Thromboelastogram-Guided Resuscitation for Patients with Traumatic Brain Injury on Novel Anticoagulants

2019 ◽  
Vol 85 (8) ◽  
pp. 861-864 ◽  
Author(s):  
Salini Hota ◽  
Matthew Ng ◽  
Dashaunda Hilliard ◽  
Jessica Burgess

Traumatic brain injuries in patients on antithrombotic agents carry significant morbidity. Initial therapy is centered around reversal of these agents. The thromboelastogram (TEG) maps the clotting cascade to guide reversal. A retrospective chart review was conducted for 118 patients presenting with a traumatic brain injury while on antithrombotics. Patients were divided between those who received a TEG on arrival and those who did not. The primary endpoint was overall mortality. Secondary endpoints included blood product utilization, and outcomes associated with specific novel anticoagulants. Mortality in the control group was 20.3 per cent compared with 18.5 per cent in the TEG group ( P = 0.81). For less severe injuries, the control group mortality was 3.8 per cent and the TEG group mortality was 8.7 per cent ( P = 0.64). For more severe injuries, mortality in the control versus TEG groups were 31.6 per cent and 25.8 per cent, respectively ( P = 0.73). Blood product utilization was significantly lower in the TEG group ( P = 0.002). Overall mortality was not significantly different between the groups. However, when stratified by severity of injury, mortality was reduced in the TEG-guided group in severely injured patients. Blood product utilization was significantly reduced with TEG-guided reversal. Trauma centers can improve the utilization of blood products in reversal of antithrombotics with the use of TEG.

2020 ◽  
Vol 4 (32) ◽  
pp. 16-21
Author(s):  
V. Shevaga ◽  
◽  
M. Semchyshyn ◽  
B. Zadorozhna ◽  
A. Zadorozhyi ◽  
...  

Introduction. High proportion of traumatic brain injury in the overall structure of morbidity and injuries of the population as one of the causes of temporary and permanent disability and mortality determines the urgency of the problem. Patients who have undergone traumatic brain injury have a number of pathological disorders, including changes in the micronutrient metabolism of iodine and chromium, and their deficiency or excess, in particular in the case of traumatic brain injury may be the trigger for a number of pathological reactions and will require appropriate correction. The aim of the study. To investigate the iodine and chromium content in the blood serum of victims outside the conflict zone and in the fighters of the joint forces organization (JFO) with traumatic brain injuries in the acute and intermediate periods, and to find out their features depending on the severity of the injury and the time from its occurrence. Materials and methods. Method of atomic-absorption of new spectrophotometry determined the content of iodine and chromium in the serum of the blood of 283 patients outside the conflict zone and 218 fighters of JFO with mild and moderate traumatic brain injury in the acute and intermediate periods (1-2, 3-5, 7-10, 14-21 days, after 1 and 3 months after injury). The control group consisted of 20 healthy individuals. Statistical analysis was performed using the program «Statistica 6.0». Results. The content of serum iodine in the blood in the victims outside the conflict zone in the presence of concussion, contusion of mild and moderate severity in the acute and intermediate periods did not differ from that of the control group (p-value more than 0.05). In the group of fighters of JFO, the content of iodine in serum of the blood compared with the indicator in the control group significantly decreased in the presence of concussion and contusion of moderate severity at 14-21 day, 1 month after brain injury (p-value less than 0.05), and for contusion of mild severity was significantly lower by 7-10, 14-21 days, 1 and 3 months after brain injury (p-value less than 0.05). No significant changes of the iodine content in the blood serum were found in victims outside the conflict zone between the periods of the study in the presence of concussion and contusion of mild severity, and contusion of mild severity and contusion moderate severity, except for its significant reduction by 3-5 days (p-value less than 0.05), and in the presence of concussion and contusion of moderate severity significant reduction of the iodine content in the blood serum was detected for 1-2, 3-5 and 7-10 days (p-value less than 0.05). In fighters of JFO no significant differences of iodine content in the blood serum were observed between the periods of the study with concussion and contusion of mild severity (p-value more than 0.05), concussion and contusion of moderate severity (p-value more than 0.05), contusion of mild severity and contusion of moderate severity (p-value more than 0.05). Comparison of identical groups of victims outside the conflict zone and fighters JFO, established the probability of differences between the study periods in all surveyed groups, both in the acute and in the intermediate periods in the presence of concussion (p-value less than 0.05), contusion of mild severity (p < 0.05), contusion of moderate severity (p-value less than 0.05). The content of chromium in the blood serum of victims outside the conflict zone and in fighters of JFO at all degrees of severity of traumatic brain injury and during the entire observation period was insignificantly reduced both in terms of indicators in the control group and between periods of the study (p-value more than 0.05). Significant differences in the content of chromium in serum of the blood in the groups of victims outside the conflict zone between the study periods were noted on 1-2, 3-5, 7-10, 14-21 days, 1 and 3 months after brain injury in the presence of concussion and contusion of mild severity (p-value less than 0.05), concussion and contusion of moderate severity (p-value less than 0.05), contusion of mild severity and contusion of moderate severity (p-value less than 0.05), and in the groups of fighters of JFO, the significant difference in serum of the blood of content chromium was detected in the presence of concussion and contusion of mild severity only for 3-5 days (p-value less than 0.05), and with concussion and contusion of moderate severity, as well as contusion of mild severity and contusion of moderate severity significant differences were observed during the entire study period (p-value less than 0.05). Comparison of identical groups of victims outside the conflict zone and fighters of JFO did not establish the probability of differences between the study periods in the presence of concussion (p-value more than 0.05), but in cases of contusion of mild severity (p-value less than 0.05), as well as in the presence of contusion of moderate severity (p-value less than 0.05), the probability of differences was on 1-2, 3-5, 7-10, 14-21 days, 1 and 3 months after brain injury. Conclusions. The changes of the iodine and chromium content in the blood serum of fighters of joint forces organization are more pronounced both during the study periods and depending on the severity of the injury, compared with the victims outside the conflict zone.


2016 ◽  
Vol 59 (4) ◽  
pp. 759-771 ◽  
Author(s):  
Sarah E. Key-DeLyria

PurposeSentence processing can be affected following a traumatic brain injury (TBI) due to linguistic or cognitive deficits. Language-related event-related potentials (ERPs), particularly the P600, have not been described in individuals with TBI history.MethodFour young adults with a history of closed head injury participated. Two had severe injuries, and 2 had mild–moderate injuries more than 24 months prior to testing. ERPs were recorded while participants read sentences designed to be grammatically correct or incorrect. Participants also completed cognitive and sentence comprehension measures.ResultsOne participant with TBI was significantly different than the control group on several behavioral sentence measures and 1 cognitive measure. However, none of the participants with TBI had a reliable P600 effect. Nonparametric bootstrapping indicated that the ERP was reliable in 10 control participants but no participants with TBI history.ConclusionsThere were few behavioral differences between individuals with TBI history and the control group, though all reported subjective difficulty with reading. The P600 was absent in the TBI group in this study. Given the heterogeneity of individuals with TBI and the difficulty in assessing subtle language impairments, exploring the P600 further may provide useful insight into language processing difficulties.


Vestnik ◽  
2021 ◽  
pp. 276-280
Author(s):  
М.Ж. Мирзабаев ◽  
Е.К. Дюсембеков ◽  
Е.С. Макежанов

Проведено исследование клинического течения очаговых травм головного мозга у больных пожилого и старческого возраста. Проведен анализ лечения больных в возрасте 60-82 лет(основная группа) и 18-59 лет(контрольная). Для исключения влияния взаимного отягощения отобраны больные только с изолированными внутримозговыми повреждениями. Результаты исследования показали, что очаговые повреждения головного мозга у лиц пожилого и старческого возраста относится к тяжелым травмам центральной системы с неблагоприятным прогнозом. Этому способствует не только травмирующий фактор и его воздействие на мозговую ткань, но и вторичные нарушения мозгового кровообращения вокруг патологического очага, вследствие первичного атеросклеротического поражения сосудов головного мозга. The clinical course of focal brain injuries in elderly and senile patients was studied. The analysis of treatment of patients aged 60-82 years (main group) and 18-59 years (control). To exclude the influence of mutual burden, patients with isolated intracerebral injuries were selected. The results of the study showed that focal brain damage in the elderly and senile age refers to severe injuries of the Central system with an unfavorable prognosis. This contributes not only to the traumatic factor and its impact on brain tissue, but also secondary disorders of cerebral circulation around the pathological focus, due to the primary atherosclerotic lesions of the cerebral vessels.


2010 ◽  
Vol 16 (6) ◽  
pp. 1089-1098 ◽  
Author(s):  
NICHOLAS MORTON ◽  
LYNNE BARKER

AbstractDeficits in self-awareness are commonly seen after Traumatic Brain Injury (TBI) and adversely affect rehabilitative efforts, independence and quality of life (Ponsford, 2004). Awareness models predict that executive and implicit functions are important cognitive components of awareness though the putative relationship between implicit and awareness processes has not been subject to empirical investigation (Crosson et al., 1989; Ownsworth, Clare, & Morris, 2006; Toglia & Kirk, 2000). Severity of injury, also thought to be a crucial determinant of awareness outcome post-insult, is under-explored in awareness studies (Sherer, Boake, Levin, Silver, Ringholz, & Walter, 1998). The present study measured the contribution of injury severity, IQ, mood state, executive and implicit functions to awareness in head-injured patients assigned to moderate/severe head-injured groups using several awareness, executive, and implicit measures. Severe injuries resulted in greater impairments across most awareness, executive and implicit measures compared with moderate injuries, although deficits were still seen in the moderate group. Hierarchical regression results showed that severity of injury, IQ, mood state, executive and implicit functions made significant unique contributions to selective aspects of awareness. Future models of awareness should account for both implicit and executive contributions to awareness and the possibility that both are vulnerable to disruption after neuropathology. (JINS, 2010,16, 1089–1098.)


2020 ◽  
Vol 49 (5) ◽  
pp. 779-785 ◽  
Author(s):  
Jussi P Posti ◽  
Jussi O T Sipilä ◽  
Teemu M Luoto ◽  
Päivi Rautava ◽  
Ville Kytö

Abstract Background we investigated trends of traumatic brain injury (TBI)-related hospitalisations, deaths, acute neurosurgical operations (ANO), and lengths of hospital stay (LOS) in patients aged ≥70 years in Finland using a population-based cohort. Methods nationwide databases were searched for all admissions with a TBI diagnosis as well as later deaths for persons ≥70 years of age during 2004–2014. Results the study period included 20,259 TBI-related hospitalisations (mean age = 80.7 years, men = 48.9%). The incidence of TBI-related hospitalisations was 283/100,000 person-years with an estimated overall annual increase of 2.9% (95% CI: 0.4–5.9%). There was an annual decrease of 2.2% in in-hospital mortality (IHM) in men (95% CI: 0.1–4.3%), with no change in women or overall. There was an annual decrease of 1.1% in odds for ANOs among hospitalised overall (95% CI: 0.1–2.1%) and of 1.4% in men (95% CI: 0.0–2.7%), while no change was observed in women. LOS decreased annually by 2.5% (95% CI: 2.1–2.9%). The incidence of TBI-related deaths was 70/100,000 person-years with an estimated annual increase of 1.6% in women (95% CI: 0.2–2.9%), but no change in men or overall. Mean ages of TBI-related admissions and deaths increased (P &lt; 0.001). Interpretation the incidence rate of geriatric TBI-related hospitalisations increased, especially in women, but LOS and the rate of ANOs among hospitalised decreased. The overall TBI-related mortality remained stable, and IHM decreased in men, while in women, the overall mortality increased and IHM remained stable. However, the overall incidence rates of TBI-related hospitalisations and deaths and the number of cases of IHM were still higher in men.


2017 ◽  
Vol 14 (02/03) ◽  
pp. 075-082
Author(s):  
Raghuvendra Kumar ◽  
Subhasis Ghosh ◽  
Tapan Dhibar ◽  
Abhishek Kumar

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of death worldwide. Long-term clinical outcome following TBI can be difficult to predict. Evaluation of the degree of severity of injury and prediction of outcome are important for the management of these patients. Objective To evaluate whether degree of severity of injury and outcome in moderate to severe TBI is possible by proton magnetic resonance spectroscopy (1H-MRS). Materials and Methods Patients with moderate (Glasgow coma scale [GCS] 9–13) and severe head injury (GCS: 5–8), within 1 week of trauma with their normal computed tomographic (CT) scan findings, their magnetic resonance imaging (MRI) finding, and neurologic status were investigated with single-voxel proton MRS (1H-MRS). The study included 51 patients and 24 controls. Result The MRS study revealed lower ratio of N-acetylaspartate (NAA)/choline (Cho) and NAA/creatine (Cr) and higher ratio of Cho/Cr and lactate level compared with the control group. The ratio of NAA/Cr, NAA/Cho, and Cho/Cr were statistically significant with initial GCS (p = < 0.00001, r = 0.7595; p = < 0.00001, r = 0.7506; and p < 0.00001, r = −0.5923, respectively), and these ratios were also statistically significant with Glasgow outcome scale (GOS) (p < 0.00001, r = 0.8498, p < 0.00001, r =0.9323, p < 0.00001, r = −0.9082, respectively). The ratio of NAA/Cr, NAA/Cho, and Cho/Cr were also statistically significant with severity of injury (p < 0.0001). Conclusion MRS can quantify damage after TBI and may be a method of assessing severity and outcome in TBI.


2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 109-116
Author(s):  
Fatemeh Ramezani Kapourchali ◽  
◽  
Ali Malekshahi Moghadam ◽  
Anoush Dehnadi Moghadam ◽  
Shahrokh Yousefzadeh-Chabok ◽  
...  

Introduction:Early and sufficient nutritional support is vital to improve outcomes in patients with traumatic brain injury. This study aims to determine the effects of dietitian involvementin the nutritional and clinical outcomes inpatients with traumatic brain injuries admitted tothe neurosurgical ICU. Materials &Methods: Forty-eight male patients with traumatic brain injuries admitted to Poursina Hospital neurosurgical ICU were studied, retrospectively. Patients were divided to either receive dietitian intervention or without any nutritional recommendation(control). Demographic information, Glasgow Coma Scale and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, the timing of initial enteral feeding, the amount of energy and protein intakeon day 4, the duration of mechanical ventilation and ICU length of stay were recorded. Results:Patients under the dietitian recommendation had significantly lower timing of initial enteral nutrition compared to the other cases (P=0.02). The average energy or protein intake and the percentage of target energy or protein intake on day4 appeared to be significantly lower in the subjects in the control group than in those with nutritional intervention(P≤0.001). There was no statistically significant difference in the duration of mechanical ventilation and ICU length of staybetween different groups of patients. Conclusions:Instead of occasional consultations for exclusive cases, the daily attendance of dietitians during multidisciplinary rounds of ICU is required to assess the nutritional needs of patients.


2020 ◽  
Vol 3 (1) ◽  
pp. 70-74
Author(s):  
Rustam Hazratkulov ◽  

Multiple traumatic hematomas (MG) account for 0.74% of all traumatic brain injuries. A comprehensive diagnostic approach to multiple traumatic intracranial hematomas allows to establish a diagnosis in the early stages of traumatic brain injury and to determine treatment tactics. A differentiated approach to the choice of surgical treatment of multiple hematomas allows to achieve satisfactory results and treatment outcomes, which accordingly contributes to the early activation of the patient, a reduction in hospital stay, a decrease in mortality and disabilityin patients with traumatic brain injury


2020 ◽  
pp. 000313482097335
Author(s):  
Isaac W. Howley ◽  
Jonathan D. Bennett ◽  
Deborah M. Stein

Moderate and severe traumatic brain injuries (TBI) are a major cause of severe morbidity and mortality; rapid diagnosis and management allow secondary injury to be minimized. Traumatic brain injury is only one of many potential causes of altered mental status; head computed tomography (HCT) is used to definitively diagnose TBI. Despite its widespread use and obvious importance, interpretation of HCT images is rarely covered by formal didactics during general surgery or even acute care surgery training. The schema illustrated here may be applied in a rapid and reliable fashion to HCT images, expediting the diagnosis of clinically significant traumatic brain injury that warrants emergent medical and surgical therapies to reduce intracranial pressure. It consists of 7 normal anatomic structures (cerebrospinal fluid around the brain stem, open fourth ventricle, “baby’s butt,” “Mickey Mouse ears,” absence of midline shift, sulci and gyri, and gray-white differentiation). These 7 features can be seen even as the CT scanner obtains images, allowing the trauma team to expedite medical management of intracranial hypertension and pursue neurosurgical consultation prior to radiologic interpretation if the features are abnormal.


BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e039767
Author(s):  
Zorry Belchev ◽  
Mary Ellene Boulos ◽  
Julia Rybkina ◽  
Kadeen Johns ◽  
Eliyas Jeffay ◽  
...  

IntroductionIndividuals with moderate-severe traumatic brain injury (m-sTBI) experience progressive brain and behavioural declines in the chronic stages of injury. Longitudinal studies found that a majority of patients with m-sTBI exhibit significant hippocampal atrophy from 5 to 12 months post-injury, associated with decreased cognitive environmental enrichment (EE). Encouragingly, engaging in EE has been shown to lead to neural improvements, suggesting it is a promising avenue for offsetting hippocampal neurodegeneration in m-sTBI. Allocentric spatial navigation (ie, flexible, bird’s eye view approach), is a good candidate for EE in m-sTBI because it is associated with hippocampal activation and reduced ageing-related volume loss. Efficacy of EE requires intensive daily training, prohibitive within most current health delivery systems. The present protocol is a novel, remotely delivered and self-administered intervention designed to harness principles from EE and allocentric spatial navigation to offset hippocampal atrophy and potentially improve hippocampal functions such as navigation and memory for patients with m-sTBI.Methods and analysisEighty-four participants with chronic m-sTBI are being recruited from an urban rehabilitation hospital and randomised into a 16-week intervention (5 hours/week; total: 80 hours) of either targeted spatial navigation or an active control group. The spatial navigation group engages in structured exploration of different cities using Google Street View that includes daily navigation challenges. The active control group watches and answers subjective questions about educational videos. Following a brief orientation, participants remotely self-administer the intervention on their home computer. In addition to feasibility and compliance measures, clinical and experimental cognitive measures as well as MRI scan data are collected pre-intervention and post-intervention to determine behavioural and neural efficacy.Ethics and disseminationEthics approval has been obtained from ethics boards at the University Health Network and University of Toronto. Findings will be presented at academic conferences and submitted to peer-reviewed journals.Trial registration numberVersion 3, ClinicalTrials.gov Registry (NCT04331392).


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