Ren Christine E, Ternovskaia Anastasia, Mikdashi Fatima, Syed Hassan, Vashee Isha, Gambhir Vainavi, Chao Natalie, Downing Jessica V, Dreizin David, Tran Quincy K
R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Department of Emergency Medicine-Surgical Critical Care, Baltimore, Maryland.
Oregon Health and Science University, Department of Emergency Medicine and Critical Care Medicine, Portland, Oregon.
West J Emerg Med. 2025 Mar;26(2):367-377. doi: 10.5811/westjem.20346.
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.
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.
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 (SBP) and standard deviation in systolic blood pressure (SBP), was not significantly associated with hospital disposition. SBP and SBP 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.
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.
弥漫性轴索损伤（DAI）是重度创伤性脑损伤（TBI）的一个特征，与高发病率和死亡率相关。尽管血压变异性（BPV）已被证明会影响总体TBI的预后，但其在DAI病例中的相关性仍不确定。我们调查了伤后24小时的BPV和其他临床因素是否与患者预后相关。
我们对一级创伤中心收治的经影像学诊断为DAI（计算机断层扫描/磁共振成像）的TBI患者进行了回顾性分析。医院处置情况（回家、护理机构、临终关怀/死亡）和入院第5天的格拉斯哥昏迷量表（GCS）评分（HD5GCS）是关注的结果。我们使用有序逻辑回归评估与临床因素的关联。
153例患者（平均年龄49±20岁，74%为男性），入院时GCS中位数为5.0（3.0 - 12.5），HD5GCS为8.0（6.0 - 11），住院时间中位数为25（15.5 - 34.5）天。以收缩压（SBP）的连续变化和收缩压标准差（SBP）衡量的BPV与医院处置情况无显著关联。SBP和SBP也与我们的次要结果HD5GCS无关。初始国际标准化比值（INR）（系数 - 3.67，比值比[OR] 0.03，95%置信区间[CI] 0.00 - 0.70）、脑挫裂伤（系数 - 2.39，OR 0.09，95% CI 0.01 - 0.75）和HD5GCS（系数0.59，OR 1.80，95% CI 1.30 - 2.49）与入住临终关怀机构或死亡的几率增加相关。血液制品的使用（系数1.06，OR 2.89，95% CI 1.10 - 7.60）、血管升压药（系数1.40，OR 4.05，95% CI 1.37 - 11.96）、高渗治疗（系数1.23，OR 3.41，95% CI 1.36 - 8.54）以及并发脑室内出血（系数0.99，OR 2.70，95% CI 0.86 - 6.49）与较差的HD5GCS相关。
血压变异性与弥漫性轴索损伤患者的预后无关。入院第5天格拉斯哥昏迷评分低、初始INR高以及伴有脑挫裂伤与较差的预后相关。
