Severe brain trauma management analysis using a high-rate recording tool: better definition allows better analysis of practice

Introduction

Review of practice is a way to enhance quality of care. We developed a high-rate recording tool able to store the data of critical care patients [1]. We recorded 15 severely brain-injured patients and analyzed our team's practice according to commonly admitted recommendations.

Methods

Fifteen patients were recorded at a rate of one value each 2 seconds during a total of 750 hours. We analyzed the data to identify 5-minute or longer episodes of cerebral hypoperfusion (CHP) and intracranial hypertension (ICHT). The episodes were electronically detected among the signal files and manually validated using software allowing signal graph visualization and scrolling.

Results

Two hundred and forty-one episodes were detected: 135 episodes of ICHT and 106 episodes of CHP. ICHT and CHP episodes were grouped in 84 cases (34%). CHP episodes were shorter than ICHT episodes (P < 0.02). Medical reactions were observed in 128 cases (53%) and more often concerned episodes lasting more than 30 minutes (n = 88, 59%) than shorter episodes (n = 61, 41%). Electronic analysis of CHP showed that overall reactions are made to increase the mean arterial pressure (47%) rather than to lower intracranial pressure (35%). Adequacy of medical decisions for mean arterial pressure and intracranial pressure management was, respectively, 45% and 55% considering recommendations made for severe head trauma management.

Conclusion

Actual monitoring of severely injured patients misses short episodes. Computers could help to better detect such episodes by adequate algorithms. This method will lower the human performance usually observed in complex management protocols and could help to improve decision-making if implemented at the bedside.