scholarly journals Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome

2021 ◽  
Author(s):  
Gopal Krishna ◽  
Varun Aggarwal ◽  
Ishwar Singh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Clinical Outcome ◽  
Road Traffic ◽  
Statistical Significance ◽  
Platelet Counts ◽  
Coagulation Abnormalities ◽  
The Mean ◽  
D Dimer

Abstract Introduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis. Design Prospective study. Methods The study included 50 patients of isolated TBI with cohorts of moderate (MHI) and severe head injury (SHI). Coagulopathy was graded according to the values of parameters in single laboratory. The incidence of coagulopathy according to the severity of TBI and correlation with disseminated intravascular coagulation (DIC) score, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen was observed. The comparison was also made between expired and discharged patients within each group. It also compared coagulation derailments with clinical presentation (Glasgow Coma Scale [GCS]) and outcome (Glasgow Outcome Scale [GOS]). Results Road traffic accident was the primary (72%) mode of injury. Fifty-two percent had MHI and rest had SHI. Eighty-four percent of cases were managed conservatively. The mean GCS was 12.23 and 5.75 in MHI and SHI, respectively. Sixty-two percent of MHI and 96% of the patients with SHI had coagulation abnormalities. On statistical analysis, DIC score (p < 0.001) strongly correlated with the severity of head injury and GOS. PT and APTT were also significantly associated with the severity of TBI. In patients with moderate TBI, D-dimer and platelet counts showed association with clinical outcome. Fibrinogen levels did not show any statistical significance. The mean platelet counts remained normal in both the groups of TBI. The mean GOS was 1.54 and 4.62 in SHI and MHI, respectively. Conclusion Coagulopathy is common in isolated TBI. The basic laboratory parameters are reliable predictors of coagulation abnormalities in TBI. Coagulopathy is directly associated with the severity of TBI, GCS, and poor outcome.

scholarly journals Quantitative cerebral blood flow using xenon-enhanced CT after decompressive craniectomy in traumatic brain injury

2018 ◽  
Vol 129 (1) ◽  
pp. 241-246 ◽  
Author(s):  
Aditya Vedantam ◽  
Claudia S. Robertson ◽  
Shankar P. Gopinath
Keyword(s):  
Traumatic Brain Injury ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Brain Injury ◽  
Clinical Outcome ◽  
Decompressive Craniectomy ◽  
Decompressive Surgery ◽  
Hemodynamic Parameters ◽  
Enhanced Ct ◽  
The Mean

OBJECTIVEFew studies have reported on changes in quantitative cerebral blood flow (CBF) after decompressive craniectomy and the impact of these measures on clinical outcome. The aim of the present study was to evaluate global and regional CBF patterns in relation to cerebral hemodynamic parameters in patients after decompressive craniectomy for traumatic brain injury (TBI).METHODSThe authors studied clinical and imaging data of patients who underwent xenon-enhanced CT (XeCT) CBF studies after decompressive craniectomy for evacuation of a mass lesion and/or to relieve intractable intracranial hypertension. Cerebral hemodynamic parameters prior to decompressive craniectomy and at the time of the XeCT CBF study were recorded. Global and regional CBF after decompressive craniectomy was measured using XeCT. Regional cortical CBF was measured under the craniectomy defect as well as for each cerebral hemisphere. Associations between CBF, cerebral hemodynamics, and early clinical outcome were assessed.RESULTSTwenty-seven patients were included in this study. The majority of patients (88.9%) had an initial Glasgow Coma Scale score ≤ 8. The median time between injury and decompressive surgery was 9 hours. Primary decompressive surgery (within 24 hours) was performed in the majority of patients (n = 18, 66.7%). Six patients had died by the time of discharge. XeCT CBF studies were performed a median of 51 hours after decompressive surgery. The mean global CBF after decompressive craniectomy was 49.9 ± 21.3 ml/100 g/min. The mean cortical CBF under the craniectomy defect was 46.0 ± 21.7 ml/100 g/min. Patients who were dead at discharge had significantly lower postcraniectomy CBF under the craniectomy defect (30.1 ± 22.9 vs 50.6 ± 19.6 ml/100 g/min; p = 0.039). These patients also had lower global CBF (36.7 ± 23.4 vs 53.7 ± 19.7 ml/100 g/min; p = 0.09), as well as lower CBF for the ipsilateral (33.3 ± 27.2 vs 51.8 ± 19.7 ml/100 g/min; p = 0.07) and contralateral (36.7 ± 19.2 vs 55.2 ± 21.9 ml/100 g/min; p = 0.08) hemispheres, but these differences were not statistically significant. The patients who died also had significantly lower cerebral perfusion pressure (52 ± 17.4 vs 75.3 ± 10.9 mm Hg; p = 0.001).CONCLUSIONSIn the presence of global hypoperfusion, regional cerebral hypoperfusion under the craniectomy defect is associated with early mortality in patients with TBI. Further study is needed to determine the value of incorporating CBF studies into clinical decision making for severe traumatic brain injury.

scholarly journals Correlation of D-Dimer level with outcome in traumatic brain injury

2016 ◽  
Vol 17 (1) ◽  
pp. 21-30
Author(s):  
Pradip Prasad Subedi ◽  
Sushil Krishna Shilpakar
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Glasgow Outcome Scale ◽  
Significant Proportion ◽  
Duration Of Hospital Stay ◽  
Icu Stay ◽  
The Mean ◽  
Hospital Stay Duration ◽  
D Dimer

Introduction: Traumatic brain injury (TBI) is a common neurosurgical emergency and a common public health problem with high mortality and long term morbidity. The cost incurred by TBI is immense. The major determinant of outcome following TBI is the severity of the primary injury. However, secondary injuries including coagulopathy are treatable prognostic factors. Many studies have revealed that coagulopathy of trauma depicted by increasing level of D-dimer is associated with poor prognosis in TBI. So, early dectection and correction of such abnormality is very important in management of TBI.Methods: This is a prospective observational study conducted at Department of Surgery TUTH (Tribhuvan University Teaching Hospital), Kathmandu,Nepal over a period of one year. One hundred and forty eight patients of TBI were included in the study. Clinical profile of the patients and D-dimer level were monitored during the hospital course. D-dimer level was correlated with outcome variables including duration of hospital stay, duration of Intensive care unit (ICU) stay and Glasgow outcome scale (GOS).Results: A total of 194 patients were admitted with the diagnosis of traumatic brain injury during the study period and out of them 148 patients were enrolled for the study. Out of 148 patients one hundred and twenty (81.1%) were males and twenty eight (18.9%) were females. The mean age was 29.71±18.07 and the age ranged from 1 to 78 years. Seventy (47.3%) patient were between 21 to 40 years of age. The mean duration of hospital stay was 9.83±13.58 days and the mean duration of ICU stay was 3.78±7.06 days. Contusion was the most common lesion in our patients. Of the patients studied 111 patients (75%)  had good recovery with GOS of 5, 9  patients (6.1%)  had GOS of 4, 6 patients (4.1%)  had GOS of 3, 1 patients (0.7%)  had GOS of 2 and 21 patients (14.1%)  had GOS of 1. Normal D-dimer was seen in 102 patients (68.9%) and elevated D-dimer in 46 patients (31.1%). Man –Whitney test shows higher D-dimer levels positively correlated with duration of hospital stay, duration of ICU stay and Glasgow Outcome Scale. Pearson chi-square test revealed higher levels of D-dimer correlated with grade of injury but not with mode of injury.Conclusion: D-dimer is elevated in significant proportion of patients with TBI and abnormal D-dimer level is associated with poor outcome in TBI.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 21-30

Multidetector Computed Tomography (MDCT) Evaluation of Traumatic Brain Injury in Head Trauma Patients in Tertiary Hospital of Eastern Region of Nepal

2021 ◽  
Vol 6 (1) ◽  
pp. 1352-1357
Author(s):  
Ajay Kumar Yadav ◽  
Binit Dev ◽  
Sushil Taparia ◽  
Parvez Kumar ◽  
Rakesh Mandal ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Ct Scan ◽  
Head Trauma ◽  
Road Traffic ◽  
Imaging Findings ◽  
Intracranial Lesions ◽  
History Of

Introduction: Traumatic brain injury (TBI) in patients with head trauma is common cause for emergency visits to hospital affecting all age groups. It is one of important leading cause of death and disability worldwide besides leading to neurological disease burden. Noncontrast enhanced Multidetector computed tomography (MDCT) is imaging modality of choice for detection of various intracranial lesions. Objectives: This study was done to analyse various imaging findings on MDCT in traumatic head injury patients along with association of CT findings with clinical manifestation and mechanism of injury. Methodology: In this ethically approved prospective study, CT scan was done in 224 consecutive patients with head injury from November 2020 to February 2021. The various imaging findings seen in CT scan were documented in proforma. The data collected was analyzed with appropriate statistical test and statistical significance was calculated. Results: Total of 224 patients with diagnosis of head injury were included in the study. The male to female ratio was 2.86 and most common age group involved was between 20-40years (41.1%). The most common mode of injury was road traffic accidents (57.6%) and most of the patients presented with history of altered sensorium (35.7%). About 47.3% patients showed abnormal findings on CT scan with scalp lesion was most common findings (82%) followed by skull fractures (54.7%) and cerebral contusions (43.4%). Patients with history of RTA had more abnormal CT scan (62%) than fall injury and physical assault. Statistically significant association seen between CT scan findings with Glasgow Coma Scale and RTA (P<0.05). Conclusion: The present study showed well documented role of CT scan in diagnosis of TBI besides detection of spectrum of intracranial lesions in patients with head trauma. Road traffic accident is most common mode of head injury with most of the victims are young middle age active male. 

scholarly journals Clinical and Diagnostic (CT scan) Case Profile of Traumatic Brain Injury (TBI) Patients in a Teritiary Care Center, Visakhapatnam - A Retrospective Observational Study

2019 ◽  
Vol 4 (05) ◽  
Author(s):  
V. Dharma Rao ◽  
Kodandarao Kuna ◽  
Mohan Patro ◽  
Deepak M. S.
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Observational Study ◽  
Ct Scan ◽  
Road Traffic ◽  
Care Center ◽  
Seat Belt ◽  
Road Accident ◽  
Retrospective Observational Study

Introduction: India experiences increase in incidence of Road Traffic Accidents (RTA). During 1970 to 2011, there is 7.3 times increase in road accident injuries. Head injury is the commonest due to RTA injury which accounts for 60% of cases in Visakhapatnam which is situated along the 9National Highway. Aim: The aim is to study the clinical and CT scan diagnostic case profile of Traumatic brain injury (TBI) in Visakhapatnam region. Material & Methods: It is a retrospective observational study of cases of TBI reported at the trauma care center at the tetitiary care King George Hospital (KGH), Visakhapatnam, for the period 2011 – 2018. Proper permission and clearance for the present study is duly obtained. Results & Discussion: Head injury is the commonest among traumatic injuries. CT scan is performed as the gold standard diagnostic test for head injury cases. Contusions followed by Sub arachnoid hemorrhage (SAH) and Sub dural hemorrhage (SDH) are the most common CT findings. About 25% needed ventilator support. Most common cause of death is CNS injuries (42%) followed by blood loss in 39% of cases. Conclusions: Regulated traffic control, wearing helmet and seat belt, limiting speed and avoiding L & U bends at road corners can prevent and minimise the incidence of fatal injuries.

scholarly journals Outcome of diffuse axonal injury in moderate and severe traumatic brain injury

2021 ◽  
Vol 12 ◽  
pp. 384
Author(s):  
Farrukh Javeed ◽  
Lal Rehman ◽  
Ali Afzal ◽  
Asad Abbas
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Road Traffic ◽  
Axonal Injury ◽  
Tertiary Care ◽  
Diffuse Axonal Injury ◽  
Average Hospital ◽  
Satisfactory Outcome ◽  
Moderate Traumatic Brain Injury

Background: Diffuse axonal injury (DAI) is a common presentation in neurotrauma. Prognosis is variable but can be dependent on the initial presentation of the patient. In our study, we evaluated the outcome of diffuse axonal injury. Methods: This study was conducted at a tertiary care center from September 2018 to December 2019 and included 133 adult patients with moderate or severe head injury (GCS ≤ 12) diagnosed to have the DAI on the basis of MRI. At 3 months, the result was assessed using the Extended Glasgow Outcome Scale (GOS-E). Results: There were a total of 97 (72.9%) males and 36 (27.1%) females with an average age of 32.4 ± 10 years with a mean GCS of 9 at admission. The most common mode of head trauma was road traffic accidents (RTAs) in 51.9% of patients followed by fall from height in 27.1%. Most patients were admitted with moderate traumatic brain injury (64.7%) and suffered Grade I diffuse axonal injury (41.4%). The average hospital stay was 9 days but majority of patients stayed in hospital for ≤ 11 days. At 3 months, mortality rate was 25.6% and satisfactory outcome observed in 48.1% of patients. The highest mortality was observed in the Grade III DAI. Conclusion: We conclude that the severity of the traumatic head injury and the grade of the DAI impact the outcome. Survivors require long-term hospitalization and rehabilitation to improve their chances of recovery.

scholarly journals Epidemiology of Pediatric Traumatic Brain Injury at Sylvanus Olympio University Hospital of Lomé in Togo

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Pilakimwe Egbohou ◽  
Tabana Mouzou ◽  
Pikabalo Tchetike ◽  
Hamza Doles Sama ◽  
Sarakawabalo Assenouwe ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Traffic Accidents ◽  
Brain Injuries ◽  
Injury Severity ◽  
Road Traffic ◽  
Skull Fracture ◽  
University Hospital ◽  
Pediatric Traumatic Brain Injury ◽  
The Mean

Introduction. Severe pediatric traumatic brain injury (pTBI) is a leading cause of disability and death in children worldwide. Children victims of pTBI are admitted to the Sylvanus Olympio University Hospital (SOUH) at the multipurpose Intensive Care Unit (ICU). We aimed in this study to describe the epidemiologic characteristics and outcomes of pTBI patients admitted in this ICU. Patients and Methods. This study was conducted at the ICU of SOUH of Lome. It was a retrospective study based on patients’ records from 0 to 15 years old admitted during the period from 1 January 2012 to 30 June 2018 (5 years and 6 months). Results. We recorded 91 pTBI included in the study. The mean age was 7.7 ± 4.3 years. The male predominated with 67.0%. Road traffic accidents were the most common cause (79.1%), followed by falls (19.8%). The average pediatric Glasgow Coma Scale (pGCS) was 6.6 ± 1.4, with a mean Injury Severity Score (ISS) of 23.1 ± 8.4. The most common brain injuries found in the CT scan were brain edema (72.9%), skull fracture (69.5%), and brain contusion (55.9%). The average duration under mechanical ventilation was 2.1 ± 2.9 days, and the mean ICU stay was 4.9 ± 4.4 days. Overall mortality was 31.9% (29 cases). Factors significantly associated (p<0.05) with death were hypotension (51.7%), anemia (43.1%), hyperthermia (46.7%), GCS < 6 (64%), and ISS > 20 (48.9%). Conclusion. pTBI mortality remains high in SOUH ICU. Factors associated with mortality were secondary systemic insults, worse GCS < 6, and ISS > 20.

scholarly journals CONSERVATIVE MANAGEMENT OF SIGNIFICANT EXTRA-DURAL HAEMATOMA : CASES AND LITERATURE REVIEW

2019 ◽  
pp. 1-3
Author(s):  
Dilraj Kadlas ◽  
Meghna Kinjalk
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Ct Scan ◽  
Conservative Management ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
History Of

OBJECTIVE: Study of natural history of significant extra dural haematoma resolution. BACKGROUND: Traumatic brain injury is one of the leading causes of death. There are various modes of injury like road traffic accident, assault, fall and others.The traumatic brain injury can range from scalp laceration to intracranial haemorrhage.The line of management is decided upon considering several factors like age, co morbidities, Glasgow coma scale neurodeficiency,CT scan findings,other associated injury. CASE REPORT: A 24-year-old gentleman sustained head injury following road traffic accident. CT scan (head) was suggestive of extradural haematoma.Patient was subjected to decompressive craniotomy and evacuation of extra dural haematoma. On 2nd post-operative day, CT Scan (head) was done which was suggestive of right frontal and right posterior parietal extra dural haematoma. The relatives did not give consent for surgery .Conservative management was done. Patient improved and haematoma resolved. A 42 year old male presented to the emergency with history of head injury . CT Scan was suggestive of extra dural haematoma. Conservative management was done as surgery was refused by the relatives.Patient was monitored.Patient was asymptomatic after discharge and during follow up period. CONCLUSION:We report two unusual cases of extradural haematoma with a good outcome and uneventful follow up period.

COMPARISON OF ANTAGONIST FASCILITATION VERSUS AGONIST INHIBITION ON SPASTICITY IN CHRONIC HEAD INJURY

2018 ◽  
Author(s):  
Dr. Barkha Khurana ◽  
Dr. Ashish Dobhal ◽  
Dr. Mohit Bhatt
Keyword(s):  
Traumatic Brain Injury ◽  
Developing Countries ◽  
Brain Injury ◽  
Head Injury ◽  
Road Traffic ◽  
Case Fatality ◽  
Road Traffic Injuries ◽  
Alcohol Involvement ◽  
Urban India

Traumatic brain injury (TBI) is a leading cause of morbidity, mortality, disability and socioeconomic losses in India and other developing countries  It is estimated that nearly 1.5 to 2 million persons are injured and 1 million1 succumb to death every year in India resulting in deaths, injuries and disabilities of young and productive people of our society. Road traffic injuries are the leading cause (60%) 2 of TBI followed by falls (20%-25%) and violence (10%). Alcohol involvement is known to be present among 15%-20% of TBIs at the time of injury. The failure to implement several proven countermeasures and neglect of people’s safety has only resulted in increase of TBI. Technological advancements in recent years have clearly reduced the case fatality rates from Injuries and TBI, especially in Urban India.

scholarly journals Agonies and nuances of geriatric head injury: experience of a tertiary care institute of Western India

2017 ◽  
Vol 4 (7) ◽  
pp. 2205
Author(s):  
Amit Mahore ◽  
Nitin Dange ◽  
Ravikiran Vutha ◽  
Mahadeo Garale
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Road Traffic ◽  
Tertiary Care ◽  
Western India ◽  
Female Ratio ◽  
Common Cause ◽  
Surgical Department ◽  
Care Institute

Background: Traumatic brain injury (TBI) is the most common cause of mortality and morbidity in emergency surgical department. The basic aim of the present study is to analyze the clinical profile, prognostic factors, impact of comorbidities on outcome and complications of traumatic brain injury in elderly patients.Methods: The study is retrospective analysis of hospital records of all admitted patients of head injury above 60 years of age over last five years at a tertiary care institute of India.Results: There were 94 males and 61 females in our study with male to female ratio of 1.54:1. The average age of male patients were 68.55 years and female patients were 64.50 years. Fall was the most common cause of head injury (59.3%) followed by road traffic accidents (36.8%) and assault was the least common (3.9%). Mortality was more in moderate and severe head injury groups with more propensity among females with comorbidities.Conclusions: Our study highlights that geriatric TBI carries a significant morbidity and mortality in India despite of advances in trauma care.

scholarly journals Clinical spectrum of paediatric head injury

2020 ◽  
pp. 220-225
Author(s):  
Krishna Govind Lodha ◽  
Tarun Kumar Gupta ◽  
Gaurav Jaiswal ◽  
Yogendra Singh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Road Traffic ◽  
Radiological Finding ◽  
Paediatric Population ◽  
Major Health Problem ◽  
Female Ratio ◽  
Paediatric Head Injury ◽  
Fall From Height

Introduction: Traumatic Brain injury is considered as a major health problem which causes frequent deaths and disabilities in paediatric population with special concern to tribal regions of developing countries like India where etiology of traumatic brain injury in the paediatric population fall from height dominant over the road traffic accident as a major. Aim and objective: The aim is to analyse the epidemiology, mechanism, clinical presentation, severity and outcome of paediatric head injury in the tribal region of northern India that could help to make preventive policies to improve their care. Material methods: It is a prospective observational study of 345 children of up to 18 years of age admitted under Department of Neurosurgery from October 2017 to April 2019. Results: The study population comprised of 345 paediatric patients. Mean age was 9.25 years.36.81% patients were in 1-6-year age group and male to female ratio was 2.45. The most common cause for trauma was fall from height in 179(52%) cases followed by RTA in 141(41%) cases. The most common radiological finding was depressed skull fractures in 97(50%) cases. There was 35% mortality in severe head injury patients. Conclusion: This study through some light on the different scenario of head injury in Tribal regions of Developing country and will help to formulate effective strategies for prevention and better care of the patients.

Sign in / Sign up

Export Citation Format

Share Document