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 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.

POSTTRAUMATIC CEREBRAL INFARCTION IN PATIENTS WITH MODERATE OR SEVERE HEAD TRAUMA

Neurology ◽  
2007 ◽  
Vol 68 (24) ◽  
pp. 2160-2160 ◽  
Author(s):  
R. K. Menon ◽  
J. W. Norris ◽  
N. Latronico ◽  
R. Marino ◽  
L. Pinelli ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Head Trauma ◽  
Severe Head Trauma ◽  
Posttraumatic Cerebral Infarction

Posttraumatic cerebral infarction in patients with moderate or severe head trauma

Neurology ◽  
2006 ◽  
Vol 67 (7) ◽  
pp. 1165-1171 ◽  
Author(s):  
R. Marino ◽  
R. Gasparotti ◽  
L. Pinelli ◽  
D. Manzoni ◽  
P. Gritti ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Head Trauma ◽  
Severe Head Trauma ◽  
Posttraumatic Cerebral Infarction

Risk factors for posttraumatic cerebral infarction in patients with moderate or severe head trauma

2008 ◽  
Vol 31 (4) ◽  
pp. 431-437 ◽  
Author(s):  
Heng-Li Tian ◽  
Zhi Geng ◽  
Yu-Hui Cui ◽  
Jin Hu ◽  
Tao Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Infarction ◽  
Head Trauma ◽  
Severe Head Trauma ◽  
Posttraumatic Cerebral Infarction

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.

X-linked Adrenoleukodystrophy: Severe Head Trauma Masked Diagnosis—A Case Report

2014 ◽  
Vol 45 (S 01) ◽  
Author(s):  
E. Haber ◽  
M. Brunner-Krainz ◽  
W. Erwa ◽  
U. Gruber-Sedlmeyer ◽  
A. Schwerin-Nagel ◽  
...  
Keyword(s):  
Case Report ◽  
Head Trauma ◽  
Severe Head Trauma

scholarly journals 243 Jugular Bulb Metabolic Data within First 12-Hours After Severe Head Trauma

1993 ◽  
Vol 8 (S3) ◽  
pp. S128-S129
Author(s):  
C.S De Deyne ◽  
J.M Decruyenaere ◽  
J.I Poelaert ◽  
F.A Colardyn
Keyword(s):  
Head Trauma ◽  
Jugular Bulb ◽  
Severe Head Trauma ◽  
Metabolic Data

Client-Centered Emergency Care

1981 ◽  
Vol 2 (6) ◽  
pp. 1-4
Author(s):  
Jennifer MacPherson
Keyword(s):  
Emergency Room ◽  
Head Trauma ◽  
Emergency Care ◽  
Severe Head Trauma ◽  
Best Interest ◽  
Motorcycle Accident ◽  
Florence Nightingale ◽  
Centered Care ◽  
Patient Emergency

Since Florence Nightingale, nurses have agreed that care should be individualized for each patient. Emergency care is no different and texts on this subject instruct the nurse to involve the client in his own care and to recognize that being an emergency victim is physically and psychologically difficult for the client. But just what is client-centered emergency care and are clients getting it?A client is brought to the emergency room, unconscious, with severe head trauma resulting from a motorcycle accident. In this instance client-centered care consists of the nurse reacting swiftly and probably unemotionally. It is not in the client's best interest at this time for the nurse to try to ascertain that person's values and life views. Here client-centered care is compatible with the values and views of both the nurse and the institution.

scholarly journals 368. Clinical Characteristics of Hospitalized COVID-19 American Indian Patients in Rural Arizona

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S253-S254
Author(s):  
Amy Nham ◽  
Ryan M Close
Keyword(s):  
American Indians ◽  
Median Number ◽  
Clinic Visit ◽  
Contact Tracing ◽  
Shortness Of Breath ◽  
Early Referral ◽  
Increased Risk ◽  
Wbc Count ◽  
The Impact ◽  
D Dimer

Abstract Background American Indians have an increased risk of serious complications from COVID-19 due to the high prevalence of comorbidities such as diabetes, heart disease, obesity, and asthma. To date, there has been limited analysis of COVID-19 in the AI population. This study describes the characteristics of hospitalized COVID-19 patients from a well-defined AI population in eastern Arizona. Additionally, we explored the impact of early referral via contact tracing versus those who self-presented. Methods Retrospective chart reviews were completed for patients hospitalized for COVID from March 29 to May 16, 2020. Summary statistics were used to describe demographics, symptoms, pre-existing conditions, and hospitalization data. Results We observed 447 laboratory-confirmed cases of COVID-19, resulting in 71 (15.9%) hospitalizations over a 7-week period and a hospitalization rate of 159 per 1,000 persons. Of the 50 hospitalizations reviewed sequentially, 56% were female, median age of 55 (IQR 44–65). Median number of days hospitalized was 4 (2–6), with 16% requiring intensive care unit support, 15% intubated, 12% readmitted, and 10% deceased. 67% had an epidemiological link, and 32% had an emergency department or outpatient clinic visit within 7 days of hospitalization. All patients were symptomatic; the most common symptoms were cough (90%), shortness of breath (78%), and subjective fever (66%). 86% of patients had a pre-existing condition; the most common pre-existing conditions were diabetes (66%), obesity (58%), and hypertension (52%, Figure 1). All patients had elevated LDH, 94% had elevated CRP, 86% had elevated d-dimer, and 40% had lymphopenia; only 10% had an elevated WBC count and 26% had thrombocytopenia (Table 1). 26% of the patients were referred in by the tracing team (Table 2). Analysis of 500 hospitalizations will be available in October 2020. Conclusion Most AI patients hospitalized had a pre-existing condition, symptoms of cough or shortness of breath, and elevated LDH, CRP, and d-dimer. More research is needed to understand the patterns of COVID-19 related disease in vulnerable populations, like AI/AN, and to examine the utility of early referral by contact tracing teams in rural settings which may guide future tracing strategies. Disclosures All Authors: No reported disclosures

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