The Use of Standardized Interpretation & Reporting for Multimodality Neuromonitoring (P11-7.004)

Abstract

<h3>Objective:</h3> Quantify consistent elements within standardized interpretation and reporting of multimodality neuromonitoring (MMM) data. <h3>Background:</h3> MMM is the integration and interpretation of information about the brain to detect and prevent secondary injury. Increasingly, measurements from intensive care unit (ICU) devices are combined as high-resolution time series not unlike EEG. Therefore, the <i>interpretation</i> of this data is time-intensive and a novel standardized method for daily reporting of clinically-relevant findings was developed. <h3>Design/Methods:</h3> A retrospective case control study was performed. We began standardized MMM 4/2015 and standardized reporting was rolled out on 8/2017. Cases were consecutive patients with severe traumatic brain injury (sTBI) who underwent formal interpretation/reporting compared with historical controls. Each reporting element within the reporting template was quantified to determine its consistency. Clinical outcome was Glasgow Outcome Score (GOS) based on chart review on follow up 3–6 months after admission. <h3>Results:</h3> There were 40 patients with reporting and 46 historical controls without reporting (age 42+/−17, 67 [84%] male). There were no differences between groups in injury severity. We tabulated 135 individual reports. Sections consistently (&gt;99%) reported included intracranial pressure, autoregulation, brain tissue oxygen, and electrocorticography. Data was reported in less than one-third for those measures not available for review or typically already reported; shifts in trends overtime were often not expressly documented. Similar outcome was seen between groups (median [IQR] GOS 3 [1–4] with reporting vs 2 [1–3] without; <i>N.S.</i>), although shift analysis stratified by age, sex, and injury severity parameters showed significant improvement in outcome category (Mann-Whitney estimate 0.38; p=0.02). <h3>Conclusions:</h3> Standardized interpretation and reporting of MMM data is a novel paradigm designed to provide critical insight and guide care. We inferred elements important to report and identified a shift toward improvement in clinical outcome as a result. <b>Disclosure:</b> Dr. Luna has nothing to disclose. Dr. Basil has nothing to disclose. Dr. Ewbank has nothing to disclose. Dr. Mizrahi has nothing to disclose. The institution of Dr. Ngwenya has received research support from Abbott. The institution of Dr. Ngwenya has received research support from Biogen. Dr. Foreman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma Inc. Dr. Foreman has received personal compensation in the range of $0-$499 for serving as a Consultant for Minnetronix, Inc.. Dr. Foreman has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for UCB Pharma Inc.. The institution of Dr. Foreman has received research support from NIH/NINDS. The institution of Dr. Foreman has received research support from DOD/CDRMP. The institution of Dr. Foreman has received research support from NSF. The institution of Dr. Foreman has received research support from Biogen, Inc.. The institution of Dr. Foreman has received research support from DOD/AFRL.