Traumatic brain injury (TBI) - moderate and severe, major trauma without traumatic brain injury Injury, Occupational Diseases, Poisoning
Conditions
Interventions
The 24-hour tissue cortisol profile will be mapped using subcutaneous microdialysis. This involves a small probe being inserted into the subcutaneous tissue overlying the abdomen, and attachment to a
Sponsors
University of Bristol
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Inclusion criteria for the TBI groups: 1. Adults aged at least 18 years of age 2. Intensive Care Unit admission 3. Traumatic brain injury: 3.1. 10 patients with moderate TBI (Glasgow Coma Score 9-12 after resuscitation or prior to intubation) 3.2. 10 patients with severe TBI (Glasgow Coma Score =8 after resuscitation or prior to intubation) Inclusion criteria for the non-TBI group: 1. Adults aged at least 18 years of age 2. Bodily injuries sustained as a result of trauma but without significant head injury 3. Intensive Care Unit admission
Exclusion criteria
Exclusion criteria: Exclusion criteria for the TBI groups: 1. Life or limb-threatening extra-cranial injury (in the opinion of the treating intensivist) 2. Patients with known pre-existing HPA axis disease 3. Untreated thyroid disease 4. Current or prior steroid therapy within the last 3 months 5. Patients less than 18 years of age 6. Patients who are pregnant 7. Prisoners 8. Widespread burns/skin breakdown creating inability to place microdialysis catheter 9. Admission with perceived devastating brain injury for purposes of prognostication or organ donation 10. Refusal of consent or assent 11. More than 48 hours after injury 12. Severe metabolic acidosis (pH <7.20) Exclusion criteria for the non-TBI group: 1. Significant head injury (GCS <13 or abnormal admission brain imaging) 2. Patients with known pre-existing HPA axis disease 3. Untreated thyroid disease 4. Current or prior steroid therapy within the last 3 months 5. Patients less than 18 years of age 6. Patients who are pregnant 7. Prisoners 8. Widespread burns/skin breakdown creating inability to place microdialysis catheter 9. Admission with devastating brain injury for purposes of prognostication or organ donation 10. Refusal of consent or assent 11. More than 48 hours after injury 12. Severe metabolic acidosis (pH <7.20)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Tissue cortisol level measured by subcutaneous microdialysis every 20 minutes for 24 hours, generating a 24-hour hormone profile | — |
Secondary
| Measure | Time frame |
|---|---|
| Measured using ICU observation charts, medical notes and ICNARC audit data (collected for every patient routinely during an ICU stay): 1. Acute hospital mortality: inpatient mortality during acute hospital stay 2. Cardiac arrest during inpatient stay 3. Duration of renal replacement therapy in hours (during ICU stay) 4. Duration of mechanical ventilation in hours (during ICU stay) 5. Total number of spikes in intracranial pressure (ICP) during ICU stay and max level recorded 6. Amount of time in hours spent with ICP greater than 20 mmHg 7. Maximum therapy intensity level whilst on ICU (relates to degree of therapy for raised ICP) 8. Number of days of ICP targeted therapy whilst on ICU 9. Total dose and duration (in hours) or inotrope and vasopressor therapy whilst on ICU 10. Length of ICU stay in days 11. Length of hospital stay in days 12. Level of care at ICU discharge using ICNARC (Intensive Care National Audit and Research Centre) scale 13. Expected dependency post-acute hospital discharge using ICNARC scale 14. Residence post-discharge from acute hospital using ICNARC data | — |
Countries
United Kingdom
Contacts
Public ContactBen Gibbison
Outcome results
None listed