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Open Access 01-12-2022 | Central Nervous System Trauma | Research article

Role of electrocardiogram findings in predicting 48-h mortality in patients with traumatic brain injury

Authors: Ji Ho Lee, Dong Hun Lee, Byung Kook Lee, Yong Soo Cho, Dong Ki Kim, Yong Hun Jung

Published in: BMC Neurology | Issue 1/2022

Abstract

Objective

Electrocardiogram (ECG) patterns can change, especially in patients with central nervous system disorders such as spontaneous subarachnoid hemorrhage. However, the association between the prognosis of traumatic brain injury (TBI) and ECG findings is unknown. Therefore, this study aimed to compare and to analyze ECG findings to predict early mortality in patients with TBI.

Methods

This retrospective observational study included patients with severe trauma and TBI who were admitted to the emergency department (ED) between January 2018 and December 2020. TBI was defined as an abbreviated injury scale score of the head of ≥3. We examined ECG findings, including PR prolongation (≥ 200 ms), QRS complex widening (≥ 120 ms), corrected QT interval prolongation (QTP, ≥ 480 ms), ST-segment elevation, and ST-segment depression (STD) at ED arrival. The primary outcome was 48-h mortality.

Results

Of the total patients with TBI, 1024 patients were included in this study and 48-h mortality occurred in 89 patients (8.7%). In multivariate analysis, QTP (odds ratio [OR], 2.017; confidence interval [CI], 1.203–3.382) and STD (OR, 8.428; 95% CI, 5.019–14.152) were independently associated with 48-h mortality in patients with TBI. The areas under the curve (AUCs) of the revised trauma score (RTS), injury severity score (ISS), QTP, STD, and the combination of QTP and STD were 0.790 (95% CI, 0.764–0.815), 0.632 (95% CI, 0.602–0.662), 0.605 (95% CI, 0.574–0.635), 0.723 (95% CI, 0.695–0.750), and 0.786 (95% CI, 0.759–0.811), respectively. The AUC of the combination of QTP and STD significantly differed from that of ISS, QTP, and STD, but not RTS.

Conclusion

Based on the ECG findings, QTP and STD were associated with 48-h mortality in patients with TBI.

Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths - United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):1–16. https://doi.org/10.15585/mmwr.ss6609a1 PMID: 28301451; PMCID: PMC5829835.CrossRefPubMedPubMedCentral

Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg. 2010;34(1):158–63. https://doi.org/10.1007/s00268-009-0266-1 PMID: 19882185.CrossRefPubMed

Rauf R, von Matthey F, Croenlein M, Zyskowski M, van Griensven M, Biberthaler P, et al. Changes in the temporal distribution of in-hospital mortality in severely injured patients-an analysis of the TraumaRegister DGU. PLoS One. 2019;14(2):e0212095. https://doi.org/10.1371/journal.pone.0212095 PMID: 30794579; PMCID: PMC6386341.CrossRefPubMedPubMedCentral

Powers AY, Pinto MB, Tang OY, Chen JS, Doberstein C, Asaad WF. Predicting mortality in traumatic intracranial hemorrhage. J Neurosurg. 2019;132(2):552–9. https://doi.org/10.3171/2018.11.JNS182199 PMID: 30797192.CrossRefPubMed

Mahadewa TGB, Golden N, Saputra A, Ryalino C. Modified revised trauma-Marshall score as a proposed tool in predicting the outcome of moderate and severe traumatic brain injury. Open Access Emerg Med. 2018;10:135–9. https://doi.org/10.2147/OAEM.S179090 PMID: 30349408; PMCID: PMC6183729.CrossRefPubMedPubMedCentral

Silvani A, Calandra-Buonaura G, Dampney RA, Cortelli P. Brain-heart interactions: physiology and clinical implications. Philos Trans A Math Phys Eng Sci. 2016;374(2067):20150181. https://doi.org/10.1098/rsta.2015.0181 PMID: 27044998.CrossRefPubMed

Zipes DP, Rubart M. Neural modulation of cardiac arrhythmias and sudden cardiac death. Heart Rhythm. 2006;3(1):108–13. https://doi.org/10.1016/j.hrthm.2005.09.021 PMID: 16399065; PMCID: PMC2566299.CrossRefPubMedPubMedCentral

Ha Y, Jeong JA, Kim Y, Churchill DG. Sodium and potassium relating to Parkinson’s disease and traumatic brain injury. Met Ions Life Sci. 2016;16:585–601. https://doi.org/10.1007/978-3-319-21756-7_16 PMID: 26860312.CrossRefPubMed

Moussouttas M, Lai EW, Khoury J, Huynh TT, Dombrowski K, Pacak K. Determinants of central sympathetic activation in spontaneous primary subarachnoid hemorrhage. Neurocrit Care. 2012;16(3):381–8. https://doi.org/10.1007/s12028-012-9673-5 PMID: 22311230.CrossRefPubMed

10.

Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96 PMID: 4814394.CrossRef

11.

Mellick D, Gerhart KA, Whiteneck GG. Understanding outcomes based on the post-acute hospitalization pathways followed by persons with traumatic brain injury. Brain Inj. 2003;17(1):55–71. https://doi.org/10.1080/0269905021000010159 PMID: 12519648.CrossRefPubMed

12.

Dübendorfer C, Billeter AT, Seifert B, Keel M, Turina M. Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury. Eur J Trauma Emerg Surg. 2013;39(1):25–34. https://doi.org/10.1007/s00068-012-0212-z PMID: 26814920.CrossRefPubMed

13.

Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29(5):623–9. https://doi.org/10.1097/00005373-198905000-00017 PMID: 2657085.CrossRefPubMed

14.

Foreman BP, Caesar RR, Parks J, Madden C, Gentilello LM, Shafi S, et al. Usefulness of the abbreviated injury score and the injury severity score in comparison to the Glasgow coma scale in predicting outcome after traumatic brain injury. J Trauma. 2007;62(4):946–50. https://doi.org/10.1097/01.ta.0000229796.14717.3a PMID: 17426553.CrossRefPubMed

15.

American College of Surgeons Committee on Trauma. Advanced trauma life support (ATLS) student course manual. 10th ed. Chicago: American College of Surgeons; 2018.

16.

Aro AL, Anttonen O, Kerola T, Junttila MJ, Tikkanen JT, Rissanen HA, et al. Prognostic significance of prolonged PR interval in the general population. Eur Heart J. 2014;35(2):123–9. https://doi.org/10.1093/eurheartj/eht176 PMID: 23677846.CrossRefPubMed

17.

Katritsis DG, Brugada J. Differential diagnosis of wide QRS Tachycardias. Arrhythmia Electrophysiol Rev. 2020;9(3):155–60. https://doi.org/10.15420/aer.2020.20 PMID: 33240511; PMCID: PMC7675136.CrossRef

18.

Collier BR, Miller SL, Kramer GS, Balon JA, Gonzalez LS 3rd. Traumatic subarachnoid hemorrhage and QTc prolongation. J Neurosurg Anesthesiol. 2004;16(3):196–200. https://doi.org/10.1097/00008506-200407000-00003 PMID: 15211156.CrossRefPubMed

19.

Johnson JN, Ackerman MJ. QTc: how long is too long? Br J Sports Med. 2009;43(9):657–62. https://doi.org/10.1136/bjsm.2008.054734 PMID: 19734499; PMCID: PMC3940069.CrossRefPubMed

20.

Kim YJ, Min SY, Lee DH, Lee BK, Jeung KW, Lee HJ, et al. The role of post-resuscitation electrocardiogram in patients with ST-segment changes in the immediate post-cardiac arrest period. JACC Cardiovasc Interv. 2017;10(5):451–9. https://doi.org/10.1016/j.jcin.2016.11.046 PMID: 28279312.CrossRefPubMed

21.

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45 PMID: 3203132.CrossRef

22.

Krishnamoorthy V, Prathep S, Sharma D, Gibbons E, Vavilala MS. Association between electrocardiographic findings and cardiac dysfunction in adult isolated traumatic brain injury. Indian J Crit Care Med. 2014;18(9):570–4. https://doi.org/10.4103/0972-5229.140144 PMID: 25249741; PMCID: PMC4166872.CrossRefPubMedPubMedCentral

23.

Dabrowski W, Schlegel TT, Wosko J, Rola R, Rzecki Z, Malbrain MLNG, et al. Changes in spatial QRS-T angle and QTc interval in patients with traumatic brain injury with or without intra-abdominal hypertension. J Electrocardiol. 2018;51(3):499–507. https://doi.org/10.1016/j.jelectrocard.2017.12.038 PMID: 29310923.CrossRefPubMed

24.

Prasad Hrishi A, Ruby Lionel K, Prathapadas U. Head rules over the heart: cardiac manifestations of cerebral disorders. Indian J Crit Care Med. 2019;23(7):329–35. https://doi.org/10.5005/jp-journals-10071-23208 PMID: 31406441; PMCID: PMC6686577.CrossRefPubMedPubMedCentral

25.

Rudehill A, Olsson GL, Sundqvist K, Gordon E. ECG abnormalities in patients with subarachnoid haemorrhage and intracranial tumours. J Neurol Neurosurg Psychiatry. 1987;50(10):1375–81. https://doi.org/10.1136/jnnp.50.10.1375 PMID: 3681317; PMCID: PMC1032467.CrossRefPubMedPubMedCentral

26.

Lenstra JJ, Kuznecova-Keppel Hesselink L, la Bastide-van GS, Jacobs B, Nijsten MWN, van der Horst ICC, et al. The association of early electrocardiographic abnormalities with brain injury severity and outcome in severe traumatic brain injury. Front Neurol. 2021;11:597737. https://doi.org/10.3389/fneur.2020.597737 PMID: 33488498; PMCID: PMC7819976.CrossRefPubMedPubMedCentral

27.

Dash M, Bithal PK, Prabhakar H, Chouhan RS, Mohanty B. ECG changes in pediatric patients with severe head injury. J Neurosurg Anesthesiol. 2003;15(3):270–3. https://doi.org/10.1097/00008506-200307000-00017 PMID: 12826977.CrossRefPubMed

28.

Sakr YL, Lim N, Amaral AC, Ghosn I, Carvalho FB, Renard M, et al. Relation of ECG changes to neurological outcome in patients with aneurysmal subarachnoid hemorrhage. Int J Cardiol. 2004;96(3):369–73. https://doi.org/10.1016/j.ijcard.2003.07.027 PMID: 15301889.CrossRefPubMed

29.

Manninen PH, Ayra B, Gelb AW, Pelz D. Association between electrocardiographic abnormalities and intracranial blood in patients following acute subarachnoid hemorrhage. J Neurosurg Anesthesiol. 1995;7(1):12–6. https://doi.org/10.1097/00008506-199501000-00003 PMID: 7881235.CrossRefPubMed

30.

Bhagat H, Narang R, Sharma D, Dash HH, Chauhan H. ST elevation--an indication of reversible neurogenic myocardial dysfunction in patients with head injury. Ann Card Anaesth. 2009;12(2):149–51. https://doi.org/10.4103/0971-9784.53446 PMID: 19602742.CrossRefPubMed

31.

Bhagat H, Chauhan H, Dash HH. ST elevation in a head-injured patient for emergency neurosurgery: do we routinely need a cardiac evaluation? Ann Card Anaesth. 2010;13(1):73–4. https://doi.org/10.4103/0971-9784.58843 PMID: 20075544.CrossRefPubMed

32.

Hashemian AM, Ahmadi K, Taherinia A, Sharifi MD, Ramezani J, Jazayeri SB, et al. ECG changes of cardiac origin in elderly patients with traumatic brain injury. Med J Islam Repub Iran. 2015;29:306 PMID: 26913269.PubMedPubMedCentral

33.

Schuiling WJ, Algra A, de Weerd AW, Leemans P, Rinkel GJ. ECG abnormalities in predicting secondary cerebral ischemia after subarachnoid haemorrhage. Acta Neurochir. 2006;148(8):853–8. https://doi.org/10.1007/s00701-006-0808-3 PMID: 16791433. discussion 858.CrossRefPubMed

34.

Demetriades D, Kuncir E, Velmahos GC, Rhee P, Alo K, Chan LS. Outcome and prognostic factors in head injuries with an admission Glasgow coma scale score of 3. Arch Surg. 2004;139(10):1066–8. https://doi.org/10.1001/archsurg.139.10.1066 PMID: 15492144.CrossRefPubMed

35.

Han JX, See AAQ, Gandhi M, King NKK. Models of mortality and morbidity in severe traumatic brain injury: an analysis of a Singapore Neurotrauma database. World Neurosurg. 2017;108:885–93.e1. https://doi.org/10.1016/j.wneu.2017.08.147 PMID: 28867312.CrossRefPubMed

36.

Dabrowski W, Siwicka-Gieroba D, Robba C, Badenes R, Bialy M, Iwaniuk P, et al. Plasma Hyperosmolality prolongs QTc interval and increases risk for atrial fibrillation in traumatic brain injury patients. J Clin Med. 2020;9(5):1293. https://doi.org/10.3390/jcm9051293 PMID: 32365845.CrossRefPubMedCentral

37.

Landstrom AP, Dobrev D, Wehrens XHT. Calcium signaling and cardiac arrhythmias. Circ Res. 2017;120(12):1969–93. https://doi.org/10.1161/CIRCRESAHA.117.310083 PMID: 28596175.CrossRefPubMedPubMedCentral

38.

Watanabe H, Koopmann TT, Le Scouarnec S, Yang T, Ingram CR, Schott JJ, et al. Sodium channel β1 subunit mutations associated with Brugada syndrome and cardiac conduction disease in humans. J Clin Invest. 2008;118(6):2260–8. https://doi.org/10.1172/JCI33891 PMID: 18464934.CrossRefPubMedPubMedCentral

Title: Role of electrocardiogram findings in predicting 48-h mortality in patients with traumatic brain injury
Authors: Ji Ho Lee
Dong Hun Lee
Byung Kook Lee
Yong Soo Cho
Dong Ki Kim
Yong Hun Jung
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Central Nervous System Trauma
Subarachnoid Hemorrhage
Subarachnoid Hemorrhage
Published in: BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-022-02717-y

2024 ASCO Annual Meeting

Springer Medicine

Role of electrocardiogram findings in predicting 48-h mortality in patients with traumatic brain injury

Abstract

Objective

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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