Impact of Temperature Profile on Outcome After Traumatic Brain Injury

温度曲线对脑外伤后结果的影响

• 批准号: 8493797
• 负责人: Lori Kennedy
• 金额: $ 3.41万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8493797
• 关键词: 16 year old; Abate; Admission activity; Age; Athletic Injuries; Attenuated; Awareness; Biological Sciences; Body Temperature; Brain; Caring; Cause of Death; Cerebrum; Cessation of life; Classification; Clinical Trials; Communities; Conflict (Psychology); Data Analyses; Development; Discipline of Nursing; Failure; Family; Fever; Foundations; Freedom; Glasgow Outcome Scale; Glucose; Goals; Guidelines; Head; Health; Hemoglobin; Hour; Hypotension; Hypoxia; Individual; Infarction; Injury; Intensive Care Units; International; Intervention; Ischemia; Lead; Left; Length of Stay; Manufactured football; Measures; Metabolism; Methods; Military Personnel; Mission; Modeling; Monitor; Motor; National Institute of Nursing Research; Neurological outcome; Normal Range; Nurses; Outcome; Patients; Population; Positioning Attribute; Prevalence; Probability; Publishing; Reaction; Regression Analysis; Relative (related person); Research; Research Personnel; Resuscitation; Rewarming; Science; Secondary Prevention; Secondary to; Serum; Severities; Strategic Planning; Temperature; Time; Tissues; Training; Trauma; Traumatic Brain Injury; Traumatic Subarachnoid Hemorrhage; Variant; Wages; base; cost; disability; experience; improved; induced hypothermia; injured; meetings; mortality; natural hypothermia; operation; outcome forecast; predictive modeling; prevent; prognostic; public health relevance; wound

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is a leading cause of death and disability, contributing to one third of all injury- related deaths in the U.S. There has been an increased awareness of TBI as the "signature wound" of current military conflict. Despite best-care practices based on published guidelines, many patients have poor outcomes due to secondary injuries. Secondary injuries occur after the primary trauma. Failure to treat secondary injury leads to lengthened intensive care unit and hospital stays and increased mortality. Identification of strategies that can prevent or minimize secondary injuries results in improved health of individuals, families, communities, and populations. Temperature management is one method to reduce secondary injury. However, the optimal goal for body temperature following TBI has not been identified. The purpose of this secondary data analysis of 456 patients is to examine the association between body temperature and neurologic outcome as measured by Extended Glasgow Outcome Scale (GOS-E) in patients ages 16 years and older after blunt moderate or severe TBI. We propose that features of body temperature over 96 hours after injury predict 6-month GOS-E adjusting for confounders. The aims of this training proposal are to: 1) Characterize the severity and duration of time the patien experiences abnormal body temperature during the first 96 hours after moderate or severe TBI; 2) Determine if aberrant temperature exposure during this period predicts neurologic outcome adjusting for confounders; 3) Determine if rate of aberrant temperature correction during this period predicts neurologic outcome adjusting for confounders; and 4) Gather an interdisciplinary panel to validate findings and identify potential implications for future research nursing practice Multiple ordinal regression analysis will be used to estimate the relative contribution of IMPACT variables (age, GCS motor score, pupillary reaction, hypoxia, hypotension, initial head CT classification, traumatic subarachnoid hemorrhage or epidural mass on CT, serum glucose, and serum hemoglobin) in predicting GOS- E. Proportion of variation in GOS-E explained by IMPACT variables will be estimated. Temperature volume will be added to the model and change in variance of GOS-E explained by the addition of temperature volume will be estimated. Then, the rate of change in temperature across the 96-hour period will be added and change in variance of GOS-E explained by the addition of the rate of change in temperature will be estimated. Meeting these study aims, we may develop a more useful predictive model, which is readily translatable to nursing practice. We seek to build the scientific foundation for nursing practice. As nurses monitor, document and treat patient body temperature, this research has the potential to influence rewarming rates in trauma resuscitation with TBI, temperature management goals after TBI, and timing of interventions to prevent/minimize fever after TBI. Finally, temperature management following TBI may improve outcomes at a relatively low cost.

描述(申请人提供)：创伤性脑损伤(TBI)是导致死亡和残疾的主要原因，占美国所有与伤害有关的死亡人数的三分之一。 越来越多的人认识到，TBI是当前军事冲突的“标志性伤口”。尽管根据已公布的指南进行最佳护理，但由于继发性损伤，许多患者的预后较差。二次损伤发生在原发创伤之后。未能治疗继发性损伤会导致重症监护病房和住院时间延长，并增加死亡率。确定可预防或最大限度减少继发性伤害的策略可改善个人、家庭、社区和人口的健康。温度管理是减少二次伤害的方法之一。然而，颅脑损伤后的最佳体温目标尚未确定。对456名患者进行二次数据分析的目的是检验16岁及以上的患者在钝性、中度或重度颅脑损伤后，体温与扩展格拉斯哥预后量表(GOS-E)测量的神经预后之间的关系。我们认为，受伤后96小时以上的体温特征可以预测6个月的GOS-E调整混杂因素。这项培训计划的目的是：1)描述患者在中度或重度脑损伤后的头96小时内体温异常的严重程度和持续时间；2)确定在此期间的异常体温暴露是否预测了对混杂因素的神经结果调整；3)确定在此期间的异常温度校正率是否预测了对混杂因素的神经结果调整；4)召集一个跨学科小组来验证研究结果，并确定未来护理实践研究的潜在意义。将使用多元有序回归分析来估计影响变量(年龄、GCS运动评分、瞳孔反应、缺氧、低血压、头颅CT初始分类、外伤性蛛网膜下腔出血或硬膜外肿块对CT、血糖和血清血红蛋白)在预测GOS-E中的相对贡献，并估计由影响变量解释的GOS-E的变异比例。将温度体积添加到模型中，并估计由温度体积添加所解释的GOS-E的方差变化。然后，将96小时内的温度变化率相加，并估计由温度变化率相加所解释的GOS-E的方差变化。为了满足这些研究目标，我们可能会开发出更有用的预测模型，它很容易翻译到护理实践中。我们力求为护理工作奠定科学基础 练习一下。随着护士监测、记录和治疗患者的体温，这项研究有可能影响创伤复苏中的复温率、脑损伤后的温度管理目标以及预防/减少脑损伤后发热的干预时机。最后，颅脑损伤后的温度管理可能会以相对较低的成本改善预后。