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（由申请人提供）：创伤性脑损伤 (TBI) 是导致死亡和残疾的主要原因，占美国所有伤害相关死亡的三分之一。 人们越来越认识到创伤性脑损伤是当前军事冲突的“标志性伤口”。尽管根据已发布的指南采取了最佳护理实践，但许多患者由于继发性损伤而预后不佳。继发性损伤发生在原发性损伤之后。未能治疗继发性损伤会导致重症监护室和住院时间延长以及死亡率增加。确定可以预防或尽量减少继发伤害的策略可以改善个人、家庭、社区和人群的健康。温度管理是减少二次伤害的方法之一。然而，TBI 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查 16 岁及以上钝性中度或重度 TBI 后患者的体温与神经系统结果之间的关联，神经系统结果是通过扩展格拉斯哥结果量表 (GOS-E) 测量的。我们建议，受伤后 96 小时内的体温特征可以预测 6 个月的 GOS-E 对混杂因素的调整。本培训计划的目的是： 1) 描述患者在中度或重度 TBI 后的前 96 小时内经历体温异常的严重程度和持续时间； 2) 确定在此期间异常的温度暴露是否可以预测神经系统结果，调整混杂因素； 3) 确定在此期间的异常温度校正率是否可以预测针对混杂因素调整的神经系统结果； 4) 组建一个跨学科小组来验证研究结果并确定对未来研究护理实践的潜在影响 将使用多重序数回归分析来估计 IMPACT 变量（年龄、GCS 运动评分、瞳孔反应、缺氧、低血压、初始头部）的相对贡献CT 分类、CT 上的创伤性蛛网膜下腔出血或硬膜外肿块、血糖和血清血红蛋白）在预测 GOS-E 中的作用。GOS-E 变异的比例解释为将估计影响变量。温度体积将被添加到模型中，并且将估计由温度体积的添加所解释的 GOS-E 方差的变化。然后，将添加 96 小时内的温度变化率，并估计由添加温度变化率解释的 GOS-E 方差变化。满足这些研究目标，我们可以开发一种更有用的预测模型，该模型很容易转化为护理实践。我们致力于建立护理的科学基础 实践。由于护士监测、记录和治疗患者体温，这项研究有可能影响 TBI 创伤复苏的复温率、TBI 后的体温管理目标，以及预防/减少 TBI 后发烧的干预措施的时机。最后，TBI 后的温度管理可以以相对较低的成本改善结果。