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a Department of
Clinical Neurosciences, University of Edinburgh, UK, b Department of Anaesthetics, University of
Edinburgh, UK
Correspondence to: Dr D F Signorini, University Department of Clinical Neurosciences, Bramwell-Dott Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
Received 23 December 1997 and in revised form 23 June 1998;
Accepted 9 July 1998
OBJECTIVES
To assess
the prognostic value of summary measures of secondary physiological
insult in addition to baseline clinical variables for patients with
traumatic brain injury.
METHODSA series of
110 patients with traumatic brain injury had data on intracranial
pressure (ICP), arterial blood pressure (ABP), cerebral perfusion
pressure (CPP), arterial O2 saturation (SaO2), temperature in °C (Temp), and heart rate in beats/min (HRT) monitored and recorded every minute. Secondary insults were defined according to
the Edinburgh University secondary insult grading system. The prognostic value of summary measures of these secondary insults was
assessed by adding them to a prognostic model for survival at 1 year
after controlling for baseline clinical variables using a previously
validated model.
RESULTSOf the eight
secondary insults measured, only ICP added significantly to the
prediction of survival in the first 72 hours after injury. The
particular type of summary measure did not seem to influence the
results. After the addition of ICP to the model, none of the other
secondary insult measures could improve the predictive power of the
model significantly.
CONCLUSIONSEarly
intracranial hypertension is confirmed as a sign of poor prognosis in
patients with traumatic brain injury, even after controlling for
baseline clinical variables. The value or otherwise of treating such
secondary insults, however, can only be definitively established in the
context of prospective randomised controlled trials. The specific
pathophysiological evolution of secondary insults is still the subject
of much research, and a clear understanding will be necessary before
the development of specific treatments is feasible.
This article has been cited by other articles:
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A. M. Rowat, J. M. Wardlaw, M. S. Dennis, and C. P. Warlow Does Feeding Alter Arterial Oxygen Saturation in Patients With Acute Stroke? Stroke, September 1, 2000; 31(9): 2134 - 2140. [Abstract] [Full Text] [PDF]
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C. W P M HUKKELHOVEN, M. J C EIJKEMANS, E. W STEYERBERG;, D F SIGNORINI, P J D ANDREWS, P A JONES, and J M WARDLAW Predicting survival using simple clinical variables: a case study in traumatic brain injury J. Neurol. Neurosurg. Psychiatry, March 1, 2000; 68(3): 396a - 397. [Full Text]
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 Other articles noted Evid. Based Ment. Health, November 1, 1999; 2(4): 104 - 104. [Full Text]
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