title: Are initial radiographic and clinical scales associated with subsequent intracranial pressure and brain oxygen levels after severe traumatic brain injury?
abstract: BACKGROUND
  Prediction of clinical course and outcome after severe traumatic brain injury (TBI) is important.
  
  
  OBJECTIVE
  To examine whether clinical scales (Glasgow Coma Scale [GCS], Injury Severity Score [ISS], and Acute Physiology and Chronic Health Evaluation II [APACHE II]) or radiographic scales based on admission computed tomography (Marshall and Rotterdam) were associated with intensive care unit (ICU) physiology (intracranial pressure [ICP], brain tissue oxygen tension [PbtO2]), and clinical outcome after severe TBI.
  
  
  METHODS
  One hundred one patients (median age, 41.0 years; interquartile range [26-55]) with severe TBI who had ICP and PbtO2 monitoring were identified. The relationship between admission GCS, ISS, APACHE II, Marshall and Rotterdam scores and ICP, PbtO2, and outcome was examined by using mixed-effects models and logistic regression.
  
  
  RESULTS
  Median (25%-75% interquartile range) admission GCS and APACHE II without GCS scores were 3.0 (3-7) and 11.0 (8-13), respectively. Marshall and Rotterdam scores were 3.0 (3-5) and 4.0 (4-5). Mean ICP and PbtO2 during the patients' ICU course were 15.5 ± 10.7 mm Hg and 29.9 ± 10.8 mm Hg, respectively. Three-month mortality was 37.6%. Admission GCS was not associated with mortality. APACHE II (P = .003), APACHE-non-GCS (P = .004), Marshall (P < .001), and Rotterdam scores (P < .001) were associated with mortality. No relationship between GCS, ISS, Marshall, or Rotterdam scores and subsequent ICP or PbtO2 was observed. The APACHE II score was inversely associated with median PbtO2 (P = .03) and minimum PbtO2 (P = .008) and had a stronger correlation with amount of time of reduced PbtO2.
  
  
  CONCLUSIONS
  Following severe TBI, factors associated with outcome may not always predict a patient's ICU course and, in particular, intracranial physiology.
authors.affiliation: Department of Neurology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19106, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Katsnelson
authors.forename: Larami
authors.initials: L
authors.lastname: Mackenzie
authors.forename: Suzanne
authors.initials: S
authors.lastname: Frangos
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Levine
authors.forename: Bryan
authors.initials: B
authors.lastname: Pukenas
authors.forename: Jennifer
authors.initials: J
authors.lastname: Faerber
authors.forename: Chuanhui
authors.initials: C
authors.lastname: Dong
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Kofke
authors.forename: Peter D
authors.initials: PD
authors.lastname: le Roux
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis* / Q000503:physiopathology*; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity