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To determine our institutional adherence to the Brain Trauma Foundation guidelines with respect to intracranial pressure (ICP) monitoring, and examine the relationship between external ventricular drain (EVD) use and mortality.
Materials & Methods:
Retrospective cohort study of 171 patients with severe traumatic brain injury (TBI). Propensity score adjusted logistic regression was used to model the association between EVD use and mortality.
EVDs were inserted in 98 of 171 patients. Of the 73 patients without an EVD, 63 (86%) would have qualified for ICP monitoring under the current guidelines. EVDs were in situ for a median of 8 days (SD 6). In adjusted analyses, EVD use was associated with hospital mortality (OR 2.8, 95% CI: 1.1 - 7.1, p=0.04) and 28-day mortality (OR 2.1, 95% CI: 0.80 - 5.6, p=0.13). We observed significant modification of the association between EVD and 28-day mortality by GCS within 12 hours (p-interaction = 0.04), indicating strong association only among those patients with GCS score of at least 6 (OR 5.0, 95% CI: 1.5 - 16.7, p<0.01).
The association of EVD with 28-day mortality was only apparent among patients with GCS score of ≥ 6. Further research is warranted to further refine which patients may benefit from ICP monitoring.
Bürger's disease or thromboangiitis obliterans (TAO) is a nonatherosclerotic segmental inflammatory obliterative vascular disease that affects medium- and small-sized arteries as well as superficial veins. Bürger's disease manifested in the brain has the following morphologic characteristics: arterial occlusions caused by thrombosis in small arteries without arteriosclerosis, and spatial predilection for the cerebral surface in the watershed region between the middle cerebral, anterior, and posterior cerebral arteries. TAO is characterized by claudication or ischemia of both legs and less so of the arms. The disease begins distally and progresses more proximally. The diagnosis of TAO requires the exclusion of an embolic source, autoimmune disease, diabetes, and hyperlipidemia. Arteriography should show the distal involvement with normal arterial lumen proximal to the popliteal or distal brachial level and the absence of atheromatous changes in the large vessels. Abstinence from tobacco will likely halt disease progression and sometimes result in regression of vascular changes.
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