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Open AccessArticle

Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

1
Department of Traumatology, John Hunter Hospital Newcastle, Newcastle, NSW 2305, Australia
2
School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2300, Australia
3
Department of Neurology, University of Melbourne, Melbourne, VIC 3050, Australia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 2000; https://doi.org/10.3390/jcm9062000
Received: 30 April 2020 / Revised: 22 June 2020 / Accepted: 23 June 2020 / Published: 25 June 2020
(This article belongs to the Section Clinical Neurology)
The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients. View Full-Text
Keywords: perfusion CT; traumatic brain injury; intracranial hypertension; intracranial pressure monitoring perfusion CT; traumatic brain injury; intracranial hypertension; intracranial pressure monitoring
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Cooper, S.; Bendinelli, C.; Bivard, A.; Parsons, M.; Balogh, Z.J. Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury. J. Clin. Med. 2020, 9, 2000.

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