Prognostication via early computed tomography head in patients treated with targeted temperature management after cardiac arrest.

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Citation: Journal of the Neurological Sciences. 406:116437, 2019 Nov 15.PMID: 31521958Institution: MedStar Washington Hospital CenterDepartment: Surgery/Surgical Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Hypothermia, Induced/mt [Methods] | *Out-of-Hospital Cardiac Arrest/dg [Diagnostic Imaging] | *Out-of-Hospital Cardiac Arrest/th [Therapy] | *Tomography, X-Ray Computed/mt [Methods] | Aged | Cohort Studies | Early Diagnosis | Female | Hospital Mortality/td [Trends] | Humans | Hypothermia, Induced/mo [Mortality] | Male | Middle Aged | Out-of-Hospital Cardiac Arrest/mo [Mortality] | Prognosis | Prospective Studies | Retrospective Studies | Tomography, X-Ray Computed/mo [Mortality] | Treatment OutcomeYear: 2019ISSN:
  • 0022-510X
Name of journal: Journal of the neurological sciencesAbstract: BACKGROUND: We evaluated computed tomography head (CTH) imaging obtained prior to targeted temperature management (TTM) in patients after cardiac arrest, and its role in prognostication.CONCLUSION: Imaging prior to TTM may help identify post-cardiac arrest patients with severe anoxic brain injury and poor outcomes. Copyright (c) 2019 Elsevier B.V. All rights reserved.METHODS: In this retrospective cohort study in a tertiary-care hospital, 341 adults presenting with out-of-hospital cardiac arrest received a CTH prior to TTM. Associations between outcomes and neuroimaging variables were evaluated with Chi-square analysis for significant associations that yielded a composite neuroimaging score-Tennessee Early Neuroimaging Score (TENS). Univariable and multivariable logistic regression analysis including TENS as an independent variable and the four outcome dependent variables were analyzed.RESULTS: Four of the neuroimaging variables-sulcal effacement, partial gray-white matter effacement, total gray-white matter effacement, deep nuclei effacement-had significant associations with each of the four outcome variables and yielded TENS. In multivariable logistic regression models adjusted for potential confounders, TENS was associated with poor discharge CPC (OR 2.15, 95%CI 1.16-3.98, p=.015), poor disposition (OR 2.62, 95%CI 1.37-5.02, p=.004), in-hospital mortality (OR 1.99, 95%CI 1.09-3.62, p=.024), and ICU mortality (OR 1.89, 95%CI 1.12-3.20, p=.018).All authors: Alexandrov AV, Alsherbini K, Chang JJ, Elijovich L, Goyal N, Kadaria D, Malkoff MD, Metter JE, Murillo L, Sareen S, Schuring C, Shrestha R, Sodhi A, Tsivgoulis G, Yankovich AOriginally published: Journal of the Neurological Sciences. 406:116437, 2019 Aug 28.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-10-10
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Journal Article MedStar Authors Catalog Article 31521958 Available 31521958

BACKGROUND: We evaluated computed tomography head (CTH) imaging obtained prior to targeted temperature management (TTM) in patients after cardiac arrest, and its role in prognostication.

CONCLUSION: Imaging prior to TTM may help identify post-cardiac arrest patients with severe anoxic brain injury and poor outcomes. Copyright (c) 2019 Elsevier B.V. All rights reserved.

METHODS: In this retrospective cohort study in a tertiary-care hospital, 341 adults presenting with out-of-hospital cardiac arrest received a CTH prior to TTM. Associations between outcomes and neuroimaging variables were evaluated with Chi-square analysis for significant associations that yielded a composite neuroimaging score-Tennessee Early Neuroimaging Score (TENS). Univariable and multivariable logistic regression analysis including TENS as an independent variable and the four outcome dependent variables were analyzed.

RESULTS: Four of the neuroimaging variables-sulcal effacement, partial gray-white matter effacement, total gray-white matter effacement, deep nuclei effacement-had significant associations with each of the four outcome variables and yielded TENS. In multivariable logistic regression models adjusted for potential confounders, TENS was associated with poor discharge CPC (OR 2.15, 95%CI 1.16-3.98, p=.015), poor disposition (OR 2.62, 95%CI 1.37-5.02, p=.004), in-hospital mortality (OR 1.99, 95%CI 1.09-3.62, p=.024), and ICU mortality (OR 1.89, 95%CI 1.12-3.20, p=.018).

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