Quantitation of ischemic events after severe traumatic brain injury in humans: a simple scoring system.
BACKGROUND
Cerebral ischemia is recognized as one of the most important mechanisms responsible for secondary brain damage following severe traumatic brain injury (TBI), contributing to an increased mortality and a worse neurologic outcome.


METHODS
A simple 5-item scoring system, taking into account the occurrence of specific potentially brain-damaging events (hypoxemia, hypotension, low cerebral blood flow, herniation, and low cerebral perfusion pressure) has been tested in a large population of severe TBI patients. Aims of this retrospective study were to validate the ability of the proposed ischemic score to predict neurologic outcome and to correlate the ischemic score with the results of microdialysis-based neurochemical monitoring and brain tissue oxygen monitoring.


RESULTS
In a population of 172 severe TBI patients, a significant correlation was found between ischemic score and neurologic outcome, both at 3 months (r = -0.32; P < 0.01) and at 6 months (r = -0.31; P < 0.01). Significant correlations were also found with the most important neurochemical analytes.


CONCLUSIONS
The ischemic score proposed here, may be determined during the acute intensive care unit period, and correlates closely with outcome, which can only be determined 3 to 6 months, after injury. It also shows a correlation with neurochemical analytes.
Mazzeo
Anna Teresa
AT
Department of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, 23219, USA. robulloc@hsc.vcu.edu
Kunene
Niki K
NK
Choi
Sung
S
Gilman
Charlotte
C
Bullock
Ross M
RM
D000328:Adult; D000367:Age Factors; D001923:Brain Chemistry / Q000502:physiology; D001930:Brain Injuries / Q000134:cerebrospinal fluid / Q000150:complications* / Q000453:epidemiology*; D002545:Brain Ischemia / Q000134:cerebrospinal fluid / Q000453:epidemiology* / Q000209:etiology*; D045604:Extracellular Fluid / Q000502:physiology; D005260:Female; D023261:Glasgow Outcome Scale; D005947:Glucose / Q000378:metabolism; D018698:Glutamic Acid / Q000378:metabolism; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D009460:Neurologic Examination; D010101:Oxygen Consumption / Q000502:physiology; D019289:Pyruvic Acid / Q000378:metabolism; D012189:Retrospective Studies; D016896:Treatment Outcome
D019344:Lactic Acid; D018698:Glutamic Acid; D019289:Pyruvic Acid; D005947:Glucose