The Impact of Substance Abuse on Mortality in Patients With Severe Traumatic Brain Injury

2008 ◽  
Vol 65 (3) ◽  
pp. 674-677 ◽  
Author(s):  
Kristine OʼPhelan ◽  
David L. McArthur ◽  
Cherylee W. J. Chang ◽  
Deborah Green ◽  
David A. Hovda
Keyword(s):  
Traumatic Brain Injury ◽  
Substance Abuse ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
The Impact

scholarly journals Sugar or salt (“SOS”): A protocol for a UK multicentre randomised trial of mannitol and hypertonic saline in severe traumatic brain injury and intracranial hypertension

2020 ◽  
pp. 175114372090169
Author(s):  
MJ Rowland ◽  
T Veenith ◽  
C Scomparin ◽  
MH Wilson ◽  
PJ Hutchinson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cost Effectiveness ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Severe Traumatic Brain Injury ◽  
Randomised Trial ◽  
Pragmatic Trial ◽  
Open Label ◽  
The Impact

Hyperosmolar solutions are widely used to treat raised intracranial pressure following severe traumatic brain injury. Although mannitol has historically been the most frequently administered, hypertonic saline solutions are increasingly being used. However, definitive evidence regarding their comparative effectiveness is lacking. The Sugar or Salt Trial is a UK randomised, allocation concealed open label multicentre pragmatic trial designed to determine the clinical and cost-effectiveness of hypertonic saline compared with mannitol in the management of patients with severe traumatic brain injury. Patients requiring intensive care unit admission and intracranial pressure monitoring post-traumatic brain injury will be allocated at random to receive equi-osmolar boluses of either mannitol or hypertonic saline following failure of routine first-line measures to control intracranial pressure. The primary outcome for the study will be the Extended Glasgow Outcome Scale assessed at six months after randomisation. Results will inform current clinical practice in the routine use of hyperosmolar therapy as well as assess the impact of potential side effects. Pre-planned longer term clinical and cost effectiveness analyses will further inform the use of these treatments.

scholarly journals Evaluating the impact of cycle helmet use on severe traumatic brain injury and death in a national cohort of over 11000 pedal cyclists: a retrospective study from the NHS England Trauma Audit and Research Network dataset

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027845 ◽  
Author(s):  
Nick Dodds ◽  
Rowena Johnson ◽  
Benjamin Walton ◽  
Omar Bouamra ◽  
David Yates ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Research Network ◽  
Lower Limb Injury ◽  
Helmet Use ◽  
Mortality And Morbidity ◽  
National Cohort ◽  
The Uk ◽  
The Impact

ObjectivesIn the last 10 years there has been a significant increase in cycle traffic in the UK, with an associated increase in the overall number of cycling injuries. Despite this, and the significant media, political and public health debate into this issue, there remains an absence of studies from the UK assessing the impact of helmet use on rates of serious injury presenting to the National Health Service (NHS) in cyclists.SettingThe NHS England Trauma Audit and Research Network (TARN) Database was interrogated to identify all adult (≥16 years) patients presenting to hospital with cycling-related major injuries, during a period from 14 March 2012 to 30 September 2017 (the last date for which a validated dataset was available).Participants11 192 patients met inclusion criteria. Data on the use of cycling helmets were available in 6621 patients.Outcome measuresTARN injury descriptors were used to compare patterns of injury, care and mortality in helmeted versus non-helmeted cohorts.ResultsData on cycle helmet use were available for 6621 of the 11 192 cycle-related injuries entered onto the TARN Database in the 66 months of this study (93 excluded as not pedal cyclists). There was a significantly higher crude 30-day mortality in un-helmeted cyclists 5.6% (4.8%–6.6%) versus helmeted cyclists 1.8% (1.4%–2.2%) (p<0.001). Cycle helmet use was also associated with a reduction in severe traumatic brain injury (TBI) 19.1% (780, 18.0%–20.4%) versus 47.6% (1211, 45.6%–49.5%) (p<0.001), intensive care unit requirement 19.6% (797, 18.4%–20.8%) versus 27.1% (691, 25.4%–28.9%) (p<0.001) and neurosurgical intervention 2.5% (103, 2.1%–3.1%) versus 8.5% (217, 7.5%–9.7%) (p<0.001). There was a statistically significant increase in chest, spinal, upper and lower limb injury in the helmeted group in comparison to the un-helmeted group (all p<0.001), though in a subsequent analysis of these anatomical injury patterns, those cyclists wearing helmets were still found to have lower rates of TBI. In reviewing TARN injury codes for specific TBI and facial injuries, there was a highly significant decrease in rates of impact injury between cyclists wearing helmets and those not.ConclusionsThis study suggests that there is a significant correlation between use of cycle helmets and reduction in adjusted mortality and morbidity associated with TBI and facial injury.

The impact of early flow and brain oxygen crisis on the outcome of patients with severe traumatic brain injury

2014 ◽  
Vol 208 (6) ◽  
pp. 1071-1077 ◽  
Author(s):  
Corrado P. Marini ◽  
Christy Stoller ◽  
Omar Shah ◽  
Antoni Policastro ◽  
Gary Lombardo ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Brain Oxygen ◽  
The Impact

The Impact of Hyperglycemia in Patients with Severe Traumatic Brain Injury

2010 ◽  
Vol 6 (1) ◽  
pp. 23
Author(s):  
Geon Ho Lee ◽  
Byeong Cheol Rim ◽  
Kyung Soo Min ◽  
Mou Seop Lee ◽  
Young Gyu Kim ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
The Impact

scholarly journals 5 Years Mortality of Severe Traumatic Brain Injury during the Establishment of Closed System Neurocritical Care Unit in a Resource Constrained Developing Country

2020 ◽  
Vol 24 (1) ◽  
Author(s):  
SYED SHAHZAD HUSSAIN ◽  
USMAN AHAMD KAMBOH ◽  
ASIF RAZA ◽  
HUSNAIN RAZA ◽  
RABIA RAZZAQ ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Closed System ◽  
Neurocritical Care ◽  
Patient Centered ◽  
Severe Tbi ◽  
A Prospective Study ◽  
Age Range ◽  
The Impact

Background & Objectives: Severe traumatic brain injury is one of the leading causes of mortality and morbidity.Efficient management of severe traumatic brain injury demands a specialty driven focused intensive care. We developed our model of closed ICU driven by Neurosurgical Neurointensivist and the corollary to thiscommitment is a TBI patient centered Neurocritical care with the capacity and capability to deal with most of the neurological illnesses.Materials & Methods: A prospective study was conducted to find out the impact of the establishment of closed system of neurocritical care on 5 year mortality of severe TBI. Total 1288 patients met the inclusion criteria, which were enrolled. Tabulation was done for gender, age range, Glasgow outcome scale and mortality.Results: It was observed that mortality reduced from 47% to 35% over a span of five years. The most common age range was 30-40 years, which is the most productive group of any population. Bed sore incidence is always on rise in any ICU. After the implementation of SOPs based management and increase in nursing staff theincidence of bedsore also showed a detrimental pattern from 35 % to 19%.Conclusion: Neurocritical care unit is proven to be an integral part of any neurosurgical unit and this closed system of NCC unit provide best SOP based care with significant reduction in mortality of patients with STBI.

How We Die: The Impact of Nonneurologic Organ Dysfunction after Severe Traumatic Brain Injury

2008 ◽  
Vol 74 (9) ◽  
pp. 866-872 ◽  
Author(s):  
Clinton D. Kemp ◽  
J. Chad Johnson ◽  
William P. Riordan ◽  
Bryan A. Cotton
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Organ Dysfunction ◽  
Severe Traumatic Brain Injury ◽  
Contributing Factors ◽  
Injury Score ◽  
Respiratory Dysfunction ◽  
Severe Tbi ◽  
The Impact ◽  
Abbreviated Injury Score

Although nonneurologic organ dysfunction (NNOD) has been shown to significantly affect mortality in subarachnoid hemorrhage, the contribution of NNOD to mortality after severe traumatic brain injury (TBI) has yet to be defined. We hypothesized that NNOD has a significant impact on mortality after severe TBI. The trauma registry was queried for all patients admitted between January 2004 and December 2004 who died during their initial hospitalization after severe TBI (head Abbreviated Injury Score 3 or greater). Cause of death and contributing factors to mortality were determined by an attending trauma surgeon from the medical record. The data were analyzed using both Fisher's exact and Wilcoxon rank sum. One hundred thirty-five patients met inclusion criteria. Sixty-seven per cent were males, 83 per cent were white, and the mean age was 38.5 years. Mean length of stay was 2.9 days. Fifty-four patients (40%) had isolated TBI (chest Abbreviated Injury Score = 0, abdominal Abbreviated Injury Score = 0). Of the 81 deaths attributed to a single cause, 48 (60%) patients died from nonsurvivable TBI or brain death, whereas 33 (40%) died of a nonneurologic cause. Cardiovascular and respiratory dysfunction (excluding pneumonia) contributed to mortality in 51.1 per cent and 34.1 per cent of patients, respectively. NNOD contributes to approximately two-thirds of all deaths after severe TBI. These complications occur early and are seen even among those with isolated head injuries. These findings demonstrate the impact of the extracranial manifestations of severe TBI on overall mortality and highlight potential areas for future intervention and research.

scholarly journals Comparison of strategies for monitoring and treating patients at the early phase of severe traumatic brain injury: the multicentre randomised controlled OXY-TC trial study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e040550
Author(s):  
Jean-Francois Payen ◽  
Marion Richard ◽  
Gilles Francony ◽  
Gérard Audibert ◽  
Emmanuel L Barbier ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Life Assessment ◽  
Secondary Outcome ◽  
Trauma Patients ◽  
Brain Tissue Oxygenation ◽  
Severe Tbi ◽  
Randomised Controlled ◽  
The Impact

IntroductionIntracranial hypertension is considered as an independent risk factor of mortality and neurological disabilities after severe traumatic brain injury (TBI). However, clinical studies have demonstrated that episodes of brain ischaemia/hypoxia are common despite normalisation of intracranial pressure (ICP). This study assesses the impact on neurological outcome of guiding therapeutic strategies based on the monitoring of both brain tissue oxygenation pressure (PbtO2) and ICP during the first 5 days following severe TBI.Methods and analysisMulticentre, open-labelled, randomised controlled superiority trial with two parallel groups in 300 patients with severe TBI. Intracerebral monitoring must be in place within the first 16 hours post-trauma. Patients are randomly assigned to the ICP group or to the ICP + PbtO2 group. The ICP group is managed according to the international guidelines to maintain ICP≤20 mm Hg. The ICP + PbtO2 group is managed to maintain PbtO2 ≥20 mm Hg in addition to the conventional optimisation of ICP. The primary outcome measure is the neurological status at 6 months as assessed using the extended Glasgow Outcome Scale. Secondary outcome measures include quality-of-life assessment, mortality rate, therapeutic intensity and incidence of critical events during the first 5 days. Analysis will be performed according to the intention-to-treat principle and full statistical analysis plan developed prior to database freeze.Ethics and disseminationThis study has been approved by the Institutional Review Board of Sud-Est V (14-CHUG-48) and from the National Agency for Medicines and Health Products Safety (Agence Nationale de Sécurité du Médicament et des produits de santé) (141 435B-31). Results will be presented at scientific meetings and published in peer-reviewed publications.The study was registered with ClinTrials NCT02754063 on 28 April 2016 (pre-results).

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