Risk factors for posttraumatic vasospasm
Clinical article
Object
Posttraumatic vasospasm (PTV) is an underrecognized cause of ischemic damage after severe traumatic brain injury (TBI) that independently predicts poor outcome. There are, however, no guidelines for PTV screening and management, partly due to limited understanding of its pathogenesis and risk factors.
Methods
A database review of 46 consecutive cases of severe TBI in pediatric and adult patients was conducted to identify risk factors for the development of PTV. Univariate analysis was performed to identify potential risk factors for PTV, which were subsequently analyzed using a multivariate logistic regression model to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
Results
Fever on admission was an independent risk factor for development of PTV (OR 22.2, 95% CI 1.9–256.8), and patients with hypothermia on admission did not develop clinically significant vasospasm during their hospital stay. The presence of small parenchymal contusions was also an independent risk factor for PTV (OR 7.8, 95% CI 0.9–69.5), whereas the presence of subarachnoid hemorrhage or other patterns of intracranial injury were not. Other variables, such as age, sex, ethnicity, degree of TBI severity, or admission laboratory values, were not independent predictors for the development of clinically significant PTV.
Conclusions
Independent risk factors for PTV include parenchymal contusions and fever. These results suggest that diffuse mechanical injury and activation of inflammatory pathways may be underlying mechanisms for the development of PTV, and that a subset of patients with these risk factors may be an appropriate population for aggressive screening. Further studies are needed to determine if treatments targeting fever and inflammation may be effective in reducing the incidence of vasospasm following severe TBI.
Abbreviations used in this paper:
CPP = cerebral perfusion pressure; GCS = Glasgow Coma Scale; ICP = intracranial pressure; MABP = mean arterial blood pressure; PbtO2 = brain tissue oxygenation; PTV = posttraumatic vasospasm; SAH = subarachnoid hemorrhage; TBI = traumatic brain injury; TCD = transcranial Doppler.
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