[Clinical and MRI predictors of coma duration, intensive care and outcome of traumatic brain injury].

Autor:	Potapov AA; Burdenko Neurosurgical Center, Moscow, Russia., Danilov GV; Burdenko Neurosurgical Center, Moscow, Russia., Sychev AA; Burdenko Neurosurgical Center, Moscow, Russia., Zakharova NE; Burdenko Neurosurgical Center, Moscow, Russia., Pronin IN; Burdenko Neurosurgical Center, Moscow, Russia., Savin IA; Burdenko Neurosurgical Center, Moscow, Russia., Oshorov AV; Burdenko Neurosurgical Center, Moscow, Russia., Polupan AA; Burdenko Neurosurgical Center, Moscow, Russia., Aleksandrova EV; Burdenko Neurosurgical Center, Moscow, Russia., Strunina YV; Burdenko Neurosurgical Center, Moscow, Russia., Likhterman LB; Burdenko Neurosurgical Center, Moscow, Russia., Okhlopkov VA; Burdenko Neurosurgical Center, Moscow, Russia., Latyshev YA; Burdenko Neurosurgical Center, Moscow, Russia., Chelushkin DM; Burdenko Neurosurgical Center, Moscow, Russia., Baranich AI; Burdenko Neurosurgical Center, Moscow, Russia., Kravchuk AD; Burdenko Neurosurgical Center, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko [Zh Vopr Neirokhir Im N N Burdenko] 2020; Vol. 84 (4), pp. 5-16.
DOI:	10.17116/neiro2020840415
Abstrakt:	Objective: This research is aimed to study the clinical and MRI predictors of coma duration, the intensity of critical care, and outcome of traumatic brain injury (TBI). Material and Methods: The data from 309 patients with TBI of varying severity were included in the analysis, of whom 257 (86.7%) were treated in the intensive care unit (ICU), including 196 (63.4%) patients admitted in a comatose state lasting longer than 1 day. All patients underwent brain MRI within 21 days after the injury. MRI findings were classified according to MRI grading scale of brain damage level and localization proposed previously. Results: The proposed MRI grading significantly correlated with the Glasgow coma (GCS, r=-0.67; p<0.0001) and Glasgow outcome (0.69; p<0.001) scores in the entire group. In a subgroup of comatose patients (GCS<9) it correlated with coma duration (r=0.52; p<0.0001). Spearman correlation analysis showed a significant relationship between the MRI classification and a number of parameters: ICU length of stay (r=0.62; p<0.0001), the duration of artificial ventilation (r=0.47; p<0.0001), the rate of artificial ventilation, sedatives, analgesics, mannitol, hypertonic saline and vasopressors usage (p<0.01). These data confirm the relationship between higher grades of MRI classification (deep brain damage) and the need for the escalation of intensive care main components. Conclusion: Our results support the hypothesis that the levels and localization of brain damage, estimated by the proposed MRI grading scale, might be predictors of coma duration, intensity and duration of intensive care, and TBI outcomes. A prognosis based on clinical and neuroimaging data comparison can be valuable for planning and efficient use of the hospital beds and ICU resources, for optimizing the patient flow and timing of patient transfer to neurorehabilitation facilities.
Databáze:	MEDLINE
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