Identification of Demographic and Clinical Prognostic Factors in Traumatic Intraventricular Hemorrhage

BACKGROUND

The presence of traumatic intraventricular hemorrhage (tIVH) following traumatic brain injury (TBI) is associated with worse neurological outcome. The mechanisms by which patients with tIVH have worse outcome are not fully understood and research is ongoing, but foundational studies that explore prognostic factors within tIVH populations are also lacking. This study aimed to further identify and characterize demographic and clinical variables within a subset of patients with TBI and tIVH that may be implicated in tIVH outcome.

METHODS

In this observational study, we reviewed a large prospective TBI database to determine variables present on admission that predicted neurological outcome 6 months after injury. A review of 7,129 patients revealed 211 patients with tIVH on admission and 6-month outcome data. Hypothesized risk factors were tested in univariate analyses with significant variables (p < 0.05) included in logistic and linear regression models. Following the addition of either the Rotterdam computed tomography or Glasgow Coma Scale (GCS) score, we employed a backward selection process to determine significant variables in each multivariate model.

RESULTS

Our study found that that hypotension (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.13-0.94, p = 0.04) and the hemoglobin level (OR = 1.33, 95% CI = 1.09-1.63, p = 0.006) were significant predictors in the Rotterdam model, whereas only the hemoglobin level (OR = 1.29, 95% CI = 1.06-1.56, p = 0.01) was a significant predictor in the GCS model.

CONCLUSIONS

This study represents one of the largest investigations into prognostic factors for patients with tIVH and demonstrates that admission hemoglobin level and hypotension are associated with outcomes in this patient population. These findings add value to established prognostic scales, could inform future predictive modeling studies, and may provide potential direction in early medical management of patients with tIVH.

Reviewing the Diverse Effects of Protein Phosphorylation in Neural Signaling Transduction

Signaling transduction pathways are now known to be foundational mechanisms for a wide variety of biological function. Nobel laureate Paul Greengard dedicated his early career to the exploration of how these molecular cascades are triggered by neurotransmitters, hence applying a general phenomenon to the nervous system. A review by Hemmings, Nairn, McGuinness, Huganir, and Greengard published in the FASEB journal in 1989 identifies three different effects of protein phosphorylation, namely vesicle release, modulation of receptor sensitivity, and initiation of positive or negative feedback systems. The work's focus on three specific examples, rather than the exhaustive approach taken by many other reviews, provides students with an accessible framework within which to learn fundamental concepts in molecular neuroscience. The review could be incorporated as assigned reading for introductory neuroscience or even upper level molecular neurobiology, as it holds very versatile teaching potential.