Pre-Hospital Whole Blood Resuscitation Reduces Fluid Requirement While Maintaining Critical Physiology in a Model of Penetrating Traumatic Brain Injury and Hemorrhage

Traumatic brain injury remains a leading cause of death and disability worldwide. Patients with severe traumatic brain injury are best treated with a multidisciplinary, evidence-based, protocol-directed approach, which has been shown to decrease mortality and improve functional outcomes. Therapy is directed at the prevention of secondary brain injury through optimizing cerebral blood flow and the delivery of metabolic fuel (ie, oxygen and glucose). This is accomplished through the measurement and treatment of elevated intracranial pressure (ICP), the strict avoidance of hypotension and hypoxemia, and in some instances, surgical management. The treatment of elevated ICP is approached in a protocolized, tiered manner, with escalation of care occurring in the setting of refractory intracranial hypertension, culminating in either decompressive surgery or barbiturate coma. With such an approach, the rates of mortality secondary to traumatic brain injury are declining despite an increasing incidence of traumatic brain injury. This review contains 3 figures, 5 tables and 69 reference Key Words: blast traumatic brain injury, brain oxygenation, cerebral perfusion pressure, decompressive craniectomy, hyperosmolar therapy, intracranial pressure, neurocritical care, penetrating traumatic brain injury, severe traumatic brain injury

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Characterization of a Novel Rat Model of Penetrating Traumatic Brain Injury

Journal of Neurotrauma ◽

10.1089/neu.2011.2182 ◽

2012 ◽

Vol 29 (6) ◽

pp. 1219-1232 ◽

Cited By ~ 34

Author(s):

Stefan Plantman ◽

Kian Chye Ng ◽

Jia Lu ◽

Johan Davidsson ◽

Mårten Risling

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Rat Model ◽

Penetrating Traumatic Brain Injury

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Prognostic performance of computerized tomography scoring systems in civilian penetrating traumatic brain injury: an observational study

Acta Neurochirurgica ◽

10.1007/s00701-019-04074-1 ◽

2019 ◽

Vol 161 (12) ◽

pp. 2467-2478 ◽

Cited By ~ 1

Author(s):

Matias Lindfors ◽

Caroline Lindblad ◽

David W. Nelson ◽

Bo-Michael Bellander ◽

Jari Siironen ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Computerized Tomography ◽

Outcome Prediction ◽

Unfavorable Outcome ◽

Receiver Operating Curve ◽

Excellent Performance ◽

Head Ct ◽

Severity Scores ◽

Penetrating Traumatic Brain Injury

Abstract Background The prognosis of penetrating traumatic brain injury (pTBI) is poor yet highly variable. Current computerized tomography (CT) severity scores are commonly not used for pTBI prognostication but may provide important clinical information in these cohorts. Methods All consecutive pTBI patients from two large neurotrauma databases (Helsinki 1999–2015, Stockholm 2005–2014) were included. Outcome measures were 6-month mortality and unfavorable outcome (Glasgow Outcome Scale 1–3). Admission head CT scans were assessed according to the following: Marshall CT classification, Rotterdam CT score, Stockholm CT score, and Helsinki CT score. The discrimination (area under the receiver operating curve, AUC) and explanatory variance (pseudo-R2) of the CT scores were assessed individually and in addition to a base model including age, motor response, and pupil responsiveness. Results Altogether, 75 patients were included. Overall 6-month mortality and unfavorable outcome were 45% and 61% for all patients, and 31% and 51% for actively treated patients. The CT scores’ AUCs and pseudo-R2s varied between 0.77–0.90 and 0.35–0.60 for mortality prediction and between 0.85–0.89 and 0.50–0.57 for unfavorable outcome prediction. The base model showed excellent performance for mortality (AUC 0.94, pseudo-R2 0.71) and unfavorable outcome (AUC 0.89, pseudo-R2 0.53) prediction. None of the CT scores increased the base model’s AUC (p > 0.05) yet increased its pseudo-R2 (0.09–0.15) for unfavorable outcome prediction. Conclusion Existing head CT scores demonstrate good-to-excellent performance in 6-month outcome prediction in pTBI patients. However, they do not add independent information to known outcome predictors, indicating that a unique score capturing the intracranial severity in pTBI may be warranted.

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