Severe brain injury ICU outcomes are associated with Cranial-Arterial Pressure Index and noninvasive Bispectral Index and transcranial oxygen saturation: a prospective, preliminary study

INTRODUCTION: The purpose of this study was to determine if noninvasive transcranial oxygen saturation (StcO(2)) and Bispectral Index (BIS) correlate with severe traumatic brain injury intensive care unit (ICU) outcomes. METHODS: This is a prospective observational study. Values of intracranial pressure (ICP), mean arterial pressure (MAP), BIS, and StcO(2 )were recorded hourly for the first six, post-injury days in 18 patients with severe brain injury. Included in the analyses was the Cranial-Arterial Pressure (CAP) Index, which is ICP/(MAP - ICP). RESULTS: After 1,883 hours of data were analyzed, we found that StcO(2 )and BIS are associated with survival, good neurological outcome, ICP ≤20, cerebral perfusion pressure (CPP) ≥60, and CAP index ≤0.30 (p ≤ 0.001). Survival and good outcome are independently associated with BIS ≥60, StcO(2 )≥70, and ICP ≤20 (p < 0.0001). BIS ≥60 or StcO(2 )≥70 is associated with survival, good outcome, CPP ≥60, ICP ≤20, CAP index ≤0.30, and fewer ICP interventions (p < 0.0001). With BIS ≥60 or StcO(2 )≥70, the rate of CPP ≥60 is 97.2% and the rate of ICP≤ 25 is 97.1%. An increased CAP index is associated with death, poor neurological outcome, and increased ICP interventions (p < 0.0001). With CAP index >0.25, MAP is not related to ICP (p = 0.16). CONCLUSION: Numerous significant associations with ICU outcomes indicate that BIS and StcO(2 )are clinically relevant. The independent associations of BIS, StcO(2), and ICP with outcomes suggest that noninvasive multi-modal monitoring may be beneficial. Future studies of patients with BIS ≥60 or StcO(2 )≥70 will determine if select patients can be managed without ICP monitoring and whether marginal ICP can be observed. An increased CAP index is associated with poor outcome

Blunt Splenic Injury in Adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma

BACKGROUND: Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. METHODS: A total of 1,488 adults (\u3e15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended chi2 test. Data are expressed as mean +/- SD; a value of p \u3c 0.05 was considered significant. RESULTS: A total of 38.5 % of patients went directly to the operating room (group I); 61.5% of patients were admitted with planned nonoperative management. Of the patients admitted with planned observation, 10.8% failed and required laparotomy; 82.1% of patients with an Injury Severity Score (ISS) \u3c 15 and 46.6% of patients with ISS \u3e 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9%), II (22.4%), III (38.1%), IV (73.7%), and V (94.9%) (p \u3c 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8%), II (9.5%), III (19.6%), IV (33.3%), and V (75.0%) (p \u3c 0.05). A total of 60.9% of the patients failed nonoperative management within 24 hours of admission; 8% failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9% of patients with small hemoperitoneum, 49.4% of patients with moderate hemoperitoneum, and 72.6% of patients with large hemoperitoneum. CONCLUSION: In this multicenter study, 38.5% of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8% of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8%, with 60.9% of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum

Blunt Splenic Injury in Adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma

BACKGROUND: Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. METHODS: A total of 1,488 adults (\u3e15 years of age) with blunt splenic injury from 27 trauma centers in 1997 were studied through the Multi-institutional Trials Committee of the Eastern Association for the Surgery of Trauma. Statistical analysis was performed with analysis of variance and extended chi2 test. Data are expressed as mean +/- SD; a value of p \u3c 0.05 was considered significant. RESULTS: A total of 38.5 % of patients went directly to the operating room (group I); 61.5% of patients were admitted with planned nonoperative management. Of the patients admitted with planned observation, 10.8% failed and required laparotomy; 82.1% of patients with an Injury Severity Score (ISS) \u3c 15 and 46.6% of patients with ISS \u3e 15 were successfully observed. Frequency of immediate operation correlated with American Association for the Surgery of Trauma (AAST) grades of splenic injury: I (23.9%), II (22.4%), III (38.1%), IV (73.7%), and V (94.9%) (p \u3c 0.05). Of patients initially managed nonoperatively, the failure rate increased significantly by AAST grade of splenic injury: I (4.8%), II (9.5%), III (19.6%), IV (33.3%), and V (75.0%) (p \u3c 0.05). A total of 60.9% of the patients failed nonoperative management within 24 hours of admission; 8% failed 9 days or later after injury. Laparotomy was ultimately performed in 19.9% of patients with small hemoperitoneum, 49.4% of patients with moderate hemoperitoneum, and 72.6% of patients with large hemoperitoneum. CONCLUSION: In this multicenter study, 38.5% of adults with blunt splenic injury went directly to laparotomy. Ultimately, 54.8% of patients were successfully managed nonoperatively; the failure rate of planned observation was 10.8%, with 60.9% of failures occurring in the first 24 hours. Successful nonoperative management was associated with higher blood pressure and hematocrit, and less severe injury based on ISS, Glasgow Coma Scale, grade of splenic injury, and quantity of hemoperitoneum

Contribution of Age and Gender to Outcome of Blunt Splenic Injury in Adults: Multicenter Study of the Eastern Association for the Surgery of Trauma

Background : The purpose of this study was to examine the contribution of age and gender to outcome after treatment of blunt splenic injury in adults. Methods : Through the Multi-Institutional Trials Committee of the Eastern Association for the Surgery of Trauma (EAST), 1488 adult patients from 27 trauma centers who suffered blunt splenic injury in 1997 were examined retrospectively. Results : Fifteen percent of patients were 55 years of age or older. A similar proportion of patients \u3e= 55 went directly to the operating room compared with patients \u3c 55 (41% vs. 38%) but the mortality for patients \u3e= 55 was significantly greater than patients \u3c 55 (43% vs. 23%). Patients \u3e= 55 failed nonoperative management (NOM) more frequently than patients \u3c 55 (19% vs. 10%) and had increased mortality for both successful NOM (8% vs. 4%, p \u3c 0.05) and failed NOM (29% vs. 12%, p = 0.054). There were no differences in immediate operative treatment, successful NOM, and failed NOM between men and women. However, women \u3e= 55 failed NOM more frequently than women \u3c 55 (20% vs. 7%) and this was associated with increased mortality (36% vs. 5%) (both p \u3c 0.05). Conclusion : Patients \u3e= 55 had a greater mortality for all forms of treatment of their blunt splenic injury and failed NOM more frequently than patients \u3c 55. Women \u3e= 55 had significantly greater mortality and failure of NOM than women \u3c 55

Contribution of Age and Gender to Outcome of Blunt Splenic Injury in Adults: Multicenter Study of the Eastern Association for the Surgery of Trauma

Background : The purpose of this study was to examine the contribution of age and gender to outcome after treatment of blunt splenic injury in adults. Methods : Through the Multi-Institutional Trials Committee of the Eastern Association for the Surgery of Trauma (EAST), 1488 adult patients from 27 trauma centers who suffered blunt splenic injury in 1997 were examined retrospectively. Results : Fifteen percent of patients were 55 years of age or older. A similar proportion of patients \u3e= 55 went directly to the operating room compared with patients \u3c 55 (41% vs. 38%) but the mortality for patients \u3e= 55 was significantly greater than patients \u3c 55 (43% vs. 23%). Patients \u3e= 55 failed nonoperative management (NOM) more frequently than patients \u3c 55 (19% vs. 10%) and had increased mortality for both successful NOM (8% vs. 4%, p \u3c 0.05) and failed NOM (29% vs. 12%, p = 0.054). There were no differences in immediate operative treatment, successful NOM, and failed NOM between men and women. However, women \u3e= 55 failed NOM more frequently than women \u3c 55 (20% vs. 7%) and this was associated with increased mortality (36% vs. 5%) (both p \u3c 0.05). Conclusion : Patients \u3e= 55 had a greater mortality for all forms of treatment of their blunt splenic injury and failed NOM more frequently than patients \u3c 55. Women \u3e= 55 had significantly greater mortality and failure of NOM than women \u3c 55

Contribution of age and gender to outcome of blunt splenic injury in adults: multicenter study of the eastern association for the surgery of trauma.

BACKGROUND: The purpose of this study was to examine the contribution of age and gender to outcome after treatment of blunt splenic injury in adults. METHODS: Through the Multi-Institutional Trials Committee of the Eastern Association for the Surgery of Trauma (EAST), 1488 adult patients from 27 trauma centers who suffered blunt splenic injury in 1997 were examined retrospectively. RESULTS: Fifteen percent of patients were 55 years of age or older. A similar proportion of patients \u3e or = 55 went directly to the operating room compared with patients \u3c 55 (41% vs. 38%) but the mortality for patients \u3e or = 55 was significantly greater than patients \u3c 55 (43% vs. 23%). Patients \u3e or = 55 failed nonoperative management (NOM) more frequently than patients \u3c 55 (19% vs. 10%) and had increased mortality for both successful NOM (8% vs. 4%, p \u3c 0.05) and failed NOM (29% vs. 12%, p = 0.054). There were no differences in immediate operative treatment, successful NOM, and failed NOM between men and women. However, women \u3e or = 55 failed NOM more frequently than women \u3c 55 (20% vs. 7%) and this was associated with increased mortality (36% vs. 5%) (both p \u3c 0.05). CONCLUSION: Patients \u3e or = 55 had a greater mortality for all forms of treatment of their blunt splenic injury and failed NOM more frequently than patients \u3c 55. Women \u3e or = 55 had significantly greater mortality and failure of NOM than women \u3c 55