scholarly journals Structure, Process, and Culture Differences of Pediatric Trauma Centers Participating in an International Comparative Effectiveness Study of Children with Severe Traumatic Brain Injury

2015 ◽  
Vol 24 (3) ◽  
pp. 353-360 ◽  
Author(s):  
Gitte Y. Larsen ◽  
Michelle Schober ◽  
Anthony Fabio ◽  
Stephen R. Wisniewski ◽  
Mary Jo C. Grant ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Comparative Effectiveness ◽  
Pediatric Trauma ◽  
Effectiveness Study ◽  
Trauma Centers ◽  
Comparative Effectiveness Study ◽  
International Comparative ◽  
Culture Differences

scholarly journals Design and Rationale of a Comparative Effectiveness Study to Evaluate Two Acupuncture Methods for the Treatment of Headaches Associated with Traumatic Brain Injury

2011 ◽  
Vol 23 (4) ◽  
pp. 237-247 ◽  
Author(s):  
Courtney Lee ◽  
Dawn Wallerstedt ◽  
Alaine Duncan ◽  
Alexandra York ◽  
Michael Hollifield ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Comparative Effectiveness ◽  
Effectiveness Study ◽  
Comparative Effectiveness Study

Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study

2021 ◽  
Vol 20 (8) ◽  
pp. 627-638
Author(s):  
Eveline Janine Anna Wiegers ◽  
Hester Floor Lingsma ◽  
Jilske Antonia Huijben ◽  
David James Cooper ◽  
Giuseppe Citerio ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Comparative Effectiveness ◽  
Effectiveness Study ◽  
Comparative Effectiveness Study

Surgical management of traumatic brain injury: a comparative-effectiveness study of 2 centers

2014 ◽  
Vol 120 (2) ◽  
pp. 434-446 ◽  
Author(s):  
Jed A. Hartings ◽  
Steven Vidgeon ◽  
Anthony J. Strong ◽  
Chris Zacko ◽  
Achala Vagal ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Surgical Management ◽  
Decompressive Craniectomy ◽  
Comparative Effectiveness ◽  
Effectiveness Study ◽  
Aggressive Approach ◽  
Long Term Outcome ◽  
Subdural Hematomas ◽  
Comparative Effectiveness Study

Object Mass lesions from traumatic brain injury (TBI) often require surgical evacuation as a life-saving measure and to improve outcomes, but optimal timing and surgical technique, including decompressive craniectomy, have not been fully defined. The authors compared neurosurgical approaches in the treatment of TBI at 2 academic medical centers to document variations in real-world practice and evaluate the efficacies of different approaches on postsurgical course and long-term outcome. Methods Patients 18 years of age or older who required neurosurgical lesion evacuation or decompression for TBI were enrolled in the Co-Operative Studies on Brain Injury Depolarizations (COSBID) at King's College Hospital (KCH, n = 27) and Virginia Commonwealth University (VCU, n = 24) from July 2004 to March 2010. Subdural electrode strips were placed at the time of surgery for subsequent electrocorticographic monitoring of spreading depolarizations; injury characteristics, physiological monitoring data, and 6-month outcomes were collected prospectively. CT scans and medical records were reviewed retrospectively to determine lesion characteristics, surgical indications, and procedures performed. Results Patients enrolled at KCH were significantly older than those enrolled at VCU (48 vs 34 years, p < 0.01) and falls were more commonly the cause of TBI in the KCH group than in the VCU group. Otherwise, KCH and VCU patients had similar prognoses, lesion types (subdural hematomas: 30%–35%; parenchymal contusions: 48%–52%), signs of mass effect (midline shift ≥ 5 mm: 43%–52%), and preoperative intracranial pressure (ICP). At VCU, however, surgeries were performed earlier (median 0.51 vs 0.83 days posttrauma, p < 0.05), bone flaps were larger (mean 82 vs 53 cm2, p < 0.001), and craniectomies were more common (performed in 75% vs 44% of cases, p < 0.05). Postoperatively, maximum ICP values were lower at VCU (mean 22.5 vs 31.4 mm Hg, p < 0.01). Differences in incidence of spreading depolarizations (KCH: 63%, VCU: 42%, p = 0.13) and poor outcomes (KCH: 54%, VCU: 33%, p = 0.14) were not significant. In a subgroup analysis of only those patients who underwent early (< 24 hours) lesion evacuation (KCH: n = 14; VCU: n = 16), however, VCU patients fared significantly better. In the VCU patients, bone flaps were larger (mean 85 vs 48 cm2 at KCH, p < 0.001), spreading depolarizations were less common (31% vs 86% at KCH, p < 0.01), postoperative ICP values were lower (mean: 20.8 vs 30.2 mm Hg at KCH, p < 0.05), and good outcomes were more common (69% vs 29% at KCH, p < 0.05). Spreading depolarizations were the only significant predictor of outcome in multivariate analysis. Conclusions This comparative-effectiveness study provides evidence for major practice variation in surgical management of severe TBI. Although ages differed between the 2 cohorts, the results suggest that a more aggressive approach, including earlier surgery, larger craniotomy, and removal of bone flap, may reduce ICP, prevent cortical spreading depolarizations, and improve outcomes. In particular, patients requiring evacuation of subdural hematomas and contusions may benefit from decompressive craniectomy in conjunction with lesion evacuation, even when elevated ICP is not a factor in the decision to perform surgery.

scholarly journals Variation in seizure prophylaxis in severe pediatric traumatic brain injury

2016 ◽  
Vol 18 (4) ◽  
pp. 499-506 ◽  
Author(s):  
Paige J. Ostahowski ◽  
Nithya Kannan ◽  
Mark S. Wainwright ◽  
Qian Qiu ◽  
Richard B. Mink ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Scale Score ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Major Complication ◽  
Trauma Centers ◽  
Multicenter Cohort Study ◽  
Seizure Prophylaxis ◽  
Diagnosis Codes

OBJECTIVE Posttraumatic seizure is a major complication following traumatic brain injury (TBI). The aim of this study was to determine the variation in seizure prophylaxis in select pediatric trauma centers. The authors hypothesized that there would be wide variation in seizure prophylaxis selection and use, within and between pediatric trauma centers. METHODS In this retrospective multicenter cohort study including 5 regional pediatric trauma centers affiliated with academic medical centers, the authors examined data from 236 children (age < 18 years) with severe TBI (admission Glasgow Coma Scale score ≤ 8, ICD-9 diagnosis codes of 800.0–801.9, 803.0–804.9, 850.0–854.1, 959.01, 950.1–950.3, 995.55, maximum head Abbreviated Injury Scale score ≥ 3) who received tracheal intubation for ≥ 48 hours in the ICU between 2007 and 2011. RESULTS Of 236 patients, 187 (79%) received seizure prophylaxis. In 2 of the 5 centers, 100% of the patients received seizure prophylaxis medication. Use of seizure prophylaxis was associated with younger patient age (p < 0.001), inflicted TBI (p < 0.001), subdural hematoma (p = 0.02), cerebral infarction (p < 0.001), and use of electroencephalography (p = 0.023), but not higher Injury Severity Score. In 63% cases in which seizure prophylaxis was used, the patients were given the first medication within 24 hours of injury, and 50% of the patients received the first dose in the prehospital or emergency department setting. Initial seizure prophylaxis was most commonly with fosphenytoin (47%), followed by phenytoin (40%). CONCLUSIONS While fosphenytoin was the most commonly used medication for seizure prophylaxis, there was large variation within and between trauma centers with respect to timing and choice of seizure prophylaxis in severe pediatric TBI. The heterogeneity in seizure prophylaxis use may explain the previously observed lack of relationship between seizure prophylaxis and outcomes.

Pediatric Traumatic Brain Injury in Adult vs Pediatric Trauma Centers: What are We Doing Different?

2016 ◽  
Vol 223 (4) ◽  
pp. e202-e203
Author(s):  
Viraj Pandit ◽  
Ahmed Hassan ◽  
Asad Azim ◽  
Peter M. Rhee ◽  
Terence O'Keeffe ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Trauma ◽  
Trauma Centers ◽  
Pediatric Traumatic Brain Injury

scholarly journals Triage of Children with Moderate and Severe Traumatic Brain Injury to Trauma Centers

2013 ◽  
Vol 30 (13) ◽  
pp. 1129-1136 ◽  
Author(s):  
Mary A. Kernic ◽  
Frederick P. Rivara ◽  
Douglas F. Zatzick ◽  
Michael J. Bell ◽  
Mark S. Wainwright ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Trauma Centers
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