Table 2.
Large studies reporting timing and features of neurological deterioration
| Study | Rate of neurological worsening | Time period for neuroworsening | Neuroworsening criteria | Radiological deterioration |
| Iaccarino et al.[13] | 32%∗ (111/352)(Clinical improvement in 6%, stable neurological function in 62%)∗29% of cohort had severe TBI, other patients had mild and moderate TBI | Clinical assessment: onset of neurological deterioration during the first 12 hours after traumaRadiological Assessment:- Injury to initial CT average 120 mins (IQR 63–98 mins)- 2nd CT average 9 hours after initial scan (IQR 154–312 mins)- 3rd CT average 38 hours after initial scan (IQR 12–14 hours) | - GCS decreased by >1 point- New pupillary abnormalities | On follow-up CT scans compared to admission CTPatients:58%- Evolution of hematoma (42% with >30% evolution) 46%- Increased edema volume30%- Onset/increase in basal cistern effacement 28%- Onset /increase of midline shift |
| Maas et al.[10] | 44% (375/846) | Within first 10 days | References Morris et al.[11] study for neuroworsening criteria | |
| Morris et al.[11] | 29% (117/409) | Median 29 h (range 3.3–447 h)a | Neuroworsening criteria (occurrence ≥ 1 of following):- Spontaneous decrease in GCS motor score ≥2 points (compared with previous exam)- New loss of pupillary reactivity- Interval development of pupillary asymmetry of ≥2 mm- Deterioration in neurologicalstatus sufficient to warrant immediate medical/surgical interventionEvents:a43%- Change in pupillary reactivity25%- Decrease ≥ 2 GCS motor score19%- Pupillary asymmetry >1 mm9%- Changes in ICP4% - Other (decrease GCS ≥ 2, new CT abnormalities, substantial change in systolic BP, systemic deterioration) |
a
Data from Juul et al. posthoc analysis of the International Selfotel Trial [9].
BP, blood pressure; CT computerized tomography; GCS, Glasgow Coma Scale; ICP, intracranial pressure; IQR, interquartile ratio; TBI, traumatic brain injury