Degree of Anticoagulation, but Not Warfarin Use Itself, Predicts Adverse Outcomes After Traumatic Brain Injury in Elderly Trauma Patients

Background: In the elderly population, use of antithrombotic therapy (AT), antiplatelets (AP – aspirin, clopidogrel) and/or anticoagulants (AC – warfarin, DoAC – Dabigatran, Rivaroxaban, Apixaban), to prevent thrombo-embolic events must be carefully weighed against the risk of intracranial hemorrhage (ICH) with trauma. We hypothesize that for all patients 65yro+ with head trauma, those on AT will be more likely to sustain a traumatic brain injury, ICH, and poorer outcomes. Methods: Data was collected from all head trauma patients 65yo+ presenting to our tertiary trauma center (level 1) over a 24-month period; age, gender, injury mechanism, medications, International Normalized Ratio, reversal therapy, Glasgow Coma Scale (GCS), ICH, surgery, Extended Glasgow Outcome Scale score (GOSE) and mortality. Results: 1365 patients were identified; 724 on AT (413 AP, 151 AC, 59 DoAC, 48 2AP, 38 AP+AC, 15 AP+DoAC) and 474 not (non-AT). When adjusted for covariates, AT patients were more likely to have ICH (p=0.0004), more invasive surgical interventions (p=0.0188), functional dependency (GOSE≤4; p<0.0001) and mortality (p<0.0001). Risk of mortality is notably high with 2AP (OR 5.74; p=0.0003) and AC+AP (OR 4.12; p=0.0118). Conclusions: Elderly trauma patients on AT, especially combination therapy, have higher risks of ICH and poorer outcomes compared to those who are not.

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Traumatic Brain Injury Caused by Motor Vehicle Collision and Alcoholism in Piauí

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0036-1583935 ◽

2016 ◽

Vol 37 (03) ◽

pp. 174-181

Author(s):

Benjamim Vale ◽

Juçara Castro ◽

Marx Araújo ◽

Herb Morais ◽

Lívio Macêdo

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Motor Vehicle ◽

Care Service ◽

Diffuse Axonal Injury ◽

Total Sample ◽

Motor Vehicle Collision ◽

Alcoholic Beverages ◽

Trauma Patients ◽

Vehicle Collision

Objectives To determine the relationship between alcohol consumption and the incidence of traumatic brain injury (TBI) with diffuse axonal injury (DAI), determining these indices, checking acquired comorbidities and characterizing the patients by gender, age and race/color, as well as describing the characteristics of the motor vehicle collision (vehicle, period of the day, day of the week and site) in people admitted to an emergency hospital in the city of Teresina, in the state of Piauí, Brazil. Methods We have analyzed the data contained in the medical records of patients admitted with a history of motor vehicle collision and severe TBI in intensive care units, based on the forms provided by the Mobile Emergency Care Service (SAMU, in the Portuguese acronym) in the period between February 28 and November 28, 2013. Results In the period covered by the present study, 200 individuals were analyzed, and 54 (27%) had consumed alcohol; of these 11 had DAI. Of the total sample, 17% (34) presented DAI, however, with unknown data regarding the consumption of alcoholic beverages. Conclusion Considering the data, we observed that the profile of the head trauma patients are brown men, mostly (53.5%) aged between 15 and 30 years. The collisions occurred mostly on weekends and at night (55%), and 89.5% of the crashes involved motorcycles.

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Trauma

Congress of Neurological Surgeons Essent ◽

10.1093/med/9780197534342.003.0005 ◽

2020 ◽

pp. 131-170

Keyword(s):

Traumatic Brain Injury ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Brain Injuries ◽

Cervical Spinal Cord ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Cord Injury

This chapter discusses traumatic spinal cord and brain injuries. The first three studies review the background and key findings of the third National Acute Spinal Cord Injury Study (NASCIS) trial, examine the efficacy of the Canadian C-Spine Rule in the evaluation of cervical spine injuries in alert and stable trauma patients; and describe the development of the Thoracolumbar Injury Classification and Severity Score (TLICS) classification system. The next two studies assess the effect of early surgical decompression in patients with traumatic cervical spinal cord injury and delineate the role of secondary brain injury in determining patient outcome in severe traumatic brain injury. The following set of four studies evaluates the efficacy of phenytoin in preventing posttraumatic seizures, as well as the efficacy of intracranial pressure monitoring, induction of hypothermia, and decompressive craniectomy for severe traumatic brain injury. The last study, which is of historical value, identifies predictors of outcome in comatose patients with traumatic acute subdural hematoma.

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The Impact of Accidental Hypothermia on Mortality in Trauma Patients Overall and Patients with Traumatic Brain Injury Specifically: A Systematic Review and Meta-Analysis

World Journal of Surgery ◽

10.1007/s00268-020-05750-5 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4106-4117

Author(s):

David Rösli ◽

Beat Schnüriger ◽

Daniel Candinas ◽

Tobias Haltmeier

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Meta Analysis ◽

Accidental Hypothermia ◽

Trauma Patients ◽

Qualitative Synthesis ◽

Pubmed Database ◽

The Impact

Abstract Background Accidental hypothermia is a known predictor for worse outcomes in trauma patients, but has not been comprehensively assessed in a meta-analysis so far. The aim of this systematic review and meta-analysis was to investigate the impact of accidental hypothermia on mortality in trauma patients overall and patients with traumatic brain injury (TBI) specifically. Methods This is a systematic review and meta-analysis using the Ovid Medline/PubMed database. Scientific articles reporting accidental hypothermia and its impact on outcomes in trauma patients were included in qualitative synthesis. Studies that compared the effect of hypothermia vs. normothermia at hospital admission on in-hospital mortality were included in two meta-analyses on (1) trauma patients overall and (2) patients with TBI specifically. Meta-analysis was performed using a Mantel–Haenszel random-effects model. Results Literature search revealed 264 articles. Of these, 14 studies published 1987–2018 were included in the qualitative synthesis. Seven studies qualified for meta-analysis on trauma patients overall and three studies for meta-analysis on patients with TBI specifically. Accidental hypothermia at admission was associated with significantly higher mortality both in trauma patients overall (OR 5.18 [95% CI 2.61–10.28]) and patients with TBI specifically (OR 2.38 [95% CI 1.53–3.69]). Conclusions In the current meta-analysis, accidental hypothermia was strongly associated with higher in-hospital mortality both in trauma patients overall and patients with TBI specifically. These findings underscore the importance of measures to avoid accidental hypothermia in the prehospital care of trauma patients.

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Early versus Late Tracheostomy: Is There an Outcome Difference?

The American Surgeon ◽

10.1177/000313481908500427 ◽

2019 ◽

Vol 85 (4) ◽

pp. 370-375 ◽

Cited By ~ 7

Author(s):

Adel Elkbuli ◽

Raed Ismail Narvel ◽

Paul J. Spano ◽

Valerie Polcz ◽

Astrid Casin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Glasgow Coma Scale ◽

Primary Outcome ◽

Injury Severity ◽

Future Research ◽

Trauma Patients ◽

Early Tracheostomy ◽

Outcome Difference ◽

The Impact

The effect of timing in patients requiring tracheostomy varies in the literature. The purpose of this study was to evaluate the impact of early tracheostomy on outcomes in trauma patients with and without traumatic brain injury (TBI). This study is a four-year review of trauma patients undergoing tracheostomy. Patients were divided into two groups based on TBI/non-TBI. Each group was divided into three subgroups based on tracheostomy timing: zero to three days, four to seven days, and greater than seven days postadmission. TBI patients were stratified by the Glasgow Coma Scale (GCS), and non-TBI patients were stratified by the Injury Severity Score (ISS). The primary outcome was ventilator-free days (VFDs). Significance was defined as P < 0.05. Two hundred eighty-nine trauma patients met the study criteria: 151 had TBI (55.2%) versus 138 (47.8%) non-TBI. There were no significant differences in demographics within and between groups. In TBI patients, statistically significant increases in VFDs were observed with GCS 13 to 15 for tracheostomies performed in four to seven versus greater than seven days ( P = 0.005). For GCS <8 and 8 to 12, there were significant increases in VFDs for tracheostomies performed at days 1 to 3 and 4 to 7 versus greater than seven days (P << 0.05 for both). For non-TBI tracheostomies, only ISS ≥ 25 with tracheostomies performed at zero to three days versus greater than seven days was associated with improved VFDs. Early tracheostomies in TBI patients were associated with improved VFDs. In trauma patients with no TBI, early tracheostomy was associated with improved VFDs only in patients with ISS ≥ 25. Future research studies should investigate reasons TBI and non-TBI patients may differ.

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Disparate Response to Metoclopramide Therapy for Gastric Feeding Intolerance in Trauma Patients With and Without Traumatic Brain Injury

Journal of Parenteral and Enteral Nutrition ◽

10.1177/0148607109335307 ◽

2009 ◽

Vol 33 (6) ◽

pp. 646-655 ◽

Cited By ~ 49

Author(s):

Roland N. Dickerson ◽

Jennifer N. Mitchell ◽

Laurie M. Morgan ◽

George O. Maish ◽

Martin A. Croce ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Trauma Patients ◽

Feeding Intolerance ◽

Gastric Feeding

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Concomitant Traumatic Brain Injury and Hemorrhagic Shock: Outcomes Using the Spanish Trauma ICU Registry (RETRAUCI)

The American Surgeon ◽

10.1177/0003134820949990 ◽

2020 ◽

pp. 000313482094999

Author(s):

Mario Chico-Fernández ◽

Jesús A. Barea-Mendoza ◽

Jon Pérez-Bárcena ◽

Iker García-Sáez ◽

Manuel Quintana-Díaz ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hemorrhagic Shock ◽

Fresh Frozen Plasma ◽

Categorical Variables ◽

P Value ◽

Trauma Patients ◽

Chi Square ◽

Exact Test ◽

Fresh Frozen

Background To compare the main outcomes of trauma patients with and without traumatic brain injury (TBI), hemorrhagic shock, and the combination of both using data from the Spanish trauma intensive care unit (ICU) registry (RETRAUCI). Methods Patients admitted to the participating ICUs from March 2015 to May 2019 were included in the study. The main outcomes were analyzed according to the presence of TBI, hemorrhagic shock, and/or both. Comparison of groups with quantitative variables was performed using the Kruskal-Wallis test, and differences between groups with categorical variables were compared using the Chi-square test or Fisher’s exact test as appropriate. A P value <.05 was considered significant. Results Overall, 310 patients (3.98%) were presented with TBI and hemorrhagic shock. Patients with TBI and hemorrhagic shock received more red blood cell (RBC) concentrates, fresh frozen plasma (FFP), a higher ratio FFP/RBC, and had a higher incidence of trauma-induced coagulopathy (60%) ( P < .001). These patients had higher mortality ( P < .001). Intracranial hypertension was the leading cause of death (50.4%). Conclusions Concomitant TBI and hemorrhagic shock occur in nearly 4% of trauma ICU patients. These patients required a higher amount of RBC concentrates and FFP and had an increased mortality.

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Drug Repurposing in Neurological Disorders: Implications for Neurotherapy in Traumatic Brain Injury

The Neuroscientist ◽

10.1177/1073858420961078 ◽

2020 ◽

pp. 107385842096107

Author(s):

Zaynab Shakkour ◽

Karl John Habashy ◽

Moussa Berro ◽

Samira Takkoush ◽

Samar Abdelhady ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Drug Administration ◽

Neurological Disorders ◽

De Novo ◽

Food And Drug Administration ◽

Drug Repurposing ◽

Adverse Outcomes ◽

Minimal Risk ◽

Wide Range

Traumatic brain injury (TBI) remains a significant leading cause of death and disability among adults and children globally. To date, there are no Food and Drug Administration–approved drugs that can substantially attenuate the sequelae of TBI. The innumerable challenges faced by the conventional de novo discovery of new pharmacological agents led to the emergence of alternative paradigm, which is drug repurposing. Repurposing of existing drugs with well-characterized mechanisms of action and human safety profiles is believed to be a promising strategy for novel drug use. Compared to the conventional discovery pathways, drug repurposing is less costly, relatively rapid, and poses minimal risk of the adverse outcomes to study on participants. In recent years, drug repurposing has covered a wide range of neurodegenerative diseases and neurological disorders including brain injury. This review highlights the advances in drug repurposing and presents some of the promising candidate drugs for potential TBI treatment along with their possible mechanisms of neuroprotection. Edaravone, glyburide, ceftriaxone, levetiracetam, and progesterone have been selected due to their potential role as putative TBI neurotherapeutic agents. These drugs are Food and Drug Administration–approved for purposes other than brain injuries; however, preclinical and clinical studies have shown their efficacy in ameliorating the various detrimental outcomes of TBI.

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Traumatic brain injury with concomitant injury to the spleen: characteristics and mortality of a high-risk trauma cohort from the TraumaRegister DGU®

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01544-5 ◽

2020 ◽

Author(s):

Marius Marc-Daniel Mader ◽

Rolf Lefering ◽

Manfred Westphal ◽

Marc Maegele ◽

Patrick Czorlich

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Injury Severity ◽

Cohort Analysis ◽

Independent Effect ◽

Trauma Patients ◽

Confounding Factors ◽

Retrospective Cohort Analysis ◽

Effect Of Splenectomy

Abstract Purpose Based on the hypothesis that systemic inflammation contributes to secondary injury after initial traumatic brain injury (TBI), this study aims to describe the effect of splenectomy on mortality in trauma patients with TBI and splenic injury. Methods A retrospective cohort analysis of patients prospectively registered into the TraumaRegister DGU® (TR-DGU) with TBI (AISHead ≥ 3) combined with injury to the spleen (AISSpleen ≥ 1) was conducted. Multivariable logistic regression modeling was performed to adjust for confounding factors and to assess the independent effect of splenectomy on in-hospital mortality. Results The cohort consisted of 1114 patients out of which 328 (29.4%) had undergone early splenectomy. Patients with splenectomy demonstrated a higher Injury Severity Score (median: 34 vs. 44, p < 0.001) and lower Glasgow Coma Scale (median: 9 vs. 7, p = 0.014) upon admission. Splenectomized patients were more frequently hypotensive upon admission (19.8% vs. 38.0%, p < 0.001) and in need for blood transfusion (30.3% vs. 61.0%, p < 0.001). The mortality was 20.7% in the splenectomy group and 10.3% in the remaining cohort. After adjustment for confounding factors, early splenectomy was not found to exert a significant effect on in-hospital mortality (OR 1.29 (0.67–2.50), p = 0.45). Conclusion Trauma patients with TBI and spleen injury undergoing splenectomy demonstrate a more severe injury pattern, more compromised hemodynamic status and higher in-hospital mortality than patients without splenectomy. Adjustment for confounding factors reveals that the splenectomy procedure itself is not independently associated with survival.

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Safety and Efficacy of Erythropoietin in Traumatic Brain Injury Patients: A Pilot Randomized Trial

Critical Care Research and Practice ◽

10.1155/2010/209848 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 20

Author(s):

R. Nirula ◽

R. Diaz-Arrastia ◽

K. Brasel ◽

J. A. Weigelt ◽

K. Waxman

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Trial ◽

Treatment Effect ◽

Neuronal Cell Death ◽

Neuron Specific Enolase ◽

Neuronal Cell ◽

Trauma Patients ◽

Stroke Patients ◽

Rule Out

Background. Erythropoietin (EPO) is a neuroprotective agent utilized in stroke patients. This pilot study represents the first randomized trial of EPO in traumatic brain injury (TBI) patients.Methods. Adult, blunt trauma patients with evidence of TBI were randomized to EPO or placebo within 6 hours of injury. Baseline and daily serum S-100B and Neuron Specific Enolase (NSE) levels were measured.Results. TBI was worse in the EPO (n=11) group compared to placebo patients (n=5). The use of EPO did not impact NSE (P=.89) or S100 B (P=.53) levels compared to placebo.Conclusions. At the dose used, EPO did not reduce neuronal cell death compared to placebo; however, TBI severity was worse in the EPO group while levels of NSE and S100-B were similar to the less injured placebo group making it difficult to rule out a treatment effect. A larger, balanced study is necessary to confirm a potential treatment effect.

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