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Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Overview of attention for article published in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, December 2016
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Title
Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study
Published in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, December 2016
DOI 10.1186/s13049-016-0341-1
Pubmed ID
Authors

Tetsuya Yumoto, Toshiharu Mitsuhashi, Yasuaki Yamakawa, Atsuyoshi Iida, Nobuyuki Nosaka, Kohei Tsukahara, Hiromichi Naito, Atsunori Nakao

Abstract

Cushing's reflex usually results from intracranial hypertension. Although Cushing's sign can implicate severe traumatic brain injury (TBI) in injured patients, no major investigations have been made. The purpose of this study was to assess the predictability of life-threatening brain injury requiring immediate neurosurgical intervention (LT-BI) among trauma patients with Cushing's sign in the prehospital setting. This was a retrospective study using data from the Japan Trauma Data Bank from the period of 2010 to 2014. Patients 16 years old or older with blunt mechanisms of injury who were transported directly from the scene and Glasgow Coma Scale for eye opening of one in the prehospital setting were included. LT-BI was defined as patients requiring burr hole evacuation or craniotomy within 24 h of hospital arrival and patients who were non-survivors due to isolated severe TBI. Prehospital systolic blood pressure (pSBP) and heart rate (pHR) were assessed using area under the receiver operating characteristic curve (AUROC) and multiple logistic regression analysis to predict LT-BI. Of 6332 eligible patients, 1859 (29%) exhibited LT-BI. AUROC of LT-BI using pSBP and pHR was 0.666 (95% confidence interval (CI); 0.652-0.681, P < 0.001), and 0.578 (95% CI; 0.563-0.594, P < 0.001), respectively. AUROC of pSBP was the highest among the 60 ≤ pHR ≤ 99 subgroup, of which AUROC was 0.680 (95% CI; 0.662-0.699, P < 0.001). Multiple logistic regression analysis showed that the higher the pSBP and the lower the pHR, the more likely that the patients had LT-BI. In a group with pSBP ≥ 180 mmHg and pHR ≤ 59 beats/min, the odds ratio and 95% CI of LT-BI after adjusting for age, sex, and severity of injuries to other body regions was 4.77 (2.85-7.97), P < 0.001 was compared with the reference group, which was defined as patients with normal vital signs. Our study has found that the combination of hypertension and bradycardia, which are the components of Cushing's sign without eye opening in the prehospital setting was a weak but a significant predictor of LT-BI, or death due to possible isolated severe TBI. Prehospital Cushing's sign with disturbed level of consciousness in trauma patients was a weak but significant predictor of the need for immediate neurosurgical intervention.

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Mendeley readers

The data shown below were compiled from readership statistics for 28 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 4%
Unknown 27 96%

Demographic breakdown

Readers by professional status Count As %
Student > Master 6 21%
Researcher 5 18%
Other 4 14%
Student > Bachelor 3 11%
Student > Ph. D. Student 2 7%
Other 3 11%
Unknown 5 18%
Readers by discipline Count As %
Medicine and Dentistry 17 61%
Nursing and Health Professions 3 11%
Unspecified 1 4%
Social Sciences 1 4%
Veterinary Science and Veterinary Medicine 1 4%
Other 0 0%
Unknown 5 18%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 December 2016.
All research outputs
#11,033,036
of 13,901,766 outputs
Outputs from Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
#785
of 870 outputs
Outputs of similar age
#232,261
of 333,675 outputs
Outputs of similar age from Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
#130
of 139 outputs
Altmetric has tracked 13,901,766 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
So far Altmetric has tracked 870 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.2. This one is in the 4th percentile – i.e., 4% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 333,675 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 18th percentile – i.e., 18% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 139 others from the same source and published within six weeks on either side of this one. This one is in the 2nd percentile – i.e., 2% of its contemporaries scored the same or lower than it.