Evidence map›Paper›PMID 34341913›Full record

ArticleNeurocritical care2022

Association of Vasopressor Choice with Clinical and Functional Outcomes Following Moderate to Severe Traumatic Brain Injury: A TRACK-TBI Study.

Camilo Toro, Nancy Temkin, Jason Barber, Geoffrey Manley, Sonia Jain, Tetsu Ohnuma, Jordan Komisarow, Brandon Foreman, Frederick K Korley, Monica S Vavilala and 9 more

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurocritical care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.0field-weighted citation impact, top 21% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 12 citations in OpenAlex.

  1. Article
  2. Review
  3. Blood Pressure Management in Neurologic Emergencies.Emergency medicine clinics of North America · 2026
    Review
  4. Article
  5. Eight rules for the haemodynamic management of traumatic brain-injured patients.European journal of anaesthesiology and intensive care · 2023
    Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors at 6 institutions in 1 country.

Camilo ToroCritical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University, Durham, NC, USA.
Nancy TemkinDepartment of Biostatistics, University of Washington, Seattle, WA, USA.
Jason BarberDepartment of Neurosurgery, University of Washington, Seattle, WA, USA.
Geoffrey ManleyBrain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, USA.
Sonia JainBiostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA.
Tetsu OhnumaCritical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University, Durham, NC, USA.
Jordan KomisarowDepartment of Neurosurgery, Duke University, Durham, NC, USA.
Brandon ForemanDepartment of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA.
Frederick K KorleyDepartment of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
Monica S VavilalaDepartment of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
Daniel T LaskowitzDepartment of Anesthesiology, Duke University, Durham, NC, USA.
Joseph P MathewDepartment of Anesthesiology, Duke University, Durham, NC, USA.
Adrian HernandezDepartment of Medicine, Duke University, Durham, NC, USA.
John SampsonDepartment of Neurosurgery, Duke University, Durham, NC, USA.
Michael L JamesCritical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University, Durham, NC, USA.
Benjamin A GoldsteinDepartment of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
Amy J MarkowitzBrain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, USA.
Vijay KrishnamoorthyCritical Care and Perioperative Population Health Research Unit, Department of Anesthesiology, Duke University, Durham, NC, USA. vijay.krishnamoorthy@duke.edu.
TRACK-TBI Investigators
Duke University · USUniversity of Washington · USUniversity of California, San Francisco · USUniversity of California, San Diego · USUniversity of Cincinnati · USUniversity of Michigan–Ann Arbor · US

Funding

Mechanisms and Clinical Impact of Myocardial Injury Following Traumatic Brain InjuryK23NS109274 · NINDS · DUKE UNIVERSITY · PI KRISHNAMOORTHY, VIJAY · 2019 to 2023
$900k
NINDS NIH HHS K23 NS109274
6 · The paper itself

Abstract

backgroundEarly hypotension following moderate to severe traumatic brain injury (TBI) is associated with increased mortality and poor long-term outcomes. Current guidelines suggest the use of intravenous vasopressors to support blood pressure following TBI; however, guidelines do not specify vasopressor type, resulting in variation in clinical practice. Minimal data are available to guide clinicians on optimal early vasopressor choice to support blood pressure following TBI. Therefore, we conducted a multicenter study to examine initial vasopressor choice for the support of blood pressure following TBI and its association with clinical and functional outcomes after injury.

methodsWe conducted a retrospective cohort study of patients enrolled in the transforming research and clinical knowledge in traumatic brain injury (TRACK-TBI) study, an 18-center prospective cohort study of patients with TBI evaluated in participating level I trauma centers. We examined adults with moderate to severe TBI (defined as Glasgow Coma Scale score < 13) who were admitted to the intensive care unit and received an intravenous vasopressor within 48 h of admission. The primary exposure was initial vasopressor choice (phenylephrine versus norepinephrine), and the primary outcome was 6-month Glasgow Outcomes Scale Extended (GOSE), with the following secondary outcomes: length of hospital stay, length of intensive care unit stay, in-hospital mortality, new requirement for dialysis, and 6-month Disability Rating Scale. Regression analysis was used to assess differences in outcomes between patients exposed to norepinephrine versus phenylephrine, with propensity weighting to address selection bias due to the nonrandom allocation of the treatment groups and patient dropout.

resultsThe final study sample included 156 patients, of whom 79 (51%) received norepinephrine, 69 (44%) received phenylephrine, and 8 (5%) received an alternate drug as their initial vasopressor. 121 (77%) of patients were men, with a mean age of 43.1 years. Of patients receiving norepinephrine as their initial vasopressor, 32% had a favorable outcome (GOSE 5-8), whereas 40% of patients receiving phenylephrine as their initial vasopressor had a favorable outcome. Compared with phenylephrine, exposure to norepinephrine was not significantly associated with improved 6-month GOSE (weighted odds ratio 1.40, 95% confidence interval 0.66-2.96, p = 0.37) or any secondary outcome.

conclusionsThe majority of patients with moderate to severe TBI received either phenylephrine or norepinephrine as first-line agents for blood pressure support following brain injury. Initial choice of norepinephrine, compared with phenylephrine, was not associated with improved clinical or functional outcomes.

Indexed as

Brain Injuries, TraumaticAdultGlasgow Coma ScaleHumansMaleProspective StudiesRetrospective StudiesVasoconstrictor AgentsVasoconstrictor AgentsShockTraumatic brain injuryVasopressors

Identifiers

PMID34341913
PMCPMC10204593
OpenAlexW3189684637

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.