scholarly journals The Utility of Thromboelastography for Predicting the Risk of Post-Traumatic Cerebral Infarction in Traumatic Brain Injury

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hao Chen ◽  
Hengli Tian
Keyword(s):  
Cerebral Infarction ◽  
Head Trauma ◽  
Multivariate Logistic Regression Analysis ◽  
Secondary Insult ◽  
Increased Risk ◽  
Post Traumatic ◽  
Independent Risk Factors ◽  
Gcs Score ◽  
Admission Glasgow Coma Scale ◽  
Traumatic Coagulopathy

Abstract INTRODUCTION Post-traumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if post-traumatic coagulopathy determined using thrombelastography was associated with cerebral infarction after head trauma. METHODS We prospectively reviewed 316 patients with head trauma to evaluate the effects of demographics, admission Glasgow Coma Scale (GCS) score, and TEG data on the development of PTCI. Multivariate logistic regression analysis was used to identify independent risk factors. RESULTS Patients with PTCI had a shorter R, greater a-Angle, and shorter K, indicating faster clotting. Additionally, TEG results were independently associated with an increased risk of PTCI. CONCLUSION TEG demonstrates that many PTCI patients are hypercoaguable and the risk of developing PTCI may be higher in patients with a shorter R, greater a-Angle, and shorter K.

scholarly journals The Influence of Hemocoagulation Disorders on the Development of Posttraumatic Cerebral Infarction and Outcome in Patients with Moderate or Severe Head Trauma

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Hao Chen ◽  
Li-Xia Xue ◽  
Yan Guo ◽  
Shi-Wen Chen ◽  
Gan Wang ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Head Trauma ◽  
Severe Head Trauma ◽  
Secondary Insult ◽  
Increased Risk ◽  
Associated Risk Factors ◽  
Gcs Score ◽  
Posttraumatic Cerebral Infarction ◽  
Admission Glasgow Coma Scale ◽  
D Dimer

Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if posttraumatic hemocoagulation disorders were associated with cerebral infarction, and evaluate their influence on outcome among patients with moderate or severe head trauma. In this study, PTCI was observed in 28 (10.57%) of the 265 patients within the first week after injury. In multivariate analysis, the thrombocytopenia (odds ratio (OR) 2.210, 95% confidence interval (CI) 1.065–4.674), abnormal prothrombin time (PT) (OR 3.241, 95% CI 1.090–7.648), D-dimer (>2 mg/L) (OR 7.260, 95% CI 1.822–28.076), or disseminated intravascular coagulation (DIC) scores (≥5) (OR 4.717, 95% CI 1.778–12.517) were each independently associated with an increased risk of PTCI. Admission Glasgow Coma Scale (GCS) score, abnormal activated partial thromboplastin time (APTT) and fibrinogen, and D-dimer (>2 mg/L) and DIC scores (≥5) showed an independent predictive effect on poor outcome. In conclusion, recognition of this important treatable cause of PTCI and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

scholarly journals Maternal risk factors associated with preterm birth after IVF/ICSI

2021 ◽  
Author(s):  
Jian Li ◽  
Jinhua Shen ◽  
Xiaoli Zhang ◽  
Yangqin Peng ◽  
Qin Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Placenta Previa ◽  
Multiple Pregnancy ◽  
Multivariate Logistic Regression Analysis ◽  
Maternal Risk ◽  
Increased Risk ◽  
Gestational Week ◽  
Independent Risk Factors ◽  
Early Preterm Birth

Abstract In vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).is associated with an increased risk of preterm (33rd - 37th gestational week), and early preterm birth (20th - 32nd gestational week). The underlying general and procedure related risk factors are not well understood so far. 4,328 infertile women undergoing IVF/ICSI were entered into this study. The study population was divided into three groups: a) early preterm birth group (n=66), b) preterm birth group (n=675 ) and c) full-term birth group (n=3653). Odds for preterm birth were calculated by stepwise multivariate logistic regression analysis. We identified seven independent risk factors for preterm birth and four independent risk factors for early preterm birth. Older (>39) or younger (<25) maternal age (OR:1.504, 95%CI: 1.108-2.042,P=0.009; OR: 2.125, 95%CI: 1.049-4.304,P=0.036, respectively), multiple pregnancy (OR: 9.780, 95%CI: 8.014-11.935,P<0.001; OR: 8.588, 95%CI: 4.866-15.157,P<0.001, respectively), placenta previa (OR: 14.954, 95%CI: 8.053-27.767,P<0.001; OR: 16.479, 95%CI: 4.381-61.976,P<0.001, respectively), and embryo reduction (OR: 3.547, 95%CI: 1.736-7.249,P=0.001; OR: 7.145, 95%CI: 1.990-25.663,P=0.003, respectively) were associated with preterm birth and early preterm birth, whereas gestational hypertension (OR: 2.494, 95%CI: 1.770-3.514,P<0.001), elevated triglycerides (OR: 1.120, 95%CI: 1.011-1.240,P=0.030) and shorter activated partial thromboplastin time (OR: 0.967, 95%CI: 0.949-0.985,P<0.001) were associated only with preterm birth. In conclusion, preterm and early preterm birth risk factors in patients undergoing assisted IVF/ICSI are in general similar to those in natural pregnancy. The lack of some associations in the early preterm group was most likely due to the lower number of early preterm birth cases. Only embryo reduction represents an IVF/ICSI specific risk factor.

scholarly journals Post-traumatic seizures and antiepileptic therapy as predictors of the functional outcome in patients with traumatic brain injury

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Valeria Pingue ◽  
Chiara Mele ◽  
Antonio Nardone
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Negative Impact ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Prophylactic Therapy ◽  
Rehabilitation Outcome ◽  
Increased Risk ◽  
Post Traumatic ◽  
Gcs Score

AbstractPost-traumatic seizures (PTS) are a common and debilitating complication of traumatic brain injury (TBI) and could have a harmful impact on the progress of patient rehabilitation. To assess the effect of PTS and relative therapy on outcome in the initial phase after TBI, during the rehabilitation process when neuroplasticity is at its highest, we retrospectively examined the clinical data of 341 adult patients undergoing rehabilitation for at least 6 months post-TBI in our neurorehabilitation unit between 2008 and 2019. We correlated through logistic regression the occurrence of seizures and use of anti-seizure medication (ASM) with neurological and functional outcomes, respectively assessed with the Glasgow Coma Scale (GCS) and the Functional Independence Measure (FIM). PTS were documented in 19.4% of patients: early PTS (EPTS) in 7.0%; late PTS (LPTS) in 9.4%; both types in 3.0%. Patients who developed EPTS had an increased risk of developing LPTS (OR = 3.90, CI 95% 1.58–9.63, p = 0.003). Patients with LPTS had a significantly higher risk of worse neurological (p < 0.0001) and rehabilitation (p < 0.05) outcome. Overall, 38.7% of patients underwent therapy with ASM; prophylactic therapy was prescribed in 24.0% of patients, of whom 14.6% subsequently developed seizures. Mortality was associated with a lower FIM and GCS score on admission but not significantly with PTS. The use of ASM was associated with a worse rehabilitation outcome, independently of the onset of epilepsy during treatment. LPTS appear to exert a negative impact on rehabilitation outcome and their occurrence is not reduced by prophylactic therapy, whereas EPTS do not influence outcome. Our findings caution against the generic use of prophylactic therapy to prevent post-traumatic epilepsy in patients with TBI.

scholarly journals Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis

2020 ◽  
Author(s):  
Julia K. Böhm ◽  
◽  
Helge Güting ◽  
Sophie Thorn ◽  
Nadine Schäfer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Antiplatelet Therapy ◽  
Post Injury ◽  
Coagulation Profile ◽  
Trauma Induced Coagulopathy ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
The Impact ◽  
Admission Glasgow Coma Scale

Abstract Background Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood. Methods This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis. Results Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to − 6, hypothermia and hypotension increased risk significantly. Conclusion Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management.

scholarly journals Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty

2020 ◽  
Author(s):  
Eiji Kijima ◽  
Tomohiro Thomas Kayama ◽  
Mitsuru Saito ◽  
Daisaburo Kurosaka ◽  
Ryo Ikeda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Operative Management ◽  
Total Knee Arthroplasties ◽  
Increased Risk ◽  
Total Knee ◽  
Sedative Hypnotics ◽  
Independent Risk Factors

Abstract Background: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, intra-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%. Conclusion: Patients with a pre-operative Hb level of <11.1 g/dL or those using sedative-hypnotics have an increased risk for post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.

scholarly journals The SNPs rs429358 and rs7412 of APOE gene are Association With Dyslipidemia but Not Cerebral Infarction in Northern Chinese Han population

2021 ◽  
Author(s):  
Dongyun GOU ◽  
Sha HE ◽  
Mengwei Yuan ◽  
Ziqian LIU ◽  
Yanyong WANG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Infarction ◽  
Chinese Han Population ◽  
Chinese Han ◽  
Han Population ◽  
Increased Risk ◽  
Northern Chinese ◽  
Ε4 Allele ◽  
Independent Risk Factors ◽  
E4 Allele

Abstract BackgroundTo analyze the relationship between apolipoprotein E(APOE) (including the SNPs rs429358 and rs7412) gene and cerebral infarction(CI) in Northern Chinese Han population.Methods457 CI patients and 416 controls (without CI) in Chinese Han population were recruited for our study to test the SNPs by polymerase chain reaction (PCR)-fluorescence probe technique.ResultsThe distribution of APOE genotypes were in Hardy-Weinberg equilibrium, and the frequencies of ɛ4 allele orɛ4 containing were significantdifference between CI and control groups. Compared to ε2 or ε3 carriers, ε4 carriers had a high level of total cholesterol (TC) and low-density lipoprotein cholesterol(LDL-C) and high presenceof dyslipidemia in recruited peoples. And we found APOE ε4 allele was associated with an increased risk of dyslipidemia in the control and CI groups (OR = 2.232, 95% CI= 1.143-4.361, P<0.000; OR = 3.442, 95% CI= 1.885-6.284, P=0.019). However, further logistic regression showed that ɛ4 allele or carriers were not the independent risk factors of CI (OR = 2.232, 95% CI= 1.143-4.361, P=0.144; OR = 3.442, 95% CI= 1.885-6.284, P=0.162).ConclusionAPOE ε4 allele was associated with an increased risk of dyslipidemia (OR = 2.232, 95% CI= 1.143-4.361; OR = 3.442, 95% CI= 1.885-6.284), but ɛ4 allele or carriers were not the independent risk factors of CI in Northern Chinese Han population (OR = 2.232, 95% CI= 1.143-4.361, P=0.144; OR = 3.442, 95% CI= 1.885-6.284, P=0.162).

scholarly journals Hydrocephalus associated with childhood nonaccidental head trauma

2016 ◽  
Vol 41 (5) ◽  
pp. E8 ◽  
Author(s):  
Sudhakar Vadivelu ◽  
Harold L. Rekate ◽  
Debra Esernio-Jenssen ◽  
Mark A. Mittler ◽  
Steven J. Schneider
Keyword(s):  
Ischemic Stroke ◽  
Head Trauma ◽  
Ct Scans ◽  
Injury Score ◽  
Ventricular Dilation ◽  
Discharge Outcomes ◽  
Evans Index ◽  
Gcs Score ◽  
The Relationship ◽  
Admission Glasgow Coma Scale

OBJECTIVE The incidence of posttraumatic ventriculomegaly (PTV) and shunt-dependent hydrocephalus after nonaccidental head trauma (NAHT) is unknown. In the present study, the authors assessed the timing of PTV development, the relationship between PTV and decompressive craniectomy (DC), and whether PTV necessitated placement of a permanent shunt. Also, NAHT/PTV cases were categorized into a temporal profile of delay in admission and evaluated for association with outcomes at discharge. METHODS The authors retrospectively reviewed the cases of patients diagnosed with NAHT throughout a 10-year period. Cases in which sequential CT scans had been obtained (n = 28) were evaluated for Evans' index to determine the earliest time ventricular dilation was observed. Discharge outcomes were assessed using the King's Outcome Scale for Childhood Head Injury score. RESULTS Thirty-nine percent (11 of 28) of the patients developed PTV. A low admission Glasgow Coma Scale (GCS) score predicted early PTV presentation (within < 3 days) versus a high GCS score (> 1 week). A majority of PTV/NAHT patients presented with a subdural hematoma (both convexity and interhemispheric) and ischemic stroke, but subarachnoid hemorrhage was significantly associated with PTV/NAHT (p = 0.011). Of 6 patients undergoing a DC for intractable intracranial pressure, 4 (67%) developed PTV (p = 0.0366). These patients tended to present with lower GCS scores and develop ventriculomegaly early. Only 2 patients developed hydrocephalus requiring shunt placement. CONCLUSIONS PTV presents early after NAHT, particularly after a DC has been performed. However, the authors found that only a few PTV/NAHT patients developed shunt-dependent hydrocephalus.

scholarly journals Paternal and maternal long-term psychological outcomes after uterine artery embolization for severe post-partum hemorrhage

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maude Bernasconi ◽  
Béatrice Eggel-Hort ◽  
Antje Horsch ◽  
Yvan Vial ◽  
Alban Denys ◽  
...  
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Uterine Artery Embolization ◽  
Stress Disorder ◽  
Post Partum ◽  
Post Traumatic Stress ◽  
Artery Embolization ◽  
Increased Risk ◽  
Post Traumatic

AbstractThis study intend to compare the long-term psychological impact (depression, post-traumatic stress disorder) on both partners between patients that underwent uterine artery embolization (UAE) for post-partum hemorrhage (PPH) and uneventful deliveries. Women who experienced severe PPH treated by UAE in our institution between 2003 and 2013 were identified in our obstetrical database. These cases were matched to controls with uneventful deliveries. Matching criteria were maternal age, parity, ethnicity, year of delivery, birthweight, gestational age and mode of delivery. Patients and their partners completed validated questionnaires measuring post-traumatic stress (TSQ), as well as depression symptoms (MINI). A total of 63 cases of PPH and 189 matched controls (1:3) participated in a study exploring gynecological and obstetrical outcomes. With a mean of 8 years post-index delivery, patients after PPH showed increased risk of depression (p = 0.015) and post-traumatic stress disorder (22.2% versus 4.8%, p < 0.005) compared to controls. PPH remains strongly associated with post-traumatic stress disorder, even after adjustment for depression (adjusted odds ratio 5.1; 95% confidence intervals 1.5–17.5). Similarly, partners of patients with PPH showed a propensity to depression (p = 0.029) and post-traumatic stress disorder (11.5% versus 1.5%, p = 0.019). In conclusion, both women and their partners are at increased risk of long-term psychological adverse outcomes after PPH. Couples may benefit from psychological support.

scholarly journals Early and Late Postoperative Seizures in Meningioma Patients and Prediction by a Recent Scoring System

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 450
Author(s):  
Peter Baumgarten ◽  
Mana Sarlak ◽  
Daniel Monden ◽  
Andrea Spyrantis ◽  
Simon Bernatz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Tumor Volume ◽  
Total Risk ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Temporal Location ◽  
Meningioma Surgery ◽  
Impaired Quality

Seizures are among the most common symptoms of meningioma. This retrospective study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified STAMPE2 score. In 556 patients who underwent meningioma surgery, we correlated different risk factors with the occurrence of postoperative seizures. A modified STAMPE2 score was applied. Risk factors for preoperative seizures were edema (p = 0.039) and temporal location (p = 0.038). For postoperative seizures preoperative tumor size (p < 0.001), sensomotory deficit (p = 0.004) and sphenoid wing location (p = 0.032) were independent risk factors. In terms of postoperative status epilepticus; sphenoid wing location (p = 0.022), tumor volume (p = 0.045) and preoperative seizures (p < 0.001) were independent risk factors. Postoperative seizures lead to a KPS deterioration and thus an impaired quality of life (p < 0.001). Late seizures occurred in 43% of patients with postoperative seizures. The small sub-cohort of patients (2.7%) with a STAMPE2 score of more than six points had a significantly increased risk for seizures (p < 0.001, total risk 70%). We concluded that besides distinct risk factors, high scores of the modified STAMPE2 score could estimate the risk of postoperative seizures. However, it seems not transferable to our cohort

scholarly journals Exploring the impact of COVID-19 and restrictions to daily living as a result of social distancing within veterans with pre-existing mental health difficulties

2020 ◽  
pp. bmjmilitary-2020-001622 ◽  
Author(s):  
Dominic Murphy ◽  
C Williamson ◽  
J Baumann ◽  
W Busuttil ◽  
N T Fear
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
Mental Health Difficulties ◽  
Post Traumatic ◽  
The Impact

IntroductionData are emerging showing the adverse consequences on mental health of the general public due to the COVID-19 pandemic. Little is known about the needs of veterans with pre-existing mental health difficulties during the COVID-19 pandemic.MethodsData were collected through a cross-sectional online survey from a randomly selected sample (n=1092) of military veterans who have sought help for mental health difficulties from a veteran-specific UK-based charity. The response rate was 25.2% (n=275). Participants were asked to complete a range of standardised mental health outcomes (post-traumatic stress disorder (PTSD): Post-traumatic Stress Disorder Checklist, common mental health difficulties (CMDs): 12-Item General Health Questionnaire, difficulties with anger: 5-Item Dimensions of Anger Reactions—Revised and alcohol misuse: Alcohol Use Disorders Identification Test) and endorse a list of potential stressors related to changes to daily life resulting from COVID-19. Regression analyses were fitted to explore predictors of mental health severity.ResultsIt was observed that symptoms of common mental disorder and PTSD (69.3% and 65.0%, respectively) were the most commonly reported to have been exacerbated by the pandemic. Lack of social support and reporting increasing numbers of stressors related to COVID-19 were consistently associated with increasing severity of a range of mental health difficulties.ConclusionsOur findings suggest veterans who had pre-existing mental health difficulties prior to the outbreak of COVID-19 may be at increased risk of experiencing CMDs as a result of the pandemic. Intervening to improve levels of social support and offering practical guidance to better manage any additional stressors relating to the pandemic may provide strategies to help reduce the burden of mental health symptoms.

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