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Podell J, Yang S, Miller S, Felix R, Tripathi H, Parikh G, Miller C, Chen H, Kuo YM, Lin CY, Hu P, Badjatia N. Rapid prediction of secondary neurologic decline after traumatic brain injury: a data analytic approach. Sci Rep 2023; 13:403. [PMID: 36624110 PMCID: PMC9829683 DOI: 10.1038/s41598-022-26318-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Secondary neurologic decline (ND) after traumatic brain injury (TBI) is independently associated with outcome, but robust predictors of ND are lacking. In this retrospective analysis of consecutive isolated TBI admissions to the R. Adams Cowley Shock Trauma Center between November 2015 and June 2018, we aimed to develop a triage decision support tool to quantify risk for early ND. Three machine learning models based on clinical, physiologic, or combined characteristics from the first hour of hospital resuscitation were created. Among 905 TBI cases, 165 (18%) experienced one or more ND events (130 clinical, 51 neurosurgical, and 54 radiographic) within 48 h of presentation. In the prediction of ND, the clinical plus physiologic data model performed similarly to the physiologic only model, with concordance indices of 0.85 (0.824-0.877) and 0.84 (0.812-0.868), respectively. Both outperformed the clinical only model, which had a concordance index of 0.72 (0.688-0.759). This preliminary work suggests that a data-driven approach utilizing physiologic and basic clinical data from the first hour of resuscitation after TBI has the potential to serve as a decision support tool for clinicians seeking to identify patients at high or low risk for ND.
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Affiliation(s)
- Jamie Podell
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA ,grid.411024.20000 0001 2175 4264Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Shiming Yang
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA ,grid.411024.20000 0001 2175 4264Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, USA ,grid.411024.20000 0001 2175 4264Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Serenity Miller
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA
| | - Ryan Felix
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA
| | - Hemantkumar Tripathi
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA
| | - Gunjan Parikh
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA ,grid.411024.20000 0001 2175 4264Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Catriona Miller
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA
| | - Hegang Chen
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA ,grid.411024.20000 0001 2175 4264Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Yi-Mei Kuo
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA
| | - Chien Yu Lin
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA
| | - Peter Hu
- grid.411024.20000 0001 2175 4264Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD 21201 USA ,grid.411024.20000 0001 2175 4264Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, USA ,grid.411024.20000 0001 2175 4264Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Neeraj Badjatia
- Program in Trauma, Shock Trauma Neurocritical Care, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD, 21201, USA. .,Department of Neurology, University of Maryland School of Medicine, Baltimore, USA.
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Bailey ZS, Leung LY, Yang X, Cardiff K, Gilsdorf J, Shear D, Kochanek PM. Prehospital Whole Blood Resuscitation Reduces Fluid Requirement While Maintaining Critical Physiology in a Model of Penetrating Traumatic Brain Injury and Hemorrhage: Implications on Resource-Limited Combat Casualty Care. Shock 2021; 55:545-553. [PMID: 32925600 DOI: 10.1097/shk.0000000000001662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ABSTRACT Prehospital resuscitation using whole blood (WB) is the standard of care for hemorrhagic shock (HS) but there is no consensus recommendation for resuscitation in the presence of traumatic brain injury (TBI) due to a lack of sufficient evidence. In order to evaluate the optimal resuscitation strategies for TBI+HS, Sprague-Dawley rats were randomized into four groups based on resuscitation fluid and prehospital mean arterial pressure (MAP) threshold (n = 9-10/group): Lactated Ringer's (LR)-60 mm Hg (LR60), LR-70 mm Hg (LR70), WB-60 mm Hg (WB60), WB-70 mm Hg (WB70). All groups received a frontal penetrating ballistic-like brain injury followed by a 35-min period of HS. During the prehospital phase, rats received an initial bolus of resuscitation fluid (WB or LR) followed by LR as needed to maintain MAP above the designated threshold for 90 min. During the in-hospital phase, rats received definitive resuscitation with shed WB. Physiological parameters were recorded continuously and cerebral edema was measured at 3 and 24 h postinjury. The WB60 group demonstrated a significantly lower prehospital fluid requirement compared WB70, LR60, and LR70 (P < 0.05). Compared to the respective LR groups, both the WB60 and WB70 groups also demonstrated improved MAP, cerebral perfusion pressure, brain tissue oxygen tension, and cerebral edema. The edema benefits were observed at 3 h, but not 24 h postinjury, and were localized to the injury site. Together, these results provide evidence that prehospital WB resuscitation and lower MAP resuscitation thresholds can reduce the prehospital fluid requirement while still maintaining critical cerebral physiology in a model of HS and concomitant TBI.
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Affiliation(s)
- Zachary S Bailey
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Army Institute of Research, Silver Spring, Maryland
| | - Lai Yee Leung
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Army Institute of Research, Silver Spring, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Xiaofang Yang
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Army Institute of Research, Silver Spring, Maryland
| | - Katherine Cardiff
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Army Institute of Research, Silver Spring, Maryland
| | - Janice Gilsdorf
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Army Institute of Research, Silver Spring, Maryland
| | - Deborah Shear
- Brain Trauma Neuroprotection Branch, Center for Military Psychiatry and Neuroscience, Walter Army Institute of Research, Silver Spring, Maryland
| | - Patrick M Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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