The ICEBERG: A score and visual representation to track the severity of traumatic brain injury: Design principles and preliminary results.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
01 08 2022
01 08 2022
Historique:
pubmed:
11
1
2022
medline:
29
7
2022
entrez:
10
1
2022
Statut:
ppublish
Résumé
Establishing neurological prognoses in traumatic brain injury (TBI) patients remains challenging. To help physicians in the early management of severe TBI, we have designed a visual score (ICEBERG score) including multimodal monitoring and treatment-related criteria. We evaluated the ICEBERG scores among patients with severe TBI to predict the 28-day mortality and long-term disability (Extended Glasgow Outcome Scale score at 3 years). In addition, we made a preliminary assessment of the nurses and doctors on the uptake and reception to the use of the ICEBERG visual tool. This study was part of a larger prospective cohort study of 207 patients with severe TBI in the Parisian region (PariS-TBI study). The ICEBERG score included six variables from multimodal monitoring and treatment-related criteria: cerebral perfusion pressure, intracranial pressure, body temperature, sedation depth, arterial partial pressure of CO 2 , and blood osmolarity. The primary outcome measures included the ICEBERG score and its relationship with hospital mortality and Extended Glasgow Outcome Score. The hospital mortality was 21% (45/207). The ICEBERG score baseline value and changes during the 72nd first hours were more strongly associated with TBI prognosis than the ICEBERG parameters measured individually. Interestingly, when the clinical and computed tomography parameters at admission were combined with the ICEBERG score at 48 hours using a multimodal approach, the predictive value was significantly increased (area under the curve = 0.92). Furthermore, comparing the ICEBERG visual representation with the traditional numerical readout revealed that changes in patient vitals were more promptly detected using ICEBERG representation ( p < 0.05). The ICEBERG score could represent a simple and effective method to describe severity in TBI patients, where a high score is associated with increased mortality and disability. In addition, ICEBERG representation could enhance the recognition of unmet therapeutic goals and dynamic evolution of the patient's condition. These preliminary results must be confirmed in a prospective manner. Diagnostic Tests or Criteria; Level III.
Sections du résumé
BACKGROUND
Establishing neurological prognoses in traumatic brain injury (TBI) patients remains challenging. To help physicians in the early management of severe TBI, we have designed a visual score (ICEBERG score) including multimodal monitoring and treatment-related criteria. We evaluated the ICEBERG scores among patients with severe TBI to predict the 28-day mortality and long-term disability (Extended Glasgow Outcome Scale score at 3 years). In addition, we made a preliminary assessment of the nurses and doctors on the uptake and reception to the use of the ICEBERG visual tool.
METHODS
This study was part of a larger prospective cohort study of 207 patients with severe TBI in the Parisian region (PariS-TBI study). The ICEBERG score included six variables from multimodal monitoring and treatment-related criteria: cerebral perfusion pressure, intracranial pressure, body temperature, sedation depth, arterial partial pressure of CO 2 , and blood osmolarity. The primary outcome measures included the ICEBERG score and its relationship with hospital mortality and Extended Glasgow Outcome Score.
RESULTS
The hospital mortality was 21% (45/207). The ICEBERG score baseline value and changes during the 72nd first hours were more strongly associated with TBI prognosis than the ICEBERG parameters measured individually. Interestingly, when the clinical and computed tomography parameters at admission were combined with the ICEBERG score at 48 hours using a multimodal approach, the predictive value was significantly increased (area under the curve = 0.92). Furthermore, comparing the ICEBERG visual representation with the traditional numerical readout revealed that changes in patient vitals were more promptly detected using ICEBERG representation ( p < 0.05).
CONCLUSION
The ICEBERG score could represent a simple and effective method to describe severity in TBI patients, where a high score is associated with increased mortality and disability. In addition, ICEBERG representation could enhance the recognition of unmet therapeutic goals and dynamic evolution of the patient's condition. These preliminary results must be confirmed in a prospective manner.
LEVEL OF EVIDENCE
Diagnostic Tests or Criteria; Level III.
Identifiants
pubmed: 35001023
doi: 10.1097/TA.0000000000003515
pii: 01586154-202208000-00011
doi:
Banques de données
ClinicalTrials.gov
['NCT01437683']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
229-237Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Lele AV, To-Adithep P, Chanthima P, Lakireddy V, Vavilala MS. Correlation between Brain Trauma Foundation guidelines and published severe traumatic brain injury research. J Neurosurg Anesthesiol . 2021;33:323–328.
Le Roux P, Menon DK, Citerio G, Vespa P, Bader MK, Brophy GM, Diringer MN, Stocchetti N, Videtta W, Armonda R, et al. Consensus summary statement of the International Multidisciplinary Consensus Conference on multimodality monitoring in Neurocritical care : a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Intensive Care Med . 2014;40(9):1189–1209.
Farahvar A, Gerber LM, Chiu YL, Carney N, Hartl R, Ghajar J. Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring. J Neurosurg . 2012;117(4):729–734.
Chesnut R, Aguilera S, Buki A, Bulger E, Citerio G, Cooper DJ, Arrastia RD, Diringer M, Figaji A, Gao G, et al. A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med . 2020;46(5):919–929.
Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients. Neurocrit Care . 2020;32(3):647–666.
Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma . 2007;24(Suppl 1):S1–S106.
Hemphill JC, Andrews P, De Georgia M. Multimodal monitoring and neurocritical care bioinformatics. Nat Rev Neurol . 2011;7(8):451–460.
Michard F. Hemodynamic monitoring in the era of digital health. Ann Intensive Care . 2016;6(1):15.
Vallee F, Fourcade O, Marty P, Sanchez P, Samii K, Genestal M. The hemodynamic “target”: a visual tool of goal-directed therapy for septic patients. Clinics . 2007;62(4):447–454.
Mateo J, Payen D, Ghout I, Vallee F, Lescot T, Welschbillig S, Tazarourte K, Azouvi P, Weiss JJ, Aegerter P, et al. Impact of extended monitoring-guided intensive care on outcome after severe traumatic brain injury: a prospective multicentre cohort study (PariS-TBI study). Brain Inj . 2017;31(12):1642–1650.
Jourdan C, Bayen E, Bahrami S, Ghout I, Darnoux E, Azerad S, Ruet A, Vallat-Azouvi C, Weiss JJ, Aegerter P, et al. Loss to follow-up and social background in an inception cohort of patients with severe traumatic brain injury: results from the PariS-TBI study. J Head Trauma Rehabil . 2016;31(3):E42–E48.
Lu J, Marmarou A, Lapane K, Turf E, Wilson L; IMPACT Group; American Brain Injury Consortium Study Participation Centers. A method for reducing misclassification in the extended Glasgow Outcome Score. J Neurotrauma . 2010;27(5):843–852.
Boer C, Franschman G, Loer SA. Prehospital management of severe traumatic brain injury: concepts and ongoing controversies. Curr Opin Anaesthesiol . 2012;25(5):556–562.
Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The Injury Severity Score revisited. J Trauma . 1988;28(1):69–77.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA . 1993;270(24):2957–2963.
Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Poccock S, Roberts I, Shakur H, Steyerberg E, et alMRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ . 2008;336(7641):425–429.
Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, Luerssen TG, Marmarou A, Foulkes MA. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma . 1992;9(Suppl 1):S287–S292.
Ling GS, Neal CJ. Maintaining cerebral perfusion pressure is a worthy clinical goal. Neurocrit Care . 2005;2(1):75–81.
Cremer OL, van Dijk GW, van Wensen E, Brekelmans GJ, Moons KG, Leenen LP, Kalkman CJ. Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med . 2005;33(10):2207–2213.
Shen L, Wang Z, Su Z, Qiu S, Xu J, Zhou Y, Yan A, Yin R, Lu B, Nie X, et al. Effects of intracranial pressure monitoring on mortality in patients with severe traumatic brain injury: a meta-analysis. PLoS One . 2016;11(12):e0168901.
Coles JP, Fryer TD, Coleman MR, Smielewski P, Gupta AK, Minhas PS, Aigbirhio F, Chatfield DA, Williams GB, Boniface S, et al. Hyperventilation following head injury: effect on ischemic burden and cerebral oxidative metabolism. Crit Care Med . 2007;35(2):568–578.
Clifton GL, Valadka A, Zygun D, Coffey CS, Drever P, Fourwinds S, Janis LS, Wilde E, Taylor P, Harshman K, et al. Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: hypothermia II): a randomised trial. Lancet Neurol . 2011;10(2):131–139.
Morrison LJ, Rizoli SB, Schwartz B, Rhind SG, Simitciu M, Perreira T, Macdonald R, Trompeo A, Stuss DT, Black SE, et al. The Toronto prehospital hypertonic resuscitation-head injury and multi organ dysfunction trial (TOPHR HIT)—methods and data collection tools. Trials . 2009;10:105.
Raj R, Luostarinen T, Pursiainen E, Posti JP, Takala RSK, Bendel S, Konttila T, Korja M. Machine learning-based dynamic mortality prediction after traumatic brain injury. Sci Rep . 2019;9(1):17672.
Kennedy RR, Merry AF. The effect of a graphical interpretation of a statistic trend indicator (Trigg's Tracking Variable) on the detection of simulated changes. Anaesth Intensive Care . 2011;39(5):881–886.