Research Reports - Visual fixation in the ICU: A strong predictor of long-term recovery after traumatic brain injury

Crit Care Med. 2016 Dec;44(12):e1186-e1193.

Arbour C(1), Baril AA, Westwick HJ, Potvin MJ, Gilbert D, Giguère JF, Lavigne GJ,
Desautels A, Bernard F, Laureys S, Gosselin N.

OBJECTIVE: Posttraumatic amnesia is superior to the initial Glasgow Coma Scale
score for predicting traumatic brain injury recovery, but it takes days/weeks to
assess. Here, we examined whether return of visual fixation-a potential marker of
higher cognitive function-within 24 hours of ICU admission could be used as an
early predictor of traumatic brain injury recovery.
DESIGN: Two-phase cohort study.
SETTING: Level-I trauma ICU.
PATIENTS: Moderate-to-severe traumatic brain injury discharged alive between 2010
and 2013.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Return of visual fixation was assessed through
standard behavioral assessments in 181 traumatic brain injury patients who had
lost the ability to fixate at ICU admission (phase 1) and compared with
posttraumatic amnesia duration and the initial Glasgow Coma Scale score to
predict performance on the Glasgow Outcome Scale-Extended 10-40 months after
injury (n = 144; phase 2a). A subgroup also completed a visual attention task (n
= 35; phase 2b) and a brain MRI after traumatic brain injury (n = 23; phase 2c).
With an area under the curve equal to 0.85, presence/absence of visual fixation
at 24 hours of ICU admission was found as performant as posttraumatic amnesia
(area under the curve, 0.81; difference between area under the curve, 0.04; p =
0.28) for predicting patients' Glasgow Outcome Scale-Extended score. Conversely,
the initial Glasgow Coma Scale score was not (area under the curve, 0.63). Even
when controlling for age/medication/CT scan findings, fixation remained a
significant predictor of Glasgow Outcome Scale-Extended scores (β, -0.29; p <
0.05). Poorer attention performances and greater regional brain volume deficits
were also observed in patients who could not fixate at 24 hours of ICU admission
versus those who could.
CONCLUSIONS: Visual fixation within 24 hours of ICU admission could be as
performant as posttraumatic amnesia for predicting traumatic brain injury
recovery, introducing a new variable of interest in traumatic brain injury
outcome research.
 

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