Martínez RKS, Cantú CHA, Ramírez BC, Borbolla GAJ, Gutiérrez MCA

Language: Spanish
References: 30
Page: 329-335
PDF size: 247.98 Kb.

ABSTRACT

Introduction: Traumatic brain injury (TBI) is a medical-surgical condition characterized by brain involvement secondary to a traumatic lesion. Patients with severe TBI are at high risk of mortality and this will depend on different factors such as the presence of intracranial hypertension, age, origin of the injury and score on the Glasgow coma scale. Measurement of the optic nerve sheath diameter (ONSD) appears to be a good indirect indicator of intercranial hypertension and therefore, a good predictor of mortality. Objective: To determine the most appropriate cut-off point, as well as the measurement of the ONSD usefulness as a prognostic indicator of mortality in patients with severe TBI in the Intensive Care Unit (ICU). Material and methods: This is an analytical, descriptive, and retrospective study. The universe of study consists of all the case/files with TBI. For the sample selection, all available records of patients with severe TBI sent to the ICU during the period from March 1 to August 31, 2021, will be included. Within the inclusion criteria patients with a Glasgow scale score of < 8 points on entry and with a computerized scan done. The dependent variables to considerer are the outcome understood as death or survival of the patient, the days hospitalized in the ICU, the presence of complications; among the dependent variables is the diameter of the optic nerve sheath measured by computerized tomography. Intervening variables were also considered such as the presence of comorbidities and overweight/obesity, the age and sex of the patient. The project consisted of four phases: 1) request for authorization and access to files, 2) application of selection criteria, 3) performance of ONSD measurements and 4) creation of the database. Finally, once the database is formed, the statistical analysis will proceed; for the descriptive part, prevalence's, means (standard deviation) and medians (percentiles) will be calculated for the variables by sex and by outcome, subsequently the diagnostic capacity of the ONSD will be analyzed through the area under the ROC curve (receiving operating characteristics) for the outcome. Afterwards the performance of this and other cut-off points are compared using the Youden index. Results: Sixty records of TBI patients admitted to the ICU were studied, 51 were men (85%), 45 patients survived (75%) and 15 patients died (25%). The average age was of 50.5 ± 10.6 years, the average Glasgow score on admission was 6.6 ± 1.6 points, the average BMI was 26.42 ± 4.10 kg/m², and the average number of days spent in the ICU was 9.03 ± 6.4. The diameter of the optic nerve was not a predictor of mortality, but if the Glasgow coma scale was, with an AUC of 0.775 (95% CI: 0.648-0.901, p = 0.002), the best cut-off point was 7 with a sensitivity of 93% and specificity of 54%. The bivariate linear regression model points to low Glasgow coma score and long hospital stay as predictors of mortality.Conclusions: The results of this study infer that, consistent with current scientific evidence, the sociodemographic characteristics of our population are similar to those reported by other authors, with men over 50 years of age being the most affected by this entity. On the other hand, the measurement of the diameter of the optic nerve sheath has been considered a good prognostic indicator of intracranial hypertension, which in turn is associated with increased mortality. However, in the present study there is no association between the diameter of the optic nerve sheath and the prognosis of mortality.

REFERENCES

1. Charry JD, Cáceres JF, Salazar AC, López LP, Solano JP. Trauma craneoencefálico. Revisión de la literatura. Rev Chil Neurocir [Internet]. 2019;43(2):177-182. Disponible en: https://www.revistachilenadeneurocirugia.com/index.php/revchilneurocirugia/article/view/82

2. Hamdan SG. Trauma craneoencefálico severo: parte I. MEDICRIT. 2005;2(7):107-148.

3. Alted López E, Bermejo Aznárez S, Chico Fernández M. Actualizaciones en el manejo del traumatismo craneoencefálico grave. Med Intensiva [Internet]. 2009;33(1):16-30. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S021056910970302X

4. Giner J, Mesa Galán L, Yus Teruel S, Guallar Espallargas MC, Pérez López C, Isla Guerrero A, et al. El traumatismo craneoencefálico severo en el nuevo milenio. Nueva población y nuevo manejo. Neurología [Internet]. 2019. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0213485319300635

5. Sistema Nacional de Epidemiología. Aspectos clínicos y epidemiológicos del trauma craneoencefálico en México. Epidemiol Secr Salud. 2008;25(26):1-4.

6. Sistema General de Seguridad Social en Salud – Colombia. Guías de práctica clínica para el diagnóstico y tratamiento del trauma craneoencefálico en Colombia [Internet]. 2014. Disponible en: https://medicosgeneralescolombianos.com/images/Guias_2014/GPC_30_TCE.pdf

7. Silva-Obregón JA, Martín-Vivas A, Romera-Ortega MA, Blanco-García JJ. Revisión del traumatismo craneoencefálico. Neurocirugia. 2008;19(2):164-165.

8. Moreira Milanesi E, Vidal Suarez J, Taborda Tafernaberry A, Nakle Buschiazzo E, Cidade Pereira L. Tomografía computarizada en traumatismo craneoencefálico leve, ¿son estas necesarias en todos los casos? Rev Uruguaya Med Interna [Internet]. 2021;6(1). Disponible en: http://revistamedicinainterna.uy/index.php/smiu/article/view/128

9. Bárcena-Orbe A, Rodríguez-Arias C, Rivero Martín B, Cañizal-García J, Mestre-Moreiro C, Calvo-Pérez J, et al. Revisión del traumatismo craneoencefálico. Neurocirugia. 2006;17(1):498-518.

10. Smith C. Neurotrauma. Handb Clin Neurol. 2017;145:115-132.

11. Martínez Martínez L, González Aguilera JC, Fonseca Muñoz JC. Valor pronóstico de las alteraciones clínicas, humorales y tomográficas en pacientes con traumatismo craneoencefálico grave. Multimed. 2012;16(3):492-504.

12. Piña-Tornés A, Garcés-Hernández R, Velázquez-González E, Lemes-Báez J. Factores pronósticos en el traumatismo craneoencefálico grave del adulto. Rev Cuba Neurol y Neurocir. 2012;2(1):28-33.

13. Frutos B, Rubio GFJ, Corral MJC, Prieto MLA, González RJ. Factores pronósticos del traumatismo craneoencefálico grave. Med Intensiva [Internet]. 2013;37(5):327-332. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0210569112002069

14. Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med [Internet]. 2007;33(10):1704-1711. Available in: http://link.springer.com/10.1007/s00134-007-0797-6

15. Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. J Neurosurg. 1997;87(1):34-40.

16. Carrillo-Esper R, Flores-Rivera O, Peña-Pérez C, Carrillo-Córdova L, Carrillo-Córdova J, Carrillo-Córdova C, et al. Evaluación ultrasonográfica del diámetro de la vaina del nervio óptico (DVNO) para la medición de la presión intracraneana (PIC): a propósito de un caso. Gac Med Mex. 2014;150(1):165-170.

17. Legrand A, Jeanjean P, Delanghe F, Peltier J, Lecat B, Dupont H. Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients. Crit Care. 2013;17(2):R61.

18. Islas ARE, Coria LGVL, Montelongo FJ, Reyes PMM, Carmona DA, Suárez SA. Medición del diámetro de la vaina del nervio óptico por ultrasonografía versus tomografía simple de cráneo en pacientes con trauma craneoencefálico. Med Crit. 2020;34(4):221-230.

19. Rodríguez-Suárez G, Misa Menéndez M, Ponz Moscoso F, Valdivia Puerta A, Mur Villar N. Valoración de la atención de urgencias al paciente con trauma grave. Rev Cuba Cir. 2002;41(3):185-193.

20. Alberdi F, García I, Atutxa L, Zabarte M. Epidemiología del trauma grave. Med Intensiva [Internet]. 2014;38(9):580-588. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0210569114001806

21. Piñón-García K, Montes-Morales MN, Correa-Borrell M, Pozo-Romero JA, Almeida-Esquivel Y. Factores de riesgo asociados a la mortalidad en pacientes con trauma craneoencefálico agudo. Rev Cuba Anestesiol Reanim. 2020;19(3):e625.

22. Umaña LL. Características sociodemográficas relacionadas con la mortalidad por trauma craneoencefálico en adultos en Colombia. 2010-2017 [Tesis]. Bogotá: Universidad del Rosario; 2021.

23. Sánchez-Torres C, Urías-Romo de Vivar EG, Martínez-Félix JI. Diámetro de la vaina del nervio óptico y tomografía axial computada en trau-matismo craneoencefálico como predictor de hipertensión intracraneal. Rev Med UAS [Internet]. 2017;7(4):198-212. Disponible en: http://dx.doi.org/10.28960/revmeduas.2007-8013.v7.n4.005

24. Zamora-Cueva R, Vásquez-Tirado G. Validez del diámetro de la vaina del nervio óptico por ultrasonografía para el diagnóstico de hipertensión intracraneana en traumatismo craneoencefálico severo. Rev Cuerpo Med HNAAA. 2021;14(2):139-144.

25. Salinas AA, Landires E. Medición de la vaina del nervio óptico por ultrasonido como herramienta para el monitoreo de la presión intracraneana en la unidad de cuidados intensivos: a propósito de un caso. Anest Analg Reanim. 2017;30:27.

26. Sosa-Remón A, Jerez-Álvarez AE, Remón-Chávez CE. Ultrasonografía del diámetro de la vaina del nervio óptico en el monitoreo de la presión intracraneal. Rev Cuba Anestesiol Reanim. 2021;20(3):e710.

27. Ortega-Zufiría JM, Choque-Cuba B, Sierra Rodríguez M, López Ramírez Y, Poveda Núñez P, Tamarit Degenhardt M, et al. Factores pronósticos del traumatismo craneoencefálico grave. Rev Argentina Neurocir. 2018;32(4):242-249.

28. Hodelin Tablada R, Domínguez Peña R, Fernández Aparicio M. Escala de Glasgow para el coma como factor pronóstico de mortalidad en el traumatismo craneoencefálico grave. Rev Cuba Neurol Neurocir. 2013;3(1):57–62.

29. Martos GC. Mortalidad del trauma craneoencefálico grave con edema cerebral en pacientes entre 20-60 años con tratamiento conservador vs craniectomía descompresiva en el Hospital Belén de Trujillo 2012-2016 [Tesis]. Perú: Universidad Privada de Antenor Orrego; 2019.

30. Chicote ÁE. Factores pronósticos en el traumatismo craneoencefálico grave en la población mayor de 64 años [Tesis]. Cantabria: Universidad de Cantabria; 2020.