Validation of a monitoring matrix for patients with brain injuries. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Cardinale, Mickaël; Esnault, Pierre; d'Aranda, Erwan; Meaudre, Eric; Lacroix, Guillaume
• Is Part Of: Injury. Volume 50:Issue 1(2019)
• Page Start: 79
• Page End: 81
• Publication Date: 2019-01
• Subjects: Acute brain injury -- Factors linked to secondary brain injury -- Neuromonitoring matrix -- Systemic brain insult; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2018.09.016
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Monitoring matrix significantly increases the detection rate of factors linked to Secondary Brain Injury which could therefore allow an earlier treatment. The use of this visual monitoring matrix is simple and inexpensive. It also provides homogenization of the detection rate among the physicians and nurses regardless of their experience. The monitoring matrix concept has revealed a way to involve all the medical and paramedical staff in neuro critical care. Abstract: Background: Brain injury is a leading cause of death and disabilities worldwide. The severity of brain damage is of course related to the primary injury. Secondary brain insults are the most powerful determinants of outcome from severe head injury. To improve the outcome, it needs to be well detected to be controlled. The detection of these factors can be difficult among numerous data. The objective of this work was to validate a monitoring matrix to help this screening. We hypothesise that a monitoring matrix will improve the detection rate of factors linked to secondary brain injury (SBI). Method: We conducted a single-center prospective observational simulation study. We designed a monitoring matrix compiling all the brain insults, intracranial data (ICP, CCP, PtiO2) and systemic data (PaCO2, PaO2, temperature, natremia, hemoglobin). Each caregiver had to analyze the same simulated data with a standard monitoring sheet and with the monitoring matrix. We then compared the detection rate of SBI factors. Results: 25 caregivers analyzed a total of 265 matrixes. The monitoring matrix had a sensitivity of 96.5% and a specificity of 99.9% versus 69.9% and 67.8% respectively for the standard monitoring sheet. The detection rate was significantly higher with the monitoring matrix (96.5%) versus the standard monitoring sheet (69.9%), regardless of the caregiver's status. It is also improved among nurses, regardless of their seniority. Conclusion: The use of this monitoring matrix is simple and inexpensive. The monitoring matrix improves significantly the detection rate of factors linked to secondary brain injury. It also provides homogenization of the detection rate among the physicians and nurses regardless of their experience. Nurses becoming as qualified as physicians, allows earlier detection and therefore a faster treatment.