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array:22 [ "pii" => "S2529849619300395" "issn" => "25298496" "doi" => "10.1016/j.neucie.2019.05.004" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "386" "copyright" => "Sociedad Española de Neurocirugía" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2020;31:1-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2529849619300401" "issn" => "25298496" "doi" => "10.1016/j.neucie.2019.07.002" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "391" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2020;31:7-13" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Decompressive craniectomy in malignant middle cerebral artery infarction: family perception, outcome and prognostic factors" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "7" "paginaFinal" => "13" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Craniectomía descompresiva en el infarto malignode arteria cerebral media: percepción familiar, resultados y factores pronósticos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1153 "Ancho" => 1583 "Tamanyo" => 76410 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Relationship between current age and current mRS. The mRS at 12 months after surgery in relation to age was also shown to be related, and despite the small sample size, it was almost statistically significant. mRS: modified Rankin Scale.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pablo García-Feijoo, Alberto Isla, Exuperio Díez-Tejedor, Beatriz Mansilla, Alexis Palpan Flores, Miguel Sáez-Alegre, Catalina Vivancos" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Pablo" "apellidos" => "García-Feijoo" ] 1 => array:2 [ "nombre" => "Alberto" "apellidos" => "Isla" ] 2 => array:2 [ "nombre" => "Exuperio" "apellidos" => "Díez-Tejedor" ] 3 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Mansilla" ] 4 => array:2 [ "nombre" => "Alexis" "apellidos" => "Palpan Flores" ] 5 => array:2 [ "nombre" => "Miguel" "apellidos" => "Sáez-Alegre" ] 6 => array:2 [ "nombre" => "Catalina" "apellidos" => "Vivancos" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849619300401?idApp=UINPBA00004B" "url" => "/25298496/0000003100000001/v1_202001140916/S2529849619300401/v1_202001140916/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Neuromonitoring in the severe traumatic brain injury. Spanish Trauma ICU Registry (RETRAUCI)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "6" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Antonio Llompart-Pou, Jesús Abelardo Barea-Mendoza, Marcelino Sánchez-Casado, Javier González-Robledo, Dolores María Mayor-García, Neus Montserrat-Ortiz, Pedro Enríquez-Giraudo, María Lourdes Cordero-Lorenzana, Mario Chico-Fernández" "autores" => array:10 [ 0 => array:3 [ "nombre" => "Juan Antonio" "apellidos" => "Llompart-Pou" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Jesús Abelardo" "apellidos" => "Barea-Mendoza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Marcelino" "apellidos" => "Sánchez-Casado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Javier" "apellidos" => "González-Robledo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Dolores María" "apellidos" => "Mayor-García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Neus" "apellidos" => "Montserrat-Ortiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 6 => array:3 [ "nombre" => "Pedro" "apellidos" => "Enríquez-Giraudo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 7 => array:3 [ "nombre" => "María Lourdes" "apellidos" => "Cordero-Lorenzana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 8 => array:4 [ "nombre" => "Mario" "apellidos" => "Chico-Fernández" "email" => array:1 [ 0 => "murgchico@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 9 => array:1 [ "colaborador" => "on behalf of the Neuro-intensive Medicine and Trauma Working Group of the SEMICYUC" ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut de Investigació Sanitària Illes Balears (IdISBa), Palma, Balearic Islands, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Complejo Hospitalario de Torrecárdenas, Almería, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Lleida, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neuromonitorización en el traumatismo craneoencefálico grave. Datos del Registro español de Trauma en UCI (RETRAUCI)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In patients with severe traumatic brain injury (TBI), the increase in intracranial pressure (ICP) associated with hypoxia phenomena is a significant cause of secondary brain injury and worse neurological outcome.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> In the light of this knowledge, monitoring of ICP and cerebral perfusion pressure has long been a standard of care in patients with severe TBI in most specialist centres.</p><p id="par0010" class="elsevierStylePara elsevierViewall">However, the BEST-TRIP study<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> compared two different therapeutic approaches for the control of ICP in severe TBI, one guided by continuous ICP monitoring and the other based on clinical examination and computed tomography (CT) findings, showing no significant differences between the two methods in patients’ clinical outcomes. The trial received significant criticisms<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> and there certainly is no evidence of any decrease in ICP monitoring in our environment since its publication. However, the results did lead to a decrease in the level of recommendation for the use of the ICP monitoring in the latest version of the Brain Trauma Foundation guidelines,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> which establish a level 2b recommendation: “Management of severe TBI patients using information from ICP monitoring is recommended to reduce in-hospital and 2-week post-injury mortality”.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Moreover, despite the recognised role of the impact of tissue hypoxia phenomena on the final outcome of patients with severe TBI8, the recommendation for the use of cerebral oxygenation monitoring techniques, such as brain tissue oxygen pressure (PbtO2), jugular venous oxygen saturation (SjvO2) and near infrared spectroscopy (NIRS), is even less clear.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> There is little information available about the actual degree of implementation of these techniques in our environment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of our study was to analyse the use of ICP monitoring and cerebral oxygenation monitoring techniques in patients with severe TBI according to the data of the Registro Español de Trauma en las Unidades de Cuidados Intensivos (RETRAUCI) [Spanish Trauma Registry in Intensive Care Units].</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">RETRAUCI has the approval of the ethics committee of the participating hospitals (coordinating centre: Hospital Universitario 12 de Octubre, Madrid: 12/209). This is a multi-centre registry with voluntary participation and implementation in 52 centres across Spain promoted by the Neuro-intensive Medicine and Trauma Working Group of the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) [Spanish Society of Intensive, Critical Medicine and Coronary Units]. The first patient was included in November 2012. The data are collected on a specific website (<a href="http://www.retrauci.org">www.retrauci.org</a>) and are then added to a new server to anonymise the data. For this study, a retrospective analysis was carried out on the patients included from November 2013 to May 2017.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patients who had a TBI with a Glasgow Coma Scale (GCS) score ≤8 points at the time of the first medical care and who were admitted to any of the participating ICUs during the study period were included. Variables were documented relating to epidemiological aspects, outpatient management, injury mechanism and severity, resource consumption, complications and outcome. The patients’ clinical progress until hospital discharge was also documented.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The registry includes the analysis of traumatic injuries according to the Abbreviated Injury Scale (AIS)<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and the calculation of different severity indices, such as the Injury Severity Score (ISS).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The survival probability is also calculated according to the Trauma and Injury Severity Score (TRISS) methodology.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients with missing data were excluded.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Quantitative data were shown as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD and categorical data as number (percentage). Patients with severe TBI monitored with ICP were compared to those not monitored. A normality study of the variables was performed using histograms and the Shapiro–Wilk test. The hypothesis test was performed with the Student t or Wilcoxon test (quantitative variables) and the chi-squared test (categorical variables), as appropriate. A multivariate analysis was performed using logistic regression to analyse the variables associated with the use of ICP monitoring. The variables that reached statistical significance in the univariate analysis were included in the maximum model. The final model was reached by way of the “work backwards” strategy. Statistical significance was considered with a p value <0.05. The statistical analysis was performed with STATA 15 (StataCorp. 2017. Stata Statistical Software: Release 15. College Station, TX, USA).</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">During the study period, 1463 patients were admitted with TBI and GCS<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>8 for whom complete data were also available. The contribution of each participating centre is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The mean age was 49.1 and 1130 were male (77.3%); the main mechanism of brain injury was accidental fall in 350 cases (23.9%), followed by car accident in 234 (16%), non-accidental fall in 230 (15.7%), motorcycle accident in 203 (13.9%) and being knocked down by a vehicle in 149 cases (10.2%); 25.3% of the patients had acute alcohol intoxication; 98 patients (8.35%) were taking anti-platelet therapy and 71 (6.05%) anticoagulants; and 1082 patients (74.6%) required airway management in the pre-hospital environment.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The mean ISS was 27.9 points. As far as non-brain injuries were concerned, 32.8% had associated facial injuries, 49.1% injuries affecting the chest, 21.2% the abdomen, 42% the limbs and 13.3% had external injuries. The mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD score according to the AIS in patients with coded injuries was: face 2 (0.8), thorax 3.31, abdomen 2.81, extremities 2.61 and external 1.71.3.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Categorisation of the TBI according to the Marshall classification was: diffuse injury <span class="elsevierStyleSmallCaps">I</span> (9%), diffuse injury <span class="elsevierStyleSmallCaps">II</span> (38.3%), diffuse injury <span class="elsevierStyleSmallCaps">III</span> (10.7%), diffuse injury <span class="elsevierStyleSmallCaps">IV</span> (1.5%), evacuated mass lesion V (23.4%) and non-evacuated mass lesion VI (17.1%).</p><p id="par0065" class="elsevierStylePara elsevierViewall">Unilateral or bilateral mydriasis was recorded in 39.3% of the patients. A total of 331 patients (22.7%) had cranial surgery within the first 24<span class="elsevierStyleHsp" style=""></span>h. In 6.6% of cases, the patients’ initial treatment was non-aggressive and they were designated as potential organ donors. Almost 18% of patients were subject to some limitation of life-sustaining treatments. The probability of survival analysed by TRISS methodology was 53% and the hospital mortality rate was 25.3%.</p><p id="par0070" class="elsevierStylePara elsevierViewall">ICP was invasively monitored in 635 patients (45.1%). For monitoring cerebral oxygenation, PbtO2 was monitored in 122 patients (8.6%), SjvO2 in 19 (1.34%) and NIRS in 25 (1.77%). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results of the use of neuromonitoring techniques in patients with a GCS score ≤8 and in those who also had a head AIS score ≥3 points, plus the distribution of classic variables relating to the prognosis of severe TBI. In this subgroup, ICP monitoring was used in 51.2%.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The monitored patients were younger (45.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.4 vs 51.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20.6; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01), more likely to go into shock (44.7% vs 33%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01), less likely to be taking anti-platelet agents and anticoagulants (10.8% vs 18.4%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) and less likely to have limitations placed on the different life-sustaining treatments used (13.7% vs 21.4%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). The most common mechanism was car accident in the group with monitoring (20.16% vs 12.2%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01) and accidental fall in the unmonitored group (26% vs 21.4%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). There were no differences in terms of gender (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.2), alcohol intoxication (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.06) or ISS (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.2). Patients with monitoring required more urgent neurosurgical procedures (38.1% vs 11.1%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01), including decompressive craniectomy (20.6% vs 2.4%; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). After the multivariate analysis, age (OR 0.98; 95% confidence interval [CI] 0.97–0.99), bilateral mydriasis at admission (OR 0.2, 95% CI 0.12–0.35) and previous anti-platelet agent or anticoagulant use (OR 0.54; 95% CI 0.31–0.91) were negatively associated with the likelihood of ICP monitoring during their stay in hospital. In contrast, the severity of the injury assessed by the ISS (OR 1; 95% CI 1–1.02) and the indication for neurosurgery in the first 24<span class="elsevierStyleHsp" style=""></span>h (OR 6.2; 95% CI 4.11–9.38) increased the likelihood of monitoring.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">The main outcome of our study was the discovery that ICP monitoring in severe TBI is performed in fewer patients than initially expected. The use of brain oximetry techniques is very limited in Spain.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Joanes recently published the results of a descriptive, cross-sectional survey analysing the initial care and management of severe TBI in Spain, under the auspices of the Neurotrauma Group of the Sociedad Española de Neurocirugía [Spanish Society of Neurosurgery].<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The survey was distributed to the neurosurgery centres of public hospitals in Spain from September 2014 to January 2015 and specifically referred to different aspects of neuromonitoring; 89.7% of the centres replied that ICP is monitored in more than 75% of patients with severe TBI.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Along the same lines, in a survey by the international CENTER-TBI group, 91% of responders reported that ICP is monitored in TBI with abnormal brain CT and GCS<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>8.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">These data contrast with our results, which show that ICP monitoring is performed only in 45% of patients with severe TBI and 51% in the same patients with a head AIS score ≥3. A recent series that included patients with severe TBI over 25 years reported an ICP monitoring rate of 57%,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> closer to our findings. Different factors may influence the low percentage of patients monitored in our population of patients with severe TBI:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">–</span><p id="par0095" class="elsevierStylePara elsevierViewall">Alcohol intoxication. This is known to affect the neurological response assessed with the GCS in patients with TBI.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a> In our population, 25.3% of the patients were under the influence of alcohol. Due to the alcohol, a patient with moderate or mild TBI can be classified as severe TBI without having a large structural lesion. In these cases, ICP may not be monitored until the confusion factor is removed. For that reason, we also analysed the percentage of patients with TBI and Glasgow ≤8 and significant cerebral structural injury according to the AIS. Even in that group, only 51% of patients had ICP monitoring. It should also be noted that we found no significant differences in the incidence of alcohol intoxication among patients with severe TBI with or without ICP monitoring.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">–</span><p id="par0100" class="elsevierStylePara elsevierViewall">Intensive care with the aim of donation. Patients with catastrophic brain injury with no possibilities of treatment are nowadays admitted to our units as potential organ donors, after a family interview and acceptance of admission conditional on progression to brain death or donation in controlled asystole. The aim is to optimise the Donation and Transplant programme in Spain by increasing the donor pool.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> In our population, this group of patients, who rarely have invasive monitoring, represented 6.6% of the overall sample.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">–</span><p id="par0105" class="elsevierStylePara elsevierViewall">Limitation of life-sustaining treatments. The average age of patients with severe TBI has progressively increased in recent years, with older people suffering from low intensity falls complicated by the use of antiplatelet agents and anticoagulants being an important part of the population. In our population, the unmonitored group was older (51.8 vs 45.3 years), included a higher percentage of falls (26% vs 21.4%) and were more likely to have measures for limitation of life-sustaining treatments indicated (21.4% vs 13.7%), with this being common in the older population.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></li></ul></p><p id="par0110" class="elsevierStylePara elsevierViewall">The percentage of monitoring found in our series, although lower than expected according to the surveys,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> is much higher than that found in similar analyses in American series. Analysing data from 10,628 adults with severe TBI and an overall mortality rate of 35% in centres providing different levels of care in terms of complexity, Alali et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> found that ICP was monitored in only 17.6% of cases. Hospitals with a higher percentage of monitoring had lower mortality rates. More recently, Piccinini et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> performed a similar analysis in 4880 patients with TBI and GCS<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>9, cranial AIS<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3 and a mortality rate of 22.9% (a population very similar to ours), and found that ICP was only monitored in 10.8% of patients. In contrast to the previous study, ICP monitoring was a predictive factor of mortality, with both of these studies highlighting the controversy stirred up by the BEST-TRIP study.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The second aspect from our study that deserves comment is the low percentage of patients in whom cerebral oxygenation monitoring techniques were used. The use of SjvO2 and NIRS is virtually non-existent and only PbtO2 is used in larger referral hospitals. However, even that is limited, being used in barely 19% of patients receiving ICP monitoring. These results are surprising, given that the role of cerebral hypoxia phenomena in the neurological outcome of neurocritical patients is well known.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The recently published BOOST-2<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> study showed that the management of severe TBI with an ICP and PbtO2 sensor reduced episodes of tissue hypoxia, with a tendency to lower mortality rates and a better functional outcome than conventional management with an ICP sensor. However, as BOOST-222 was a phase 2 study not designed to find differences in the neurological outcome of patients, these results need to be validated in a phase 3 study. Because of the small number of patients in whom cerebral oxygenation monitoring techniques were used, no logistic regression study was carried out to analyse the factors associated with their use.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Our study has certain limitations, the main one being considering as severe TBI patients with TBI and GCS<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>8 at the first point of contact with medical care, at which time different confounding factors can be at play. It would be more appropriate to consider the inclusion of patients assessed after adequate resuscitation, but the RETRAUCI design does not allow successive assessments of neurological response and, additionally, almost three out of four patients required airway management in the pre-hospital setting, so a neurological examination would likely have been affected by the sedation and muscle relaxation. This point is definitely the greatest limitation of our study. It should also be taken into account that the implantation of ICP sensors in Spain falls mainly on neurosurgery teams. Therefore, the on-site or off-site nature of the neurosurgery on-call system and the availability of specific care units for patients with severe TBI could affect the number of patients who had invasive ICP monitoring. RETRAUCI is not designed to analyse differences between centres, although it is well known that the implementation of clinical practice guidelines varies, even between large reference hospitals.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Thirdly, we acknowledge a possible selection bias, reflected in the large percentages of patients with alcohol intoxication and signs of uncal herniation, and the fact that in almost one in five, there was some type of limitation of life-sustaining treatments. In addition, as it is a trauma registry, the coding of injuries was performed according to the AIS and the probability of survival analysed with the TRISS methodology, instead of using specific TBI calculators such as the IMPACT calculator, which has recently been validated in our environment.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In conclusion, our study shows a snapshot of the monitoring of ICP in severe TBI in our setting, in which a larger number of patients are monitored than in other similar series. The use of brain oximetry techniques in Spain is very limited.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">RETRAUCI had a grant for the development of an electronic registry awarded to Dr Chico-Fernández (Fundación Mutua Madrileña, reference number AP117892013).</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1286156" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1188630" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1286155" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1188629" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack442058" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-12-05" "fechaAceptado" => "2019-05-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1188630" "palabras" => array:4 [ 0 => "Severe traumatic brain injury" 1 => "Monitorization" 2 => "Intracranial pressure" 3 => "Brain tissue oxygenation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1188629" "palabras" => array:4 [ 0 => "Traumatismo craneoencefálico grave" 1 => "Monitorización" 2 => "Presión intracraneal" 3 => "Presión tisular de oxígeno" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">To analyze the use of intracranial pressure (ICP) and cerebral oximetry monitoring in patients with severe traumatic brain injury (TBI) according to the Spanish Trauma ICU Registry (RETRAUCI).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We included TBI patients with Glasgow Coma Scale score ≤8. Hypotheses were tested using the Student-T or Wilcoxon tests (quantitative variables) and the Chi-square test (categorical variables). Multivariate analysis using logistic regression was performed to analyze the variables associated with the use of ICP monitoring.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We analyzed 1463 patients. Age 49.1 years. Males 1130 (77.3%). Mechanism of injury: falls in 350 cases (23.9%). ISS 27.9. Uni- or bilateral mydriasis was present in 39.3% of the patients. Neurosurgical intervention within 24<span class="elsevierStyleHsp" style=""></span>h was performed in 331 patients (22.7%). ICP was monitored in 635 patients (45.1%), pbtO2 in 122 patients (8.6%), SjVO<span class="elsevierStyleInf">2</span> in 19 patients (1.34%) and NIRS was used in 25 cases (1.77%). In the multivariate analysis, age, bilateral mydriasis at admission and previous use of antiplatelets or anticoagulants was inversely related with ICP monitoring. Severity of injury and the need of neurosurgical intervention increased the probability of ICP monitoring.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Our study shows a picture of ICP monitoring in severe TBI patients in our environment. Use of cerebral oximetry techniques is very limited.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Analizar el empleo de la monitorización de la presión intracraneal (PIC) y la oxigenación cerebral en los pacientes con traumatismo craneoencefálico (TCE) grave de acuerdo a los datos del Registro español de Trauma en las Unidades de Cuidados Intensivos (RETRAUCI).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron los pacientes con TCE y una puntuación en la escala de coma de Glasgow ≤ 8 puntos. El contraste de hipótesis se realizó con el test de la t-Student o de Wilcoxon (variables cuantitativas) y el test de Chi-Cuadrado (variables categóricas). Se realizó un análisis multivariante mediante regresión logística para analizar las variables asociadas al empleo de monitorización de la PIC.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 1463 pacientes. Edad 49,1 años, hombres 1130 (77,3%). Mecanismo lesional: caídas accidentales 350 casos (23,9%). ISS 27,9. Un 39,3% presentaron midriasis uni- o bilateral en la recogida. Cirugía craneal <24<span class="elsevierStyleHsp" style=""></span>horas 331 pacientes (22,7%). La PIC se monitorizó en 635 pacientes (45,1%), la ptiO2 en 122 pacientes (8,6%), la SjO2 en 19 pacientes (1,34%) y se empleó el NIRS en 25 casos (1,77%). Tras el análisis multivariante, la edad, la midriasis bilateral al ingreso y la toma previa antiagregantes o anticoagulantes se asociaron negativamente con la probabilidad de monitorización de la PIC. La gravedad lesional y la necesidad de neurocirugía urgente aumentaron la probabilidad de monitorización.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Nuestro trabajo muestra una foto fija de la monitorización de la PIC en el TCE grave en nuestro medio. El empleo de técnicas de oximetría cerebral en nuestro país es muy limitado.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Llompart-Pou JA, Barea-Mendoza JA, Sánchez-Casado M, González-Robledo J, Mayor-García DM, Montserrat-Ortiz N, et al. Neuromonitorización en el traumatismo craneoencefálico grave. Datos del Registro español de Trauma en UCI (RETRAUCI). Neurocirugía. 2020;31:1–6.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospital Universitario 12 de Octubre, Madrid: 142 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitario de Donostia, Donostia: 121 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitari Son Espases, Palma: 113 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitario Marqués de Valdecilla, Santander: 102 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Virgen de las Nieves, Granada: 90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Clínico Universitario Salamanca, Salamanca: 84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Virgen de la Salud, Toledo: 83 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitario La Paz, Madrid: 78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital SS Torrecárdenas, Almería: 76 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Arnau de Vilanova, Lleida: 72 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Ntra. Sra. de La Candelaria, Santa Cruz de Tenerife: 60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitario Río Hortega, Valladolid: 46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitario Puerta del Mar, Cádiz: 43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitario Central de Asturias, Asturias: 43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitari Germans Trias i Pujol, Barcelona: 37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complexo Hospitalario Universitario A Coruña, A Coruña: 30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitari Joan XXIII, Tarragona: 27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitario Miguel Servet, Zaragoza: 24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital Universitario Lucus Augusti, Lugo: 22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ciudad Sanitaria Reina Sofía, Córdoba: 21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rest of participating hospitals <20 patients per site \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2203213.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Number of patients per participating site (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1463).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">AIS: Abbreviated Injury Scale; GCS: Glasgow Coma Scale; ISS: Injury Severity Score; NIRS: near-infrared spectroscopy; PbtO2: brain tissue oxygen pressure; SD: standard deviation; SjvO2: jugular venous oxygen saturation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GCS<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>8, N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1463 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GCS<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>8 and head AIS<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>3, N<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1114 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ICP</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">635 (45.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">571 (51.26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intraparenchymal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">604 (42.93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">542 (48.74) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intraventricular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21 (1.49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (1.62) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Both \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (0.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (0.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">PtiO2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">122 (8.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99 (8.81) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">SjO2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (1.34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (1.60) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">NIRS</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (1.77) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (2.15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.52<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">GCS</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6-8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">584 (39.92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">464 (40.24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4-5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">283 (19.34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">234 (20.29) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">596 (40.74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">455 (39.46) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">ISS</span> (mean<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.52 (13.59) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Shock with need for vasopressor support (mean</span> ± <span class="elsevierStyleItalic">SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">556 (38.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">421 (37.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2203212.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Use of neuromonitoring in patients with a GCS score ≤8 and in those who also had a head AIS score ≥3 points.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Visualizing the pressure and time burden of intracranial hypertension in adult and paediatric traumatic brain injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. 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