scholarly journals Head injury alert: A new level of trauma activation?

Trauma ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 213-219 ◽  
Author(s):  
Daniel Ricaurte ◽  
Daniel Slack ◽  
Aaron Gilson ◽  
Michael Nowicki ◽  
Monika Nelson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Head Injury ◽  
Injury Severity ◽  
Care Center ◽  
Tertiary Care ◽  
Injured Patient ◽  
Community Hospitals ◽  
Specific Patient ◽  
Head Ct ◽  
Trauma Activation

Introduction Trauma activation requires mobilization of significant resources to be available at short notice. In 2014, the American College of Surgeons Committee on Trauma issued its latest recommendations for care of the injured patient. Amongst trauma activation criteria, elderly patients that fell from any height on anticoagulation were included. We hypothesized that a reduced trauma team could preserve patient safety while reducing time and cost spent. Method A ‘Head Injury Alert’ was created to denote anti-coagulated patients with a GCS > 14 who fell from a height of <20 feet. An ED attending, surgical resident and one nurse evaluate the patient with the goal of obtaining a head CT within 30 min of presentation. Data were prospectively acquired from June 2017 to August 2018, which included age, anticoagulation, injury severity score (ISS), time-to-CT, outcomes, missed injuries, disposition and activations requiring escalation of care. Results Two hundred and seventy-seven head injury activations occurred; 55% of patients were female, while 45% were male. Average age was 78 years old. The most common anticoagulant was Warfarin (31%). 50% of patients were discharged, 47% were admitted, 2% died before disposition and 1% were transferred to a tertiary care center; 7% required admission to the ICU. The average time-to-CT was 25 min and ISS ranged from 0 to 26. Twenty-two patients (7%) presented with positive head CT. Of the five deaths, three patients had intracranial hemorrhage, one pneumonia present on admission and one cardiac arrest. Conclusion This level III evidence, prospective study suggests head injury alert can be safely applied as a new level of trauma activation at community hospitals. It helps identify a specific patient population and injury mechanism that can be safely triaged using limited resources. With this, community hospitals can maximize their resources and minimize cost, while maintaining patient safety.

Neurotrauma Audit at Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh

2019 ◽  
Vol 16 (02/03) ◽  
pp. 109-112
Author(s):  
Ambuj Kumar ◽  
Ketan Hedaoo ◽  
Jitin Bajaj ◽  
Mallika Sinha ◽  
Shailendra Ratre ◽  
...  
Keyword(s):  
Head Injury ◽  
Injury Severity ◽  
Road Traffic ◽  
Spinal Injury ◽  
Care Center ◽  
Clinical Status ◽  
Tertiary Care ◽  
Treatment Strategies ◽  
Spine Injury ◽  
Severity Of Injury

Abstract Introduction For the prevention and better management of traumatic brain and spine injury patients, it is mandatory to understand the demographic and clinical profiles of cases of a particular region. This study was aimed at describing the epidemiology, pattern, and outcomes of head and spine injury patients at a tertiary care center in central India. Materials and Methods All the patients with head and spine injury admitted to the Department of Neurosurgery between September 1, 2018, and August 31, 2019 were included in the study. Data of all these patients were collected from the medical record section and analyzed for age, sex, mode of injury, severity of injury, management, and outcomes. Results During the study period, 932 patients with head injury and 241 patients with spine injury were admitted to our department. Around 65% of the patients in both head and spine injury categories fell in the age group of 26 to 55 years. Approximately 80% of all neurotrauma patients were male. The most common mode of injury was road traffic accident followed by fall from height. Mortality for severe head injury was 39% and that for ASIA A (American Spinal Injury Association grade A) cervical spine injury was 65%. Conclusion Even after aggressive treatment strategies, morbidity and mortality are very high, and the ultimate outcome depends mainly on the clinical status immediately after trauma. The data from this study can be helpful in strategy-making for the prevention and management of head and spine injury patients, especially in the central Indian population.

scholarly journals Serum Concentration of Myelin Basic Protein as a Prognostic Marker in Mild-to-moderate Head Injury Patients: A Prospective Study in a Tertiary Care Center

2021 ◽  
Author(s):  
Ashvamedh Singh ◽  
Kulwant Singh ◽  
Anurag Sahu ◽  
R. S. Prasad ◽  
N. Pandey ◽  
...  
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Myelin Basic Protein ◽  
Prognostic Marker ◽  
Outcome Prediction ◽  
Basic Protein ◽  
Care Center ◽  
Tertiary Care ◽  
Gcs Score ◽  
A Prospective Study

Abstract Objective To estimate the level of myelin basic protein (MBP) and look for its validity in outcome prediction among mild-to-moderate head injury patients. Materials and Methods It was a prospective study done at the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University from Jan 2018 to July 2019. All patients who presented to us within 48 hours of injury with mild-to-moderate head injury with apparently normal CT brain were include in the study. The serum sample were collected on the day of admission and 48 hours later, and patients were treated with standard protocols and observed 6 months postdischarge. Results Of the 32 patients enrolled, we observed mean MBP level was higher for severity of brain damage, but not associated with age, mode of injury, and radiological diagnosis. Mean MBP levels were not statistically associated with Glasgow coma scale (GCS) score at admission but was correlated to outcome with p < 0.05, with sensitivity of 50% and specificity 72%, that is, patients with good outcome have lower mean MBP levels. Conclusion MBP as per our analysis can be used as a prognostic marker in patients with head injury. It is not the absolute value rather a trend showing rise in serum MBP levels, which carries a significant value in outcome prediction.

Maxillofacial trauma severity effects in patients with head injury in a tertiary care center in Yogyakarta, Indonesia

2021 ◽  
Author(s):  
Sandy Nur Vania Putri ◽  
Aditya Rifqi Fauzi ◽  
Dewi Kartikawati Paramita ◽  
Ishandono Dachlan ◽  
Rosadi Seswandhana
Keyword(s):  
Head Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Maxillofacial Trauma ◽  
Tertiary Care Center ◽  
Trauma Severity

Back Transporting Infants From Neonatal Intensive Care Units to Community Hospitals for Recovery Care: Effect on Total Hospital Charges

PEDIATRICS ◽  
1992 ◽  
Vol 90 (1) ◽  
pp. 22-26
Author(s):  
Ciaran S. Phibbs ◽  
Lynn Mortensen
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Community Hospital ◽  
Care Center ◽  
Tertiary Care ◽  
Small Sample ◽  
Hospital Charges ◽  
Neonatal Intensive Care Units ◽  
Community Hospitals

Many neonates are referred to neonatal intensive care units (NICUs) for specialized care far from their parents' residence. This distance can add to the stress of the parents and reduce the contact of the parents with their newborn. Small studies have found that back transporting these neonates to hospitals closer to their homes is safe and cost-effective. Despite these findings, the reluctance of many insurers to pay for back transports prevents or delays many back transports. Insurers may not consider the findings of the previous studies to be conclusive, given that the comparisons were between small numbers of neonates back transported and neonates who remained in tertiary care, and the potential for differences in severity of illness between the groups is significant. In this study the effect on hospital charges of back transports was examined by comparing the charges for care in community hospitals with what these charges would have been in a tertiary care center. The advantage of this method is that it avoids case-mix differences between the groups and thus minimizes the potential for small-sample bias. Data were collected for all back transports from a NICU to non-tertiary care centers (n = 90) for a 9-month period. We were able to obtain the itemized bills for the care at community hospitals for 42 of these patients. Each bill was recalculated using the charges for the NICU to determine potential for savings. The average charges for recovery care were about $6200 lower at the community hospital than they would have been at the NICU. When the charges for the back transport are subtracted (mean = $1603), the average net savings are $4,600. These savings are even larger ($6163) for neonates who stayed at the community hospital for more than 7 days.

scholarly journals Spectrum of Pediatric Head Injury with Management and Outcome: A Single Tertiary Care Center Study

2015 ◽  
Vol 12 (01) ◽  
pp. 010-018
Author(s):  
Sudhansu Mishra ◽  
Rama Deo ◽  
Somnath Jena ◽  
Pratap Nath
Keyword(s):  
Head Injury ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Pediatric Head Injury ◽  
Center Study

scholarly journals Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications

2020 ◽  
Vol 5 (1) ◽  
pp. e000483 ◽  
Author(s):  
Abid D Khan ◽  
Anna J Elseth ◽  
Jacqueline A Brosius ◽  
Eliza Moskowitz ◽  
Sean C Liebscher ◽  
...  
Keyword(s):  
Patient Safety ◽  
Brain Injury ◽  
Length Of Stay ◽  
Resource Utilization ◽  
Injury Severity ◽  
Improve Patient Safety ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Head Ct ◽  
The Brain

BackgroundThe Brain Injury Guidelines provide an algorithm fortreating patients with traumatic brain injury (TBI) and intracranial hemorrhage(ICH) that does not mandate hospital admission, repeat head CT, orneurosurgical consult for all patients. The purposes of this study are toreview the guidelines’ safety, to assess resource utilization, and to proposeguideline modifications that improve patient safety and widespreadreproducibility.MethodsA multi-institutional review of TBI patients was conducted. Patients with ICH on CT were classified as BIG 1, 2, or 3 based on the guidelines. BIG 3 patients were excluded. Variables collected included demographics, Injury Severity Score (ISS), hospital length of stay (LOS), intensive care unit LOS, number of head CTs, type of injury, progression of injury, and neurosurgical interventions performed.Results269 patients met inclusion criteria. 98 were classifiedas BIG 1 and 171 as BIG 2. The median length of stay (LOS) was 2 (2,4)days and the ICU LOS was 1 (0,2) days. Most patients had a neurosurgeryconsultation (95.9%) and all patients included had a repeat head CT. 370repeat head CT scans were performed, representing 1.38 repeat scans perpatient. 11.2% of BIG 1 and 11.1% of BIG 2 patients demonstratedworsening on repeat head CT. Patients who progressed exhibited a higherISS (14 vs. 10, p=0.040), and had a longer length of stay (4 vs. 2 days;p=0.015). After adjusting for other variables, the presence of epiduralhematoma (EDH) and intraparenchymal hematoma were independent predictors ofprogression. Two BIG 2 patients with EDH had clinical deteriorationrequiring intervention.DiscussionThe Brain Injury Guidelines may improve resourceallocation if utilized, but alterations are required to ensure patientsafety. The modified Brain Injury Guidelines refine the originalguidelines to enhance reproducibility and patient safety while continuing toprovide improved resource utilization in TBI management.

scholarly journals Prevalence of Head Injury of Patients Arriving in a Tertiary Care Center

2020 ◽  
Vol 2 (1) ◽  
pp. 38-41
Author(s):  
Arbindra Kumar Yadav ◽  
Jagat Narayan Rajbanshi ◽  
Saroj Kumar Kushwaha ◽  
Pankaj Raj Nepal
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
Emergency Admission ◽  
P Value ◽  
Cross Sectional ◽  
Severity Of Injury

Background and purpose: The prevalence of head injury is increasing with increasing number of automobiles, especially motorbike. With the objective to evaluate the prevalence of head injury and factors that could affect the severity of head injury, this study was performed in a tertiary hospital at far- eastern Nepal. Methodology: This is a cross-sectional study over the duration of one year. Association of age, gender, and mode of injury was checked with severity of injury using Chi-square test where P-value was kept significant at <0.01. Result: Total numbers of patient admitted through the emergency department, during the study period, were 832. Mean age of patient in the study group was 34.59 (SD 18.92) years. Majority of them falls in the category of 20-29 years. Among the different categories of head injuries, mild head injury (76%) was the most common presentation followed by moderate head injury and severe head injury, which were 14% and 10% respectively.  Conclusion: Head injury seems to be the major cause of emergency admission in for eastern part of Nepal. Among them road traffic accidents seems to be the major burden which is more common in young gentlemen with significant number of severe head injury.

Patient Safety Rounds in a Pediatric Tertiary Care Center

2008 ◽  
Vol 34 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Michael L. Rinke ◽  
Karen P. Zimmer ◽  
Christoph U. Lehmann ◽  
Paul Colombani ◽  
George Dover ◽  
...  
Keyword(s):  
Patient Safety ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study

2019 ◽  
Vol 41 (2) ◽  
pp. 40-44 ◽  
Author(s):  
Dipendra K Shrestha ◽  
Binod Rajbhandari ◽  
Amit Pradhanang ◽  
Gopal Sedain ◽  
Sushil K Shilpakar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Risk Factor ◽  
Head Injury ◽  
Prolonged Mechanical Ventilation ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Ventilator Associated Pneumonia ◽  
Neurosurgical Patients

Introduction: Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute Methods: A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done. Results: Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin. Conclusion: Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP.

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