Univariate comparison of performance of different cerebrovascular reactivity indices for outcome association in adult TBI: a CENTER-TBI study

• DOI: 10.1007/s00701-019-03844-1
• Publication Date: 2019-03-15T20:37:34Z
• Authors: Frederick A. Zeiler; Ari Ercole; Manuel Cabeleira; Tommaso Zoerle; Nino Stocchetti; David K. Menon; Peter Smielewski; Marek Czosnyka
• Keywords: Neuroradiology; Glasgow Outcome Scale; Univariate analysis; Decompressive craniectomy; Trauma Center

Monitoring cerebrovascular reactivity in adult traumatic brain injury (TBI) has been linked to global patient outcome. Three intra-cranial pressure (ICP)-derived indices have described. It is unknown which index superior for outcome association TBI outside previous single-center evaluations. The goal of this study evaluate 6- 12-month using uniform data harvested multiple centers. Using the prospectively collected from Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) study, following were derived: PRx (correlation between ICP and mean arterial (MAP)), PAx pulse amplitude (AMP) MAP), RAC AMP cerebral perfusion (CPP)). Univariate logistic regression models created assess vascular with dichotomized at 6 12 months, as assessed by Glasgow Outcome Score–Extended (GOSE). Models compared via area under receiver operating curve (AUC) Delong's test. Two separate groups cohort assessed: total population available (n = 204) only those without decompressive craniectomy 159), identical results. PRx, PAx, perform similar both outcomes, alive/dead favorable/unfavorable, trending towards higher AUC values. There statistically values index, % time above threshold, hourly dose threshold each patients poor outcomes. appear their associations moderate/severe TBI, showing tendency achieve stronger associations. Further work required determine role these monitoring patients.