Abstract
Discussion Forum (0)
ePoster
Topic: Brain Injury
Reynen, Emily1, Hunniford, Victoria1, Stapleton, Kallie1, Boyd, J. Gordon1
1Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Introduction/Background:
Traumatic Brain Injury (TBI) is among the most common neurological causes of admission to the intensive care unit (ICU) and is a common cause of death and disability.(1–3) In 2016, the Brain Trauma Foundation (BTF) published updated clinical practice guidelines (CPG) for the management of TBI.(4) Optimal rates of adherence to clinical practice guidelines are unknown.
Objectives:
Our primary objective is to retrospectively characterize the degree of adherence between care received and CPG for patients admitted to the ICU with TBI. Our secondary objective is to evaluate mortality and functional outcomes.
Methods:
This study is a retrospective analysis of all patients aged 18 years or older admitted to our level 3 ICU with a TBI between January 1, 2012 and December 31, 2017. Ethics approval was granted by the Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (HSREB). Eligible participants were identified through the patient discharge database using ICD 10 codes. Data was retrieved manually from patients' electronic charts and entered into a de-identified standardized data extraction excel spreadsheet. Descriptive statistics including median and interquartile ranges (IQR) were used to analyze the data. Outcomes of interest include patient demographic data, interventions used in case management, morbidity and mortality. Missing data was quantified as a proportion of the total data available.
Results:
A total of 326 patients were identified, of these, 311 were eligible for inclusion. The most common reason for exclusion from the study was patients who did not experience a TBI. Key baseline characteristics are reported in Table 1.
A CT head was completed in 307 patients (99%), of which 283 (92%) had an abnormal finding. The median Marshall score was 3 (IQR: 2 to 5). Neurosurgical interventions were performed in 127 patients (41%), the most common being a crainiotomy (n=44). Interventions to lower ICP were used in 117 patients and 48 patients had an ICP monitor placed. Details of ICP lowering therapy are outlined in table 2.
A total of 46 patients experienced a seizure prior to arrival at KHSC. Of the 262 patients who did not experience a seizure prior to presenting to hospital, 72 (27%) received seizure prophylaxis. Anti-seizure medications received are described in figure 1. Median duration of seizure prophylaxis was 7 days (IQR: 7 to 14 days). Despite prophylaxis, 20 patients experienced a seizure, of which 7 were diagnosed clinically and 13 on EEG.
The median mRS at time of discharge or transfer was 4 (IQR: 3 to 6). The median length of ICU stay was 6 days (IQR: 2 to 11) and total hospital stay was 11 days (IQR: 3 to 26). When available, the most common discharge destination was a rehabilitation facility (25%) followed by home (with or without supports) in 21%. Goals of care were documented on the official KHSC form in 13 (4%) of cases. A total of 102 (33%) of patients died before hospital discharge. The majority of deaths (n=101 [99%]) occurred in the ICU.
Conclusion:
Our study confirms that TBI is associated with clinically important functional morbidity and mortality. Few patients received seizure prophylaxis or had an ICP monitor placed. These management strategies represent a potential opportunity for improved guideline adherence and will be the focus of a subsequent quality improvement initiative.
Image 1
Image 2
Image 3
References:
1. ICU Medical Conditions | The Ottawa Hospital [Internet]. [cited 2020 May 9]. Available from: http://www.ottawahospital.on.ca/en/clinical-services/my-icu-the-intensive-care-unit/icu-patients/icu-medical-conditions/
2. Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(August):728–41.
3. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: Institutional variations in care and effect on outcome*. Crit Care Med [Internet]. 2002;30(8):1870–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-200208000-00033
4. Carney N, Totten AM, O'Reilly C, Ullman JS, Bell MJ, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. 2016;(September). Available from: https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf
Topic: Brain Injury
Reynen, Emily1, Hunniford, Victoria1, Stapleton, Kallie1, Boyd, J. Gordon1
1Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Introduction/Background:
Traumatic Brain Injury (TBI) is among the most common neurological causes of admission to the intensive care unit (ICU) and is a common cause of death and disability.(1–3) In 2016, the Brain Trauma Foundation (BTF) published updated clinical practice guidelines (CPG) for the management of TBI.(4) Optimal rates of adherence to clinical practice guidelines are unknown.
Objectives:
Our primary objective is to retrospectively characterize the degree of adherence between care received and CPG for patients admitted to the ICU with TBI. Our secondary objective is to evaluate mortality and functional outcomes.
Methods:
This study is a retrospective analysis of all patients aged 18 years or older admitted to our level 3 ICU with a TBI between January 1, 2012 and December 31, 2017. Ethics approval was granted by the Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (HSREB). Eligible participants were identified through the patient discharge database using ICD 10 codes. Data was retrieved manually from patients' electronic charts and entered into a de-identified standardized data extraction excel spreadsheet. Descriptive statistics including median and interquartile ranges (IQR) were used to analyze the data. Outcomes of interest include patient demographic data, interventions used in case management, morbidity and mortality. Missing data was quantified as a proportion of the total data available.
Results:
A total of 326 patients were identified, of these, 311 were eligible for inclusion. The most common reason for exclusion from the study was patients who did not experience a TBI. Key baseline characteristics are reported in Table 1.
A CT head was completed in 307 patients (99%), of which 283 (92%) had an abnormal finding. The median Marshall score was 3 (IQR: 2 to 5). Neurosurgical interventions were performed in 127 patients (41%), the most common being a crainiotomy (n=44). Interventions to lower ICP were used in 117 patients and 48 patients had an ICP monitor placed. Details of ICP lowering therapy are outlined in table 2.
A total of 46 patients experienced a seizure prior to arrival at KHSC. Of the 262 patients who did not experience a seizure prior to presenting to hospital, 72 (27%) received seizure prophylaxis. Anti-seizure medications received are described in figure 1. Median duration of seizure prophylaxis was 7 days (IQR: 7 to 14 days). Despite prophylaxis, 20 patients experienced a seizure, of which 7 were diagnosed clinically and 13 on EEG.
The median mRS at time of discharge or transfer was 4 (IQR: 3 to 6). The median length of ICU stay was 6 days (IQR: 2 to 11) and total hospital stay was 11 days (IQR: 3 to 26). When available, the most common discharge destination was a rehabilitation facility (25%) followed by home (with or without supports) in 21%. Goals of care were documented on the official KHSC form in 13 (4%) of cases. A total of 102 (33%) of patients died before hospital discharge. The majority of deaths (n=101 [99%]) occurred in the ICU.
Conclusion:
Our study confirms that TBI is associated with clinically important functional morbidity and mortality. Few patients received seizure prophylaxis or had an ICP monitor placed. These management strategies represent a potential opportunity for improved guideline adherence and will be the focus of a subsequent quality improvement initiative.
Image 1
Image 2
Image 3
References:
1. ICU Medical Conditions | The Ottawa Hospital [Internet]. [cited 2020 May 9]. Available from: http://www.ottawahospital.on.ca/en/clinical-services/my-icu-the-intensive-care-unit/icu-patients/icu-medical-conditions/
2. Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(August):728–41.
3. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: Institutional variations in care and effect on outcome*. Crit Care Med [Internet]. 2002;30(8):1870–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-200208000-00033
4. Carney N, Totten AM, O'Reilly C, Ullman JS, Bell MJ, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. 2016;(September). Available from: https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf
ePoster
Topic: Brain Injury
Reynen, Emily1, Hunniford, Victoria1, Stapleton, Kallie1, Boyd, J. Gordon1
1Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Introduction/Background:
Traumatic Brain Injury (TBI) is among the most common neurological causes of admission to the intensive care unit (ICU) and is a common cause of death and disability.(1–3) In 2016, the Brain Trauma Foundation (BTF) published updated clinical practice guidelines (CPG) for the management of TBI.(4) Optimal rates of adherence to clinical practice guidelines are unknown.
Objectives:
Our primary objective is to retrospectively characterize the degree of adherence between care received and CPG for patients admitted to the ICU with TBI. Our secondary objective is to evaluate mortality and functional outcomes.
Methods:
This study is a retrospective analysis of all patients aged 18 years or older admitted to our level 3 ICU with a TBI between January 1, 2012 and December 31, 2017. Ethics approval was granted by the Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (HSREB). Eligible participants were identified through the patient discharge database using ICD 10 codes. Data was retrieved manually from patients' electronic charts and entered into a de-identified standardized data extraction excel spreadsheet. Descriptive statistics including median and interquartile ranges (IQR) were used to analyze the data. Outcomes of interest include patient demographic data, interventions used in case management, morbidity and mortality. Missing data was quantified as a proportion of the total data available.
Results:
A total of 326 patients were identified, of these, 311 were eligible for inclusion. The most common reason for exclusion from the study was patients who did not experience a TBI. Key baseline characteristics are reported in Table 1.
A CT head was completed in 307 patients (99%), of which 283 (92%) had an abnormal finding. The median Marshall score was 3 (IQR: 2 to 5). Neurosurgical interventions were performed in 127 patients (41%), the most common being a crainiotomy (n=44). Interventions to lower ICP were used in 117 patients and 48 patients had an ICP monitor placed. Details of ICP lowering therapy are outlined in table 2.
A total of 46 patients experienced a seizure prior to arrival at KHSC. Of the 262 patients who did not experience a seizure prior to presenting to hospital, 72 (27%) received seizure prophylaxis. Anti-seizure medications received are described in figure 1. Median duration of seizure prophylaxis was 7 days (IQR: 7 to 14 days). Despite prophylaxis, 20 patients experienced a seizure, of which 7 were diagnosed clinically and 13 on EEG.
The median mRS at time of discharge or transfer was 4 (IQR: 3 to 6). The median length of ICU stay was 6 days (IQR: 2 to 11) and total hospital stay was 11 days (IQR: 3 to 26). When available, the most common discharge destination was a rehabilitation facility (25%) followed by home (with or without supports) in 21%. Goals of care were documented on the official KHSC form in 13 (4%) of cases. A total of 102 (33%) of patients died before hospital discharge. The majority of deaths (n=101 [99%]) occurred in the ICU.
Conclusion:
Our study confirms that TBI is associated with clinically important functional morbidity and mortality. Few patients received seizure prophylaxis or had an ICP monitor placed. These management strategies represent a potential opportunity for improved guideline adherence and will be the focus of a subsequent quality improvement initiative.
Image 1
Image 2
Image 3
References:
1. ICU Medical Conditions | The Ottawa Hospital [Internet]. [cited 2020 May 9]. Available from: http://www.ottawahospital.on.ca/en/clinical-services/my-icu-the-intensive-care-unit/icu-patients/icu-medical-conditions/
2. Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(August):728–41.
3. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: Institutional variations in care and effect on outcome*. Crit Care Med [Internet]. 2002;30(8):1870–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-200208000-00033
4. Carney N, Totten AM, O'Reilly C, Ullman JS, Bell MJ, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. 2016;(September). Available from: https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf
Topic: Brain Injury
Reynen, Emily1, Hunniford, Victoria1, Stapleton, Kallie1, Boyd, J. Gordon1
1Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Introduction/Background:
Traumatic Brain Injury (TBI) is among the most common neurological causes of admission to the intensive care unit (ICU) and is a common cause of death and disability.(1–3) In 2016, the Brain Trauma Foundation (BTF) published updated clinical practice guidelines (CPG) for the management of TBI.(4) Optimal rates of adherence to clinical practice guidelines are unknown.
Objectives:
Our primary objective is to retrospectively characterize the degree of adherence between care received and CPG for patients admitted to the ICU with TBI. Our secondary objective is to evaluate mortality and functional outcomes.
Methods:
This study is a retrospective analysis of all patients aged 18 years or older admitted to our level 3 ICU with a TBI between January 1, 2012 and December 31, 2017. Ethics approval was granted by the Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (HSREB). Eligible participants were identified through the patient discharge database using ICD 10 codes. Data was retrieved manually from patients' electronic charts and entered into a de-identified standardized data extraction excel spreadsheet. Descriptive statistics including median and interquartile ranges (IQR) were used to analyze the data. Outcomes of interest include patient demographic data, interventions used in case management, morbidity and mortality. Missing data was quantified as a proportion of the total data available.
Results:
A total of 326 patients were identified, of these, 311 were eligible for inclusion. The most common reason for exclusion from the study was patients who did not experience a TBI. Key baseline characteristics are reported in Table 1.
A CT head was completed in 307 patients (99%), of which 283 (92%) had an abnormal finding. The median Marshall score was 3 (IQR: 2 to 5). Neurosurgical interventions were performed in 127 patients (41%), the most common being a crainiotomy (n=44). Interventions to lower ICP were used in 117 patients and 48 patients had an ICP monitor placed. Details of ICP lowering therapy are outlined in table 2.
A total of 46 patients experienced a seizure prior to arrival at KHSC. Of the 262 patients who did not experience a seizure prior to presenting to hospital, 72 (27%) received seizure prophylaxis. Anti-seizure medications received are described in figure 1. Median duration of seizure prophylaxis was 7 days (IQR: 7 to 14 days). Despite prophylaxis, 20 patients experienced a seizure, of which 7 were diagnosed clinically and 13 on EEG.
The median mRS at time of discharge or transfer was 4 (IQR: 3 to 6). The median length of ICU stay was 6 days (IQR: 2 to 11) and total hospital stay was 11 days (IQR: 3 to 26). When available, the most common discharge destination was a rehabilitation facility (25%) followed by home (with or without supports) in 21%. Goals of care were documented on the official KHSC form in 13 (4%) of cases. A total of 102 (33%) of patients died before hospital discharge. The majority of deaths (n=101 [99%]) occurred in the ICU.
Conclusion:
Our study confirms that TBI is associated with clinically important functional morbidity and mortality. Few patients received seizure prophylaxis or had an ICP monitor placed. These management strategies represent a potential opportunity for improved guideline adherence and will be the focus of a subsequent quality improvement initiative.
Image 1
Image 2
Image 3
References:
1. ICU Medical Conditions | The Ottawa Hospital [Internet]. [cited 2020 May 9]. Available from: http://www.ottawahospital.on.ca/en/clinical-services/my-icu-the-intensive-care-unit/icu-patients/icu-medical-conditions/
2. Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(August):728–41.
3. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: Institutional variations in care and effect on outcome*. Crit Care Med [Internet]. 2002;30(8):1870–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-200208000-00033
4. Carney N, Totten AM, O'Reilly C, Ullman JS, Bell MJ, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. 2016;(September). Available from: https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf
Care of Patients with Traumatic Brain Injury at Kingston Health Sciences Centre (KHSC): A Retrospective Review of Clinical Practice
Emily Reynen
Abstract
Discussion Forum (0)
ePoster
Topic: Brain Injury
Reynen, Emily1, Hunniford, Victoria1, Stapleton, Kallie1, Boyd, J. Gordon1
1Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Introduction/Background:
Traumatic Brain Injury (TBI) is among the most common neurological causes of admission to the intensive care unit (ICU) and is a common cause of death and disability.(1–3) In 2016, the Brain Trauma Foundation (BTF) published updated clinical practice guidelines (CPG) for the management of TBI.(4) Optimal rates of adherence to clinical practice guidelines are unknown.
Objectives:
Our primary objective is to retrospectively characterize the degree of adherence between care received and CPG for patients admitted to the ICU with TBI. Our secondary objective is to evaluate mortality and functional outcomes.
Methods:
This study is a retrospective analysis of all patients aged 18 years or older admitted to our level 3 ICU with a TBI between January 1, 2012 and December 31, 2017. Ethics approval was granted by the Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (HSREB). Eligible participants were identified through the patient discharge database using ICD 10 codes. Data was retrieved manually from patients' electronic charts and entered into a de-identified standardized data extraction excel spreadsheet. Descriptive statistics including median and interquartile ranges (IQR) were used to analyze the data. Outcomes of interest include patient demographic data, interventions used in case management, morbidity and mortality. Missing data was quantified as a proportion of the total data available.
Results:
A total of 326 patients were identified, of these, 311 were eligible for inclusion. The most common reason for exclusion from the study was patients who did not experience a TBI. Key baseline characteristics are reported in Table 1.
A CT head was completed in 307 patients (99%), of which 283 (92%) had an abnormal finding. The median Marshall score was 3 (IQR: 2 to 5). Neurosurgical interventions were performed in 127 patients (41%), the most common being a crainiotomy (n=44). Interventions to lower ICP were used in 117 patients and 48 patients had an ICP monitor placed. Details of ICP lowering therapy are outlined in table 2.
A total of 46 patients experienced a seizure prior to arrival at KHSC. Of the 262 patients who did not experience a seizure prior to presenting to hospital, 72 (27%) received seizure prophylaxis. Anti-seizure medications received are described in figure 1. Median duration of seizure prophylaxis was 7 days (IQR: 7 to 14 days). Despite prophylaxis, 20 patients experienced a seizure, of which 7 were diagnosed clinically and 13 on EEG.
The median mRS at time of discharge or transfer was 4 (IQR: 3 to 6). The median length of ICU stay was 6 days (IQR: 2 to 11) and total hospital stay was 11 days (IQR: 3 to 26). When available, the most common discharge destination was a rehabilitation facility (25%) followed by home (with or without supports) in 21%. Goals of care were documented on the official KHSC form in 13 (4%) of cases. A total of 102 (33%) of patients died before hospital discharge. The majority of deaths (n=101 [99%]) occurred in the ICU.
Conclusion:
Our study confirms that TBI is associated with clinically important functional morbidity and mortality. Few patients received seizure prophylaxis or had an ICP monitor placed. These management strategies represent a potential opportunity for improved guideline adherence and will be the focus of a subsequent quality improvement initiative.
Image 1
Image 2
Image 3
References:
1. ICU Medical Conditions | The Ottawa Hospital [Internet]. [cited 2020 May 9]. Available from: http://www.ottawahospital.on.ca/en/clinical-services/my-icu-the-intensive-care-unit/icu-patients/icu-medical-conditions/
2. Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(August):728–41.
3. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: Institutional variations in care and effect on outcome*. Crit Care Med [Internet]. 2002;30(8):1870–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-200208000-00033
4. Carney N, Totten AM, O'Reilly C, Ullman JS, Bell MJ, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. 2016;(September). Available from: https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf
Topic: Brain Injury
Reynen, Emily1, Hunniford, Victoria1, Stapleton, Kallie1, Boyd, J. Gordon1
1Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Introduction/Background:
Traumatic Brain Injury (TBI) is among the most common neurological causes of admission to the intensive care unit (ICU) and is a common cause of death and disability.(1–3) In 2016, the Brain Trauma Foundation (BTF) published updated clinical practice guidelines (CPG) for the management of TBI.(4) Optimal rates of adherence to clinical practice guidelines are unknown.
Objectives:
Our primary objective is to retrospectively characterize the degree of adherence between care received and CPG for patients admitted to the ICU with TBI. Our secondary objective is to evaluate mortality and functional outcomes.
Methods:
This study is a retrospective analysis of all patients aged 18 years or older admitted to our level 3 ICU with a TBI between January 1, 2012 and December 31, 2017. Ethics approval was granted by the Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (HSREB). Eligible participants were identified through the patient discharge database using ICD 10 codes. Data was retrieved manually from patients' electronic charts and entered into a de-identified standardized data extraction excel spreadsheet. Descriptive statistics including median and interquartile ranges (IQR) were used to analyze the data. Outcomes of interest include patient demographic data, interventions used in case management, morbidity and mortality. Missing data was quantified as a proportion of the total data available.
Results:
A total of 326 patients were identified, of these, 311 were eligible for inclusion. The most common reason for exclusion from the study was patients who did not experience a TBI. Key baseline characteristics are reported in Table 1.
A CT head was completed in 307 patients (99%), of which 283 (92%) had an abnormal finding. The median Marshall score was 3 (IQR: 2 to 5). Neurosurgical interventions were performed in 127 patients (41%), the most common being a crainiotomy (n=44). Interventions to lower ICP were used in 117 patients and 48 patients had an ICP monitor placed. Details of ICP lowering therapy are outlined in table 2.
A total of 46 patients experienced a seizure prior to arrival at KHSC. Of the 262 patients who did not experience a seizure prior to presenting to hospital, 72 (27%) received seizure prophylaxis. Anti-seizure medications received are described in figure 1. Median duration of seizure prophylaxis was 7 days (IQR: 7 to 14 days). Despite prophylaxis, 20 patients experienced a seizure, of which 7 were diagnosed clinically and 13 on EEG.
The median mRS at time of discharge or transfer was 4 (IQR: 3 to 6). The median length of ICU stay was 6 days (IQR: 2 to 11) and total hospital stay was 11 days (IQR: 3 to 26). When available, the most common discharge destination was a rehabilitation facility (25%) followed by home (with or without supports) in 21%. Goals of care were documented on the official KHSC form in 13 (4%) of cases. A total of 102 (33%) of patients died before hospital discharge. The majority of deaths (n=101 [99%]) occurred in the ICU.
Conclusion:
Our study confirms that TBI is associated with clinically important functional morbidity and mortality. Few patients received seizure prophylaxis or had an ICP monitor placed. These management strategies represent a potential opportunity for improved guideline adherence and will be the focus of a subsequent quality improvement initiative.
Image 1
Image 2
Image 3
References:
1. ICU Medical Conditions | The Ottawa Hospital [Internet]. [cited 2020 May 9]. Available from: http://www.ottawahospital.on.ca/en/clinical-services/my-icu-the-intensive-care-unit/icu-patients/icu-medical-conditions/
2. Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(August):728–41.
3. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: Institutional variations in care and effect on outcome*. Crit Care Med [Internet]. 2002;30(8):1870–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-200208000-00033
4. Carney N, Totten AM, O'Reilly C, Ullman JS, Bell MJ, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. 2016;(September). Available from: https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf
ePoster
Topic: Brain Injury
Reynen, Emily1, Hunniford, Victoria1, Stapleton, Kallie1, Boyd, J. Gordon1
1Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Introduction/Background:
Traumatic Brain Injury (TBI) is among the most common neurological causes of admission to the intensive care unit (ICU) and is a common cause of death and disability.(1–3) In 2016, the Brain Trauma Foundation (BTF) published updated clinical practice guidelines (CPG) for the management of TBI.(4) Optimal rates of adherence to clinical practice guidelines are unknown.
Objectives:
Our primary objective is to retrospectively characterize the degree of adherence between care received and CPG for patients admitted to the ICU with TBI. Our secondary objective is to evaluate mortality and functional outcomes.
Methods:
This study is a retrospective analysis of all patients aged 18 years or older admitted to our level 3 ICU with a TBI between January 1, 2012 and December 31, 2017. Ethics approval was granted by the Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (HSREB). Eligible participants were identified through the patient discharge database using ICD 10 codes. Data was retrieved manually from patients' electronic charts and entered into a de-identified standardized data extraction excel spreadsheet. Descriptive statistics including median and interquartile ranges (IQR) were used to analyze the data. Outcomes of interest include patient demographic data, interventions used in case management, morbidity and mortality. Missing data was quantified as a proportion of the total data available.
Results:
A total of 326 patients were identified, of these, 311 were eligible for inclusion. The most common reason for exclusion from the study was patients who did not experience a TBI. Key baseline characteristics are reported in Table 1.
A CT head was completed in 307 patients (99%), of which 283 (92%) had an abnormal finding. The median Marshall score was 3 (IQR: 2 to 5). Neurosurgical interventions were performed in 127 patients (41%), the most common being a crainiotomy (n=44). Interventions to lower ICP were used in 117 patients and 48 patients had an ICP monitor placed. Details of ICP lowering therapy are outlined in table 2.
A total of 46 patients experienced a seizure prior to arrival at KHSC. Of the 262 patients who did not experience a seizure prior to presenting to hospital, 72 (27%) received seizure prophylaxis. Anti-seizure medications received are described in figure 1. Median duration of seizure prophylaxis was 7 days (IQR: 7 to 14 days). Despite prophylaxis, 20 patients experienced a seizure, of which 7 were diagnosed clinically and 13 on EEG.
The median mRS at time of discharge or transfer was 4 (IQR: 3 to 6). The median length of ICU stay was 6 days (IQR: 2 to 11) and total hospital stay was 11 days (IQR: 3 to 26). When available, the most common discharge destination was a rehabilitation facility (25%) followed by home (with or without supports) in 21%. Goals of care were documented on the official KHSC form in 13 (4%) of cases. A total of 102 (33%) of patients died before hospital discharge. The majority of deaths (n=101 [99%]) occurred in the ICU.
Conclusion:
Our study confirms that TBI is associated with clinically important functional morbidity and mortality. Few patients received seizure prophylaxis or had an ICP monitor placed. These management strategies represent a potential opportunity for improved guideline adherence and will be the focus of a subsequent quality improvement initiative.
Image 1
Image 2
Image 3
References:
1. ICU Medical Conditions | The Ottawa Hospital [Internet]. [cited 2020 May 9]. Available from: http://www.ottawahospital.on.ca/en/clinical-services/my-icu-the-intensive-care-unit/icu-patients/icu-medical-conditions/
2. Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(August):728–41.
3. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: Institutional variations in care and effect on outcome*. Crit Care Med [Internet]. 2002;30(8):1870–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-200208000-00033
4. Carney N, Totten AM, O'Reilly C, Ullman JS, Bell MJ, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. 2016;(September). Available from: https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf
Topic: Brain Injury
Reynen, Emily1, Hunniford, Victoria1, Stapleton, Kallie1, Boyd, J. Gordon1
1Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
Introduction/Background:
Traumatic Brain Injury (TBI) is among the most common neurological causes of admission to the intensive care unit (ICU) and is a common cause of death and disability.(1–3) In 2016, the Brain Trauma Foundation (BTF) published updated clinical practice guidelines (CPG) for the management of TBI.(4) Optimal rates of adherence to clinical practice guidelines are unknown.
Objectives:
Our primary objective is to retrospectively characterize the degree of adherence between care received and CPG for patients admitted to the ICU with TBI. Our secondary objective is to evaluate mortality and functional outcomes.
Methods:
This study is a retrospective analysis of all patients aged 18 years or older admitted to our level 3 ICU with a TBI between January 1, 2012 and December 31, 2017. Ethics approval was granted by the Queen's University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (HSREB). Eligible participants were identified through the patient discharge database using ICD 10 codes. Data was retrieved manually from patients' electronic charts and entered into a de-identified standardized data extraction excel spreadsheet. Descriptive statistics including median and interquartile ranges (IQR) were used to analyze the data. Outcomes of interest include patient demographic data, interventions used in case management, morbidity and mortality. Missing data was quantified as a proportion of the total data available.
Results:
A total of 326 patients were identified, of these, 311 were eligible for inclusion. The most common reason for exclusion from the study was patients who did not experience a TBI. Key baseline characteristics are reported in Table 1.
A CT head was completed in 307 patients (99%), of which 283 (92%) had an abnormal finding. The median Marshall score was 3 (IQR: 2 to 5). Neurosurgical interventions were performed in 127 patients (41%), the most common being a crainiotomy (n=44). Interventions to lower ICP were used in 117 patients and 48 patients had an ICP monitor placed. Details of ICP lowering therapy are outlined in table 2.
A total of 46 patients experienced a seizure prior to arrival at KHSC. Of the 262 patients who did not experience a seizure prior to presenting to hospital, 72 (27%) received seizure prophylaxis. Anti-seizure medications received are described in figure 1. Median duration of seizure prophylaxis was 7 days (IQR: 7 to 14 days). Despite prophylaxis, 20 patients experienced a seizure, of which 7 were diagnosed clinically and 13 on EEG.
The median mRS at time of discharge or transfer was 4 (IQR: 3 to 6). The median length of ICU stay was 6 days (IQR: 2 to 11) and total hospital stay was 11 days (IQR: 3 to 26). When available, the most common discharge destination was a rehabilitation facility (25%) followed by home (with or without supports) in 21%. Goals of care were documented on the official KHSC form in 13 (4%) of cases. A total of 102 (33%) of patients died before hospital discharge. The majority of deaths (n=101 [99%]) occurred in the ICU.
Conclusion:
Our study confirms that TBI is associated with clinically important functional morbidity and mortality. Few patients received seizure prophylaxis or had an ICP monitor placed. These management strategies represent a potential opportunity for improved guideline adherence and will be the focus of a subsequent quality improvement initiative.
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References:
1. ICU Medical Conditions | The Ottawa Hospital [Internet]. [cited 2020 May 9]. Available from: http://www.ottawahospital.on.ca/en/clinical-services/my-icu-the-intensive-care-unit/icu-patients/icu-medical-conditions/
2. Maas AIR, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(August):728–41.
3. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: Institutional variations in care and effect on outcome*. Crit Care Med [Internet]. 2002;30(8):1870–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00003246-200208000-00033
4. Carney N, Totten AM, O'Reilly C, Ullman JS, Bell MJ, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury 4th Edition. 2016;(September). Available from: https://braintrauma.org/uploads/03/12/Guidelines_for_Management_of_Severe_TBI_4th_Edition.pdf
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