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Introduction of the Uppsala Traumatic Brain Injury register for regular surveillance of patient characteristics and neurointensive care management including secondary insult quantification and clinical outcome.

Nyholm L, Howells T, Enblad P, Lewén A - Ups. J. Med. Sci. (2013)

Bottom Line: The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay.Favorable outcome was achieved by 64% of adults.The Uppsala TBI register enables the routine monitoring of NIC quality indexes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.

ABSTRACT

Background: To improve neurointensive care (NIC) and outcome for traumatic brain injury (TBI) patients it is crucial to define and monitor indexes of the quality of patient care. With this purpose we established the web-based Uppsala TBI register in 2008. In this study we will describe and analyze the data collected during the first three years of this project.

Methods: Data from the medical charts were organized in three columns containing: 1) Admission data; 2) Data from the NIC period including neurosurgery, type of monitoring, treatment, complications, neurological condition at discharge, and the amount of secondary insults; 3) Outcome six months after injury. Indexes of the quality of care implemented include: 1) Index of improvement; 2) Index of change; 3) The percentages of 'Talk and die' and 'Talk and deteriorate' patients.

Results: Altogether 314 patients were included 2008-2010: 66 women and 248 men aged 0-86 years. Automatic reports showed that the proportion of patients improving during NIC varied between 80% and 60%. The percentage of deteriorated patients was less than 10%. The percentage of Talk and die/Talk and deteriorate cases was <1%. The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay. The occurrences of secondary insults were less than 5% of good monitoring time for intracranial pressure (ICP) >25 mmHg, cerebral perfusion pressure (CPP) <50 mmHg, and systolic blood pressure <100 mmHg. Favorable outcome was achieved by 64% of adults.

Conclusion: The Uppsala TBI register enables the routine monitoring of NIC quality indexes.

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Related in: MedlinePlus

Mean occurrence of secondary insults (% of GMT) according to predefined threshold levels (mmHg) in TBI patients with ICP monitoring ≥16 years (n = 146) and in deteriorated patients ≥16 years (n = 20), included in the Uppsala TBI register 2008–2010. (ICP = intracranial pressure; CPP = cerebral perfusion pressure; SBP = systolic blood pressure; MAP = mean arterial pressure).
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Figure 4: Mean occurrence of secondary insults (% of GMT) according to predefined threshold levels (mmHg) in TBI patients with ICP monitoring ≥16 years (n = 146) and in deteriorated patients ≥16 years (n = 20), included in the Uppsala TBI register 2008–2010. (ICP = intracranial pressure; CPP = cerebral perfusion pressure; SBP = systolic blood pressure; MAP = mean arterial pressure).

Mentions: Analysis of the occurrence of secondary insults for all patients according to predefined insult thresholds showed that ICP >25 and >35 mmHg, CPP <50 and <40 mmHg, SBP <100 and <90 mmHg, and MAP <70 and >120 mmHg occurred in less than 5% of GMT (Figure 4). CPP <60, >70, and >80 mmHg, SBP >160 and >180 mmHg, and MAP <80 and >110 mmHg were present in a larger proportion of GMT (Figure 4). Eleven cases were excluded from the analysis of secondary insults since no monitoring data were stored for these patients because they had initially been treated in the general intensive care unit.


Introduction of the Uppsala Traumatic Brain Injury register for regular surveillance of patient characteristics and neurointensive care management including secondary insult quantification and clinical outcome.

Nyholm L, Howells T, Enblad P, Lewén A - Ups. J. Med. Sci. (2013)

Mean occurrence of secondary insults (% of GMT) according to predefined threshold levels (mmHg) in TBI patients with ICP monitoring ≥16 years (n = 146) and in deteriorated patients ≥16 years (n = 20), included in the Uppsala TBI register 2008–2010. (ICP = intracranial pressure; CPP = cerebral perfusion pressure; SBP = systolic blood pressure; MAP = mean arterial pressure).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713382&req=5

Figure 4: Mean occurrence of secondary insults (% of GMT) according to predefined threshold levels (mmHg) in TBI patients with ICP monitoring ≥16 years (n = 146) and in deteriorated patients ≥16 years (n = 20), included in the Uppsala TBI register 2008–2010. (ICP = intracranial pressure; CPP = cerebral perfusion pressure; SBP = systolic blood pressure; MAP = mean arterial pressure).
Mentions: Analysis of the occurrence of secondary insults for all patients according to predefined insult thresholds showed that ICP >25 and >35 mmHg, CPP <50 and <40 mmHg, SBP <100 and <90 mmHg, and MAP <70 and >120 mmHg occurred in less than 5% of GMT (Figure 4). CPP <60, >70, and >80 mmHg, SBP >160 and >180 mmHg, and MAP <80 and >110 mmHg were present in a larger proportion of GMT (Figure 4). Eleven cases were excluded from the analysis of secondary insults since no monitoring data were stored for these patients because they had initially been treated in the general intensive care unit.

Bottom Line: The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay.Favorable outcome was achieved by 64% of adults.The Uppsala TBI register enables the routine monitoring of NIC quality indexes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.

ABSTRACT

Background: To improve neurointensive care (NIC) and outcome for traumatic brain injury (TBI) patients it is crucial to define and monitor indexes of the quality of patient care. With this purpose we established the web-based Uppsala TBI register in 2008. In this study we will describe and analyze the data collected during the first three years of this project.

Methods: Data from the medical charts were organized in three columns containing: 1) Admission data; 2) Data from the NIC period including neurosurgery, type of monitoring, treatment, complications, neurological condition at discharge, and the amount of secondary insults; 3) Outcome six months after injury. Indexes of the quality of care implemented include: 1) Index of improvement; 2) Index of change; 3) The percentages of 'Talk and die' and 'Talk and deteriorate' patients.

Results: Altogether 314 patients were included 2008-2010: 66 women and 248 men aged 0-86 years. Automatic reports showed that the proportion of patients improving during NIC varied between 80% and 60%. The percentage of deteriorated patients was less than 10%. The percentage of Talk and die/Talk and deteriorate cases was <1%. The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay. The occurrences of secondary insults were less than 5% of good monitoring time for intracranial pressure (ICP) >25 mmHg, cerebral perfusion pressure (CPP) <50 mmHg, and systolic blood pressure <100 mmHg. Favorable outcome was achieved by 64% of adults.

Conclusion: The Uppsala TBI register enables the routine monitoring of NIC quality indexes.

Show MeSH
Related in: MedlinePlus