Background: Diffuse axonal injury (DAI), a feature seen in severe traumatic brain injury (TBI), is associated with substantial morbidity and mortality. Although blood pressure variability (BPV) has been shown to impact TBI outcomes overall, its relevance in DAI cases remains uncertain. We investigated whether 24-hour post-injury BPV and other clinical factors were linked to patient outcomes.
\nMethods: We conducted a retrospective analysis of Level I trauma center-admitted TBI patients with radiographic DAI diagnosis (computed tomography/magnetic resonance imaging). Hospital disposition (home, nursing facility, hospice/death) and Glasgow Coma Scale (GCS) on hospital day 5 (HD5GCS) were outcomes of interest. We assessed associations with clinical factors using ordinal logistic regression.
\nResults: Among 153 patients (mean age 49 ± 20 years, 74% male), median admission GCS was 5.0 (3.0-12.5), HD5GCS was 8.0 (6.0-11), and median hospital stay was 25 (15.5-34.5) days. The BPV, measured as successive variation in systolic blood pressure (SBPSV) and standard deviation in systolic blood pressure (SBPSD), was not significantly associated with hospital disposition. SBPSV and SBPSD were also not associated with our secondary outcome of HD5GCS. Initial international normalized ratio (INR) (Coefficient -3.67, odds ratio [OR] 0.03, 95% confidence interval [CI] 0.00-0.70), cerebral contusion (Coeff -2.39, OR 0.09, 95% CI 0.01-0.75), and HD5GCS (Coeff 0.59, OR 1.80, 95% CI 1.30-2.49) were associated with increased odds of discharge to hospice or death. Administration of blood products (Coeff 1.06, OR 2.89, 95% CI 1.10-7.60), vasopressors (Coeff 1.40, OR 4.05, 95% CI 1.37-11.96), and hyperosmolar therapy (Coeff 1.23, OR 3.41, 95% CI 1.36-8.54), and concurrent intraventricular hemorrhage (Coeff 0.99, OR 2.70, 95% CI 0.86-6.49) were linked to poorer HD5GCS.
\nConclusion: Blood pressure variability was not correlated with outcomes in patients with diffuse axonal injury. Low Glasgow Coma Score on hospital day 5, high initial INR, and concomitant cerebral contusion were associated with poorer outcomes.
","language":"eng","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":"diffuse axonal injury"},{"word":"DAI"},{"word":"Blood pressure variability"},{"word":"BPV"},{"word":"Traumatic Brain Injury"},{"word":"traumatic axonal injury"}],"section":"Trauma","is_remote":true,"remote_url":"https://escholarship.org/uc/item/27s1j3b9","frozenauthors":[{"first_name":"Christine","middle_name":"E.","last_name":"Ren","name_suffix":"","institution":"R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Department of Emergency Medicine-Surgical Critical Care, Baltimore, Maryland; Oregon Health and Science University, Department of Emergency Medicine and Critical Care Medicine, Portland, Oregon","department":""},{"first_name":"Anastasia","middle_name":"","last_name":"Ternovskaia","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, Maryland","department":"Research Associate Program"},{"first_name":"Fatima","middle_name":"","last_name":"Mikdashi","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, Maryland","department":"Research Associate Program"},{"first_name":"Hassan","middle_name":"","last_name":"Syed","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":""},{"first_name":"Isha","middle_name":"","last_name":"Vashee","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, Maryland","department":""},{"first_name":"Vainavi","middle_name":"","last_name":"Gambhir","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, Maryland","department":""},{"first_name":"Natalie","middle_name":"","last_name":"Chao","name_suffix":"","institution":"University of Maryland School of Medicine, Baltimore, Maryland","department":""},{"first_name":"Jessica","middle_name":"V.","last_name":"Downing","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Department of Emergency Medicine-Surgical Critical Care, Baltimore, Maryland","department":"Department of Emergency Medicine"},{"first_name":"David","middle_name":"","last_name":"Dreizin","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Imaging, Division of Emergency and Trauma Imaging, Baltimore, Maryland","department":""},{"first_name":"Quincy","middle_name":"K.","last_name":"Tran","name_suffix":"","institution":"University of Maryland School of Medicine, Department of Emergency Medicine, Research Associate Program, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Program in Trauma, Baltimore, Maryland","department":"Emergency Medicine"}],"date_submitted":"2024-04-20T20:10:12.455000Z","date_accepted":"2024-10-22T17:33:59.307000Z","date_published":"2024-12-31T14:00:00Z","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/20346/galley/31101/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/20346/galley/30199/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/20346/galley/31101/download/"}]}