scholarly journals Comparison of the predictive value of two international guidelines for safe discharge of patients with mild traumatic brain injuries and associated intracranial pathology

Author(s):  
Sebastian Vestlund ◽  
Sebastian Tryggmo ◽  
Tomas Vedin ◽  
Per-Anders Larsson ◽  
Marcus Edelhamre

Abstract Purpose To determine and compare the sensitivity, specificity, and proportion of patients eligible for discharge by the Brain Injury Guidelines and the Mild TBI Risk Score in patients with mild traumatic brain injury and concomitant intracranial injury. Methods Retrospective review of the medical records of adult patients with traumatic intracranial injuries and an initial Glasgow Coma Scale score of 14–15, who sought care at Helsingborg Hospital between 2014/01/01 and 2019/12/31. Both guidelines were theoretically applied. The sensitivity, specificity, and percentage of the cohort that theoretically could have been discharged by either guideline were calculated. The outcome was defined as death, in-hospital intervention, admission to the intensive care unit, requiring emergency intubation due to intracranial injury, decreased consciousness, or seizure within 30 days of presentation. Results Of the 538 patients included, 8 (1.5%) and 10 (1.9%) were eligible for discharge according to the Brain Injury Guidelines and the Mild TBI Risk Score, respectively. Both guidelines had a sensitivity of 100%. The Brain Injury Guidelines had a specificity of 2.3% and the Mild TBI Risk Score had a specificity of 2.9%. Conclusion There was no difference between the two guidelines in sensitivity, specificity, or proportion of the cohort eligible for discharge. Specificity and proportion of cohort eligible for discharge were lower than each guideline’s original study. At present, neither guideline can be recommended for implementation in the current or similar settings.

2013 ◽  
Vol 4 (4) ◽  
pp. 56-60 ◽  
Author(s):  
Mariy Lazarevna Chukhlovina

The review article concerns some issues of improved diagnostics and main neuro-radiological criteria of traumatic brain injuries in childhood. Special attention is given to anatomic and physiological features of brain in children, aiming for proper evaluation of severity in traumatic brain injury. We provide a summary of data concerning modern echniques of brain trauma diagnostics, and its consequences in children. Utility of neurovisualization, electrophysiological techniques, biochemical approaches for detecting the brain damage biomarkers, demonstrated in order to determine severity of brain trauma in childhood.


Author(s):  
Jean-Pierre Dolle ◽  
Rene Schloss ◽  
Martin L. Yarmush

Traumatic Brain Injuries (TBI) affect up to 1.5 million people annually within the United States with as many as 250,000 being hospitalized and 50,000 dying [1]. TBI events occur when the brain experiences a sudden trauma such as a rapid acc/deceleration. These events produce high inertial forces that result in a shearing or elongation of axons (commonly known as Diffuse Axonal Injury [2].


2020 ◽  
Vol 3 (1) ◽  
pp. 70-74
Author(s):  
Rustam Hazratkulov ◽  

Multiple traumatic hematomas (MG) account for 0.74% of all traumatic brain injuries. A comprehensive diagnostic approach to multiple traumatic intracranial hematomas allows to establish a diagnosis in the early stages of traumatic brain injury and to determine treatment tactics. A differentiated approach to the choice of surgical treatment of multiple hematomas allows to achieve satisfactory results and treatment outcomes, which accordingly contributes to the early activation of the patient, a reduction in hospital stay, a decrease in mortality and disabilityin patients with traumatic brain injury


Author(s):  
Yu-Chin Tsai ◽  
Shao-Chun Wu ◽  
Ting-Min Hsieh ◽  
Hang-Tsung Liu ◽  
Chun-Ying Huang ◽  
...  

Thank you for Eduardo Mekitarian Filho’s appreciation of our work on the study of stress-induced hyperglycemia (SIH) and diabetic hyperglycemia (DH) in patients with traumatic brain injuries [...]


2016 ◽  
Vol 12 (2) ◽  
pp. 63-66
Author(s):  
Bal G Karmacharya ◽  
Brijesh Sathian

The objective of this study was to review the demographics, causes injury, severity, treatment and outcome of traumatic brain injuries in victims of the April 2015 earthquake who were admitted in Manipal Teaching Hospital, Pokhara. A total of 37 patients was admitted under Neurosurgery Services. Collapse of buildings was the commonest cause of head injury. The majority of them had mild head injury. Associated injuries to other parts of the body were present in 40.54% patients.Nepal Journal of Neuroscience 12:63-66, 2015


2021 ◽  
Vol 62 (5) ◽  
Author(s):  
Luong Xuan Hien ◽  
Nguyen Quoc Tien ◽  
Tran Thi Phuong

This was an epidemiological study through a retrospective review of 215 medical records of patients with brain injury due to land traffic accidents treated at Ninh Binh Provincial General Hospital. Theresults showed that the majority of research subjects were male, accounting for 80.5%; The age group with higher prevalence of accidents was under 30 years old, accounting for 31.2%; The agegroup of 50-59 years old was at lower prevalence of accidents accounting for 15.8%. The time of the higher chance of occurring accident was between 4p.m and 11p.m daily. The majorityof traffic accidents occurred when riding motorbikes and electric bicycles (82.3%). About 75.0% of the victims received first aid with a gauze bandage; 5.4% of them had broken bones fixed. Amongthe brain injuries, 34.4% of the victims suffered from frontal trauma; 29.3% had unilateral cerebral hemisphere injury, 24.2% had temporal region injury, 15.8% had occipital region injury, and 8.4% ofvictims had parietal injury. More than half of the study subjects (53.5%) were hospitalized for 7-10 days. The rate of patients who have been discharged from the hospital with improved symptoms was81.4%; and 14.9% of patients were transferred to higher level hospitals.


2021 ◽  
Vol 18 ◽  
pp. 24-31
Author(s):  
Brady Armitage ◽  
B. Sue Graves

Sports medicine advancements are continuously evolving allowing professionals to utilize tools to provide for their athletes’ care. These tools have allowed clinicians to better diagnose and determine the extent of an athlete’s injury. Over the last 20 years, an emphasis has been placed on mild traumatic brain injuries (mTBI) and/or concussions. This focus on mTBI and concussions has led to an understanding of the mechanism of injury (MOI), development of grading/severity scales of injury, and diagnostic tools for properly assessing an athlete suffering from an injury to the brain. Clinicians understanding of concussion has excelled in recent years, but with advancement in technologies and diagnostic tools, all professionals need to understand the importance of incorporating tools into the diagnostic procedure. Thus, the purpose of this review is to evaluate common tools in practice, as well as newer tools, that could be utilized by sports medicine professionals.


2021 ◽  
Author(s):  
Sahra Kim ◽  
Alyssa Currao ◽  
Jennifer R. Fonda ◽  
Brigitta Beck ◽  
Alexandra Kenna ◽  
...  

Abstract Background: Since 2006, efforts have been made to increase the identification of traumatic brain injuries (TBIs) in post-9/11 military personnel. The BAT-L is the first validated instrument to diagnose TBIs throughout the lifespan in post-9/11 Veterans. The objective is to investigate the correspondence of the Boston Assessment of TBI-Lifetime (BAT-L) diagnostic prevalence and injury severity of traumatic brain injury with in-theater medical records from Department of Defense (DoD). Methods: A convenience sample of 153 Veterans deployed in 2011 enrolled in the TRACTS longitudinal cohort study was examined. Retrospective review of DoD online medical records to determine diagnostic prevalence and injury severity for all head injury cases during deployment were compared with diagnostic prevalence and injury severity from the BAT-L clinical interview using Chi-square analyses.Results: There was moderate correspondence for TBI diagnosis between the BAT-L and DoD records (κ = 0.42). Sensitivity was 72.7% and specificity was 82.8%. Comparison of injury severity also had moderate correspondence (κ = 0.41). Missing TBI diagnostic data from DoD records was frequent; 43% percent of TBIs reported on the BAT-L did not have any documentation of mTBI assessment or diagnosis in DoD records while 83% did not have in-theater documentation.Conclusions: Diagnosis of TBI via the BAT-L retrospective interview was both sensitive and specific when compared to DoD medical records. However, diagnostic correspondence was only moderate. This lack of diagnostic agreement was related to multiple factors including lack of documentation of injury, differences in assessment tools and goals, and other combat-related motivational factors associated with failure to report injuries while deployed. Several policies were implemented to address underreporting and under-documentation of TBI, yet challenges remain. Findings suggest changes at both individual-level (e.g. service members) and system-level (e.g. DoD/military branches) are needed to adequately diagnose and document all TBI during deployment.


Author(s):  
Adam Thomas Biggs ◽  
Hugh M. Dainer ◽  
Lanny F Littlejohn

Hyperbaric oxygen therapy has been proposed as a method to treat traumatic brain injuries. The combination of pressure and increased oxygen concentration produces a higher content of dissolved oxygen in the bloodstream, which could generate a therapeutic benefit for brain injuries. This dissolved oxygen penetrates deeper into damaged brain tissue than otherwise possible and promotes healing. The result includes improved cognitive functioning and an alleviation of symptoms. However, randomized controlled trials have failed to produce consistent conclusions across multiple studies. There are numerous explanations that might account for the mixed evidence, although one possibility is that prior evidence focuses primarily on statistical significance. The current analyses explored existing evidence by calculating an effect size from each active treatment group and each control group among previous studies. An effect size measure offers several advantages when comparing across studies as it can be used to directly contrast evidence from different scales, and it provides a proximal measure of clinical significance. When exploring the therapeutic benefit through effect sizes, there was a robust and consistent benefit to individuals who underwent hyperbaric oxygen therapy. Placebo effects from the control condition could account for approximately one-third of the observed benefits, but there appeared to be a clinically significant benefit to using hyperbaric oxygen therapy as a treatment intervention for traumatic brain injuries. This evidence highlights the need for design improvements when exploring interventions for traumatic brain injury as well as the importance of focusing on clinical significance in addition to statistical significance.


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