P17 Evaluation of new orleans criteria for cranial CT scan in mild traumatic brain injury at an emergency trauma unit of a developing country

ObjectivesTo assess compliance to New Orleans Criteria for cranial CT scan and its predictive value for intracranial pathology in mild TBI.DesignA retrospective review.SubjectsAll patients with mild traumatic brain injury presenting at the emergency unit of a National Trauma Centre of a Developing Country over 24 months.MethodsPatients information were retrieved from medical record and entered into SPSS spreadsheet. The New Orleans Criteria (NOC) was used to determine indications for brain CT scan. Compliance to the criteria was determined. The CT scan findings were evaluated in all patients that had scan and the findings were compared between those met NOC and those who did not.ResultsOne-hundred and eighteen patients were studied. Majority were males 92 (82%) with mean age of 27 year. Most injuries (66.9%) resulted from road traffic crashes. Among 65 (55.1%) patients who met NOC only 41 (63.1%) had CT scan while 25 (47.2%) patients who did not had CT giving a compliance rate of 58.5%. Twenty three (56.1%) patients who met NOC had abnormal CT compared to 9 (36%) patients that did not. The most common abnormal CT findings in both groups were skull vault fractures (9 for NOC group and 2 for non NOC group) only two patients had surgical intervention and both met NOC criteria.ConclusionsThe compliance for NOC guideline was below average in our Centre. NOC guideline is useful in predicting abnormal CT findings. There is a need for continuous education of emergency physicians to ensure optimal CT scan utilisation in mild TBI.

Download Full-text

A comparison of Canadian Head CT rule and New Orleans criteria in mild TBI (Traumatic Brain Injury) patients in a Tertiary Hospital in Karachi, Pakistan.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.11.3496 ◽

2020 ◽

Vol 27 (10) ◽

pp. 2030-2035

Author(s):

Ramesh Kumar ◽

Qazi Muhammad Zeeshan ◽

Shiraz Ahmed Ghori ◽

Atiq Ahmed Khan ◽

Asim Rehmani ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Multivariate Analysis ◽

Brain Injury ◽

New Orleans ◽

Care Facility ◽

P Value ◽

Mild Tbi ◽

Head Ct ◽

Ct Findings ◽

Specificity And Sensitivity

Objectives: The aim of our study is to compare the Canadian Head CT rule to New Orleans Criteria, to find a more efficient guideline in predicting the important CT findings in mild Traumatic Brain Injury (TBI) cases. Study Design: Observational study. Setting: Tertiary Health Care Facility in Karachi, Pakistan. Period: 6 months from June 2017 to December 2017. Material & Methods: We divided a sample of 150 mild TBI patients into two groups of Glasgow coma scale (GCS) scores of 13-14 and GCS score of 15. Then using a separate scoring system for both the CCHR and NOC, we evaluated their accuracy and efficiency in predicting mild TBI through a total of 7 major clinical items. Specificity and sensitivity were calculated to compare both the scoring systems and results were compared through univariate and multivariate analysis. A p value of less than 0.05 was considered to be statistically significant. Results: We analyzed the relation between clinical items and important CT findings and found that the CCHR, through multivariate analysis, was more closely associated with important CT findings. We also found that the factors of age, and the Glasgow comma scale score were also strong indicators of important CT findings regardless of which guideline was used. Conclusion: In our study, we found CCHR to be a stronger predictor of important CT findings than the NOC. We found that CCHR performed significantly higher than the NOC.

Download Full-text

What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000717 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000717

Author(s):

Panu Teeratakulpisarn ◽

Phati Angkasith ◽

Thanakorn Wannakul ◽

Parichat Tanmit ◽

Supatcha Prasertcharoensuk ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

High Risk ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Skull Fracture ◽

Brain Ct ◽

Baseline Characteristics ◽

Gcs Score ◽

The Brain

BackgroundAlthough there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.MethodsThis was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.ResultsThere were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.DiscussionOpen skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.Level of evidenceIII.

Download Full-text

Neurosurgical intervention in patients with mild traumatic brain injury and its effect on neurological outcomes

Journal of Neurosurgery ◽

10.3171/2015.4.jns142440 ◽

2016 ◽

Vol 124 (2) ◽

pp. 538-545 ◽

Cited By ~ 11

Author(s):

Kevin James Tierney ◽

Natasha V. Nayak ◽

Charles J. Prestigiacomo ◽

Ziad C. Sifri

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Nonoperative Management ◽

Intervention Group ◽

Clinical Predictors ◽

Neurological Outcomes ◽

Cranial Ct ◽

Delayed Intervention ◽

Neurosurgical Intervention

OBJECT The object of this study was to determine the mortality and neurological outcome of patients with mild traumatic brain injury (mTBI) who require neurosurgical intervention (NSI), identify clinical predictors of a poor outcome, and investigate the effect of failed nonoperative management and delayed NSI on outcome. METHODS A cross-sectional study of 10 years was performed, capturing all adults with mTBI and NSI. Primary outcome variables were mortality and Glasgow Outcome Scale (GOS) score. Patients were divided into an immediate intervention group, which received an NSI after the initial cranial CT scan, and a delayed intervention group, which had failed nonoperative management and received an NSI after 2 or more cranial CT scans. RESULTS The mortality rate in mTBI patients requiring NSI was 13%, and the mean GOS score was 3.6 ± 1.2. An age > 60 years was independently predictive of a worse outcome, and epidural hematoma was independently predictive of a good outcome. Logistic regression analysis using independent variables was calculated to create a model for predicting poor neurological outcomes in patients with mTBI undergoing NSI and had 74.1% accuracy. Patients in the delayed intervention group had worse mortality (25% vs 9%) and worse mean GOS scores (2.9 ± 1.3 vs 3.7 ± 1.2) than those in the immediate intervention group. CONCLUSIONS Data in this study demonstrate that patients with mTBI requiring NSI have higher mortality rates and worse neurological outcomes and should therefore be classified separately from mTBI patients not requiring NSI. Additionally, mTBI patients requiring NSI after the failure of nonoperative management have worse outcomes than those receiving immediate intervention and should be considered separately.

Download Full-text

Evaluating mild traumatic brain injury management at a regional emergency department

Injury Prevention ◽

10.1136/injuryprev-2018-042865 ◽

2018 ◽

Vol 24 (5) ◽

pp. 390-394

Author(s):

Ashlee Maree Brown ◽

Dara M Twomey ◽

Anna Wong Shee

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Best Practice ◽

Medical Service ◽

Regional Health ◽

Diagnosis Codes ◽

Retrospective Audit ◽

Concussive Injury

BackgroundEmergency departments (EDs) are usually the first point of contact, and often the only medical service available, for patients with mild traumatic brain injury (mTBI) in rural and regional areas. Clinical practice guidelines (CPGs) have been created to ensure best practice management of mTBI in EDs. Adherence to mTBI CPGs has rarely been evaluated in rural and regional areas.AimThe aim of this paper was to assess a regional health service’s adherence to their mTBI CPG.MethodsThis was a 12-month retrospective audit of 1280 ED records of patients ≥16 years presenting with mTBI to a regional Australian ED. Case selection used the Victorian Admitted Episodes Dataset codes for suspected head injury: principal diagnosis codes (S00-T98), concussive injury recorded in diagnosis codes (S06.00-S06.05) and unintentional external cause code (V00-X59). The data were collected to determine 4-hour observation rates, CT scan rates, safe discharge and appropriate referral documentation.ResultsFewer people received a CT scan than qualified (n=245, 65.3%), only 45% had 4-hour observations recorded, safe discharge was documented in 74.1% of cases and 33% received educational resources.Discussion/conclusionSeveral key elements for the management of mTBI were under-recorded, particularly 4-hour observations, safe discharge and education. Acquired brain injury clinic referrals were received in overwhelmingly fewer cases than had a CT scan (n=19, 6.3%). Overall, this study suggests that the regional health service does not currently fully adhere to the CPG and that the referral services are potentially underutilised.

Download Full-text

Neutrophil to lymphocyte ratio as a predictive biomarker for computed tomography scan use in mild traumatic brain injury

Biomarkers in Medicine ◽

10.2217/bmm-2020-0150 ◽

2020 ◽

Vol 14 (12) ◽

pp. 1085-1090

Author(s):

George A Alexiou ◽

Georgios D Lianos ◽

Aggeliki Tzima ◽

Athanasios Sotiropoulos ◽

Anastasios Nasios ◽

...

Keyword(s):

Computed Tomography ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Characteristic Curve ◽

Predictive Biomarker ◽

Health Concern ◽

Mild Tbi ◽

Ct Findings ◽

The Mean

Aim: Traumatic brain injury (TBI) is a serious health concern. We set out to investigate the role of neutrophil-to-lymphocytes ratio (NLR) at admission for predicting the need for computed tomography (CT) in mild-TBI. Materials & methods: A retrospective study of adult patients who presented with mild-TBI Results: One hundred and thirty patients met the inclusion criteria. Seventy-four patients had positive CT-findings. The mean NLR-levels at presentations were 5.6 ± 4.8. Patients with positive CT-findings had significant higher NLR-levels. Receiver operating characteristic curve analysis was conducted and the threshold of NLR-levels for detecting the cases with positive CT-findings was 2.5, with 78.1% sensitivity and 63% specificity Conclusion: To the best of our knowledge no previous study has assessed the value of NLR-levels for predicting the need for CT in mild-TBI.

Download Full-text

Preinjury Psychological Factors and Case Formulation in Mild Traumatic Brain Injury Rehabilitation: A Case Report

Rehabilitation Counseling Bulletin ◽

10.1177/0034355219878500 ◽

2019 ◽

Vol 63 (3) ◽

pp. 156-167 ◽

Cited By ~ 1

Author(s):

Joanne E. Taylor ◽

Renée F. Seebeck

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Psychological Factors ◽

Illustrative Case ◽

Case Formulation ◽

Treatment Team ◽

Mild Tbi ◽

Case Examples ◽

Rehabilitation Professionals

Mild traumatic brain injury (TBI) accounts for the majority of TBIs. Most cases recover within 3 months and usual medical advice covers physical and cognitive rest, activity and fatigue management, and education. However, in some cases, symptoms can persist and there may be ongoing postconcussion difficulties. It is well established that pre- and postinjury psychological factors can contribute to cases of persistent postconcussion symptoms. However, there are few illustrative case examples in the published literature on mild TBI. This case example demonstrates the pivotal role that preinjury psychological factors can play in recovery from mild TBI, using an example of a 35-year-old woman with persistent mild TBI symptoms who had a limited response to previous brief treatment through a Concussion Clinic. Through the process of assessment and development of a psychological case formulation, preinjury psychological factors that had been barriers to recovery and prior rehabilitation efforts were identified. Rehabilitation counselors are equipped to (1) identify and address such barriers, (2) communicate this information to other rehabilitation professionals in the treatment team to facilitate a shared understanding of how factors might affect the client’s functioning and (3) contribute to team case formulation.

Download Full-text

Coping Strategies as a Predictor of Post-concussive Symptoms in Children with Mild Traumatic Brain Injury versus Mild Orthopedic Injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617710001700 ◽

2011 ◽

Vol 17 (2) ◽

pp. 317-326 ◽

Cited By ~ 34

Author(s):

Stacey E. Woodrome ◽

Keith Owen Yeates ◽

H. Gerry Taylor ◽

Jerome Rusin ◽

Barbara Bangert ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Coping Strategies ◽

Mild Traumatic Brain Injury ◽

Group Differences ◽

Post Injury ◽

Mild Tbi ◽

Orthopedic Injury ◽

Children's Coping ◽

Over Time

AbstractThis study examined whether children's coping strategies are related to post-concussive symptoms following mild traumatic brain injury (TBI) versus orthopedic injury (OI). Participants were 8- to 15-year-old children with mild TBI (n = 167) or OI (n = 84). They rated their current preferred coping strategies and post-injury symptoms at 2 weeks (baseline) and 1, 3, and 12 months post-injury. Children's reported use of coping strategies did not vary significantly over time, so their baseline coping ratings were examined as predictors of post-concussive symptoms across time. Self-ratings of symptoms were positively related to emotion-focused strategies and negatively related to problem-focused engagement after both mild TBI and OI. Higher problem-focused disengagement predicted larger group differences in children's ratings of symptoms, suggesting that problem-focused disengagement moderates the effects of mild TBI. Coping strategies collectively accounted for approximately 10–15% of the variance in children's post-concussive symptoms over time. The findings suggest that coping may play an important role in accounting for children's perceptions of post-concussive symptoms after mild TBI. (JINS, 2011, 17, 317–326)

Download Full-text

Patients with mild traumatic brain injury: Immediate and long-term outcome compared to intra-cranial injuries on CT scan

Brain Injury ◽

10.1080/02699050600832569 ◽

2006 ◽

Vol 20 (11) ◽

pp. 1131-1137 ◽

Cited By ~ 31

Author(s):

Charlotte Sadowski-Cron ◽

Jörg Schneider ◽

Pascal Senn ◽

Bogdan P. Radanov ◽

Pietro Ballinari ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Term Outcome ◽

Long Term Outcome

Download Full-text

The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study

The Journal of Headache and Pain ◽

10.1186/s10194-020-01207-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Kelly M. Naugle ◽

Christopher Carey ◽

Eric Evans ◽

Jonathan Saxe ◽

Ryan Overman ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Pain Catastrophizing ◽

Pain Modulation ◽

Conditioned Pain Modulation ◽

Mild Tbi ◽

Inhibitory Capacity ◽

Pressure Pain Thresholds ◽

Post Traumatic

Abstract Background Post-traumatic headache (PTH) is one of the most common and long-lasting symptoms following mild traumatic brain injury (TBI). However, the pathological mechanisms underlying the development of persistent PTH remain poorly understood. The primary purpose of this prospective pilot study was to evaluate whether early pain modulatory profiles (sensitization and endogenous pain inhibitory capacity) and psychological factors after mild TBI predict the development of persistent PTH in mild TBI patients. Methods Adult mild TBI patients recruited from Level I Emergency Department Trauma Centers completed study sessions at 1–2 weeks, 1-month, and 4-months post mild TBI. Participants completed the following outcome measures during each session: conditioned pain modulation to measure endogenous pain inhibitory capacity, temporal summation of pain and pressure pain thresholds of the head to measure sensitization of the head, Pain Catastrophizing Scale, Center for Epidemiological Studies – Depression Scale, and a standardized headache survey. Participants were classified into persistent PTH (PPTH) and no-PPTH groups based on the 4-month data. Results The results revealed that mild TBI patients developing persistent PTH exhibited significantly diminished pain inhibitory capacity, and greater depression and pain catastrophizing following injury compared to those who do not develop persistent PTH. Furthermore, logistic regression indicated that headache pain intensity at 1–2 weeks and pain inhibitory capacity on the conditioned pain modulation test at 1–2 weeks predicted persistent PTH classification at 4 months post injury. Conclusions Overall, the results suggested that persistent PTH is characterized by dysfunctional alterations in endogenous pain modulatory function and psychological processes in the early stages following mild TBI, which likely exacerbate risk for the maintenance of PTH.

Download Full-text