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{ "pk": 16181, "title": "Blood Pressure Variability and Outcome in Traumatic Brain Injury: A Propensity Score Matching Study", "subtitle": null, "abstract": "Introduction:\n Patients with tIPH (used here to refer to traumatic intraparenchymal hemorrhagic contusion) or intraparenchymal hemorrhage face high rates of mortality and persistent functional deficits. Prior studies have found an association between blood pressure variability (BPV) and neurologic outcomes in patients with spontaneous IPH. Our study investigated the association between BPV and discharge destination (a proxy for functional outcome) in patients with tIPH.\nMethods:\n We retrospectively reviewed the charts of patients admitted to a Level I trauma center for ≥ 24 hours with tIPH. We examined variability in hourly BP measurements over the first 24 hours of hospitalization. Our outcome of interest was discharge destination (home vs facility). We performed 1:1 propensity score matching and multivariate regressions to identify demographic and clinical factors predictive of discharge home.\nResults: \nWe included 354 patients; 91 were discharged home and 263 to a location other than home. The mean age was 56 (SD 21), 260 (73%) were male, 22 (6%) were on anticoagulation, and 54 (15%) on antiplatelet therapy. Our propensity-matched cohorts included 76 patients who were discharged home and 76 who were discharged to a location other than home. One measure of BPV (successive variation in systolic BP) was identified as an independent predictor of discharge location in our propensity-matched cohorts (odds ratio 0.89, 95% confidence interval 0.8-0.98; P = 0.02). Our model demonstrated good goodness of fit (P-value for Hosmer-Lemeshow test = 0.88) and very good discriminatory capability (AUROC = 0.81). High Glasgow Coma Scale score at 24 hours and treatment with fresh frozen plasma were also associated with discharge home.\nConclusion: \nOur study suggests that increased BPV is associated with lower rates of discharge home after initial hospitalization among patients with tIPH. Additional research is needed to evaluate the impact of BP control on patient outcomes.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Traumatic Brain Injury" }, { "word": "Blood pressure variability" }, { "word": "intraparenchymal contusion" }, { "word": "intraparenchymal hemorrhage" }, { "word": "discharge destination" } ], "section": "Trauma", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/2mn4c7xw", "frozenauthors": [ { "first_name": "Quincy", "middle_name": "K.", "last_name": "Tran", "name_suffix": "", "institution": "University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland", "department": "None" }, { "first_name": "Hannah", "middle_name": "", "last_name": "Frederick", "name_suffix": "", "institution": "University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland", "department": "None" }, { "first_name": "Cecilia", "middle_name": "", "last_name": "Tran", "name_suffix": "", "institution": "University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" }, { "first_name": "Hammad", "middle_name": "", "last_name": "Baqai", "name_suffix": "", "institution": "University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" }, { "first_name": "Tucker", "middle_name": "", "last_name": "Lurie", "name_suffix": "", "institution": "University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; Wellspan York Hospital, Department of Emergency Medicine, York, Pennsylvania\n\nWellspan York Hospital Department of Emergency Medicine, York PA, USA", "department": "None" }, { "first_name": "Julianna", "middle_name": "", "last_name": "Solomon", "name_suffix": "", "institution": "University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" }, { "first_name": "Ayah", "middle_name": "", "last_name": "Aligabi", "name_suffix": "", "institution": "University of Maryland School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland", "department": "None" }, { "first_name": "Joshua", "middle_name": "", "last_name": "Olexa", "name_suffix": "", "institution": "University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland", "department": "None" }, { "first_name": "Stephanie", "middle_name": "", "last_name": "Cardona", "name_suffix": "", "institution": "Mount Sinai Hospital, Department of Critical Care Medicine, York, New York", "department": "None" }, { "first_name": "Uttam", "middle_name": "", "last_name": "Bodanapally", "name_suffix": "", "institution": "University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland", "department": "None" }, { "first_name": "Gary", "middle_name": "", "last_name": "Schwartzbauer", "name_suffix": "", "institution": "University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland; University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland", "department": "None" }, { "first_name": "Jessica", "middle_name": "", "last_name": "Downing", "name_suffix": "", "institution": "University of Maryland School of Medicine, The R. Adams Cowley Shock Trauma Center, Baltimore, Maryland", "department": "None" } ], "date_submitted": "2021-12-05T23:04:06Z", "date_accepted": "2021-12-05T23:04:06Z", "date_published": "2022-08-19T22:58:24Z", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/16181/galley/8112/download/" } ] }