Description

A patient with traumatic brain injury may have other injuries that impact prognosis. The Edinburgh University Secondary Insult Grades (EUSIG) describe the severity of these insults.


Parameters:

(1) mean intracranial pressure (ICP)

(2) systolic blood pressure (hypertension or hypotension)

(3) mean blood pressure

(4) mean cerebral perfusion pressure (CPP)

(5) hypoxemia, PaO2

(6) hypoxemia, oxygen saturation

(7) fever (pyrexia)

(8) heart rate (bradycardia or tachycardia)

(9) hypercarbia

(10) oxygen extraction fraction as percent oxygen saturation in jugular vein

(11) oxygen extraction fraction

 

Parameter

Finding

Grade

mean intracranial pressure

< 20 mm Hg

0

 

20 - 29 mm Hg

1

 

30 - 39 mm Hg

2

 

>= 40 mm Hg

3

systolic blood pressure

<= 50 mm Hg

3

 

51 - 70 mm Hg

2

 

71 - 90 mm Hg

1

 

91 - 159 mm Hg

0

 

160 - 189 mm Hg

1

 

190 - 219 mm Hg

2

 

>= 220 mm Hg

3

mean blood pressure

<= 40 mm Hg

3

 

41 - 55 mm Hg

2

 

56 - 70 mm Hg

1

 

71 - 109 mm Hg

0

 

110 - 129 mm Hg

1

 

130 - 149 mm Hg

2

 

>= 150 mm Hg

3

mean cerebral perfusion pressure

> 60 mm Hg

0

 

51 - 60 mm Hg

1

 

41 - 50 mm Hg

2

 

<= 40 mm Hg

3

hypoxemia

> 8 kPa

0

 

7.1 - 8.0 kPa

1

 

6.1 - 7.0 kPa

2

 

<= 6.0 kPa

3

oxygen saturation

> 90%

0

 

86 - 90%

1

 

81 - 85%

2

 

<= 80%

3

fever

< 38°C

0

 

38 - 38.9°C

1

 

39 - 39.9°C

2

 

>= 40°C

3

heart rate

<= 30 beats per minute

3

 

31 - 40 beats per minute

2

 

41 - 50 beats per minute

1

 

51 to 119 beats per minute

0

 

120 - 134 beats per minute

1

 

135 - 149 beats per minute

2

 

>= 150 beats per minute

3

PaCO2

<= 2 kPa

3

 

2.1 - 2.5 kPa

2

 

2.6 - 3.0 kPa

1

 

3.1 - 5.9 kPa

0

 

6.0 - 7.9 kPa

1

 

8.0 - 9.9 kPa

2

 

>= 10.0 kPa

3

percent oxygen saturation jugular vein

<=45%

3

 

46 - 49%

2

 

50 - 54%

1

 

55 - 74%

0

 

75 - 84%

1

 

85 - 94%

2

 

>= 95%

3

oxygen extraction fraction

<= 4

1

 

4.1 - 8.9

0

 

>= 9.0

1

 

where:

• Pyrexia had to last at least 60 minutes before it was counted.

• Other parameters needed to be present for at least 5 minutes before being counted.

• Andrews et al (2002) listed the oxygen extraction fraction parameters. The units for the oxygen extraction fraction is presumed to be kPa.

• Mean arterial pressure = ((systolic) + (2* (diastolic))) / 3


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