Blood Pressure Variability and Outcome in Traumatic Brain Injury: A Propensity Score Matching Study-Reference-Cited by-同舟云学术

Blood Pressure Variability and Outcome in Traumatic Brain Injury: A Propensity Score Matching Study

Published:2022-08-19 Issue:5 Volume:23 Page:769-780
ISSN:1936-900X
Container-title:Western Journal of Emergency Medicine
language:
Short-container-title:WestJEM

Author:

Tran Quincy¹,Frederick Hannah²,Tran Cecilia³,Baqai Hammad²,Lurie Tucker⁴,Solomon Julianna²,Aligabi Ayah²,Olexa Joshua⁵,Cardona Stephanie⁶,Bodanapally Uttam⁷,Schwartzbauer Gary⁸,Downing Jessica⁹

Affiliation:

1. University of Maryland School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, Baltimore, Maryland; The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland

2. University of Maryland School of Medicine, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, Baltimore, Maryland

3. University of Maryland School of Medicine, Baltimore, Maryland

4. University of Maryland School of Medicine, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, Baltimore, Maryland; Wellspan York Hospital, Department of Emergency Medicine, York, Pennsylvania

5. University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland

6. Mount Sinai Hospital, Department of Critical Care Medicine, York, New York

7. The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland

8. The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland

9. The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Program in Trauma/Surgical Critical Care, Baltimore, Maryland

Abstract

Introduction: Patients with tIPH (used here to refer to traumatic intraparenchymal hemorrhagic contusion) or intraparenchymal hemorrhage face high rates of mortality and persistent functional deficits. Prior studies have found an association between blood pressure variability (BPV) and neurologic outcomes in patients with spontaneous IPH. Our study investigated the association between BPV and discharge destination (a proxy for functional outcome) in patients with tIPH. Methods: We retrospectively reviewed the charts of patients admitted to a Level I trauma center for ≥ 24 hours with tIPH. We examined variability in hourly BP measurements over the first 24 hours of hospitalization. Our outcome of interest was discharge destination (home vs facility). We performed 1:1 propensity score matching and multivariate regressions to identify demographic and clinical factors predictive of discharge home. Results: We included 354 patients; 91 were discharged home and 263 to a location other than home. The mean age was 56 (SD 21), 260 (73%) were male, 22 (6%) were on anticoagulation, and 54 (15%) on antiplatelet therapy. Our propensity-matched cohorts included 76 patients who were discharged home and 76 who were discharged to a location other than home. One measure of BPV (successive variation in systolic BP) was identified as an independent predictor of discharge location in our propensity-matched cohorts (odds ratio 0.89, 95% confidence interval 0.8-0.98; P = 0.02). Our model demonstrated good goodness of fit (P-value for Hosmer-Lemeshow test = 0.88) and very good discriminatory capability (AUROC = 0.81). High Glasgow Coma Scale score at 24 hours and treatment with fresh frozen plasma were also associated with discharge home. Conclusion: Our study suggests that increased BPV is associated with lower rates of discharge home after initial hospitalization among patients with tIPH. Additional research is needed to evaluate the impact of BP control on patient outcomes.

Publisher

Western Journal of Emergency Medicine

Subject

General Medicine,Emergency Medicine

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