title: Predictive Factors That May Contribute to Secondary Insults With Nursing Interventions in Adults With Traumatic Brain Injury.
abstract: BACKGROUND
  Nursing interventions pose risks and benefits to patients with traumatic brain injury at a neurointensive care unit.
  
  
  OBJECTIVE
  The aim of this study was to investigate the risk of inducing high intracranial pressure (ICP) related to interventions and whether intracranial compliance, baseline ICP, or autoregulation could be used as predictors.
  
  
  METHODS
  The study had a quantitative, prospective, observational design. Twenty-eight patients with TBI were included, and 67 interventions were observed. The definition of a secondary ICP insult was ICP of 20 mm Hg or greater for 5 minutes or more within a continuous 10-minute period.
  
  
  RESULTS
  Secondary ICP insults related to nursing interventions occurred in 6 patients (21%) and 8 occasions (12%). Patients with baseline ICP of 15 mm Hg or greater had 4.7 times higher risk of developing an insult. The predictor with the best combination of sensitivity and specificity was baseline ICP.
  
  
  CONCLUSIONS
  Baseline ICP of 15 mm Hg or greater was the most important factor to determine the risk of secondary ICP insult related to nursing intervention.
authors.affiliation: Questions or comments about this article may be directed to Lena Nyholm, PhD CCRN, at Lena.nyholm@neuro.uu.se. She is a Registered Nurse, Department of Neuroscience and Neurosurgery, Uppsala University Hospital, Uppsala University, Uppsala, Sweden. Tim Howells, PhD, is Software Engineer, Department of Neuroscience and Neurosurgery, Uppsala University, Uppsala, Sweden. Per Enblad, MD PhD, is Professor of Neurosurgery and Head of Neurointensive Care Unit, Department of Neuroscience and Neurosurgery, Uppsala University, Uppsala, Sweden. The study was financially supported by the Uppsala County Council (ALF) and Swedish Research Council. The authors declare no conflicts of interest.
authors.forename: Lena
authors.initials: L
authors.lastname: Nyholm
authors.forename: Tim
authors.initials: T
authors.lastname: Howells
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000451:nursing; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D065816:Neuroscience Nursing; D011446:Prospective Studies