Novel index for predicting mortality during the first 24 hours after traumatic brain injury

Journal of Neurosurgery (2018)

Hypoperfusion: brain often loses its ability to control blood flow properly, which can lead to low blood flow after traumatic brain injury

Pressure-reactivity index (PRx): how well the brain can regulate blood flow

Abstract:

The study proposes a new index for predicting mortality in the first 24 hours after traumatic brain injury (TBI).
It combines pressure-reactivity index (PRx), cerebral perfusion pressure (CPP), and intracranial pressure (ICP) to assess cerebral autoregulation and hypoperfusion.
Data were retrospectively analyzed from 295 TBI patients’ continuous ICP and arterial blood pressure recordings.
The cumulative time of severe hypoperfusion events (low CPP, high PRx, and high ICP) was evaluated as a predictor of six-month mortality.

Findings:

Longer accumulated duration of severe hypoperfusion events during the first 24 hours was strongly associated with mortality
A threshold of less than 25 minutes of combined hypoperfusion significantly predicted mortality when combined with basic clinical factors
The predictive accuracy of the index improved further in patients with mean ICP above 20 or 22 mm Hg.
The novel index provides quantitative early risk stratification for TBI patients based on real-time physiological monitoring.

Conclusion:

A short period (about 25 minutes) of very low brain blood flow → a strong warning sign that the patient may not survive
The amount of time a TBI patient experiences severe cerebral hypoperfusion within the first 24 hours is a strong and early predictor of mortality, using physiological monitering as guidance.

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