440 Retrospective Assessment of the Clinical Timeline and Predictors for Vasospasm Severity in Traumatic Brain Injury Within a Safety-Net Hospital Population

Abstract

INTRODUCTION: Unlike aneurysmal subarachnoid hemorrhage, vasospasm following traumatic brain injury (TBI) is poorly understood and no guidelines-based recommendations for surveillance exist. METHODS: TBI patients admitted to the surgical ICU 11/2014-12/2020 with 2+ instances of TCD-diagnosed vasospasm were included. Clinical timelines, TBI severity by Glasgow Coma Score (GCS) (mild = 13-15, moderate = 9-12, severe = 3-8), presence of subarachnoid hemorrhage (tSAH), and vasospasm severity (mild, moderate, or severe) were extracted from records. One-way ANOVA analysis compared the highest severity of vasospasm noted with date of onset and total days of vasospasm. Significant differences in means were further analyzed with Games-Howell post-hoc test. Stata® determined the dependence of vasospasm severity upon imaging findings or the GCS via Chi2 analysis. RESULTS: Forty-four patients were identified (31 male, 13 female, median age 40 (15-92) years). Amongst mild TBIs (13), vasospasm was mild (9), moderate (1), and severe (3). For moderate TBIs (2), vasospasm was mild (1), moderate (0), and severe (1). For severe TBIs (29), vasospasm was mild (16), moderate (6), and severe (7). Thirty-two patients had tSAH, 19 with mild, 6 moderate, and 7 with severe vasospasm. Of the 12 patients without tSAH, 7 had mild, 1 moderate, and 4 with severe vasospasm. Median time to onset did not differ between mild (Hospital Day (HD) 3), moderate (HD 4), and severe (HD 3) vasospasm (p = 0.47). Mean duration of mild vasospasm (2.35 days) differed from severe vasospasm (6.73 days), (p < 0.05). Neither presence of tSAH nor severity of TBI was related to severity of vasospasm (p = 0.11 and p = 0.61). CONCLUSIONS: Our study found that post-traumatic vasospasm can impact TBI patients, early, regardless of TBI severity or the presence of tSAH, suggesting early and routine surveillance for PTV may be warranted in all critically ill TBI patients.