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Mohseni, Shahin
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Khalili, H., Ahl, R., Paydar, S., Sjölin, G., Cao, Y., Fard, H. A., . . . Mohseni, S. (2020). Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial. World Journal of Surgery
Open this publication in new window or tab >>Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial
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2020 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Observational studies have demonstrated improved outcomes in TBI patients receiving in-hospital beta-blockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta-blockers on outcomes in TBI patients.

Methods: Adult patients with severe TBI (intracranial AIS >= 3) were included in the study. Hemodynamically stable patients at 24 h after injury were randomized to receive either 20 mg propranolol orally every 12 h up to 10 days or until discharge (BB+) or no propranolol (BB-). Outcomes of interest were in-hospital mortality and Glasgow Outcome Scale-Extended (GOS-E) score on discharge and at 6-month follow-up. Subgroup analysis including only isolated severe TBI (intracranial AIS >= 3 with extracranial AIS <= 2) was carried out. Poisson regression models were used.

Results: Two hundred nineteen randomized patients of whom 45% received BB were analyzed. There were no significant demographic or clinical differences between BB+ and BB- cohorts. No significant difference in inhospital mortality (adj. IRR 0.6 [95% CI 0.3-1.4], p = 0.2) or long-term functional outcome was measured between the cohorts (p = 0.3). One hundred fifty-four patients suffered isolated severe TBI of whom 44% received BB. The BB? group had significantly lower mortality relative to the BB- group (18.6% vs. 4.4%, p = 0.012). On regression analysis, propranolol had a significant protective effect on in-hospital mortality (adj. IRR 0.32, p = 0.04) and functional outcome at 6-month follow-up (GOS-E >= 5 adj. IRR 1.2, p = 0.02).

Conclusion: Propranolol decreases in-hospital mortality and improves long-term functional outcome in isolated severe TBI. This randomized trial speaks in favor of routine administration of beta-blocker therapy as part of a standardized neurointensive care protocol.

Level of evidence: Level II; therapeutic.

Study type: Therapeutic study.

Place, publisher, year, edition, pages
Springer, 2020
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-79883 (URN)10.1007/s00268-020-05391-8 (DOI)000510269300001 ()32002583 (PubMedID)
Note

Funding Agency:

Research department of Shiraz University of Medical Sciences  1396-01-3814792

Available from: 2020-02-14 Created: 2020-02-14 Last updated: 2020-02-14Bibliographically approved
Stenberg, E., Mohseni, S., Cao, Y. & Näslund, E. (2020). Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery. Obesity Surgery, 30(1), 139-145
Open this publication in new window or tab >>Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery
2020 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 30, no 1, p. 139-145Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery.

METHODS: Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss.

RESULTS: In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002).

CONCLUSIONS: Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2020
Keywords
Beta-blockade, Gastric bypass, Postoperative outcome
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-75571 (URN)10.1007/s11695-019-04108-8 (DOI)000512073200018 ()31346982 (PubMedID)2-s2.0-85069715589 (Scopus ID)
Funder
Novo NordiskStockholm County Council
Note

Funding Agencies:

Region Auvergne-Rhone-Alpes Region Bourgogne-Franche-Comte Region Hauts-de-France Region Nouvelle-Aquitaine OLL-884791

SRP Diabetes 

Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2020-03-17Bibliographically approved
Bass, G. A., Gillis, A. E., Cao, Y., Mohseni, S. & European Society for Trauma and Emergency Surgery (ESTES), C. S. (2020). Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease. BJS open
Open this publication in new window or tab >>Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease
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2020 (English)In: BJS open, ISSN 2474-9842Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Complicated acute biliary calculous disease poses clinical challenges. The European Society of Trauma and Emergency Surgery (ESTES) snapshot audit of complicated biliary calculous disease aims to make novel comparisons between self-reported institutional adherence to the Tokyo guidelines (TG18) and 'real-world' contemporary practice across Europe.

METHODS: A preplanned analysis of a prospective observational multicentre audit that captured patients undergoing emergency admission for complicated biliary calculous disease (complicated cholecystitis, biliary pancreatitis, or choledocholithiasis with or without cholangitis) between 1 and 31 October 2018 was performed. An anonymized survey was administered to participating sites.

RESULTS: Following an open call for participation, 25 centres from nine countries enrolled 338 patients. All centres completed the anonymized survey. Fifteen centres (60 per cent) self-reported that a minority of patients were treated surgically on index admission, favouring interval cholecystectomy. This was replicated in the snapshot audit, in which 152 of 338 patients (45·0 per cent) underwent index admission cholecystectomy, 17 (5·0 per cent) had interval cholecystectomy, and the remaining 169 (50·0 per cent) had not undergone surgery by the end of the 60-day follow-up. Centres that employed a dedicated acute care surgery model of care were more likely to perform index admission cholecystectomy compared with a traditional general surgery 'on call' service (57 versus 38 per cent respectively; odds ratio 2·14 (95 per cent c.i. 1·37 to 3·35), P < 0·001). Six centres (24 per cent) self-reported routinely performing blood cultures in acute cholecystitis; patient-level audit data revealed that blood cultures were done in 47 of 154 patients (30·5 per cent). No centre self-reported omitting antibiotics in the management of acute cholecystitis, and 144 of 154 (93·5 per cent) of patients in the snapshot audit received antibiotics during their index admission.

CONCLUSION: Awareness of TG18 recommendations was high, but self-reported adherence and objective snapshot audit data showed low compliance with TG18 in patients with complicated acute biliary calculous disease.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-81926 (URN)10.1002/bjs5.50294 (DOI)000533513200001 ()32418332 (PubMedID)
Available from: 2020-05-19 Created: 2020-05-19 Last updated: 2020-05-29Bibliographically approved
Cao, Y., Bass, G. A., Ahl, R., Pourlotfi, A., Geijer, H., Montgomery, S. & Mohseni, S. (2020). The statistical importance of P-POSSUM scores for predicting mortality after emergency laparotomy in geriatric patients. BMC Medical Informatics and Decision Making, 20(1), Article ID 86.
Open this publication in new window or tab >>The statistical importance of P-POSSUM scores for predicting mortality after emergency laparotomy in geriatric patients
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2020 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 20, no 1, article id 86Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Geriatric patients frequently undergo emergency general surgery and accrue a greater risk of postoperative complications and fatal outcomes than the general population. It is highly relevant to develop the most appropriate care measures and to guide patient-centered decision-making around end-of-life care. Portsmouth - Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) has been used to predict mortality in patients undergoing different types of surgery. In the present study, we aimed to evaluate the relative importance of the P-POSSUM score for predicting 90-day mortality in the elderly subjected to emergency laparotomy from statistical aspects.

METHODS: One hundred and fifty-seven geriatric patients aged ≥65 years undergoing emergency laparotomy between January 1st, 2015 and December 31st, 2016 were included in the study. Mortality and 27 other patient characteristics were retrieved from the computerized records of Örebro University Hospital in Örebro, Sweden. Two supervised classification machine methods (logistic regression and random forest) were used to predict the 90-day mortality risk. Three scalers (Standard scaler, Robust scaler and Min-Max scaler) were used for variable engineering. The performance of the models was evaluated using accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Importance of the predictors were evaluated using permutation variable importance and Gini importance.

RESULTS: The mean age of the included patients was 75.4 years (standard deviation =7.3 years) and the 90-day mortality rate was 29.3%. The most common indication for surgery was bowel obstruction occurring in 92 (58.6%) patients. Types of post-operative complications ranged between 7.0-36.9% with infection being the most common type. Both the logistic regression and random forest models showed satisfactory performance for predicting 90-day mortality risk in geriatric patients after emergency laparotomy, with AUCs of 0.88 and 0.93, respectively. Both models had an accuracy > 0.8 and a specificity ≥0.9. P-POSSUM had the greatest relative importance for predicting 90-day mortality in the logistic regression model and was the fifth important predictor in the random forest model. No notable change was found in sensitivity analysis using different variable engineering methods with P-POSSUM being among the five most accurate variables for mortality prediction.

CONCLUSION: P-POSSUM is important for predicting 90-day mortality after emergency laparotomy in geriatric patients. The logistic regression model and random forest model may have an accuracy of > 0.8 and an AUC around 0.9 for predicting 90-day mortality. Further validation of the variables' importance and the models' robustness is needed by use of larger dataset.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Emergency laparotomy, Geriatric, Gini importance, Machine learning, P-POSSUM, Permutation variable importance, Prediction
National Category
Geriatrics Surgery
Identifiers
urn:nbn:se:oru:diva-81772 (URN)10.1186/s12911-020-1100-9 (DOI)32380980 (PubMedID)
Available from: 2020-05-11 Created: 2020-05-11 Last updated: 2020-05-22Bibliographically approved
Ahl, R., Matthiessen, P., Fang, X., Cao, Y., Sjölin, G., Lindgren, R., . . . Mohseni, S. (2020). β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes. Annals of Surgery, 271(1), 140-146
Open this publication in new window or tab >>β-Blockade in Rectal Cancer Surgery: A Simple Measure of Improving Outcomes
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2020 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 271, no 1, p. 140-146Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To ascertain whether regular β-blocker exposure can improve short- and long-term outcomes after rectal cancer surgery.

BACKGROUND: Surgery for rectal cancer is associated with substantial morbidity and mortality. There is increasing evidence to suggest that there is a survival benefit in patients exposed to β-blockers undergoing non-cardiac surgery. Studies investigating the effects on outcomes in patients subjected to surgery for rectal cancer are lacking.

METHODS: All adult patients undergoing elective abdominal resection for rectal cancer over a 10-year period were recruited from the prospectively collected Swedish Colorectal Cancer Registry. Patients were subdivided according to preoperative β-blocker exposure status. Outcomes of interest were 30-day complications, 30-day cause-specific mortality, and 1-year all-cause mortality. The association between β-blocker use and outcomes were analyzed using Poisson regression model with robust standard errors for 30-day complications and cause-specific mortality. One-year survival was assessed using Cox proportional hazards regression model.

RESULTS: A total of 11,966 patients were included in the current study, of whom 3513 (29.36%) were exposed to regular preoperative β-blockers. A significant decrease in 30-day mortality was detected (incidence rate ratio = 0.06, 95% confidence interval: 0.03-0.13, P < 0.001). Deaths of cardiovascular nature, respiratory origin, sepsis, and multiorgan failure were significantly lower in β-blocker users, as were the incidences in postoperative infection and anastomotic failure. The β-blocker positive group had significantly better survival up to 1 year postoperatively with a risk reduction of 57% (hazard ratio = 0.43, 95% confidence interval: 0.37-0.52, P < 0.001).

CONCLUSIONS: Preoperative β-blocker use is strongly associated with improved survival and morbidity after abdominal resection for rectal cancer.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020
Keywords
beta-blocker, mortality, rectal cancer, surgery
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-74248 (URN)10.1097/SLA.0000000000002970 (DOI)000525016300026 ()30048321 (PubMedID)2-s2.0-85077036188 (Scopus ID)
Available from: 2019-05-13 Created: 2019-05-13 Last updated: 2020-04-30Bibliographically approved
Maghami, S., Cao, Y., Ahlstrand, R., Detlofsson, E., Matthiessen, P., Sarani, B. & Mohseni, S. (2019). Beta-blocker Therapy is Associated with Decreased 1-year Mortality After Emergency Laparotomy in Geriatric Patients. Scandinavian Journal of Surgery, Article ID 1457496919877582.
Open this publication in new window or tab >>Beta-blocker Therapy is Associated with Decreased 1-year Mortality After Emergency Laparotomy in Geriatric Patients
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2019 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, article id 1457496919877582Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND AND AIMS: Emergency laparotomy is associated with a great risk of mortality in the elderly. The hyperadrenergic state induced by surgical trauma may play an important role in the pathophysiology of this increased risk. Studies have shown that beta-blocker exposure may be associated with decreased morbidity and mortality in the perioperative period. We aimed to study the effect of beta-blocker on mortality in geriatric patients undergoing emergency laparotomy.

MATERIAL AND METHODS: ). The Poisson regression analysis was used to evaluate the association.

RESULTS:  = 0.004). No significant differences in the incidence of post-operative complications between the two groups could be measured.

CONCLUSION: Beta-blocker therapy may be associated with reduced 1-year mortality following emergency laparotomy in geriatric patients.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Beta-blockers, emergency laparotomy, geriatrics, mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-76831 (URN)10.1177/1457496919877582 (DOI)31544597 (PubMedID)
Available from: 2019-09-30 Created: 2019-09-30 Last updated: 2019-09-30Bibliographically approved
Ahl, R., Matthiessen, P., Fang, X., Cao, Y., Sjölin, G., Lindgren, R., . . . Mohseni, S. (2019). Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery. British Journal of Surgery, 106(4), 477-483
Open this publication in new window or tab >>Effect of beta-blocker therapy on early mortality after emergency colonic cancer surgery
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2019 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, no 4, p. 477-483Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Emergency colorectal cancer surgery is associated with significant mortality. Induced adrenergic hyperactivity is thought to be an important contributor. Downregulating the effects of circulating catecholamines may reduce the risk of adverse outcomes. This study assessed whether regular preoperative beta-blockade reduced mortality after emergency colonic cancer surgery.

METHODS: This cohort study used the prospectively collected Swedish Colorectal Cancer Registry to recruit all adult patients requiring emergency colonic cancer surgery between 2011 and 2016. Patients were subdivided into those receiving regular beta-blocker therapy before surgery and those who were not (control). Demographics and clinical outcomes were compared. Risk factors for 30-day mortality were evaluated using Poisson regression analysis.

RESULTS: A total of 3187 patients were included, of whom 685 (21·5 per cent) used regular beta-blocker therapy before surgery. The overall 30-day mortality rate was significantly reduced in the beta-blocker group compared with controls: 3·1 (95 per cent c.i. 1·9 to 4·7) versus 8·6 (7·6 to 9·8) per cent respectively (P < 0·001). Beta-blocker therapy was the only modifiable protective factor identified in multivariable analysis of 30-day all-cause mortality (incidence rate ratio 0·31, 95 per cent c.i. 0·20 to 0·47; P < 0·001) and was associated with a significant reduction in death of cardiovascular, respiratory, sepsis and multiple organ failure origin.

CONCLUSION: Preoperative beta-blocker therapy may be associated with a reduction in 30-day mortality following emergency colonic cancer surgery.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Surgery Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-69119 (URN)10.1002/bjs.10988 (DOI)000459801800023 ()30259967 (PubMedID)
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2019-05-13Bibliographically approved
Ah, R., BChir, M. B., Cao, Y., Geijer, H., Taha, K., Pourhossein-Sarmeh, S., . . . Mohseni, S. (2019). Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients. Bulletin of emergency and trauma, 7(3), 223-231
Open this publication in new window or tab >>Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients
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2019 (English)In: Bulletin of emergency and trauma, ISSN 2322-2522, Vol. 7, no 3, p. 223-231Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy.

Methods: All geriatric patients (≥65 years) undergoing emergency laparotomy at a single university hospital between 1/2015 and 12/2016 were included in this cohort study. Demographics and outcomes were retrospectively collected from medical records. Association between prognostic markers and 30-day mortality was assessed using Poisson and backward stepwise regression models. Prognostic value was assessed using receiver operating characteristic (ROC) curves.

Results: =0.004) while osteopenia was not. P-POSSUM had poor prognostic value for 30-day mortality with an area under the ROC curve (AUC) of 0.59. The prognostic value of P-POSSUM improved significantly when adjusting for patient covariates (AUC=0.83).

Conclusion: P-POSSUM and osteopenia alone hardly predict 30-day mortality in geriatric patients following emergency laparotomy. P-POSSUM adjusted for other patient covariates improves the prediction.

Place, publisher, year, edition, pages
Shiraz University of Medical Sciences, 2019
Keywords
Emergency Laparotomy, Emergency Surgery, Geriatric, Mortality
National Category
Medical and Health Sciences Surgery Geriatrics
Identifiers
urn:nbn:se:oru:diva-79242 (URN)10.29252/beat-070303 (DOI)31392220 (PubMedID)
Available from: 2020-01-20 Created: 2020-01-20 Last updated: 2020-01-22Bibliographically approved
Mohseni, S., Ivarsson, J., Ahl, R., Dogan, S., Saar, S., Reinsoo, A., . . . Talving, P. (2019). Simultaneous common bile duct clearance and laparoscopic cholecystectomy: experience of a one-stage approach. European Journal of Trauma and Emergency Surgery, 45(2), 337-342
Open this publication in new window or tab >>Simultaneous common bile duct clearance and laparoscopic cholecystectomy: experience of a one-stage approach
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2019 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 45, no 2, p. 337-342Article in journal (Refereed) Published
Abstract [en]

Introduction: The timing and optimal method for common bile duct (CBD) clearance and laparoscopic cholecystectomy remains controversial. Several different approaches are available in clinical practice. The current study presents the experience of two European hospitals of simultaneous laparoscopic cholecystectomy (LC) and intra-operative endoscopic retrograde cholangiopacreatography (IO-ERCP) done by surgeons.

Methods: Retrospective analysis of all consecutive patients subjected to LC+IO-ERCP during their index admission between 4/2014 and 9/2016. Data accrued included patient demographics, laboratory markers, operation time (min) reported as mean (SD) and hospital length of stay (LOS) reported as median (lower quartile, upper quartile).

Results: During the 29-month study, a total of 201 consecutive LC+IO-ERCPs were performed. The mean age of patients was 55 +/- 19years and 67% were female. The mean intervention time was 105 +/- 44min. The total LOS was 4 (3, 7) days and the post-operative LOS was 2 (1, 3)days. A total of 6 (3%) patients experienced post-interventional pancreatitis and two (1%) patients suffered a Strasberg type A bile leak. All patients were successfully discharged.

Conclusion: Simultaneous LC+IO-ERCP is associated with few complications. Further studies investigating cost-benefit and patient satisfaction are warranted.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2019
Keywords
Laparoscopic cholecystectomy, ERCP, One-stage approach
National Category
Anesthesiology and Intensive Care Surgery
Identifiers
urn:nbn:se:oru:diva-73874 (URN)10.1007/s00068-018-0921-z (DOI)000463718800020 ()29417182 (PubMedID)2-s2.0-85041502184 (Scopus ID)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-23Bibliographically approved
Ahl, R., Sarani, B., Sjölin, G. & Mohseni, S. (2019). The Association of Intracranial Pressure Monitoring and Mortality: A Propensity Score-Matched Cohort of Isolated Severe Blunt Traumatic Brain Injury. Journal of Emergencies, Trauma and Shock, 12(1), 18-22
Open this publication in new window or tab >>The Association of Intracranial Pressure Monitoring and Mortality: A Propensity Score-Matched Cohort of Isolated Severe Blunt Traumatic Brain Injury
2019 (English)In: Journal of Emergencies, Trauma and Shock, ISSN 0974-2700, E-ISSN 0974-519X, Vol. 12, no 1, p. 18-22Article in journal (Refereed) Published
Abstract [en]

Background: Intracranial pressure (ICP) monitoring in traumatic brain injury (TBI) is common. Yet, its efficacy varies between studies, and the actual effect on the outcome is debated. This study investigates the association of ICP monitoring and clinical outcome in patients with an isolated severe blunt TBI.

Patients and Methods: Patients were recruited from the American College of Surgeons-Trauma Quality Improvement Program database during 2014. Inclusion criteria were limited to adult patients (>= 18 years) who had a sustained isolated severe intracranial injury (Abbreviated Injury Scale [AIS] head of >= 3 and Glasgow Coma Scale [GCS] of <= 8) following blunt trauma to the head. Patients with AIS score >0 for any extracranial body area were excluded. Patients' demographics, injury characteristics, interventions, and outcomes were collected for analysis. Patients receiving ICP monitoring were matched in a 1:1 ratio with controls who were not ICP monitored using propensity score matching.

Results: A total of 3289 patients met inclusion criteria. Of these, 601 (18.3%) were ICP monitored. After propensity score matching, 557 pairs were available for analysis with a mean age of 44 (standard deviation 18) years and 80.2% of them were male. Median GCS on admission was 4[3,7], and a third of patients required neurosurgical intervention. There were no statistical differences in any variables included in the analysis between the ICP-monitored group and their matched counterparts. ICP-monitored patients required significantly longer intensive care unit and hospital length of stay and had an increased mortality risk with odds ratio of 1.6 (95% confidence interval: 1.1-2.5, P = 0.038).

Conclusion: ICP monitoring is associated with increased in-hospital mortality in patients with an isolated severe TBI. Further investigation into which patients may benefit from this intervention is required.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
Keywords
Intracranial pressure monitoring, mortality, traumatic brain injury
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-74288 (URN)000465973700004 ()31057279 (PubMedID)2-s2.0-85064845093 (Scopus ID)
Available from: 2019-05-15 Created: 2019-05-15 Last updated: 2019-10-08Bibliographically approved
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