The Incidence and Significance of Hemostatic Abnormalities in Patients with Head Injuries

Neurosurgery ◽  
1989 ◽  
Vol 24 (6) ◽  
pp. 825-832 ◽  
Author(s):  
John D. Olson ◽  
Howard H. Kaufman ◽  
Joel Moake ◽  
Thomas W. O'Gorman ◽  
Keith Hoots ◽  
...  
Keyword(s):  
Degradation Products ◽  
Head Injuries ◽  
Entire Group ◽  
Stepwise Logistic Regression ◽  
Test Results ◽  
Stepwise Logistic Regression Analysis ◽  
Severity Of Injury ◽  
Head Injured ◽  
Injured Patients ◽  
High Degree

Abstract Abnormal coagulation and fibrinolysis is a frequent complication in patients with head injury. This complication can be severe enough to lead to hemorrhage or thrombosis. A study was undertaken to determine if the hemostatic abnormalities are reliable indicators of outcome. Hemostasis in 269 patients with head injuries alone was screened using platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin clotting time (TCT), fibrinogen assay (FIB), level of fibrin-fibrinogen degradation products (FDP), and disseminated intravascular coagulation (DIC) score in the first 24 hours after injury. Test results were compared with the outcome (discharged or dead) in the entire group and in subgroups divided on the basis of the severity of injury as determined by the Glasgow coma score (GCS). Increased consumptive coagulopathy at admission, as reflected in the DIC score, predicts the outcome of head-injured patients with a high degree of accuracy. The degree of increase of the initial FDP level and prolongation of TCT also correlated positively with the outcome. Prolongation of the APTT correlated strongly with unfavorable outcome in a large group of patients, and in a small group, markedly accelerated APTT also predicted death. Stepwise logistic regression analysis demonstrated that GCS, FDP level, and DIC score predicted outcome. Other tests did not provide additional predictive value. Abnormal hemostasis frequently complicates the course of patients with head injuries. This study demonstrates that hemostasis tests are predictors of outcome in these patients.

Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial

1991 ◽  
Vol 75 (5) ◽  
pp. 731-739 ◽  
Author(s):  
J. Paul Muizelaar ◽  
Anthony Marmarou ◽  
John D. Ward ◽  
Hermes A. Kontos ◽  
Sung C. Choi ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Control Group ◽  
Content Type ◽  
Cerebral Vasoconstriction ◽  
Number Of Patients ◽  
Severity Of Injury ◽  
Head Injured ◽  
Injured Patients ◽  
To Receive

✓ There is still controversy over whether or not patients should be hyperventilated after traumatic brain injury, and a randomized trial has never been conducted. The theoretical advantages of hyperventilation are cerebral vasoconstriction for intracranial pressure (ICP) control and reversal of brain and cerebrospinal fluid (CSF) acidosis. Possible disadvantages include cerebral vasoconstriction to such an extent that cerebral ischemia ensues, and only a short-lived effect on CSF pH with a loss of HCO3− buffer from CSF. The latter disadvantage might be overcome by the addition of the buffer tromethamine (THAM), which has shown some promise in experimental and clinical use. Accordingly, a trial was performed with patients randomly assigned to receive normal ventilation (PaCO2 35 ± 2 mm Hg (mean ± standard deviation): control group), hyperventilation (PaCO2 25 ± 2 mm Hg: HV group), or hyperventilation plus THAM (PaCO2 25 ± 2 mm Hg: HV + THAM group). Stratification into subgroups of patients with motor scores of 1–3 and 4–5 took place. Outcome was assessed according to the Glasgow Outcome Scale at 3, 6, and 12 months. There were 41 patients in the control group, 36 in the HV group, and 36 in the HV + THAM group. The mean Glasgow Coma Scale score for each group was 5.7 ± 1.7, 5.6 ± 1.7, and 5.9 ± 1.7, respectively; this score and other indicators of severity of injury were not significantly different. A 100% follow-up review was obtained. At 3 and 6 months after injury the number of patients with a favorable outcome (good or moderately disabled) was significantly (p < 0.05) lower in the hyperventilated patients than in the control and HV + THAM groups. This occurred only in patients with a motor score of 4–5. At 12 months posttrauma this difference was not significant (p = 0.13). Biochemical data indicated that hyperventilation could not sustain alkalinization in the CSF, although THAM could. Accordingly, cerebral blood flow (CBF) was lower in the HV + THAM group than in the control and HV groups, but neither CBF nor arteriovenous difference of oxygen data indicated the occurrence of cerebral ischemia in any of the three groups. Although mean ICP could be kept well below 25 mm Hg in all three groups, the course of ICP was most stable in the HV + THAM group. It is concluded that prophylactic hyperventilation is deleterious in head-injured patients with motor scores of 4–5. When sustained hyperventilation becomes necessary for ICP control, its deleterious effect may be overcome by the addition of THAM.

Prediction tree for severely head-injured patients

1991 ◽  
Vol 75 (2) ◽  
pp. 251-255 ◽  
Author(s):  
Sung C. Choi ◽  
Jan P. Muizelaar ◽  
Thomas Y. Barnes ◽  
Anthony Marmarou ◽  
Danny M. Brooks ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Predictive Accuracy ◽  
Head Injuries ◽  
Pupillary Response ◽  
Prognostic Indicators ◽  
Critical Threshold ◽  
Content Type ◽  
Intermediate Outcomes ◽  
Head Injured ◽  
Injured Patients

✓ Prediction tree techniques are employed in the analysis of data from 555 patients admitted to the Medical College of Virginia hospitals with severe head injuries. Twenty-three prognostic indicators are examined to predict the distribution of 12-month outcomes among the five Glasgow Outcome Scale categories. A tree diagram, illustrating the prognostic pattern, provides critical threshold levels that split the patients into subgroups with varying degrees of risk. It is a visually useful way to look at the prognosis of head-injured patients. In previous analyses addressing this prediction problem, the same set of prognostic factors (age, motor score, and pupillary response) was used for all patients. These approaches might be considered inflexible because more informative prediction may be achieved by somewhat different combinations of factors for different patients. Tree analysis reveals that the pattern of important prognostic factors differs among various patient subgroups, although the three previously mentioned factors are still of primary importance. For example, it is noted that information concerning intracerebral lesions is useful in predicting outcome for certain patients. The overall predictive accuracy of the tree technique for these data is 77.7%, which is somewhat higher than that obtained via standard prediction methods. The predictive accuracy is highest among patients who have a good recovery or die; it is lower for patients having intermediate outcomes.

Development of a Bayesian Network for the Prognosis of Head Injuries using Graphical Model Selection Techniques

1999 ◽  
Vol 38 (01) ◽  
pp. 37-42 ◽  
Author(s):  
G. C. Sakellaropoulos ◽  
G. C. Nikiforidis
Keyword(s):  
Model Selection ◽  
Bayesian Network ◽  
Analytical Approach ◽  
Graphical Model ◽  
Head Injuries ◽  
Sources Of Information ◽  
Laboratory Findings ◽  
Learning Techniques ◽  
Head Injured ◽  
Injured Patients

Abstract:The assessment of a head-injured patient’s prognosis is a task that involves the evaluation of diverse sources of information. In this study we propose an analytical approach, using a Bayesian Network (BN), of combining the available evidence. The BN’s structure and parameters are derived by learning techniques applied to a database (600 records) of seven clinical and laboratory findings. The BN produces quantitative estimations of the prognosis after 24 hours for head-injured patients in the outpatients department. Alternative models are compared and their performance is tested against the success rate of an expert neurosurgeon.

Physician Prehospital Care in Mexico City: Retrospective Analysis of Endotracheal Intubation in Patients with Severe Head Trauma

2020 ◽  
Vol 35 (2) ◽  
pp. 128-132
Author(s):  
J. Sebastián Espino-Núñez ◽  
Mirsha Quinto-Sánchez ◽  
Anabel C. Carrada-Varela ◽  
Fernando Román-Morales
Keyword(s):  
Retrospective Analysis ◽  
Endotracheal Intubation ◽  
Mexico City ◽  
Head Trauma ◽  
Prehospital Care ◽  
Head Injuries ◽  
Head Injured ◽  
Prehospital Diagnosis ◽  
Medical Emergencies ◽  
Injured Patients

AbstractIntroduction:In Mexico, physicians have become part of public service prehospital care. Head injured patients are a sensitive group that can benefit from early advanced measures to protect the airway, with the objective to reduce hypoxia and maintain normocapnia.Problem:The occurrence of endotracheal intubation to patients with severe head injuries by prehospital physicians working at Mexico City’s Service of Emergency Medical Care (SAMU) is unknown.Methods:A retrospective analysis of five-year data (2012-2016) from Mexico City’s Medical Emergencies Regulation Center was performed. Only SAMU ambulance services were analyzed. Adult patients with a prehospital diagnosis of head injury based on mechanism of injury and physical examination with a Glasgow Coma Scale (GCS) <nine were included.Results:A total of 293 cases met the inclusion criteria; the mean GCS was five points. Of those, 150 (51.1%) patients were intubated. There was no difference in the occurrence of intubation among the different GCS scales, or if the patient was considered to have isolated head trauma versus polytrauma. Fifteen patients were intubated using sedation and neuromuscular blockage. Four patients were intubated with sedation alone and six patients with neuromuscular blockage alone. One patient was intubated using opioid analgesia, sedation, and neuromuscular blockage.Conclusions:Patients with severe head injuries cared by prehospital physicians in Mexico City were intubated 51.1% of the time and were more likely to be intubated without the assistance of anesthetics.

Golf Related Head Injuries in Children: The Little Tigers

1998 ◽  
Vol 43 (5) ◽  
pp. 139-140 ◽  
Author(s):  
A.C. McGuffie ◽  
M.O. Fitzpatrick ◽  
D. Hall
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Emergency Departments ◽  
Head Injuries ◽  
Western Society ◽  
Accident And Emergency ◽  
Head Injured ◽  
Accident And Emergency Department ◽  
Injured Patients

Head injury is a major cause of morbidity in Western society and sport related incidents account for approximately 11% of all head injured patients attending Accident and Emergency Departments. 1 Golf was shown to be one of the sports most commonly associated with head injury requiring referral to a regional neurosurgical centre.2 Previous studies have demonstrated that it is predominantly children who sustain golf related head injuries which present either to an accident and emergency department3 or a regional neurosurgical centre.2 This study examines the number and pattern of golf related head injuries in children presenting to an accident and emergency department or requiring admission to the regional neurosurgical centre, over a three month period.

Cause of decline in head-injury mortality rate in San Diego County, California

1985 ◽  
Vol 62 (4) ◽  
pp. 528-531 ◽  
Author(s):  
Melville R. Klauber ◽  
Lawrence F. Marshall ◽  
Belinda M. Toole ◽  
Sharen L. Knowlton ◽  
Sharon A. Bowers
Keyword(s):  
Head Injury ◽  
San Diego ◽  
Head Injuries ◽  
Mortality Rates ◽  
San Diego County ◽  
Content Type ◽  
Severity Of Injury ◽  
Prehospital Emergency ◽  
Injured Patients ◽  
Number Of Individuals

✓ Even with an increasing population, there were 100 fewer deaths due to head injury in San Diego County, California, in 1982 compared to 1980. During the 5 years from 1976 to 1980 there was nearly a constant death rate from head injuries, followed in the next 2 years by a decline of 24%. The number of deaths at the scene of injury declined 28%, and the number of individuals listed as dead on arrival at the hospital declined 68%. Mortality rates in the emergency room increased slightly and later death rates declined slightly. Mortality rates of hospitalized patients, adjusted for severity of injury, did not vary materially by year. This decline in deaths due to head injury followed a marked improvement in the county's emergency ground and prehospital air evacuation services. The data strongly suggest that advanced prehospital emergency medical services can substantially reduce mortality rates in head-injured patients. The authors postulate that some patients who ordinarily “would die now talk” because of early airway and circulatory management by highly trained paramedical personnel and airborne trauma specialists. Despite a search for other factors that might explain these observations, no satisfactory alternatives could be identified.

A Clinical Study of Post-Traumatic Amnesia

1971 ◽  
Vol 16 (4) ◽  
pp. 341-346
Author(s):  
O. Schwartz ◽  
G. C. Sisler
Keyword(s):  
Head Injuries ◽  
Verbal Learning ◽  
Paired Associates ◽  
Immediate Recall ◽  
Criterion Score ◽  
Traumatic Amnesia ◽  
Initial Learning ◽  
Head Injured ◽  
Post Traumatic ◽  
Injured Patients

Fifteen consecutive patients with head injuries, admitted to the neurosurgical services of the Winnipeg General and St. Boniface hospitals, were given two memory tests within 24 hours following recovery of consciousness. The first test concerned immediate recall of a series of digits, presented orally. The second was a paired-associates test which involved learning and retaining pairs of stimuli and also required that when one stimulus of the pair is given the subjects correctly respond with the other associated stimulus. Fifteen control subjects admitted to hospital for acute episodes other than head injury were tested. The controls were matched with the head-injured subjects for age and education. During the eight-minute retention interval a distraction stimulus was administered randomly to six of the head-injured subjects and to six matched controls. No defect was found in immediate (a few seconds) memory of the head-injured group. The distracting stimulus had no significant influence on retention. Verbal learning, as defined by the number of trials to reach a criterion score on a memory test, was impaired and verbal retention, tested by recall at one hour after the initial learning period, was also impaired. These findings suggest that head-injured patients have at least a temporarily decreased ability to form lasting memory traces.

Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation

1996 ◽  
Vol 85 (5) ◽  
pp. 751-757 ◽  
Author(s):  
Karl L. Kiening ◽  
Andreas W. Unterberg ◽  
Tillman F. Bardt ◽  
Gerd-Helge Schneider ◽  
Wolfgang R. Lanksch
Keyword(s):  
Oxygen Saturation ◽  
Cerebral Oxygenation ◽  
Jugular Vein ◽  
Head Injuries ◽  
Jugular Bulb ◽  
Cerebral White Matter ◽  
Content Type ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

✓ Monitoring of cerebral oxygenation is considered to be of great importance in minimizing secondary hypoxic and ischemic brain damage following severe head injury. Although the threshold for cerebral hypoxia in jugular bulb oximetry (measurement of O2 saturation in the jugular vein (SjvO2)) is generally accepted to be 50% oxygen saturation, a comparable value in brain tissue PO2 (PtiO2) monitoring, a new method for direct assessment of PO2 in the cerebral white matter, has not yet been established. Hence, the purpose of this study was to compare brain PtiO2 with SjvO2 in severely head injured patients during phases of reduced cerebral perfusion pressure (CPP) to define a threshold in brain PtiO2 monitoring. In addition, the safety and data quality of both SjvO2 and brain PtiO2 monitoring were studied. In 15 patients with severe head injuries, SjvO2 and brain PtiO2 were monitored simultaneously. For brain PtiO2 monitoring a polarographic microcatheter was inserted in the frontal cerebral white matter, whereas for SjvO2 measurements were obtained by using a fiberoptic catheter placed in the jugular bulb. Intracranial pressure was monitored by means of an intraparenchymal catheter. Mean arterial blood pressure, CPP, end-tidal CO2, and arterial oxygen saturation (pulse oximetry) were continuously recorded. All data were simultaneously stored and analyzed using a multimodal computer system. For specific analysis, phases of marked deterioration in systemic blood pressure and consecutive reductions in CPP were investigated. There were no complications that could be attributed to the PtiO2 catheters, that is, no intracranial bleeding or infection. The “time of good data quality” was 95% in brain PtiO2 compared to 43% in SjvO2; PtiO2 monitoring could be performed twice as long as SjvO2 monitoring. During marked decreases in CPP, SjvO2 and brain PtiO2 correlated closely. A significant second-order regression curve of SjvO2 versus brain PtiO2 (p < 0.01) was plotted. At a threshold of 50% in SjvO2, brain PtiO2 was found to be within the range of 3 to 12 mm Hg, with a regression curve “best fit” value of 8.5 mm Hg. There was a close correlation between CPP and oxygenation parameters (PtiO2 and SjvO2) when CPP fell below a breakpoint of 60 mm Hg, suggesting intact cerebral autoregulation in most patients. This study demonstrates that monitoring brain PtiO2 is a safe, reliable, and sensitive diagnostic method to follow cerebral oxygenation. In comparison to SjvO2, PtiO2 is more suitable for long-term monitoring. It can be used to minimize episodes of secondary cerebral maloxygenation after severe head injury and may, hopefully, improve the outcome in severely head injured patients.

Althesin in the Management of Head Injuries

Neurosurgery ◽  
1983 ◽  
Vol 12 (1) ◽  
pp. 77-79 ◽  
Author(s):  
Michael Mcllhany ◽  
Richard Rapport ◽  
Robert Dunn ◽  
Mohamed Namazie ◽  
Alex Delilikan
Keyword(s):  
Head Trauma ◽  
Half Life ◽  
Head Injuries ◽  
Craniocerebral Trauma ◽  
Continuous Intravenous Infusion ◽  
Intravenous Steroid ◽  
Major Disadvantage ◽  
Head Injured ◽  
Injured Patients ◽  
Recent Attention

Abstract The aggressive treatment of major craniocerebral trauma has received recent attention. Barbiturate administration has been beneficial in some cases of sustained, uncontrolled intracranial hypertension. One major disadvantage of pentobarbital narcosis is the long half-life of the drug (15 to 48 hours). We have used Althesin, an intravenous steroid anesthetic (alfaxalone and alfadolone acetate; Glaxo Laboratories Ltd., Greenford, Middlesex, England), in eight seriously head-injured patients. Althesin combines the theoretical advantages of pentobarbital in the management of head trauma with almost immediate reversibility (serum half-life, 1.6 minutes). Raised intracranial pressure and clinical outcome seem to be influenced favorably and the side effects are negligible when the drug is administered by continuous intravenous infusion over several days. Further study of this compound in the management of head trauma seems warranted.

Skull X-Ray Assessment of Head Injuries: A Decision Analytic Approach

1984 ◽  
Vol 23 (03) ◽  
pp. 135-138 ◽  
Author(s):  
J. I. Balla ◽  
A. S. Elstein
Keyword(s):  
Head Injuries ◽  
Ct Scanning ◽  
Cost Effective ◽  
X Rays ◽  
Intracranial Haematoma ◽  
X Ray ◽  
Neurological Signs ◽  
Cost Effective Method ◽  
Head Injured ◽  
Injured Patients

SummaryWe demonstrate the value of skull x-rays in the assessment of head injured patients. With the use of the simple decision analytic technique of 2 x 2 tables and literature derived figures, it is shown that in patients with a normal neurological examination following head injuries, skull x-rays are a cost-effective method of detecting preventable complications. The positive predictive value (PVP) of skull x-rays in these patients is. 03, in contrast to .001 of the group as a whole. Such cases should then have a CT scan to detect early cases of intracranial haematoma (ICH). The presence of abnormal neurological signs has a high PVP of .2 for complications; in these patients, skull x-rays do not improve the detection of ICH and CT scanning alone should be carried out.

Sign in / Sign up

Export Citation Format

Share Document