Application And Prognosis Prediction Using Non-invasive Brain-Edema Monitor In Patients After Traumatic Brain Injury

BackgroundTraumatic brain injury(TBI)is a common disease in department of neurosurgery.It is easy to create disability and death.It needs to use dehydrator or surgical intervention to prevent and control the occurrence and development of secondary injury,which is the key to improve the prognosis of patients.Correctly and timely diagnosis of brain trauma severity and prediction of prognosis in patients with TBI have an important guiding role in saving the life and disease observation,and for Improving prognosis of patients.As a new technique applied to craniocerebral,non-invasive brain-edema monitor is stable and reliable,which may be of great significance in guiding clinical treatment and prognosis.Therefore,its ability to measure early brain edema and predict prognosis after brain injury needs to be effectively evaluated.Objective1 To investigate the effect and clinical value of non-invasive brain-edema monitor on the severity of traumatic brain injury in patients after TBI.2 To investigate the relationship between cerebral electromagnetic impedance and the prognosis of the patients with brain edema after TBI.MethodsFrom June 2016 to April 2017,a total of 62 patients with traumatic brain injury in NICU(Department of neurosurgery intensive care unit)of a three grade hospital in Guangzhou,Guangdong province were selected.Cerebral electromagnetic impedance(CEI)data were measured constantly using non-invasive brain-edema monitor(Chongqing Born-Fuke Medical Equipment Co.Ltd,Chongqing,China).At the same time,intracranial pressure monitoring was performed.6 hours after admission to the hospital,the head CT examination is required to make a clear diagnosis.The eligible patients will be included in the study.The clinical symptoms,consciousness,pupil,vital signs and records of CEI monitoring were observed.6 months after injury,the prognosis of the patients after TBI was evaluated by the Glasgow outcome score.ResultsThis study was finally included in the monitoring sample of 62 cases,all of which were brain trauma patients.Respectively,the mean CEI in patients with mild,moderate and severe brain injury were 103.00 ± 19.79,89.96 ± 18.39 and 76.70 ±25.42.The correlation coefficient between the score of GCS on admission and the stable minimum Cerebral electromagnetic impedance was 0.661(P<0.001,95%CI:0.486-0.784).The correlation coefficient between the stable minimum Cerebral electromagnetic impedance and the ICP measurements at the same time point was-0.790(P<0.001,95%CI:0.8704-0.669).The diagnostic accuracy rate of the brain edema of the monitoring system was 72.22%.CEI in patients with good outcome was 90.13 ± 18.22,and in patients with poor outcome was 56.75 + 22.16,between this two groups the difference was significantly(t=6.220,P<0.001).Patients,in-hospital mortality and diagnosis of brain death were recorded.Outcome was assessed at 6 months using Glasgow Outcome Scale(GOS).There were 43 patients with good prognosis(GOS:4-5 score)and 19 cases with poor prognosis(GOS:1-3),the total good prognosis was 69.35%and the total poor prognosis was 30.65%.There were 3 cases of death,with a mortality rate of 4.83%.The correlation coefficient of the Cerebral electromagnetic impedance and the prognosis of the patients with brain trauma was 0.694(P<0.001,95%CI:0.532-0.807),and the difference was statistically significant.Area under the ROC curve of the CEI prediction of poor prognosis was 0.886(95%CI:0.778-0.993)and it predicted poor prognosis of optimal cut-off value was 72.5,its the sensitivity was 89%,specificity of 91%.Conclusions1 Cerebral electromagnetic impedance can reflect the consciousness,intracranial pressure and brain edema of patients with traumatic brain injury,which is conducive to the observation and evaluation of the condition of patients with brain injury.Cerebral electromagnetic impedance can reflect the severity of craniocerebral injury in patients with traumatic brain injury and predict prognosis.2 Non-invasive brain-edema monitor can achieve noninvasive dynamic quantitative monitoring of bedside,and it can meet the clinical needs of timely diagnosis of patient's condition and prognosis.It has great clinical application value.