210 Post-Traumatic Seizure in Pediatric Traumatic Brain Injury: Incidence, Risk Factors, and Outcomes in 124,444 Patients

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 256-257
Author(s):  
Kavelin Rumalla ◽  
Megan Lilley ◽  
Mrudula Gandham ◽  
Rachana Kombathula ◽  
Usiakimi Igbaseimokumo
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Subdural Hematoma ◽  
Multivariable Analysis ◽  
Injury Incidence ◽  
Cerebral Contusion ◽  
Level Of Consciousness ◽  
Incidence Risk ◽  
Post Traumatic

Abstract INTRODUCTION Post traumatic seizures (PTS) are the most common complication following a traumatic brain injury (TBI). The nationwide incidence, risk factors, and outcomes associated with PTS in pediatric TBI are not well understood. METHODS We queried the Kids Inpatient Database (2003, 2006, 2009, 2012) using ICD-9-CM codes to identify all patients (age <21) that had a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis of a PTS (780.33, 780.39). Severity of TBI was determined by level of consciousness and nature of the injury (open/closed). Variables included demographics, comorbidity, hospital type, and TBI type. level of consciousness (LOC), open/closed wound, and surgical management. Risk factors for PTS were identified in univariate and multivariable analysis (alpha set at <0.05). RESULTS >The rate of PTS was 6.9% among 124,444 patients hospitalized for TBI. The rate was impacted by LOC: no LOC (6.3%), brief LOC (7.5%), moderate LOC (10.6%), prolonged LOC w/baseline return (13.9%), or prolonged LOC w/no return (6.4%). The rate also varied by type of TBI: subdural hematoma (12.0%), cerebral laceration (7.4%), subarachnoid hemorrhage (6.5%), concussion (6.0%), and epidural hematoma (4.0%). In multivariable analysis, risk factors for PTS included age 0–5 (compared to 6–10, 11–15, 16–20), African American race, 2 + pre-existing comorbidities, cerebral contusion/laceration, subdural hematoma, closed wound, brief LOC, moderate LOC, and prolonged LOC w/baseline return (all P < 0.05). Surgically managed patients were more likely to suffer PTS (10.7% vs. 6.5%, P < 0.0001) unless treated within 24 hours of admission (6.7% vs. 9.6%, P < 0.0001). CONCLUSION PTS is common in children with TBI and is impacted by age, comorbidity, race, and severity/type of injury. Patients with mild to moderate TBI are at the highest risk and prompt surgery is associated with decreased risk of PTS.

212 Hydrocephalus in Pediatric Traumatic Brain Injury: National Incidence, Risk Factors, and Outcomes in 124,444 Patients

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 257-257
Author(s):  
Kavelin Rumalla ◽  
Vijay Letchuman ◽  
Bharadwaj Jilakara ◽  
Akhil Pulumati ◽  
Usiakimi Igbaseimokumo
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Subdural Hematoma ◽  
Multivariable Analysis ◽  
Wound Complications ◽  
Total Hospital Cost ◽  
Total Hospital ◽  
Incidence Risk

Abstract INTRODUCTION Hydrocephalus is a well-known and life-threatening sequel of traumatic brain injury (TBI) in adults, but is not as well characterized in children. We investigated the national incidence, risk factors, and outcomes associated with hydrocephalus in pediatric TBI. METHODS The Kids Inpatient Database (KID) is the largest pediatric hospital database in the U.S. and is sampled every 3 years. We queried the KID 2003, 2006, 2009, and 2012 using ICD-9-CM codes to identify all patients (age 0–20) with a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis code for hydrocephalus (331.3-331.5, excluding congenital hydrocephalus [742.3]. Variables included demographics, comorbidities, TBI severity (consciousness, type of wound) complications (medical or neurological), and discharge outcomes. Both univariate and multivariable analysis was utilized to identify factors associated with hydrocephalus and alpha was set at P < 0.05. RESULTS >In 124,444 patients hospitalized for TBI. The average rate of hydrocephalus was 1.0% but was affected by the type of TBI: subdural hematoma (2.4%), subarachnoid hemorrhage (1.4%), epidural hematoma (1.0%), cerebral laceration (0.9%), concussion (0.2%). The risk factors for hydrocephalus in multivariable analysis were age 0–5 (compared to other ages), Medicaid insurance, electrolyte disorder, chronic neurological condition, weight loss, subarachnoid hemorrhage, subdural hematoma, open wound, postoperative neurological complication, and septicemia (all P < 0.05). The likelihood of hydrocephalus was increased among surgically managed patients (6.0% vs. 0.5%) but decreased among those who underwent operation on admission day (0.8% vs. 4.1%) (both P < 0.05). The mortality rate for TBI patients without hydrocephalus was higher (5.4%) than those with hydrocephalus (1.1%). However, average LOS (25 vs. 5 days) and mean total hospital costs ($86,596 vs. $16,791) were greater among patients with hydrocephalus. CONCLUSION Hydrocephalus following TBI in children is relatively uncommon but is more likely in patients with certain demographics, pre-existing comorbidities, and injury patterns and attracts a higher total hospital cost.

Pulmonary embolism following severe traumatic brain injury: incidence, risk factors and impact outcome

2017 ◽  
Vol 43 (9) ◽  
pp. 1433-1435 ◽  
Author(s):  
Mabrouk Bahloul ◽  
Hedi Chelly ◽  
Kais Regaieg ◽  
Nessrine Rekik ◽  
Samar Bellil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Pulmonary Embolism ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Injury Incidence ◽  
Incidence Risk ◽  
Impact Outcome

Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution

2017 ◽  
Vol 127 (1) ◽  
pp. 16-22 ◽  
Author(s):  
Pierre Esnault ◽  
Mickaël Cardinale ◽  
Henry Boret ◽  
Erwan D'Aranda ◽  
Ambroise Montcriol ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Anticoagulation Therapy ◽  
Spine Injury ◽  
Hemorrhagic Complication ◽  
Injury Incidence ◽  
Severe Tbi ◽  
Systemic Anticoagulation

OBJECTIVEBlunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI.METHODSThe authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation.RESULTSIn total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9–34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7–80.9), cervical spine injury (OR 13.5, 95% CI 3.1–59.4), thoracic trauma (OR 7.3, 95% CI 1.1–51.2), and hepatic lesion (OR 13.3, 95% CI 2.1–84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication.CONCLUSIONSBlunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.

scholarly journals Incidence, Risk Factors, and Effects on Outcome of Ventilator-Associated Pneumonia in Patients With Traumatic Brain Injury

CHEST Journal ◽  
2020 ◽  
Vol 158 (6) ◽  
pp. 2292-2303 ◽  
Author(s):  
Chiara Robba ◽  
Paola Rebora ◽  
Erika Banzato ◽  
Eveline J.A. Wiegers ◽  
Nino Stocchetti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ventilator Associated Pneumonia ◽  
Incidence Risk

scholarly journals Post-Traumatic Headache After Mild Traumatic Brain Injury In A One-Year Follow Up Study – Risk Factors And Return To Work

2021 ◽  
Author(s):  
Yvonn Kraemer ◽  
Kaisa Mäki ◽  
Ivan Marinkovic ◽  
Taina Nybo ◽  
Harri Isokuortti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Return To Work ◽  
Mild Traumatic Brain Injury ◽  
Outpatient Clinic ◽  
Post Traumatic ◽  
One Year

Abstract Background: Post-traumatic headache (PTH) is a common symptom following mild traumatic brain injury (mTBI). Patients at risk to develop acute PTH (aPTH) and further persistent PTH (pPTH) need to be recognized. Methods: This is a one-year follow-up of 127 patients with mTBI, aged 18 to 68, referred to outpatient clinic in the Helsinki University Hospital. Symptoms were assessed at the emergency department (ED), with structured interview at outpatient clinic visit and with Rivermead post-concussion symptom questionnaire at one, three, and 12 months after injury. Psychiatric disorders were assessed with Structured Clinical Interview for DSM-IV Axis I disorders at 3-4 months and return to work (RTW) from patient records. Results: At one month, 77/127 patients (61%) had aPTH. According to multiple logistic regression analysis, risk factors for aPTH were headache at the emergency department (ED) (OR 5.43), other pain (OR 3.19), insomnia (OR 3.23), and vertigo (OR 5.98). At three months, 17 patients (22% of aPTH patients) had developed pPTH, and at one year, 4 patients (24% of pPTH patients) still presented with pPTH. Risk factors for pPTH at three months were older age (OR 1.06) and current insomnia (OR 12.3). The frequency of psychiatric disorders did not differ between the groups. pPTH patients performed worse on their RTW. Conclusions: Risk factors for aPTH were insomnia, headache at ED, other pain, and vertigo and for pPTH, insomnia and older age. RTW rate was lower among pPTH patients.

scholarly journals Acute Subdural Hematoma after Isolated Traumatic Brain Injury: Risk Factors and Prediction of Mortality

2015 ◽  
Vol 25 (2) ◽  
pp. 36-40
Author(s):  
Dalia Adukauskienė ◽  
Asta Mačiulienė ◽  
Aušra Čiginskienė ◽  
Agnė Adukauskaitė ◽  
Justina Čyžiūtė
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Blood Cell ◽  
Cell Count ◽  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Blood Cell Count ◽  
Lethal Outcome ◽  
Pupil Reaction

The aim of this study was to determine mortality and it‘s risk factors also prediction of lethal outcome in case of acute subdural hematoma after isolated traumatic brain injury (ITBI). Methods. A retrospective study of 162 patients after ITBI was carried out in Neurosurgical Intensive Care Unit (NITS) of Lithuanian University of Health Sciences Hospital (LUHSH) Kaunas Clinics (KC). Demographic (gender, age), clinical (pupil reaction to light, Glasgow Coma Scale (GCS) score, APACHE II scale score) and laboratory (white blood cell count, glycemia) data analysis on the first day after the injury was made. Conclusions. The mortality rate of acute subdural hematoma after isolated traumatic brain injury was 41 pct. Risk factors of mortality were estimated to be patient age ≥ 65 yrs, absence of pupil reaction to light, GCS 3-8, APACHE II score ≥ 16 points, white blood cell count ≥10,1 x 109/l and glycemia ≥5,6mmol/l. It was estimated the evident relation between predicted lethal outcome and real mortality when the risk of lethal outcome was higher than 25 pct.

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