Abstract Details

Quantify consistent elements within standardized interpretation and reporting of multimodality neuromonitoring (MMM) data.

MMM is the integration and interpretation of information about the brain to detect and prevent secondary injury. Increasingly, measurements from intensive care unit (ICU) devices are combined as high-resolution time series not unlike EEG. Therefore, the interpretation of this data is time-intensive and a novel standardized method for daily reporting of clinically-relevant findings was developed.

A retrospective case control study was performed. We began standardized MMM 4/2015 and standardized reporting was rolled out on 8/2017. Cases were consecutive patients with severe traumatic brain injury (sTBI) who underwent formal interpretation/reporting compared with historical controls. Each reporting element within the reporting template was quantified to determine its consistency. Clinical outcome was Glasgow Outcome Score (GOS) based on chart review on follow up 3-6 months after admission.

There were 40 patients with reporting and 46 historical controls without reporting (age 42+/-17, 67 [84%] male). There were no differences between groups in injury severity. We tabulated 135 individual reports. Sections consistently (>99%) reported included intracranial pressure, autoregulation, brain tissue oxygen, and electrocorticography. Data was reported in less than one-third for those measures not available for review or typically already reported; shifts in trends overtime were often not expressly documented. Similar outcome was seen between groups (median [IQR] GOS 3 [1-4] with reporting vs 2 [1-3] without; N.S.), although shift analysis stratified by age, sex, and injury severity parameters showed significant improvement in outcome category (Mann-Whitney estimate 0.38; p=0.02).