Comparative study of computed tomographic scoring systems and predictors of early mortality in severe traumatic brain injury

Abstract OBJECTIVE To verify the values and the time course of regional cerebral blood flow (rCBF) in the cortex located beneath an evacuated acute subdural hematoma (SDH) and their relationship with neurological outcome. METHODS rCBF levels were measured in multiple regions of interest, by means of a Xe-computed tomographic technique, in the cortex underlying an evacuated SDH and contralaterally in 20 patients with moderate or severe traumatic brain injury and an evacuated acute SDH. Twenty-three patients with moderate or severe traumatic brain injury and an evacuated extradural hematoma or diffuse injury served as the control group. Outcome was evaluated by means of the Glasgow Outcome Scale at 12 months. RESULTS Values for the maximum (rCBFmax) and the mean of all rCBF levels in the cortex beneath the evacuated SDH were more frequently consistent with hyperemia. The side-to-side differences in the mean of all rCBF and rCBFmax levels between lesioned and nonlesioned hemispheres were greater in patients with evacuated SDH than in controls (P = 0.0013 and P = 0.0018, respectively). The side-to-side difference in the maximum rCBF value was higher in SDH patients with unfavorable outcomes than in controls at 24 to 96 hours and at 4 to 7 days and higher than in patients with favorable outcomes at 4 to 7 days. The widest side-to-side difference in rCBFmax value was more elevated in patients with an evacuated SDH with unfavorable outcome than in patients with a favorable outcome (P = 0.047), whereas no differences were found in controls. The SDH thickness and the associated midline shift were greater in patients with unfavorable outcomes than in those with favorable outcomes. CONCLUSION On average, hyperemic long-lasting rCBF values frequently occur in the cortex located beneath an evacuated SDH and seem to be associated with unfavorable outcome.

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Sarcopenia Measured Using Masseter Area Predicts Early Mortality after Severe Traumatic Brain Injury

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2017.07.209 ◽

2017 ◽

Vol 225 (4) ◽

pp. S96

Author(s):

Parker J. Hu ◽

Patrick L. Bosarge ◽

Rindi Uhlich ◽

Jeffrey D. Kerby

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Early Mortality

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Persistently High Serum Substance P Levels and Early Mortality in Patients with Severe Traumatic Brain Injury

World Neurosurgery ◽

10.1016/j.wneu.2019.08.064 ◽

2019 ◽

Vol 132 ◽

pp. e613-e617 ◽

Cited By ~ 5

Author(s):

Leonardo Lorente ◽

María M. Martín ◽

Antonia Pérez-Cejas ◽

Agustín F. González-Rivero ◽

Mónica Argueso ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Substance P ◽

Severe Traumatic Brain Injury ◽

High Serum ◽

Early Mortality

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The Delis–Kaplan Executive Function System Sorting Test as an evaluative tool for executive functions after severe traumatic brain injury: A comparative study

Journal of Clinical and Experimental Neuropsychology ◽

10.1080/13803395.2011.625351 ◽

2012 ◽

Vol 34 (2) ◽

pp. 151-159 ◽

Cited By ~ 24

Author(s):

Eyal Heled ◽

Dan Hoofien ◽

Dana Margalit ◽

Rachel Natovich ◽

Eugenia Agranov

Keyword(s):

Traumatic Brain Injury ◽

Executive Function ◽

Brain Injury ◽

Comparative Study ◽

Executive Functions ◽

Severe Traumatic Brain Injury ◽

Function System ◽

Sorting Test

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Sarcopenia Measured Using Masseter Area Predicts Early Mortality following Severe Traumatic Brain Injury

Journal of Neurotrauma ◽

10.1089/neu.2017.5422 ◽

2018 ◽

Vol 35 (20) ◽

pp. 2400-2406 ◽

Cited By ~ 10

Author(s):

Parker Hu ◽

Rindi Uhlich ◽

Jared White ◽

Jeffrey Kerby ◽

Patrick Bosarge

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Early Mortality

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Prediction of early mortality after primary decompressive craniectomy in patients with severe traumatic brain injury

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-020-00096-5 ◽

2021 ◽

Vol 36 (1) ◽

Author(s):

Safwat Abouhashem ◽

Amr Albakry ◽

Shawkat El-Atawy ◽

Faten Fawzy ◽

Sahar Elgammal ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Lung Injury ◽

Decompressive Craniectomy ◽

Severe Traumatic Brain Injury ◽

Early Mortality ◽

Abdominal Injury ◽

Radiological Findings ◽

Group I ◽

Significant Difference

Abstract Objectives Traumatic brain injury (TBI) is a worldwide major health problem associated with a high rate of morbidity and mortality. Intracranial hypertension following TBI is the main but not the only cause of early mortality. Decompressive craniectomy (DC) is used to decrease the intracranial pressure (ICP) and prevent brain herniation following TBI; however, the clinical outcome after DC for patients with TBI generates continuous debate. Prediction of early mortality after DC will help in making the surgery decision. The aim of this study is to predict early mortality after DC based on the initial clinical and radiological findings. Methods In this study, 104 patients with severe traumatic brain injury have been treated by decompressive craniectomy and were retrospectively analyzed. Patients were divided into two groups; group I involved 32 patients who died within 28 days while group II involved 72 patients who survived after 28 days. The relationship between initial Glasgow Coma Scale score (GCS), pupil size and reactivity, associated injuries, and radiological findings were analyzed as predictor factors for early mortality. Results A total of 104 patients with severe TBI have been treated by DC and were analyzed; the early mortality occurred in 32 patients, 30.77%. There is a significant difference between groups in gender, mean GCS, Marshall scale, presence of isochoric pupils, and lung injury. After stratification, odds of early mortality increases with the lower GCS, higher Marshall scale, lung injury, and abdominal injury while male gender and the presence of isochoric pupils decrease the odds of mortality. After univariate regression, the significant impact of GCS disappears except for GCS-8 which decreases the odds of mortality in comparison to other GCS scores while higher Marshall scale, presence of isochoric pupils, and lung injury increase the odds of mortality, but most of these effects disappear after multiple regressions except for lung injury and isochoric pupils. Conclusion Prediction of early mortality after DC is multifactorial, but the odds of early mortality after decompressive craniectomy in severe traumatic brain injury are progressively increased with the lower GCS, higher Marshall scale, and the presence of lung or abdominal injury.

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