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: 8392814
• 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/8392814
• 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; 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. PUBLIC HEALTH RELEVANCE: This proposal has high impact given the prevalence and societal effect of traumatic brain injury. Traumatic brain injury contributes to one third of all injury-related deaths in the U.S. Despite best-care practices based on published guidelines, many patients have poor outcomes due to secondary injuries. Nurses are in an excellent position to intervene to manage body temperature. New discoveries from this research may help to prevent and/or minimize disability and death by reducing secondary injury resulting from abnormal body temperature.

描述（由申请人提供）：创伤性脑损伤（TBI）是死亡和残疾的主要原因，在美国，所有相关死亡的三分之一造成 作为当前军事冲突的“标志性伤口”，人们对TBI的认识越来越多。尽管基于已发表的指南的最佳护理做法，但由于继发性伤害，许多患者的结局差。初次创伤后发生继发性伤害。未能治疗继发性伤害会导致重症监护病房和住院延长并增加死亡率。确定可以预防或最小化继发伤害的策略，从而改善了个人，家庭，社区和人口的健康状况。温度管理是减少继发损伤的一种方法。但是，尚未确定TBI后体温的最佳目标。对456名患者进行二次数据分析的目的是检查体温与神经系统结局之间的关联，如钝性或重度TBI后16岁以上的患者在格拉斯哥结局量表（GOS-E）中测量。我们建议在受伤后96小时内体温的特征预测了6个月的GOS-E调节混杂因素。该培训建议的目的是：1）表征Patien在中度或重度TBI后的最初96小时内的严重程度和持续时间； 2）确定在此期间的温度暴露是否会预测混杂因素的神经系统结果； 3）确定在此期间的异常温度校正率是否预测了混杂因素的神经系统结果； 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。将估计由影响变量解释的GOS-E变异比例。温度体积将添加到模型中，并通过添加温度体积的添加来解释GOS-E的方差变化。然后，将添加96小时周期的温度变化率，并通过估计温度变化速率来解释GOS-E的变化。满足这些研究的目的，我们可能会开发一个更有用的预测模型，该模型很容易被翻译成护理实践。我们寻求建立护理科学基础 实践。当护士监测，记录和治疗患者体温时，这项研究可能会影响使用TBI，TBI之后的温度管理目标以及干预措施的重新加热率，以防止/最小化TBI之后的发烧。最后，TBI之后的温度管理可能会以相对较低的成本改善结果。 公共卫生相关性：鉴于创伤性脑损伤的流行和社会影响，该提议具有很大的影响。尽管基于已发表的指南，但由于最佳护理做法，脑部损伤造成了美国与伤害有关的所有与伤害有关的死亡的三分之一，但由于继发性伤害，许多患者的结局很差。护士处于干预以管理体温的良好位置。这项研究的新发现可能有助于预防和/或通过减少因体温异常而导致的继发性损伤来最大程度地减少残疾和死亡。