Quincy Tran, MD, PhD, FCCM
Associate Professor
University of Maryland Medical Center
Baltimore, MD, United States
Disclosure information not submitted.
Matthew Fairchild, n/a
Student
University of Maryland Research Associate Program, United States
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Maie Abdel-Wahab, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Ayah Aligabi, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Hammad Baqai, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Vera Bzhilyanskaya, BS
Student
University of Maryland Research Associate Program
College Park, Maryland, United States
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Hannah Frederick, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Fatima Mikdashi, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Saad Pirzada
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Iana Sahadzic, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Aditi Singh, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Julianna Solomon, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Kaitlyn Tang, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Isha Yardi, n/a
Student
University of Maryland Research Associate Program, United States
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Manahel Zahid
Student
University of Maryland Research Associate Program, United States
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Cecilia Tran, BS
Student
University of Maryland School of Medicine
Baltimore, Maryland, United States
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Joshua Olexa
University of Maryland Department of Neurosurgery
Baltimore, MD
Disclosure information not submitted.
Uttam Bodanapally, MD
Physician
University of Maryland R Adams Cowley Shock Trauma Center, United States
Disclosure information not submitted.
Gary Schwartzbauer, MD, PhD
Physician
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, United States
Disclosure information not submitted.
Title: Blood Pressure Variability And Outcome In Traumatic Brain Injury: A Propensity Score Matching Study
Introduction: Traumatic Brain Injury (TBI) is a leading cause for disability and neurological impairment in survivors. Up to 50% of patients with mild TBI had neuropsychological impairments after a year of injury. Currently, treatment for patients with traumatic intracerebral hemorrhage or contusions (tICH) is supportive care. Therefore, identifying any therapeutic targets will have potential to improve patients’ outcomes. Although blood pressure variability (BPV) was associated with outcome in spontaneous intracerebral hemorrhage (sICH) but it was not shown in patients with tICH. We hypothesized that BPV may associate with tICH patients’ functional outcome.
Methods: We performed a retrospective study of all adult patients who presented to our regional Level 1 trauma center between 01/01/2018-12/31/2019. Primary outcome was being discharged home directly (DCH), which was an indicator of patients’ good functional outcome. We used 1:1 propensity score matching (PSM) to identify and matched patients with/without DCH. Only patients who had intraparenchymal hemorrhage or contusion were eligible. We excluded patients who did not have at least 4 blood pressure measurements or length of stay < 24 hours. Multivariable logistic regression was used to identify characteristics associated with outcome.
Results: We electronically identified 354 patients and analyzed 152 patients in our matched cohorts, 76 (50%) were discharged home. Basic demographic factors (Age, admission Glasgow Coma Scale [GCS], hematoma volume, percentages of patients taking anticoagulation, types of hemorrhage, requiring intubation, external ventricular drain or craniectomy) were equal in both matched groups. Multivariable logistic regression showed that successive variation in systolic blood pressure (SBPSV) (OR 0.88, 95%CI 0.7-0.99, P=0.046), admission hematoma volume (OR 0.92 (95%CI 0.8-0.99, P=0.048) and 24-hour GCS (OR 1.5, 95%CI 1.2-1.99, P=0.001) were significantly associated with patients’ likelihood of DCH.
Conclusion: In our propensity score matched cohorts, besides clinical factors (initial hematoma volume or GCS), blood pressure variability (SBPSV) was a predictor for patients’ functional outcome. Until further studies are available, clinicians should avoid blood pressure variability in TBI patients.