cerebral contusion were associated with poorer outcomes.https://escholarship.org/uc/item/27s1j3b9 |
| spellingShingle | Christine E. Ren Anastasia Ternovskaia Fatima Mikdashi Hassan Syed Isha Vashee Vainavi Gambhir Natalie Chao Jessica V. Downing David Dreizin Quincy K. Tran Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study Western Journal of Emergency Medicine |
| title | Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study |
| title_full | Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study |
| title_fullStr | Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study |
| title_full_unstemmed | Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study |
| title_short | Blood Pressure Variability and Outcome Predictors for Traumatic Brain Injury Patients with Diffuse Axonal Injury: A Retrospective Cohort Study |
| title_sort | blood pressure variability and outcome predictors for traumatic brain injury patients with diffuse axonal injury a retrospective cohort study |
| url | https://escholarship.org/uc/item/27s1j3b9 |
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