gms | German Medical Science

Objective: Intra-hospital transport (IHT) of neurosurgical intensive care unit (NICU) patients can be hazardous. The potential of serum biomarkers for risk assessment of IHT-associated complications in brain-injured patients treated on NICU remains unknown. The present study was conducted to investigate the value of several serum biomarkers on IHT-associated complications in brain-injured NICU patients.

Methods: Prospective analysis of 523 IHTs in 223 NICU patients from 05/2019 to 05/2020. Demographic data, cranial computed tomography (CCT) scan on admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) before IHT, modified Rankin Scale (mRS) at discharge as well as indications and consequences of all IHTs were analyzed. Alteration of ICP/CPP, hemodynamic and pulmonary events were defined as complications. Furthermore, hemoglobin, hematocrit, serum sodium, and albumin levels were evaluated as serum biomarkers. The study population was dichotomized into: IHTs with complications and IHTs without complications.

Results: The entire study population consisted of 98 women (43.9%) and 125 men (56.1%) with a mean age of 62.9 ± 14.9 years. At least one IHT-associated complication was identified in 58.7% of all IHTs and 60.1% of all IHTs had no direct therapeutic consequence. No significant difference was found between the two groups with regard to median GCS score on admission (p=0.21), APACHE II score before (p=0.56) and mRS score (p=0.09) at discharge. Furthermore, IHT for emergency CCT was not associated with a higher complication rate compared to IHT for routine control CCT (p=0.8) and postoperative CCT (p=0.66). In patients with lower hemoglobin levels before IHT, significantly higher rates of elevated intracranial pressure (ICP) (p<0.0001), decreased cerebral perfusion pressure (CPP; p=0.03) and more hemodynamic (p<0.0001) and pulmonary events (p=0.01) were observed. In addition, lower hematocrit levels prior to IHT were associated with a higher complication rate concerning hemodynamic (p<0.0001), pulmonary (p=0.006), ICP (p<0.0001), and CPP (p=0.01) events.

Conclusion: IHTs should be carried out on a restricted basis due to their risk for pulmonary and hemodynamic complications. Hemoglobin and hematocrit levels should be checked before IHT, as lower levels of these biomarkers are associated with a higher risk for ICP, CPP, hemodynamic and pulmonary events during transport.