Abstract
The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients.
Highlights
In patients with severe traumatic brain injury (STBI), interventions are aimed at maintaining cerebral perfusion pressure (CPP) by minimising intracranial hypertension (ICH)
These reflect the typical demographics of STBI: patients were young, predominantly male (82%), with median pre-intubation Glasgow Coma Score (GCS) of 5, median head and neck abbreviated injury score (HNAIS) of 5 and were severely injured
Given the current uncertainty around the indications for invasive Intracranial pressure (ICP) monitoring in STBI patients, we have investigated if computed tomography (CTP) could be used to predict which patients are likely to need intervention for ICH and would require an ICP monitoring device
Summary
In patients with severe traumatic brain injury (STBI), interventions are aimed at maintaining cerebral perfusion pressure (CPP) by minimising intracranial hypertension (ICH). CTP involves continual scanning while a bolus of intravenous contrast transits through the brain vasculature It has a well-established role in the management of strokes and guides decisions on thrombolytic therapy by defining the area of ischaemic penumbra [5,6,7,8]. Several small studies have used CTP to investigate the cerebral blood flow changes after intervention for ICH in humans [14,15,16], and in animal models [17], CTP has been shown to predict short- and long-term functional outcomes in both mild and severe traumatic brain injury [18,19,20,21,22,23,24,25,26]
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