Impact of Temperature Profile on Outcome After Traumatic Brain Injury

Summary

Principal Investigator: Lori Kennedy Madden
Abstract: 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.
Funding Period: 2012-07-01 - 2014-06-30
more information: NIH RePORT

Detail Information

Research Grants31

  1. Metabolic Dysfunction and Neuroprotection after Pediatric Head Injury
    Susanna Scafidi; Fiscal Year: 2013
    ..The studies will also assess whether the natural capability of developing brain to use alternative substrates for energy may provide neuroprotection if these substrates are administered in pharmacologic doses shortly after TBI. ..
  2. Modulating Secondary Damage Following Traumatic Brain Injury in the Child
    Stuart H Friess; Fiscal Year: 2013
    ..The goal of this proposal is to develop new and effective therapies to treat acute traumatic brain injury in children utilizing an immature large animal model. ..
  3. Pacific NorthWest Regional Center of Excellence (PNWRCE)
    Jay A Nelson; Fiscal Year: 2013
    ..pseudomallei host pathogen response during both the septicemic as well as the intracellular phases of the disease. ..
  4. Duration of Hypothermia for Neuroprotection after Pediatric Cardiac Arrest
    ERICKA LINN FINK; Fiscal Year: 2013
    ..The impact of cardiac arrest for families is significant in terms of effects on family life and financially, since care for a child surviving cardiac arrest can amount to one million dollars over a lifetime. ..
  5. Massachusetts Alzheimer's Disease Research Center
    Bradley T Hyman; Fiscal Year: 2013
    ..Going forward, the MADRC will continue to expand its clinical and neuropathological resources, its innovative training and scientific programs directed toward AD research. ..
  6. Optimizing Heart and Brain Cooling during Cardiac Arrest
    Lance B Becker; Fiscal Year: 2013
    ..We foresee a future wherein many more patients would survive cardiac arrest, having been cooled with ongoing CPR being performed, before ROSC, rather than hours after ROSC, as is the current practice. ..
  7. Pathophysiology and Treatment of Fanconi's Anemia
    Markus Grompe; Fiscal Year: 2013
    ..abstract_text> ..