Association Between Relative Anemia and Early Functional Recovery After Severe Traumatic Brain Injury (TBI)

Kevin R. Carr, Michelle Rodriguez, Alex Ottesen, Joel E Michalek, Colin Son, Vaibhav Patel, David Jimenez, Ali Seifi

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Severe traumatic brain injury is associated with a multi-systemic response and changes in metabolic demand. Patients requiring intracranial pressure monitoring or cerebrospinal fluid diversion, often signifies a greater severity of injury. For this group, the association between RBC transfusion, transfusion thresholds, and clinical recovery is unknown. In this study, we studied the association between transfusion and clinical recovery for severe traumatic brain injury patients requiring external ventricular drain or intracranial pressure monitor placement. Methods: Eighty-nine patients with a primary diagnosis of traumatic brain injury requiring implantation of either an intracranial pressure monitor or external ventricular drainage device were identified. All patients were managed in a Level 1 Trauma facility by board-certified neuro-intensive care practitioners for the course of their intensive care unit duration. The correlation between transfusion and clinical recovery, defined by change in Glasgow Coma Scale was assessed. Results: Thirty-four patients required surgical decompression, and 56.18 % of the cumulative cohort were transfused during admission. Overall, transfusion was not associated with significant clinical recovery (change in GCS > 3) for Hgb threshold of 7 mg/dL (<3, 29.03 vs. ≥3, 37.93 %; p = 0.49), nor for higher stratifications (8 mg/dL, p = 0.63; 9 mg/dL, p = 0.79, 10 mg/dL, p = 1). For patients who required transfusions at thresholds ≥8 mg/dL, there was a positive association with decreased length of hospitalization, [p = 0.01; <8 mg/dL: 22 (12–33), ≥8 mg/dL: 14 (7.75–20)] [median (IQR)]. Similarly, length of ICU stay was shorter for patients transfused at thresholds ≥9 mg/dL, (p = 0.02). Conclusions: From our studies, we demonstrate no significant clinical benefit associated with stratified transfusion goals; however, there was a decrease in length of hospitalization for patients with transfusion thresholds of Hgb ≥ 8 mg/dL. Larger, randomized controlled trials may be required to more accurately assess outcomes in this patient population. In patients admitted for primary severe traumatic brain injury, we demonstrate no significant clinical benefit associated with stratified transfusion goals; however, there was a noticeable decrease in length of hospitalization for patients with transfusion thresholds of Hgb ≥ 8 mg/dL. Larger, randomized controlled trials may be required to more accurately assess outcomes in this patient population.

Original languageEnglish (US)
Pages (from-to)185-192
Number of pages8
JournalNeurocritical Care
Volume25
Issue number2
DOIs
StatePublished - Oct 1 2016

Fingerprint

Anemia
Intracranial Pressure
Hospitalization
Traumatic Brain Injury
Randomized Controlled Trials
Surgical Decompression
Glasgow Coma Scale
Wounds and Injuries
Ventricular Pressure
Critical Care
Population
Intensive Care Units
Cerebrospinal Fluid
Drainage
Length of Stay
Equipment and Supplies

Keywords

  • Anemia
  • Intracranial pressure
  • Severe TBI
  • Ventriculostomy

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Clinical Neurology

Cite this

Association Between Relative Anemia and Early Functional Recovery After Severe Traumatic Brain Injury (TBI). / Carr, Kevin R.; Rodriguez, Michelle; Ottesen, Alex; Michalek, Joel E; Son, Colin; Patel, Vaibhav; Jimenez, David; Seifi, Ali.

In: Neurocritical Care, Vol. 25, No. 2, 01.10.2016, p. 185-192.

Research output: Contribution to journalArticle

Carr, Kevin R. ; Rodriguez, Michelle ; Ottesen, Alex ; Michalek, Joel E ; Son, Colin ; Patel, Vaibhav ; Jimenez, David ; Seifi, Ali. / Association Between Relative Anemia and Early Functional Recovery After Severe Traumatic Brain Injury (TBI). In: Neurocritical Care. 2016 ; Vol. 25, No. 2. pp. 185-192.
@article{26f831ce56b74ccab7c7f554dc3b72ac,
title = "Association Between Relative Anemia and Early Functional Recovery After Severe Traumatic Brain Injury (TBI)",
abstract = "Background: Severe traumatic brain injury is associated with a multi-systemic response and changes in metabolic demand. Patients requiring intracranial pressure monitoring or cerebrospinal fluid diversion, often signifies a greater severity of injury. For this group, the association between RBC transfusion, transfusion thresholds, and clinical recovery is unknown. In this study, we studied the association between transfusion and clinical recovery for severe traumatic brain injury patients requiring external ventricular drain or intracranial pressure monitor placement. Methods: Eighty-nine patients with a primary diagnosis of traumatic brain injury requiring implantation of either an intracranial pressure monitor or external ventricular drainage device were identified. All patients were managed in a Level 1 Trauma facility by board-certified neuro-intensive care practitioners for the course of their intensive care unit duration. The correlation between transfusion and clinical recovery, defined by change in Glasgow Coma Scale was assessed. Results: Thirty-four patients required surgical decompression, and 56.18 {\%} of the cumulative cohort were transfused during admission. Overall, transfusion was not associated with significant clinical recovery (change in GCS > 3) for Hgb threshold of 7 mg/dL (<3, 29.03 vs. ≥3, 37.93 {\%}; p = 0.49), nor for higher stratifications (8 mg/dL, p = 0.63; 9 mg/dL, p = 0.79, 10 mg/dL, p = 1). For patients who required transfusions at thresholds ≥8 mg/dL, there was a positive association with decreased length of hospitalization, [p = 0.01; <8 mg/dL: 22 (12–33), ≥8 mg/dL: 14 (7.75–20)] [median (IQR)]. Similarly, length of ICU stay was shorter for patients transfused at thresholds ≥9 mg/dL, (p = 0.02). Conclusions: From our studies, we demonstrate no significant clinical benefit associated with stratified transfusion goals; however, there was a decrease in length of hospitalization for patients with transfusion thresholds of Hgb ≥ 8 mg/dL. Larger, randomized controlled trials may be required to more accurately assess outcomes in this patient population. In patients admitted for primary severe traumatic brain injury, we demonstrate no significant clinical benefit associated with stratified transfusion goals; however, there was a noticeable decrease in length of hospitalization for patients with transfusion thresholds of Hgb ≥ 8 mg/dL. Larger, randomized controlled trials may be required to more accurately assess outcomes in this patient population.",
keywords = "Anemia, Intracranial pressure, Severe TBI, Ventriculostomy",
author = "Carr, {Kevin R.} and Michelle Rodriguez and Alex Ottesen and Michalek, {Joel E} and Colin Son and Vaibhav Patel and David Jimenez and Ali Seifi",
year = "2016",
month = "10",
day = "1",
doi = "10.1007/s12028-016-0273-7",
language = "English (US)",
volume = "25",
pages = "185--192",
journal = "Neurocritical Care",
issn = "1541-6933",
publisher = "Humana Press",
number = "2",

}

TY - JOUR

T1 - Association Between Relative Anemia and Early Functional Recovery After Severe Traumatic Brain Injury (TBI)

AU - Carr, Kevin R.

AU - Rodriguez, Michelle

AU - Ottesen, Alex

AU - Michalek, Joel E

AU - Son, Colin

AU - Patel, Vaibhav

AU - Jimenez, David

AU - Seifi, Ali

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background: Severe traumatic brain injury is associated with a multi-systemic response and changes in metabolic demand. Patients requiring intracranial pressure monitoring or cerebrospinal fluid diversion, often signifies a greater severity of injury. For this group, the association between RBC transfusion, transfusion thresholds, and clinical recovery is unknown. In this study, we studied the association between transfusion and clinical recovery for severe traumatic brain injury patients requiring external ventricular drain or intracranial pressure monitor placement. Methods: Eighty-nine patients with a primary diagnosis of traumatic brain injury requiring implantation of either an intracranial pressure monitor or external ventricular drainage device were identified. All patients were managed in a Level 1 Trauma facility by board-certified neuro-intensive care practitioners for the course of their intensive care unit duration. The correlation between transfusion and clinical recovery, defined by change in Glasgow Coma Scale was assessed. Results: Thirty-four patients required surgical decompression, and 56.18 % of the cumulative cohort were transfused during admission. Overall, transfusion was not associated with significant clinical recovery (change in GCS > 3) for Hgb threshold of 7 mg/dL (<3, 29.03 vs. ≥3, 37.93 %; p = 0.49), nor for higher stratifications (8 mg/dL, p = 0.63; 9 mg/dL, p = 0.79, 10 mg/dL, p = 1). For patients who required transfusions at thresholds ≥8 mg/dL, there was a positive association with decreased length of hospitalization, [p = 0.01; <8 mg/dL: 22 (12–33), ≥8 mg/dL: 14 (7.75–20)] [median (IQR)]. Similarly, length of ICU stay was shorter for patients transfused at thresholds ≥9 mg/dL, (p = 0.02). Conclusions: From our studies, we demonstrate no significant clinical benefit associated with stratified transfusion goals; however, there was a decrease in length of hospitalization for patients with transfusion thresholds of Hgb ≥ 8 mg/dL. Larger, randomized controlled trials may be required to more accurately assess outcomes in this patient population. In patients admitted for primary severe traumatic brain injury, we demonstrate no significant clinical benefit associated with stratified transfusion goals; however, there was a noticeable decrease in length of hospitalization for patients with transfusion thresholds of Hgb ≥ 8 mg/dL. Larger, randomized controlled trials may be required to more accurately assess outcomes in this patient population.

AB - Background: Severe traumatic brain injury is associated with a multi-systemic response and changes in metabolic demand. Patients requiring intracranial pressure monitoring or cerebrospinal fluid diversion, often signifies a greater severity of injury. For this group, the association between RBC transfusion, transfusion thresholds, and clinical recovery is unknown. In this study, we studied the association between transfusion and clinical recovery for severe traumatic brain injury patients requiring external ventricular drain or intracranial pressure monitor placement. Methods: Eighty-nine patients with a primary diagnosis of traumatic brain injury requiring implantation of either an intracranial pressure monitor or external ventricular drainage device were identified. All patients were managed in a Level 1 Trauma facility by board-certified neuro-intensive care practitioners for the course of their intensive care unit duration. The correlation between transfusion and clinical recovery, defined by change in Glasgow Coma Scale was assessed. Results: Thirty-four patients required surgical decompression, and 56.18 % of the cumulative cohort were transfused during admission. Overall, transfusion was not associated with significant clinical recovery (change in GCS > 3) for Hgb threshold of 7 mg/dL (<3, 29.03 vs. ≥3, 37.93 %; p = 0.49), nor for higher stratifications (8 mg/dL, p = 0.63; 9 mg/dL, p = 0.79, 10 mg/dL, p = 1). For patients who required transfusions at thresholds ≥8 mg/dL, there was a positive association with decreased length of hospitalization, [p = 0.01; <8 mg/dL: 22 (12–33), ≥8 mg/dL: 14 (7.75–20)] [median (IQR)]. Similarly, length of ICU stay was shorter for patients transfused at thresholds ≥9 mg/dL, (p = 0.02). Conclusions: From our studies, we demonstrate no significant clinical benefit associated with stratified transfusion goals; however, there was a decrease in length of hospitalization for patients with transfusion thresholds of Hgb ≥ 8 mg/dL. Larger, randomized controlled trials may be required to more accurately assess outcomes in this patient population. In patients admitted for primary severe traumatic brain injury, we demonstrate no significant clinical benefit associated with stratified transfusion goals; however, there was a noticeable decrease in length of hospitalization for patients with transfusion thresholds of Hgb ≥ 8 mg/dL. Larger, randomized controlled trials may be required to more accurately assess outcomes in this patient population.

KW - Anemia

KW - Intracranial pressure

KW - Severe TBI

KW - Ventriculostomy

UR - http://www.scopus.com/inward/record.url?scp=84989225452&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84989225452&partnerID=8YFLogxK

U2 - 10.1007/s12028-016-0273-7

DO - 10.1007/s12028-016-0273-7

M3 - Article

VL - 25

SP - 185

EP - 192

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

IS - 2

ER -