comparative analysis of cervical spine management in a subset of severe traumatic brain injury cases using computer simulation颈椎管理比较分析的一个子集,使用计算机模拟严重创伤性脑损伤病例.pdf

Comparative Analysis of Cervical Spine Management in a Subset of Severe Traumatic Brain Injury Cases Using Computer Simulation 1,3 2 1 1 Kimbroe J. Carter *, C. Michael Dunham , Frank Castro , Barbara Erickson 1 Medical Decision Making Society of Youngstown Ohio, St. Elizabeth Health Center, Youngstown, Ohio, United States of America, 2 Trauma/Critical Services, St. Elizabeth Health Center, Youngstown, Ohio, United States of America, 3 Department of Pathology, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, Ohio, United States of America Abstract Background: No randomized control trial to date has studied the use of cervical spine management strategies in cases of severe traumatic brain injury (TBI) at risk for cervical spine instability solely due to damaged ligaments. A computer algorithm is used to decide between four cervical spine management strategies. A model assumption is that the emergency room evaluation shows no spinal deficit and a computerized tomogram of the cervical spine excludes the possibility of fracture of cervical vertebrae. The study’s goal is to determine cervical spine management strategies that maximize brain injury functional survival while minimizing quadriplegia. Methods/Findings: The severity of TBI is categorized as unstable, high risk and stable based on intracranial hypertension, hypoxemia, hypotension, early ventilator associated pneumonia, admission Glasgow Coma Scale (GCS) and age. Complications resulting from cervical spine management are simulated using three decision trees. Each case starts with an amount of primary and secondary brain injury and ends as a functional survivor, severely brain injured, quadriplegic or dead. Cerv