scholarly journals Prognostic Value of Leucocytosis in Paediatric Traumatic Brain Injury

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Soumya Mukherjee ◽  
Gnanamurthy Sivakumar ◽  
John Goodden ◽  
Atul Tyagi ◽  
P D Chumas
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Prognostic Value ◽  
Leucocyte Count ◽  
Prediction Models ◽  
Cerebral Performance Category ◽  
Length Of Hospital Stay ◽  
Mass Effect ◽  
Ct Findings

Abstract INTRODUCTION Prognostic factors in paediatric traumatic brain injury (TBI) remain unclear. This study assessed the prognostic value of leucocytosis in paediatric isolated TBI METHODS A total of 106 paediatric isolated TBI patients treated at our institution between June 2008 and June 2016 were retrospectively analysed. Data collected included initial blood leucocyte count (WCC), presenting Glasgow Coma Score (GCS), computed tomography (CT), hospital stay, and Paediatric Cerebral Performance Category Scale (PCPCS), and their relationship with WCC were statistically evaluated. RESULTS A total of 39, 37, and 30 patients had severe, moderate, and mild TBI, respectively. For patients with GCS 3-8, 9-13, and 14-15, WCC was 20, 15.9, and 10.7 × 109/L, respectively. Differences in WCC were significant between the different GCS groups (P < .01). WCC was greatest and smallest in patients with CT findings demonstrating significant mass effect (Marshall grading V-VI) and minimal mass effect (Marshall grading I-II), respectively (P < .05). Length of hospital stay and extent of midline shift on CT each significantly correlated with WCC (P < .05). In addition, higher WCC counts were associated with a poorer 6-mo PCPCS rating (P < .05). Multivariate regression analysis revealed a cut-off leucocyte count of 16.1 × 109/L, and Neutrophil-to-Lymphocyte ratio (NLR) of 5.2, above which GCS, CT findings, length of hospital stay and PCPCS were less favourable. Application of the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT) adult TBI prediction model to our paediatric cohort, using area under the operating curve (AUROC) and coefficient analyses, demonstrated increased accuracy with incorporation of WCC count as a risk factor. CONCLUSION High leucocyte count (>16.1 × 109/L) and NLR > 5.2 each have a predictive value for poor GCS, severe CT findings, lengthy hospital stay and poor PCPCS in isolated paediatric TBI. Incorporating initial leucocyte count into TBI prediction models may increase the accuracy of prognostication.

FP2-1 Prognostic value of leucocytosis in paediatric traumatic brain injury

2019 ◽  
Vol 90 (3) ◽  
pp. e25.3-e24
Author(s):  
S Mukherjee ◽  
G Sivakumar ◽  
J Goodden ◽  
A Tyagi ◽  
P Chumas
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Prognostic Value ◽  
Prediction Models ◽  
Cerebral Performance Category ◽  
Length Of Hospital Stay ◽  
Multivariate Regression Analysis ◽  
Computed Tomographic ◽  
Ct Findings

ObjectivesWe assessed leucocytosis and evaluated its prognostic value in isolated paediatric traumatic brain injury (TBI).DesignRetrospective analysis.Subjects106 consecutive paediatric patients with isolated TBI admitted between June 2008 and June 2016.MethodsInitial blood leucocyte count (WCC), Glasgow Coma Score (GCS), computed tomographic (CT) findings, duration of hospital stay, and Paediatric Cerebral Performance Category Scale (PCPCS) scores were analysed.ResultsMean age was 4.2 years. For patients with GCS 3–8, 9–13 and 14–15, WCC was 20, 15.9 and 10.7 × 109/L respectively. Differences in WCC were significant between the different GCS groups (p<0.01). Length of hospital stay, extent of midline shift on CT and poor 6 month PCPCS rating were each significantly correlated with WCC (p<0.05). Multivariate regression analysis revealed a cut-off WCC of 16.1 × 109/L, above which GCS, CT findings, length of hospital stay and PCPCS were less favourable. Application of the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT) adult TBI prediction model to our paediatric cohort, using area under the operating curve (AUROC) and coefficient analyses, demonstrated increased accuracy with incorporation of WCC as a risk factor.ConclusionsHigh initial leucocytosis (>16.1×109/L) is predictive for poor GCS, severe CT findings, lengthy hospital stay and poor PCPCS in isolated paediatric TBI. Incorporating WCC into TBI prediction models may increase the accuracy of prognostication.

scholarly journals The incidence and effect of coagulopathy on short-term outcomes in patients undergoing craniotomy following traumatic brain injury

2017 ◽  
Vol 04 (02) ◽  
pp. 085-090
Author(s):  
Sonia Bansal ◽  
Rohini Surve ◽  
Madhusudhan Rao ◽  
Bhadri Narayan ◽  
Mariamma Philip ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Platelet Count ◽  
Brain Injury ◽  
Blood Loss ◽  
Hospital Stay ◽  
Point Of Care ◽  
Length Of Hospital Stay ◽  
Liver Function Tests ◽  
Intraoperative Blood Loss ◽  
Gcs Score

Abstract Background: Coagulopathy in isolated traumatic brain injury (TBI) is well-known, and studies have found an association between coagulopathy and unfavourable outcomes. This study was conducted to determine the incidence and causes of coagulopathy in patients with TBI undergoing craniotomy and its effect on post-operative outcome. Materials and Methods: The data collected was demographics, computed tomography diagnosis, post-resuscitation Glasgow Coma Scale (GCS) score, pre- and post-operative platelet count, liver function tests, intraoperative blood loss and transfusion, fluids infused and incidence of redo surgery. Point of care (Coaguchek XS) monitor was used to obtain prothrombin time and international normalised ratio (INR) at 24 h and 72 h of injury. Coagulopathy was defined as INR ≥1.3 and thrombocytopenia as platelet count ≤100,000/mcL. Outcome measures assessed were the length of hospital stay, GCS at discharge and in-hospital mortality. Results: In 166 patients, the average pre-operative GCS was 8.8 ± 3.6. The incidence of coagulopathy was 42.8% and increased to 55.6% on the 3rd day, and thrombocytopenia from 3.5% in the first 24 h increased to 14.7% at 72 h. Patients with coagulopathy had lower pre-operative admission GCS (median 7 vs. 9, P = 0.03), greater intraoperative blood loss and received more intravenous fluids. There was no difference in the incidence of post-operative haematomas, length of hospital stay and GCS at discharge or mortality. Conclusion: In patients with TBI, the incidence of coagulopathy increased at the end of 72 h. In this study, there was no difference in outcomes in patients who underwent craniotomy with deranged coagulation.

Transfusions and long-term functional outcomes in traumatic brain injury

2010 ◽  
Vol 113 (3) ◽  
pp. 539-546 ◽  
Author(s):  
Matthew A. Warner ◽  
Terence O'Keeffe ◽  
Premal Bhavsar ◽  
Rashmi Shringer ◽  
Carol Moore ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Glucose Level ◽  
Functional Outcomes ◽  
Length Of Hospital Stay ◽  
Number Of Patients ◽  
Transfusion Volume ◽  
Gcs Score

Object In this paper, the authors' goal was to examine the relationship between transfusion and long-term functional outcomes in moderately anemic patients (lowest hematocrit [HCT] level 21–30%) with traumatic brain injury (TBI). While evidence suggests that transfusions are associated with poor hospital outcomes, no study has examined transfusions and long-term functional outcomes in this population. The preferred transfusion threshold remains controversial. Methods The authors performed a retrospective review of patients who were admitted with TBI between September 2005 and November 2007, extracting data such as HCT level, status of red blood cell transfusion, admission Glasgow Coma Scale (GCS) score, serum glucose, and length of hospital stay. Outcome measures assessed at 6 months were Glasgow Outcome Scale-Extended score, Functional Status Examination score, and patient death. A multivariate generalized linear model controlling for confounding variables was used to assess the association between transfusion and outcome. Results During the study period, 292 patients were identified, and 139 (47.6%) met the criteria for moderate anemia. Roughly half (54.7%) underwent transfusions. Univariate analyses showed significant correlations between outcome score and patient age, admission GCS score, head Abbreviated Injury Scale score, number of days with an HCT level < 30%, highest glucose level, number of days with a glucose level > 200 mg/dl, length of hospital stay, number of patients receiving a transfusion, and transfusion volume. In multivariate analysis, admission GCS score, receiving a transfusion, and transfusion volume were the only variables associated with outcome (F = 2.458, p = 0.007; F = 11.694, p = 0.001; and F = 1.991, p = 0.020, respectively). There was no association between transfusion and death. Conclusions Transfusions may contribute to poor long-term functional outcomes in anemic patients with TBI. Transfusion strategies should be aimed at patients with symptomatic anemia or physiological compromise, and transfusion volume should be minimized.

Prognostic value of leukocytosis in pediatric traumatic brain injury

2020 ◽  
pp. 1-11
Author(s):  
Soumya Mukherjee ◽  
Gnanamurthy Sivakumar ◽  
John R. Goodden ◽  
Atul K. Tyagi ◽  
Paul D. Chumas
Keyword(s):  
Traumatic Brain Injury ◽  
Risk Factor ◽  
Brain Injury ◽  
Hospital Stay ◽  
Neutrophil Count ◽  
Prognostic Value ◽  
Independent Risk Factor ◽  
Leukocyte Count ◽  
Poor Outcome ◽  
Gcs Score

OBJECTIVEThe purpose of this study was to assess leukocytosis and its prognostic value in pediatric isolated traumatic brain injury (TBI).METHODSTwo hundred one children with isolated TBI admitted to the authors’ institution between June 2006 and June 2018 were prospectively followed and their data retrospectively analyzed. Initial blood leukocyte count (i.e., white cell count [WCC]), Glasgow Coma Scale (GCS) score, CT scans, duration of hospital stay, and Pediatric Cerebral Performance Category Scale (PCPCS) scores were analyzed.RESULTSThe mean age was 4.2 years (range 0.2–16 years). Seventy-four, 70, and 57 patients had severe (GCS score 3–8), moderate (GCS score 9–13), and mild (GCS score 14–15) TBI, respectively, with associated WCC of 20, 15.9, and 10.7 × 109/L and neutrophil counts of 15.6, 11.3, and 6.1 × 109/L, respectively (p < 0.01). Higher WCC and neutrophil counts were demonstrated in patients with increased intracranial mass effect on CT, longer hospital stay, and worse 6-month PCPCS score (p < 0.05). Multivariate regression revealed a cutoff leukocyte count of 16.1 × 109/L, neutrophil count of 11.9 × 109/L, and neutrophil-to-lymphocyte ratio (NLR) of 5.2, above which length of hospital stay and PCPCS scores were less favorable. Furthermore, NLR was the second most important independent risk factor for a poor outcome (after GCS score). The IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) adult TBI prediction model applied to this pediatric cohort demonstrated increased accuracy when WCC was incorporated as a risk factor.CONCLUSIONSIn the largest and first prospective study of isolated pediatric head injury to date, the authors have demonstrated that WCC > 16.1 × 109/L, neutrophil count > 11.9 × 109/L and NLR > 5.2 each have predictive value for lengthy hospital stay and poor PCPCS scores, and NLR is an independent risk factor for poor outcome. Incorporating the initial leukocyte count into TBI prediction models may improve prognostication.

scholarly journals Traumatic brain injury from ground level fall in the elderly: a systematic review

2021 ◽  
Author(s):  
Luiz Ricardo Avelino Rodrigues ◽  
Ana Elisa Chves de Vasconcelos ◽  
Matheus Duarte Rodrigues ◽  
Tobias Mosart Sobrinho ◽  
Wagner Gonçalves Horta
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Ground Level ◽  
The Elderly ◽  
Antiarrhythmic Agents ◽  
Geriatric Population

Background: Traumatic Brain Injury (TBI) is an anatomical or functional injury that affects the skull or brain and other associated structures. When analyzing the occurrence of TBI in the geriatric population, Ground Level Fall (GLF) is the main mechanism of trauma. Objectives: To understand the scenario of TBI from GLF in the elderly, characterizing it, in order to point out associated factors and its consequences. Desing and setting: Systematic review at the University of Pernambuco in Recife city. Methods: This is a systematic review of articles indexed in the MEDLINE/ Pubmed, LILACS, BDENF and BINACIS databases and two other works from Google Scholar in April 2021. Original articles in Portuguese and English that met the objectives of this review and were published in the last ten years (2011-2021) were included. Results: Four articles were included. The mean age of elderly who developed TBI from GLF was around 80 years, with a higher prevalence in females. In ad- dition, it was observed that most victims already had associated comorbidities and medications, such as anticoagulants, antiplatelet agents and antiarrhythmic agents. Patients had an average length of hospital stay from 2 to 7.7 days. Limbs and Face injuries were observed. Conclusions: TBI from GLF in the elderly is frequent and even though the length of hospital stay and deaths related to this trauma were low, physical and psychological consequences are also associated to this injury. Clinical Trial or Systematic Review Registration: 254698, https://www.crd.york. ac.uk/prospero/

A Comparison of Rehabilitation Outcome Measures for Traumatic Brain Injury

2003 ◽  
Vol 23 (1) ◽  
pp. 2-9
Author(s):  
Surya Shah ◽  
Steven J. Muncer
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Rating Scale ◽  
Length Of Hospital Stay ◽  
Predictive Ability ◽  
Coefficient Of Determination ◽  
Effective Measure ◽  
Disability Rating Scale ◽  
Floor Effects

This study evaluates the appropriateness, responsiveness, and predictive ability of the Modified Barthel Index (MBI), the Disability Rating Scale (DRS), the Barry Rehabilitation In-patient Screening of Cognition (BRISC), and the Glasgow Coma Scale (GCS) for 78 patients with traumatic brain injury referred for in-patient rehabilitation. Appropriateness was evaluated by examining means, standard deviations, coefficients of variation, and ceiling and floor effects. Responsiveness was determined by examining paired t-test results for admission and discharge scores, and on the basis of an effect size calculation. Predictive power was evaluated by performing two stepwise regressions with length of rehabilitation and total length of hospital stay. The results suggest that although the DRS and GCS have some advantages, notably in low ceiling and floor effects, overall the MBI is the most effective measure, particularly for prediction, with a moderate coefficient of determination (r2 = 0.42) and no significant differences between predicted and real length of hospital stay.

scholarly journals Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

2018 ◽  
Vol 25 (1) ◽  
pp. 3-8
Author(s):  
Thiago Henrique da Silva ◽  
Thais Massetti ◽  
Talita Dias da Silva ◽  
Laercio da Silva Paiva ◽  
Denise Cardoso Ribeiro Papa ◽  
...  
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Medical Records ◽  
Length Of Hospital Stay ◽  
Public Health Problem ◽  
Prolonged Hospital Stay ◽  
Severe Tbi ◽  
Prolonged Hospital

ABSTRACT Traumatic brain injury (TBI) is a public health problem with high mortality and socioeconomic repercussions. We aimed to investigate the influence of TBI severity on the length of mechanical ventilation (MV) stay and length of hospital stay and on the prevalence of tracheostomy, pneumonia, neurosurgery and death. This retrospective, observational study evaluated medical records of 67 patients with TBI admitted to Irmandade da Santa Casa de Misericórdia de São Paulo. Severity was determined according to the Glasgow Coma Scale (GCS): mild (13-15 points; 36 patients; 53.7%), moderate (9-12 points; 14 patients; 20.9%) or severe (3-8 points; 17 patients; 25.4%). Severe TBI patients had higher prevalence of tracheostomy, pneumonia and neurosurgery. No significant differences were observed between TBI severity, mortality and length of MV stay. However, TBI severity influenced the length of hospital stay. TBI severity at admission, evaluated according to the GCS, influenced the prevalence of tracheostomy, pneumonia, neurosurgery and was associated to prolonged hospital stay.

MANAGEMENT OF MULTIPLE TRAUMATIC INTRACRANIAL HEMATOMAS

2020 ◽  
Vol 3 (1) ◽  
pp. 70-74
Author(s):  
Rustam Hazratkulov ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Surgical Treatment ◽  
Brain Injury ◽  
Hospital Stay ◽  
Treatment Outcomes ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Diagnostic Approach ◽  
Early Activation ◽  
Intracranial Hematomas

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

GCS-Pupil Score Has a Stronger Association with Mortality and Poor Functional Outcome than GCS Alone in Pediatric Severe Traumatic Brain Injury

2021 ◽  
pp. 1-8
Author(s):  
Binod Balakrishnan ◽  
Heather VanDongen-Trimmer ◽  
Irene Kim ◽  
Sheila J. Hanson ◽  
Liyun Zhang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcome ◽  
Cerebral Performance Category ◽  
Regression Tree ◽  
Classification And Regression Tree ◽  
Continuous Variables ◽  
Poor Functional Outcome ◽  
Severity Scores ◽  
Pupil Reactivity

<b><i>Background:</i></b> The Glasgow Coma Scale (GCS), used to classify the severity of traumatic brain injury (TBI), is associated with mortality and functional outcomes. However, GCS can be affected by sedation and neuromuscular blockade. GCS-Pupil (GCS-P) score, calculated as GCS minus Pupil Reactivity Score (PRS), was shown to better predict outcomes in a retrospective cohort of adult TBI patients. We evaluated the applicability of GCS-P to a large retrospective pediatric severe TBI (sTBI) cohort. <b><i>Methods:</i></b> Admissions to pediatric intensive care units in the Virtual Pediatric Systems (VPS, LLC) database from 2010 to 2015 with sTBI were included. We collected GCS, PRS (number of nonreactive pupils), cardiac arrest, abusive head trauma status, illness severity scores, pediatric cerebral performance category (PCPC) score, and mortality. GCS-P was calculated as GCS minus PRS. χ<sup>2</sup> or Fisher’s exact test and Mann-Whitney U test compared categorical and continuous variables, respectively. Classification and regression tree analysis identified thresholds of GCS-P and GCS along with other independent factors which were further examined using multivariable regression analysis to identify factors independently associated with mortality and unfavorable PCPC at PICU discharge. <b><i>Results:</i></b> Among the 2,682 patients included in the study, mortality was 23%, increasing from 4.7% for PRS = 0 to 80% for PRS = 2. GCS-P identified more severely injured patients with GCS-P scores 1 and 2 who had worse outcomes. GCS-P ≤ 2 had higher odds for mortality, OR = 68.4 (95% CI = 50.6–92.4) and unfavorable PCPC, OR = 17.3 (8.1, 37.0) compared to GCS ≤ 5. GCS-P ≤ 2 also had higher specificity and positive predictive value for both mortality and unfavorable PCPC compared to GCS ≤ 5. <b><i>Conclusions:</i></b> GCS-P, by incorporating pupil reactivity to GCS scoring, is more strongly associated with mortality and poor functional outcome at PICU discharge in children with sTBI.

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