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Electrocardiographic changes are frequently seen in patients post traumatic brain injury. The prognosis in patients with traumatic brain injury is poor when there is associated abnormal electrocardiographic changes. Though there are many indicators to assess prognosis in traumatic brain injury, ECG is a easily available point of care test which can help understand the outcome in traumatic brain injury patients at an early stage. This study aims to determine the relation of electrocardiographic changes and severity of the head injury and to assess the usefulness of ECG as a prognostic indicator in the outcome of patients with traumatic brain injury.
It is a single centre prospective observational study, conducted between the year 2020 to 2022. Inclusion criteria- all patients with traumatic brain injury diagnosed on computed tomography or magnetic resonance imaging of brain, aged above 18 years and 12 lead ECG taken within 12 hours of arrival to hospital. Patients with history of heart disease, stroke, hypertension, previous documented abnormal ECG were excluded from the study. Initial Glagow coma scale was used to assess the severity of head injury, which was then correlated with the ECG changes. Patients were followed up after 30 days and outcome was assessed by Glasgow Outcome scale. Further, initial ECG changes were correlated with one month outcome.
In our prospective observational study, results showed electrocardiographic changes to be more frequent in patients with severe head injury. The most common ECG abnormality noted were heart rate variability, T wave changes and repolarization abnormalities. These electrocardiographic changes appeared to have significant positive correlation with outcome in patients with traumatic brain injury.
Electrocardiography can be used as a preliminary and simple method to assess the severity of head injury as well as predict the prognosis of patients with traumatic brain injury.
Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV. Estimating the global incidence of traumatic brain injury. Journal of neurosurgery. 2018 Apr 27;130(4):1080-97.https://doi.org/10.3171/2017.10.JNS17352
Fan X, DU FH, Tian JP. The electrocardiographic changes in acute brain injury patients. Chinese Medical Journal. 2012 Oct 5;125(19):3430-3.https://doi.org/10.3760/cma.j.issn.0366-6999.2012.19.013
Bramwell C. Can a head injury cause auricular fibrillation?. The Journal of Nervous and Mental Disease. 1934 Dec 1;80(6):716.https://doi.org/10.1016/S0140-6736(01)02445-X
Chen Z, Venkat P, Seyfried D, Chopp M, Yan T, Chen J. Brain–heart interaction: cardiac complications after stroke. Circulation research. 2017 Aug 4;121(4):451-68.https://doi.org/10.1161/CIRCRESAHA.117.311170
Krishnamoorthy V, Mackensen GB, Gibbons EF, Vavilala MS. Cardiac dysfunction after neurologic injury: what do we know and where are we going?. Chest. 2016 May 1;149(5):1325-31.https://doi.org/10.1016/j.chest.2015.12.014
Krishnamoorthy V, Prathep S, Sharma D, Gibbons E, Vavilala MS. Association between electrocardiographic findings and cardiac dysfunction in adult isolated traumatic brain injury. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2014 Sep;18(9):570. 10.4103/0972-5229.140144
HERSCH C. Electrocardiographic changes in head injuries. Circulation. 1961 Jun;23(6):853-60.https://doi.org/10.1016/S1875-4597(09)60044-8
Singla SL, Garg P, Mehta RK. Electrocardiographic changes in craniocerebral trauma-- could they serve as prognostic indicators?. Journal of the Indian Medical Association. 2002 Mar 1;100(3):188-90.
Coghlan LA, Hindman BJ, Bayman EO, Banki NM, Gelb AW, Todd MM, Zaroff JG, IHAST Investigators. Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial. Stroke. 2009 Feb 1;40(2):412-8.
Lacy PS, Earle AM. Central neural control of blood pressure and cardiac arrhythmias
during subarachnoid hemorrhage in rats. Stroke. 1985 Nov;16(6):998-102.
Wybraniec MT, Mizia-Stec K, Krzych Ł. Neurocardiogenic injury in subarachnoid hemorrhage: A wide spectrum of catecholamin-mediated brain-heart interactions. Cardiology Journal. 2014;21(3):220-8. 10.5603/CJ.a2014.0019
Frontera JA, Parra A, Shimbo D, Fernandez A, Schmidt JM, Peter P, Claassen J, Wartenberg KE, Rincon F, Badjatia N, Naidech A. Cardiac arrhythmias after subarachnoid hemorrhage: risk factors and impact on outcome. Cerebrovascular diseases. 2008;26(1):71-8. https://doi.org/10.1159/000135711
Padilla-Zambrano HS, Garcia-Ballestas E, Rojas AN, Moscote-Salazar LR, Ghosh A, Pal R, Agrawal A. “Broken heart syndrome” Cardiovascular manifestations of traumatic brain injury. Heart and Mind. 2018 Jan 1;2(1):12.10.4103/hm.hm_12_18
Astarabadi M, Khurrum M, Asmar S, Bible L, Chehab M, Castanon L, Ditillo M, Douglas M, Joseph B. The impact of non-neurological organ dysfunction on outcomes in severe isolated traumatic brain injury. Journal of Trauma and Acute Care Surgery. 2020 Aug 1;89(2):405-10. 10.1097/TA.0000000000002771
Collier BR, Miller SL, Kramer GS, Balon JA, Gonzalez III LS. Traumatic subarachnoid hemorrhage and QTc prolongation. Journal of Neurosurgical Anesthesiology. 2004 Jul 1;16(3):196-200.10.1097/00008506-200407000-00003
Samudrala VD, Kumar A, Agrawal A. Electrocardiographic changes in patients with isolated traumatic brain injury and their correlation with outcome. Indian Journal of Neurotrauma. 2016 Aug;13(02):070-4. 10.1055/s-0036-1586237
Rudehill A, Olsson GL, Sundqvist K, Gordon E. ECG abnormalities in patients with subarachnoid haemorrhage and intracranial tumours. Journal of Neurology, Neurosurgery & Psychiatry. 1987 Oct 1;50(10):1375-81. http://dx.doi.org/10.1136/jnnp.50.10.1375