Page 52 - NNS 2014 Program & Abstract Book

TBI data from the Nationwide Emergency Department Sample
were gathered and sport-related injuries were identified by E-code.
Patient characteristics were compared using chi-squared tests and
odds of inpatient admission were calculated using logistic regression.
A total of 106,217 sport-related TBIs occurred over a period from
2006–2011. Of these, 70,509 (66.4%) were among middle school- or
high school-aged adolescents (age 12–18). Overall, ED presentation
with sports-related TBI increased 77.5% from 53,058 in 2006 to
94,181 in 2011. The number of patients admitted to inpatient care
increased by 8.0%, from 2,850 to 3,078, over the same period, how-
ever the actual proportion of ED patients admitted to inpatient care
decreased from 5.4% in 2006 to 3.3% in 2011. Across the study
period, patients in the Midwest/West were proportionally more likely
to be admitted than those in the East/South.
Increased ED presentation with sport-related TBI is cause for
concern, especially among school-age adolescents. Falling admission
rates suggest that the rise in ED presentations may be driven by in-
creased TBI awareness rather than by increasing TBI incidence. While
additional research is warranted, it is clear that the prevention of
sport-related TBI, especially among adolescents, must be addressed.
Key words
emergency department, epidemiology, sports-related, TBI
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ACUTE CARE CLINICAL INDICATORS ASSOCIATED WITH
DISCHARGE OUTCOMES IN CHILDREN WITH SEVERE
TRAUMATIC BRAIN INJURY
Vavilala, M.S.1, Kernic, M.A.1, Wang, J.1 , Kannan, N.1, Mink, R.B.2,
Wainwright, M.S.3, Groner, J.I.4, Bell, M.J.5, Giza, C.C.6, Zatzick, D.F.1,
Ellenbogen, R.G.1, Boyle, L.N.1, Mitchell, P.H.1, Rivara, F.P.1
1University of Washington, Seattle, USA
2Harbor-UCLA & Los Angeles BioMedical Research Institute, Los
Angeles, USA
3Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago,
USA
4Ohio State University College of Medicine, Columbus, USA
5University of Pittsburgh, Pittsburgh, USA
6Mattel Children’s Hospital, UCLA, Los Angeles, USA
We tested the relationship between severe pediatric traumatic brain
injury (TBI) guideline indicators during the first 72 hours after hos-
pital admission and discharge outcomes.
Records of children £ 17 years with severe TBI were abstracted at 5
pediatric trauma centers. Total percent adherence to the clinical in-
dicators across all treatment locations (pre-hospital [PH], emergency
department [ED], operating room [OR], and intensive care unit [ICU]
were determined. Main outcomes were discharge survival and Glas-
cow outcome scale (GOS) score. Total adherence rate ranged from
68–78%. Clinical indicators of adherence were associated with sur-
vival (aHR 0.94; 95% CI 0.91, 0.96). Three indicators were associated
with survival: absence of PH hypoxia (aHR 0.20; 95% CI 0.08, 0.46),
early ICU start of nutrition (aHR 0.06; 95% CI 0.01, 0.26), and ICU
paCO2 < 30 mm Hg in the absence of radiographic or clinical signs of
cerebral herniation (aHR 0.22; 95% CI 0.06, 0.8). Clinical indicators
of adherence were associated with favorable GOS among survivors
(aHR 0.99; 95% CI 0.98, 0.99). Three indicators were associated with
favorable discharge GOS: all OR CPP > 40 mm Hg (aRR 0.64; 95%
CI 0.55, 0.75), all ICU CPP > 40 mm Hg (aRR 0.74; 95% CI 0.63,
0.87), and no surgery (any type); aRR 0.72; 95% CI 0.53, 0.97).
Acute care clinical indicators of adherence to the Pediatric
Guidelines were associated with significantly higher discharge sur-
vival and improved discharge GOS. Some indicators were protective,
regardless of treatment location.
Key words
evidence-based guidelines, outcomes, pediatric, traumatic brain injury
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PLASMA AND CEREBROSPINAL FLUID ERYTHROPOIETIN
CONCENTRATIONS FOLLOWING ERYTHROPOIETIN
ADMINISTRATION IN TRAUMATIC BRAIN INJURY
Goodman, J.C.1, Yamal, J.M.3, Benoit, J.3, Rubin, M.L.3, Hannay, H.J.2,
Gopinath, S.P.1, Tilley, B.C.3, Robertson, C.S.1
1Baylor College of Medicine, Houston, USA
2University of Houston, Houston, USA
3University of Texas School of Public Health, Houston, USA
The objective is to examine erythropoietin (EPO) dynamics in plasma
and CSF following erythropoietin administration in patients with
traumatic brain injury (TBI).
As part of a study of transfusion threshold and epoetin alfa ad-
ministration (500 IU/kg EPO [Epogen , Amgen, Inc., Thousand Oaks,
CA]) in TBI, EPO concentrations were measured by ELISA in plasma
and CSF at 6, 12, 24, 48, 72 and 96 hours after injury. Patients
(N = 200) were randomized to placebo (N = 98), single dose EPO
(N = 64) or three doses of EPO (N = 38) given 24 hours apart started
within 6 hours of injury.
Before treatment, the median plasma EPO levels were 15.7 (in-
terquartile range [IQR] = 40.3) mIU/ml (normal range 4–27 mIU/ml).
In the placebo group, the median plasma EPO levels gradually in-
creased over time, peaking at 111.6 (IQR = 161.5) mIU/ml at 48 hours
after injury. In the patients receiving EPO, the median plasma levels
peaked at 1,745.0 (IQR = 770.5) mIU/ml at 12 hours after injury.
These plasma levels of EPO were sustained in the patients receiving
three doses compared to those receiving a single dose.
Prior to the initial dose, CSF EPO was undetectable in most pa-
tients. In patients receiving EPO, the median CSF levels increased to
11.8 (IQR = 64.7) mIU/ml at 12 hours after injury and peaked at 18
hours, and remained elevated above baseline values through 48 hours.
In the placebo group, EPO peaked at 48 and 72 hours.
EPO administration results in a sustained rise of plasma and CSF
EPO levels. CSF levels are approximately 1% of plasma levels indi-
cating small but definite CNS penetration. There is an endogenous EPO
response in the placebo group consisting of a gradual increase in both
plasma and CSF that peaks 4 days after injury. (Supported by National
Institute of Neurological Disorders and Stroke P01-NS38660).
Key words
anemia, cerebrospinal fluid, erythropoietin, pharmacokinetics
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WHAT WILL YOU SEE IN INTRACRANIAL PRESSURE
WAVEFORM ANALYSIS?
Oshio, K., Onodera, H., Sase, T., Tanaka, Y.
St Marianna University School of Medicine, Department of Neuro-
surgery, Kawasaki, Japan
Intracranial pressure (ICP) is monitored commonly in the severe
traumatic brain injury. However, we only know the facts from the
value of the mean ICP whether ICP is high or low. It does not reflect
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