El Ahmadieh Tarek Y, Bedros Nicole, Stutzman Sonja E, Nyancho Daniel, Venkatachalam Aardhra M, MacAllister Matthew, Ban Vin Shen, Dahdaleh Nader S, Aiyagari Venkatesh, Figueroa Stephen, White Jonathan A, Batjer H Hunt, Bagley Carlos A, Olson DaiWai M, Aoun Salah G
Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Division of Trauma, Department of Surgery, Baylor University Medical Center, Baylor, Texas, USA.
World Neurosurg. 2021 Jan;145:e163-e169. doi: 10.1016/j.wneu.2020.09.152. Epub 2020 Oct 2.
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in young adults. Automated infrared pupillometry (AIP) has shown promising results in predicting neural damage in aneurysmal subarachnoid hemorrhage and ischemic stroke. We aimed to explore potential uses of AIP in triaging patients with TBI. We hypothesized that a brain injury severe enough to require an intervention would show Neurologic Pupil Index (NPI) changes.
We conducted a prospective pilot study at a level-1 trauma center between November 2019 and February 2020. AIP readings of consecutive patients seen in the emergency department with blunt TBI and abnormal imaging findings on computed tomography were recorded by the assessing neurosurgery resident. The relationship between NPI and surgical intervention was studied.
Thirty-six patients were enrolled, 9 of whom received an intervention. NPI was dichotomized into normal (≥3) versus abnormal (<3) and was predictive of intervention (Fisher exact test; P < 0.0001). Six of the 9 patients had a Glasgow Coma Scale (GCS) score ≤8 and imaging signs of increased intracranial pressure (ICP) and underwent craniectomy (n = 4) or ICP monitor placement (n = 2) and had an abnormal NPI. Three patients underwent ICP monitor placement for GCS score ≤8 in accordance with TBI guidelines despite minimal imaging findings and had a normal NPI. The GCS score of these patients improved within 24 hours, requiring ICP monitor removal. NPI was normal in all patients who did not require intervention.
AIP could be useful in triaging comatose patients after blunt TBI. An NPI ≥3 may be reassuring in patients with no signs of mass effect or increased ICP.
创伤性脑损伤（TBI）是年轻成年人发病和死亡的主要原因。自动红外瞳孔测量法（AIP）在预测动脉瘤性蛛网膜下腔出血和缺血性卒中的神经损伤方面已显示出有前景的结果。我们旨在探索AIP在TBI患者分诊中的潜在用途。我们假设，严重到需要干预的脑损伤会出现神经瞳孔指数（NPI）变化。
我们于2019年11月至2020年2月在一家一级创伤中心进行了一项前瞻性试点研究。评估的神经外科住院医师记录了急诊科连续收治的钝性TBI且计算机断层扫描成像结果异常的患者的AIP读数。研究了NPI与手术干预之间的关系。
共纳入36例患者，其中9例接受了干预。NPI分为正常（≥3）与异常（<3），并可预测干预情况（Fisher精确检验；P<0.0001）。9例患者中有6例格拉斯哥昏迷量表（GCS）评分≤8，并有颅内压（ICP）升高的影像学表现，接受了颅骨切除术（n=4）或ICP监测器置入（n=2），且NPI异常。3例患者根据TBI指南因GCS评分≤8接受了ICP监测器置入，尽管影像学表现轻微，且NPI正常。这些患者的GCS评分在24小时内改善，需要移除ICP监测器。所有不需要干预的患者NPI均正常。
AIP可用于钝性TBI后昏迷患者的分诊。对于没有占位效应或ICP升高迹象的患者，NPI≥3可能令人安心。
