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Citation
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Vallée F, Nougue H, Cartailler J, Koundé PR, Mebazaa A, Gayat E, Azouvi P, Mateo J. J. Trauma Acute Care Surg. 2022; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Establishing neurological prognoses in traumatic brain injury (TBI) patients remains challenging. To help physicians in the early management of severe TBI, we have designed a visual score (ICEBERG score) including multimodal monitoring and treatment-related criteria. We evaluated the ICEBERG scores among patients with severe TBI to predict the 28-day mortality and long-term disability (Extended Glasgow Outcome Score (GOSE) at 3 years). Additionally, we made a preliminary assessment of the nurses and doctors on the uptake and reception to the use of the ICEBERG visual tool.
METHODS: This study was part of a larger prospective cohort study of 207 patients with severe TBI in the Parisian region (PariS-TBI study). The ICEBERG score included 6 variables from multimodal monitoring and treatment-related criteria: cerebral perfusion pressure (CPP), intracranial pressure (ICP), body temperature, sedation depth, arterial partial pressure of CO2 and blood osmolarity. The primary outcome measures included the ICEBERG score and its relationship with hospital mortality and GOSE.
RESULTS: The hospital mortality was 21% (45/207). The ICEBERG score baseline value and changes during the 72nd first hours were more strongly associated with TBI prognosis than the ICEBERG parameters measured individually. Interestingly, when the clinical and CT parameters at admission were combined with the ICEBERG score at 48 h using a multimodal approach, the predictive value was significantly increased (AUC = 0.92). Furthermore, comparing the ICEBERG visual representation with the traditional numerical readout revealed that changes in patient vitals were more promptly detected using ICEBERG representation (p < 0.05).
CONCLUSIONS: The ICEBERG score could represent a simple and effective method to describe severity in TBI patients, where a high score is associated with increased mortality and disability. Additionally, ICEBERG representation could enhances the recognition of unmet therapeutic goals and dynamic evolution of the patient's condition. These preliminary results must be confirmed in a prospective manner. STUDY TYPE: Prognostic. LEVEL OF EVIDENCE: Level III.
Language: en |