title: Clinical variables and neuromonitoring information (intracranial pressure and brain tissue oxygenation) as predictors of brain-death development after severe traumatic brain injury.
abstract: OBJECTIVE
  The aim of this study was to ascertain the role of clinical variables and neuromonitoring data as predictors of brain death (BD) after severe traumatic brain injury (TBI).
  
  
  METHODS
  This prospective observational study involved severe TBI patients admitted to the intensive care unit between October 2009 and May 2011. The following variables were recorded: gender, age, reference Glasgow Coma Scale after resuscitation, pupillary reactivity, prehospital hypotension and desaturation, injury severity score, computed tomography (CT) findings, intracranial hypertension, and low brain tissue oxygenation (Pti02) levels (<16 mm Hg), as well as the final result of BD.
  
  
  RESULTS
  Among 61 patients (86.9% males) who met the inclusion criteria, the average age was 37.69 ± 16.44 years. Traffic accidents were the main cause of TBI (62.3%). The patients at risk of progressing to BD (14.8% of the entire cohort) were those with a mass lesion on CT (odds ratio [OR] 33.6; 95% confidence interval [CI]: 3.75-300.30; P = .002), altered pupillary reaction at admission (OR 25.5; 95% CI: 2.27-285.65; P = .009), as well low Pti02 levels on admission (OR 20.41; 95% CI: 3.52-118.33; P < .001) and during the first 24 hours of neuromonitoring (OR 20; 95% CI: 2.90-137.83; P < .001). Multivariate logistic regression showed that a low Pti02 level on admission was the best independent predictor for BD (OR 20.41; 95% CI: 3.53-118.33; P = .001).
  
  
  CONCLUSIONS
  Clinical variables and neuromonitoring information may identify TBI patients at risk of deterioration to BD.
authors.affiliation: NeuroCritical Care Unit, Virgen del Rocío University Hospital, Seville, Spain. juanjoegea@hotmail.com
authors.forename: J J
authors.initials: JJ
authors.lastname: Egea-Guerrero
authors.forename: E
authors.initials: E
authors.lastname: Gordillo-Escobar
authors.forename: J
authors.initials: J
authors.lastname: Revuelto-Rey
authors.forename: J
authors.initials: J
authors.lastname: Enamorado-Enamorado
authors.forename: A
authors.initials: A
authors.lastname: Vilches-Arenas
authors.forename: M
authors.initials: M
authors.lastname: Pacheco-Sánchez
authors.forename: J M
authors.initials: JM
authors.lastname: Domínguez-Roldán
authors.forename: F
authors.initials: F
authors.lastname: Murillo-Cabezas
mesh_terms: D000328:Adult; D001926:Brain Death; D001930:Brain Injuries / Q000503:physiopathology*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies