Journal of Trauma and Injury

Original Articles

Outcomes and physiologic responses associated with ketamine administration after traumatic brain injury in the United States and Canada: a retrospective analysis: Austin J. Peters, Saad A. Khan, Seiji Koike, Susan Rowell, Martin Schreiber; J Trauma Inj. 2023;36(4):354-361. Published online November 7, 2023; DOI: https://doi.org/10.20408/jti.2023.0034

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Abstract PDF Supplementary Material: Purpose
Ketamine has historically been contraindicated in traumatic brain injury (TBI) due to concern for raising intracranial pressure. However, it is increasingly being used in TBI due to the favorable respiratory and hemodynamic properties. To date, no studies have evaluated whether ketamine administered in subjects with TBI is associated with patient survival or disability.
Methods
We performed a retrospective analysis of data from the multicenter Prehospital Tranexamic Acid Use for Traumatic Brain Injury trial, comparing ketamine-exposed and ketamine-unexposed TBI subjects to determine whether an association exists between ketamine administration and mortality, as well as secondary outcome measures.
Results
We analyzed 841 eligible subjects from the original study, of which 131 (15.5%) received ketamine. Ketamine-exposed subjects were younger (37.3±16.9 years vs. 42.0±18.6 years, P=0.037), had a worse initial Glasgow Coma Scale score (7±3 vs. 8±4, P=0.003), and were more likely to be intubated than ketamine-unexposed subjects (88.5% vs. 44.2%, P<0.001). Overall, there was no difference in mortality (12.2% vs. 15.5%, P=0.391) or disability measures between groups. Ketamine-exposed subjects had significantly fewer instances of elevated intracranial pressure (ICP) compared to ketamine-unexposed subjects (56.3% vs. 82.3%, P=0.048). In the very rare outcomes of cardiac events and seizure activity, seizure activity was statistically more likely in ketamine-exposed subjects (3.1% vs. 1.0%, P=0.010). In the intracranial hemorrhage subgroup, cardiac events were more likely in ketamine-exposed subjects (2.3% vs. 0.2%, P=0.025). Ketamine exposure was associated with a smaller increase in TBI protein biomarker concentrations.
Conclusions
Ketamine administration was not associated with worse survival or disability despite being administered to more severely injured subjects. Ketamine exposure was associated with reduced elevations of ICP, more instances of seizure activity, and lower concentrations of TBI protein biomarkers.; Summary

Correlation between Optic Nerve Sheath Diameter Measured by Computed Tomography and Elevated Intracranial Pressure in Patients with Traumatic Brain Injury: Tae Kyoo Lim, Byug Chul Yu, Dae Sung Ma, Gil Jae Lee, Min A Lee, Sung Yeol Hyun, Yang Bin Jeon, Kang Kook Choi; J Trauma Inj. 2017;30(4):140-144. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.140

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6 Citations

Purpose

The optic nerve sheath diameter (ONSD) measured by ultrasonography is among the indicators of intracranial pressure (ICP) elevation. However, whether ONSD measurement is useful for initial treatment remains controversial. Thus, this study aimed to investigate the relationship between ONSD measured by computed tomography (CT) and ICP in patients with traumatic brain injury (TBI).

Methods

A total of 246 patients with severe trauma from January 1, 2015 until December 31, 2015 were included in the study. A total of 179 patients with brain damage with potential for ICP elevation were included in the TBI group. The remaining 67 patients comprised the non-TBI group. A comparison was made between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of ONSD when used as a screening test for the TBI group including those with TBI with midline shift (with elevated ICP).

Results

The mean injury severity score (ISS) and glasgow coma scale (GCS) of all patients were 24.2±6.1 and 5.4±0.8, respectively. The mean ONSD of the TBI group (5.5±1.0 mm) was higher than that of the non-TBI group (4.7±0.6 mm). Some significant differences in age (55.3±18.1 vs. 49.0±14.8, p<0.001), GCS (11.7±4.1 versus 13.3±3.0, p<0.001), and ONSD (5.5±1.0 vs. 4.7±0.6, p<0.001) were observed between the TBI and the non-TBI group. An ROC analysis was used to assess the correlation between TBI and ONSD. Results showed an area under the ROC curve (AUC) value of 0.752. The same analysis was used in the TBI with midline shift group, which showed an AUC of 0.912.

Conclusions

An ONSD of >5.5 mm, measured on CT, is a good indicator of ICP elevation. However, since an ONSD is not sensitive enough to detect an increased ICP, it should only be used as one of the parameters in detecting ICP along with other screening tests.

Summary

Citations

Citations to this article as recorded by

Correlation Between Optic Nerve Sheath Diameter at Initial Head CT and the Rotterdam CT Score
Aletor O Amakhian, Elohor B Obi-Egbedi-Ejakpovi, Eghosa Morgan, Ademola A Adeyekun, Munir M Abubakar
Cureus.2023;[Epub] CrossRef
Sono-clinical decision rule for repeat head computed tomography scan in traumatic brain injury in emergency settings
Priyanka Modi, Sanjeev Bhoi, Savan Pandey
WFUMB Ultrasound Open.2023; 1(2): 100026. CrossRef
Sonographic Measurement of the Optic Nerve Sheath Diameter to Improve Detection of Elevated Intracranial Pressure
Faten Farid Awdallah, Islam Hassan Abulnaga, Suzy Fawzy Michael, Hassan Khaled Nagi, Mohamed Hosny Abdallah
Biomedical and Pharmacology Journal.2022; 15(3): 1677. CrossRef
Serial Optic Nerve Sheath Diameter via Radiographic Imaging
Diane McLaughlin, Lisa Anderson, Jinhong Guo, Molly McNett
Neurology Clinical Practice.2021;[Epub] CrossRef
The association between intracranial pressure and optic nerve sheath diameter on patients with head trauma
Kaan Çelik, Bekir Enes Demiryurek
Arquivos de Neuro-Psiquiatria.2021; 79(10): 879. CrossRef
MRI measurement of optic nerve sheath diameter using 3D driven equilibrium sequence as a non-invasive tool for the diagnosis of idiopathic intracranial hypertension
Ahmed S. Abdelrahman, Mai M. K. Barakat
Egyptian Journal of Radiology and Nuclear Medicine.2020;[Epub] CrossRef

Assessment of the Clinical and the Radiological Prognostic Factors that Determine the Management of a Delayed, Traumatic, Intraparenchymal Hemorrhage (DTIPH): Je Il Ryu, Choong Hyun Kim, Jae Min Kim, Jin Hwan Cheong; J Trauma Inj. 2015;28(4):223-231. Published online December 31, 2015; DOI: https://doi.org/10.20408/jti.2015.28.4.223

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Abstract PDF: PURPOSE
Delayed, traumatic, intraparenchymal hemorrhage (DTIPH) is a well-known contributing factor to secondary brain damage that evokes severe brain edema and intracranial hypertension. Once it has occurred, it adversely affects the patient's outcome. The aim of this study was to evaluate the prognosis factors for DTIPH by comparing clinical, radiological and hematologic results between two groups of patients according to whether surgical treatment was given or not.
METHODS
The author investigated 26 patients who suffered DTIPH during the recent consecutive five-year period. The 26 patients were divided according to their having undergone either a decompressive craniectomy (n=20) or continuous conservative treatment (n=6). A retrospective investigation was done by reviewing their admission records and radiological findings.
RESULTS
This incidence of DTIPH was 6.6% among the total number of patients admitted with head injuries. The clinical outcome of DTIPH was favorable in 9 of the 26 patients (34.6%) whereas it was unfavorable in 17 patients (65.4%). The patients with coagulopathy had an unexceptionally high rate of mortality. Among the variables, whether the patient had undergone a decompressive craniectomy, the patient's preoperative clinical status, and the degree of midline shift had significant correlations with the ultimate outcome.
CONCLUSION
In patients with DTIPH, proper evaluation of preoperative clinical grading and radiological findings can hamper deleterious secondary events because it can lead to a swift and proper decompressive craniectomy to reduce the intracranial pressure. Surgical decompression should be carefully selected, paying attention to the patient's accompanying injury and hematology results, especially thrombocytopenia, in order to improve the patient's neurologic outcomes.; Summary

Availability of the Optic Nerve Sheath Diameter Measured by Using Ultrasonography as a Secondary Survey for Patient with Head Injuries in the Emergency Department: Dong Wook Lee, Jung Won Lee, Sae Hoon Park, Ihl Sung Park, Hyun Jung Lee, Byeong Dae Yoo, Hyung Jun Moon; J Trauma Inj. 2013;26(3):104-110.

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Abstract PDF: PURPOSE
Bedside ultrasonography is available in most emergency departments, and detecting the intracranial pressure is elevated is critical. Our objective is to evaluate the availability of bedside optic nerve ultrasound (ONUS) as a secondary survey for patients with head injuries in the emergency department (ED).
METHODS
From September, 2012, to March, 2013, we performed a prospective study of patients presenting to the ED after an accident. Patients with head injuries but without obvious ocular trauma or ocular disease were included. The ONUS was performed using a 3 to 12 MHz linear probe on closed eyelids after a primary survey. We analyzed the correlation between the brain computed tomography (CT) findings that suggested elevated intracranial pressure (ICP) and the Optic nerve sheath diameter (ONSD) measured by using ONUS.
RESULTS
A total of 81 patients were enrolled. Forty-seven had CT results consistent with elevated ICP, and their mean ONSD was 5.98+/-0.59 mm; the mean ONSD of patients who showed no signs of elevated ICP on CT was 4.63+/-0.21 mm. The sensitivity and the specificity for the ONSD, compared with elevated ICP, were 98.87% and 100%, respectively, when the cut-off value was set to 4.96 mm. The area under curve (AUC) was 0.997 in the receiver operating characteristic curve (ROC curve).
CONCLUSION
An evaluation using ONUS is a simple noninvasive procedure and is a potentially useful tool as a secondary survey to identify an elevated ICP.; Summary

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