Prognostication via early computed tomography head in patients treated with targeted temperature management after cardiac arrest.


Journal

Journal of the neurological sciences
ISSN: 1878-5883
Titre abrégé: J Neurol Sci
Pays: Netherlands
ID NLM: 0375403

Informations de publication

Date de publication:
15 Nov 2019
Historique:
received: 02 07 2019
revised: 10 08 2019
accepted: 27 08 2019
pubmed: 16 9 2019
medline: 15 9 2020
entrez: 16 9 2019
Statut: ppublish

Résumé

We evaluated computed tomography head (CTH) imaging obtained prior to targeted temperature management (TTM) in patients after cardiac arrest, and its role in prognostication. In this retrospective cohort study in a tertiary-care hospital, 341 adults presenting with out-of-hospital cardiac arrest received a CTH prior to TTM. Associations between outcomes and neuroimaging variables were evaluated with Chi-square analysis for significant associations that yielded a composite neuroimaging score-Tennessee Early Neuroimaging Score (TENS). Univariable and multivariable logistic regression analysis including TENS as an independent variable and the four outcome dependent variables were analyzed. Four of the neuroimaging variables-sulcal effacement, partial gray-white matter effacement, total gray-white matter effacement, deep nuclei effacement-had significant associations with each of the four outcome variables and yielded TENS. In multivariable logistic regression models adjusted for potential confounders, TENS was associated with poor discharge CPC (OR 2.15, 95%CI 1.16-3.98, p = .015), poor disposition (OR 2.62, 95%CI 1.37-5.02, p = .004), in-hospital mortality (OR 1.99, 95%CI 1.09-3.62, p = .024), and ICU mortality (OR 1.89, 95%CI 1.12-3.20, p = .018). Imaging prior to TTM may help identify post-cardiac arrest patients with severe anoxic brain injury and poor outcomes.

Sections du résumé

BACKGROUND BACKGROUND
We evaluated computed tomography head (CTH) imaging obtained prior to targeted temperature management (TTM) in patients after cardiac arrest, and its role in prognostication.
METHODS METHODS
In this retrospective cohort study in a tertiary-care hospital, 341 adults presenting with out-of-hospital cardiac arrest received a CTH prior to TTM. Associations between outcomes and neuroimaging variables were evaluated with Chi-square analysis for significant associations that yielded a composite neuroimaging score-Tennessee Early Neuroimaging Score (TENS). Univariable and multivariable logistic regression analysis including TENS as an independent variable and the four outcome dependent variables were analyzed.
RESULTS RESULTS
Four of the neuroimaging variables-sulcal effacement, partial gray-white matter effacement, total gray-white matter effacement, deep nuclei effacement-had significant associations with each of the four outcome variables and yielded TENS. In multivariable logistic regression models adjusted for potential confounders, TENS was associated with poor discharge CPC (OR 2.15, 95%CI 1.16-3.98, p = .015), poor disposition (OR 2.62, 95%CI 1.37-5.02, p = .004), in-hospital mortality (OR 1.99, 95%CI 1.09-3.62, p = .024), and ICU mortality (OR 1.89, 95%CI 1.12-3.20, p = .018).
CONCLUSION CONCLUSIONS
Imaging prior to TTM may help identify post-cardiac arrest patients with severe anoxic brain injury and poor outcomes.

Identifiants

pubmed: 31521958
pii: S0022-510X(19)30369-7
doi: 10.1016/j.jns.2019.116437
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

116437

Informations de copyright

Copyright © 2019 Elsevier B.V. All rights reserved.

Auteurs

Jason J Chang (JJ)

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: jjwchang@hotmail.com.

Georgios Tsivgoulis (G)

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA; Second Department of Neurology, "Attikon University Hospital", National & Kapodistrian University of Athens, School of Medicine, Athens, Greece.

Nitin Goyal (N)

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.

Khalid Alsherbini (K)

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis, TN, USA.

Craig Schuring (C)

Division of Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Rabin Shrestha (R)

Division of Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Andrei Yankovich (A)

Division of Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Jeffrey E Metter (JE)

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.

Srishti Sareen (S)

Division of Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Lucas Elijovich (L)

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis, TN, USA.

Marc D Malkoff (MD)

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis, TN, USA.

Luis Murillo (L)

Division of Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Dipen Kadaria (D)

Division of Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Andrei V Alexandrov (AV)

Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.

Amik Sodhi (A)

Division of Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH