Risk Factors for Conversion to Permanent Ventricular Shunt in Patients Receiving Therapeutic Ventriculostomy for Traumatic Brain Injury

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. 85-88 ◽  
Author(s):  
David F. Bauer ◽  
Gerald. McGwin ◽  
Sherry M. Melton ◽  
Richard L. George ◽  
James M. Markert
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Average Length ◽  
Discharge Disposition ◽  
Csf Diversion ◽  
History Of Culture

Abstract BACKGROUND: Intracranial pressure is routinely monitored in patients with severe traumatic brain injury (TBI). Patients with TBI sometimes develop hydrocephalus, requiring permanent cerebrospinal fluid (CSF) diversion. OBJECTIVE: To quantify the need for permanent CSF diversion in patients with TBI. METHODS: Patients who received a ventriculostomy after TBI between June 2007 and July 2008 were identified, and their medical records were abstracted to a database. RESULTS: Sixteen of 71 patients (22.5%) receiving a ventriculostomy required a ventriculoperitoneal or ventriculoatrial shunt before discharge from the hospital. The average number of days between ventriculostomy and shunt was 18.3. Characteristics that predispose these patients to require permanent CSF diversion include the need for craniotomy within 48 hours of admission (odds ratio, 5.20; 95% confidence interval, 1.48-18.35) and history of culture-positive CSF (odds ratio, 5.52; 95% confidence interval, 1.19-25.52). Length of stay was increased in patients receiving permanent CSF diversion (average length of stay, 61 vs 31 days; P = .04). Patient discharge disposition was similar between shunted and nonshunted patients. CONCLUSION: In this retrospective study, 22% of TBI patients who required a ventriculostomy eventually needed permanent CSF diversion. Patients with TBI should be assessed for the need for permanent CSF diversion before discharge from the hospital. Care must be taken to prevent ventriculitis. Future studies are needed to evaluate more thoroughly the risk factors for the need for permanent CSF diversion in this patient population.

scholarly journals Adverse Outcomes and Prediction of Cardiopulmonary Complications in Elective Spine Surgery

2017 ◽  
Vol 8 (3) ◽  
pp. 218-223 ◽  
Author(s):  
Peter G. Passias ◽  
Gregory W. Poorman ◽  
Edward Delsole ◽  
Peter L. Zhou ◽  
Samantha R. Horn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Length Of Stay ◽  
Confidence Interval ◽  
Spine Surgery ◽  
Odds Ratio ◽  
Risk Index ◽  
Improvement Program ◽  
Discharge Disposition ◽  
Cardiopulmonary Complications

Study Design: Retrospective cohort study. Objectives: The purpose of this study was to report incidence of cardiopulmonary complications in elective spine surgery, demographic and surgical predictors, and outcomes. Understanding the risks and predictors of these sentinel events is important for risk evaluation, allocation of hospital resources, and counseling patients. Methods: A retrospective review of the National Surgical Quality Improvement Program (NSQIP) was performed on 60 964 patients undergoing elective spine surgery (any region; laminectomy, arthrodesis, discectomy, or laminoplasty) between 2011 and 2013. Incidence of myocardial infarction, cardiac arrest, unplanned reintubation, on ventilator >48 hours, perioperative pneumonia, and pulmonary embolism was measured. Demographic and surgical predictors of cardiopulmonary complications and associated outcomes (length of stay, discharge disposition, and mortality) were measured using binary logistic regression controlling for confounders. Results: Incidence rates per 1000 elective spine patients were 2.1 myocardial infarctions, 1.3 cardiac arrests, 4.3 unplanned intubations, 3.5 on ventilator >48 hours, 6.1 perioperative pneumonia, and 3.7 pulmonary embolisms. In analysis of procedure, diagnosis, and approach risk factors, thoracic cavity (odds ratio = 2.47; confidence interval = 1.95-3.12), scoliosis diagnosis, and combined approach (odds ratio = 1.51; confidence interval = 1.15-1.96) independently added the most risk for cardiopulmonary complication. Cardiac arrest had the highest mortality rate (34.57%). Being on ventilator greater than 48 hours resulted in the greatest increase to length of stay (17.58 days). Conclusions: Expected risk factors seen in the Revised Cardiac Risk Index were applicable in the context of spine surgery. Surgical planning should take into account patients who are at higher risk for cardiopulmonary complications and the implications they have on patient outcome.

Risk Factors for Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury

2020 ◽  
Vol 86 (1) ◽  
pp. 8-14
Author(s):  
Sahil Gambhir ◽  
Areg Grigorian ◽  
Divya Ramakrishnan ◽  
Catherine M. Kuza ◽  
Brian Sheehan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Risk Factor ◽  
Brain Injury ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Independent Risk Factor ◽  
Factors Associated ◽  
Severe Tbi ◽  
Life Sustaining Treatment

Studies demonstrate a significant variation in decision-making regarding withdrawal of life-sustaining treatment (WLST) practices for patients with severe traumatic brain injury (TBI). We investigated risk factors associated with WLST in severe TBI. We hypothesized age ≥65 years would be an independent risk factor. In addition, we compared survivors with patients who died in hospital after WLST to identify potential factors associated with in-hospital mortality. The Trauma Quality Improvement Program (2010–2016) was queried for patients with severe TBI of the head. Patients were compared by age (age < 65 and age ≥ 65 years) and survival after WLST (survivors versus non-survivors) at hospitalization discharge. A multivariable logistic regression model was used for analysis. From 1,403,466 trauma admissions, 328,588 (23.4%) patients had severe TBI. Age ≥ 65 years was associated with increased WLST (odds ratio: 1.76, confidence interval: 1.59–1.94, P < 0.001), whereas nonwhite race was associated with decreased WLST (odds ratio: 0.60, confidence interval: 0.55–0.65, P < 0.001). Compared with non-survivors of WLST, survivors were older (74 vs 61 years, P < 0.001) and more likely to have comorbidities such as hypertension (57% vs 38.5%, P < 0.001). Age ≥ 65 years was an independent risk factor for WLST, and nonwhite race was associated with decreased WLST. Patients surviving until discharge after WLST decision were older (≥74 years) and had multiple comorbidities.

scholarly journals Coagulopathy after hemorrhagic traumatic brain injury, an observational study of the incidence and prognosis

2019 ◽  
Vol 162 (2) ◽  
pp. 329-336 ◽  
Author(s):  
Jort A. N. van Gent ◽  
Thomas A. van Essen ◽  
Mettine H. A. Bos ◽  
Suzanne C. Cannegieter ◽  
Jeroen T. J. M. van Dijck ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Outcome ◽  
Confidence Interval ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Trauma Patients ◽  
Intracranial Hemorrhages ◽  
Mortality And Morbidity ◽  
Traumatic Intracranial Hemorrhage

Abstract Background Traumatic brain injury is associated with high rates of mortality and morbidity. Trauma patients with a coagulopathy have a 10-fold increased mortality risk compared to patients without a coagulopathy. The aim of this study was to identify the incidence of coagulopathy and relate early coagulopathy to clinical outcome in patients with traumatic intracranial hemorrhages. Methods Between September 2015 and December 2016, 108 consecutive cranial trauma patients with traumatic intracranial hemorrhages were included in this study. To assess the relationship between patients with a coagulopathy and outcome, a chi-squared test was performed. Results A total of 29 out of the 108 patients (27%) with a traumatic intracranial hemorrhage developed a coagulopathy within 72 h after admission. Overall, a total of 22 patients (20%) died after admission of which ten were coagulopathic at emergency department presentation. Early coagulopathy in patients with traumatic brain injury is associated with progression of hemorrhagic injury (odds ratio 2.4 (95% confidence interval 0.8–8.0)), surgical intervention (odds ratio 2.8 (95% confidence interval 0.87–9.35)), and increased in-hospital mortality (odds ratio 23.06 (95% confidence interval 5.5–95.9)). Conclusion Patients who sustained a traumatic intracranial hemorrhage remained at risk for developing a coagulopathy until 72 h after trauma. Patients who developed a coagulopathy had a worse clinical outcome than patients who did not develop a coagulopathy.

Trauma and thyroid-stimulating hormone abnormalities in pediatric patients

Trauma ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 118-125
Author(s):  
Shefali Aggarwal ◽  
Joshua Fogel ◽  
Krishan Kumar ◽  
Nadeem Shabbir
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Confidence Interval ◽  
Medical History ◽  
Odds Ratio ◽  
Pediatric Trauma ◽  
Thyroid Stimulating Hormone ◽  
Secondary Outcome ◽  
Trauma Patients ◽  
Stimulating Hormone

Background There is limited literature on trauma and endocrine abnormalities in the pediatric trauma setting. Aim We studied demographic, medical history, injury experience, and mortality factors to determine their association with abnormal thyroid-stimulating hormone in pediatric trauma patients. Methods The 414 pediatric trauma patients were from those seen at an emergency department. The primary outcome variable was abnormal thyroid-stimulating hormone. Secondary outcome variables were abnormal high and abnormal low thyroid-stimulating hormone. Predictor variables were demographics (age, sex, race/ethnicity, body mass index), medical history (thyroid disease, diabetes mellitus, autoimmune disease, psychiatric disease), injury experience (injury cause, injury severity score ≥ 15, moderate/severe traumatic brain injury, length of stay), and mortality (mortality, survival probability). Multivariate logistic regression analyses were conducted. Results There were 8.0% ( n = 33) with any abnormal thyroid-stimulating hormone value. In the analysis for abnormal thyroid-stimulating hormone, females (odds ratio:4.95, 95% confidence interval: 2.01, 12.21, p < 0.01) and traumatic brain injury (odds ratio: 8.11, 95% confidence interval: 2.51, 26.16, p < 0.001) were each significantly associated with increased odds. In the analysis for abnormal high thyroid-stimulating hormone (odds ratio: 3.75, 95% confidence interval: 1.37, 10.24, p < 0.05), traumatic brain injury (odds ratio: 11.59, 95% confidence interval: 3.45, 38.97, p < 0.001), and mortality (odds ratio: 35.59, 95% confidence interval: 1.40, 906.57, p < 0.05) were each significantly associated with increased odds. In the analysis for abnormal low thyroid-stimulating hormone, only females (odds ratio: 11.10, 95% confidence interval: 1.26, 97.60, p < 0.05) were significantly associated with increased odds. Conclusion In conclusion, females and traumatic brain injury have increased odds for abnormal thyroid-stimulating hormone. Mortality has increased odds for abnormal high thyroid-stimulating hormone. We suggest that clinicians in the pediatric trauma setting carefully monitor females and traumatic brain injury patients with abnormal thyroid-stimulating hormone.

P22 Phenytoin versus levetiracetam for post traumatic brain injury seizure prophylaxis; a retrospective study at a UK major trauma centre

2019 ◽  
Vol 90 (3) ◽  
pp. e31.2-e31
Author(s):  
L Harris ◽  
S Hateley ◽  
B Seemungal
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Major Trauma ◽  
Average Length ◽  
Study Data ◽  
Trauma Centre ◽  
Seizure Prophylaxis ◽  
Major Trauma Centre ◽  
The Impact

Objectives12% of patients with severe Traumatic brain injury (TBI) suffer from seizures. Evidence suggests that the use of an antiepileptic drug (AED) is beneficial in preventing early post TBI seizures. To date, no specific NICE guidelines exist on the choice of post TBI seizure prophylaxis. This study aims to identify the trend in AED usage, the impact on length of stay and to compare the tolerability of phenytoin and levetiracetam.DesignRetrospective observational study.Subjects201 patients.MethodsAll patients admitted to a Major Trauma Unit following a head injury treated with levetiracetam or phenytoin for seizure prophylaxis were included in the study. Data was collected between October 2013 – September 2014 and November 2016 – October 2017. Patient demographics, Glasgow Coma Score (GCS) on admission, length of treatment, AED toxicity, length of stay, complications, surgical input and length of ITU stay were recorded.Results85.6% of patients were treated with phenytoin in 2013–2014% and 82.5% were treated with levetiracetam in 2016–2017. The average length of stay for phenytoin was 23.2 days and 13.9 days for levetiracetam. Subgroup analysis was performed on patients with an admission GCS of 14–15. Length of stay for phenytoin was 14.9 days (SD −11.87) and levetiracetam 9.4 days (SD 10.588) (p=0.07). 24% of patients on phenytoin and 14% on levetiracetam suffered from dizziness.ConclusionsThis suggests that levetiracetam is tolerated better with fewer side effects. We recommend its use in clinical practice.

scholarly journals Spatial Neglect Hinders Success of Inpatient Rehabilitation in Individuals With Traumatic Brain Injury

2015 ◽  
Vol 30 (5) ◽  
pp. 451-460 ◽  
Author(s):  
Peii Chen ◽  
Irene Ward ◽  
Ummais Khan ◽  
Yan Liu ◽  
Kimberly Hreha
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Current Knowledge ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Spatial Neglect ◽  
Future Research ◽  
Discharge Disposition ◽  
The Impact

Background. Current knowledge about spatial neglect and its impact on rehabilitation mostly originates from stroke studies. Objective. To examine the impact of spatial neglect on rehabilitation outcome in individuals with traumatic brain injury (TBI). Methods. The retrospective study included 156 consecutive patients with TBI (73 women; median age = 69.5 years; interquartile range = 50-81 years) at an inpatient rehabilitation facility (IRF). We examined whether the presence of spatial neglect affected the Functional Independence Measure (FIM) scores, length of stay, or discharge disposition. Based on the available medical records, we also explored whether spatial neglect was associated with tactile sensation or muscle strength asymmetry in the extremities and whether specific brain injuries or lesions predicted spatial neglect. Results. In all, 30.1% (47 of 156) of the sample had spatial neglect. Sex, age, severity of TBI, or time postinjury did not differ between patients with and without spatial neglect. In comparison to patients without spatial neglect, patients with the disorder stayed in IRF 5 days longer, had lower FIM scores at discharge, improved slower in both Cognitive and Motor FIM scores, and might have less likelihood of return home. In addition, left-sided neglect was associated with asymmetric strength in the lower extremities, specifically left weaker than the right. Finally, brain injury–induced mass effect predicted left-sided neglect. Conclusions. Spatial neglect is common following TBI, impedes rehabilitation progress in both motor and cognitive domains, and prolongs length of stay. Future research is needed for linking specific traumatic injuries and lesioned networks to spatial neglect and related impairment.

Does Health Care Insurance Affect Outcomes after Traumatic Brain Injury? Analysis of the National Trauma Databank

2010 ◽  
Vol 76 (10) ◽  
pp. 1108-1111 ◽  
Author(s):  
Rodrigo F. Alban ◽  
Cherisse Berry ◽  
Eric Ley ◽  
James Mirocha ◽  
Daniel R. Margulies ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Injury Severity ◽  
Unit Length ◽  
Multivariate Logistic Regression Analysis ◽  
National Trauma ◽  
Severe Tbi

Increasing evidence indicates insurance status plays a role in the outcome of trauma patients; however its role on outcomes after traumatic brain injury (TBI) remains unclear. A retrospective review was queried within the National Trauma Data Bank. Moderate to severe TBI insured patients were compared with their uninsured counterparts with respect to demographics, Injury Severity Score, Glasgow Coma Scale score, and outcome. Multivariate logistic regression analysis was used to determine independent risk factors for mortality. Of 52,344 moderate to severe TBI patients, 41,711 (79.7%) were insured. Compared with the uninsured, insured TBI patients were older (46.1 ± 22.4 vs 37.3 ± 16.3 years, P < 0.0001), more severely injured (ISS > 16: 78.4% vs 74.4%, P < 0.0001), had longer intensive care unit length of stay (6.0 ± 9.4 vs 5.1 ± 7.6, P < 0.0001) and had higher mortality (9.3% vs 8.0%, P < 0.0001). However, when controlling for confounding variables, the presence of insurance had a significant protective effect on mortality (adjusted odds ratio 0.89; 95% confidence interval: 0.82-0.97, P = 0.007). This effect was most noticeable in patients with head abbreviated injury score = 5 (adjusted odds ratio 0.7; 95% confidence interval: 0.6-0.8, P < 0.0001), indicating insured severe TBI patients have improved outcomes compared with their uninsured counterparts. There is no clear explanation for this finding however the role of insurance in outcomes after trauma remains a topic for further investigation.

scholarly journals A review of minor traumatic brain injury presentations and their management in Brisbane emergency departments

2021 ◽  
Vol 5 ◽  
pp. 205970022110065
Author(s):  
Gary Mitchell ◽  
Jack Taylor ◽  
Gilbert Jin ◽  
Rahul Snelling
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Emergency Departments ◽  
Average Length ◽  
Return To Play ◽  
Ct Scans ◽  
Retrospective Audit ◽  
Ct Head ◽  
Minor Traumatic Brain Injury

Objective A retrospective audit of minor traumatic brain injury presentations to three Brisbane emergency departments aiming to assess rates of CT scans and compliance with the Canadian CT Head Rule (CCTHR), as well as reviewing the demographics of patients and their management. Method Minor traumatic brain injury presentations to the Emergency departments of the Royal Brisbane and Women’s Hospital, Redcliffe Hospital and Queen Elizabeth II Hospital between July 1st and August 30th, 2019 were identified via diagnosis searches in patient tracking systems. Data collected included patient demographics, use of CT scans and Abbreviated Westmead Post Traumatic Amnesia Scale assessment, length of stay and discharge advice regarding return to sport. Results 200 minor traumatic brain injury presentations were included. 75% of patients received a CT head with only 9% of these found to be non-compliant with the CCTHR. The most common indications for CTs were age >65, GCS <15 at 2 hours post injury and anticoagulation. Only 40% of patients that qualified for A-WTPAS received the assessment. 18% of presentations were due to sporting injuries and 69% were not given return to play advice. The average length of stay was 250 minutes with 41.5% of presentations longer than 4 hours. 99% of the patients were discharged home from the ED with 1% admitted. Conclusion The study characterised minor traumatic brain injury management across three emergency departments and showed that most patients received CT head scans that were indicated. However, other areas of management such as A-WPTAs and return to play advice must be improved.

scholarly journals Young Age as a Risk Factor for Impaired Cerebral Autoregulation after Moderate to Severe Pediatric Traumatic Brain Injury

2008 ◽  
Vol 108 (4) ◽  
pp. 588-595 ◽  
Author(s):  
Serena S. Freeman ◽  
Yuthana Udomphorn ◽  
William M. Armstead ◽  
Dana M. Fisk ◽  
Monica S. Vavilala
Keyword(s):  
Traumatic Brain Injury ◽  
Risk Factor ◽  
Brain Injury ◽  
Confidence Interval ◽  
Glasgow Coma Scale ◽  
Glasgow Coma Scale Score ◽  
Cerebral Autoregulation ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Coma Scale

Background Little is known about age and cerebral autoregulation in children with traumatic brain injury (TBI). The authors compared cerebral autoregulation between young (aged &lt;4 yr) and older (aged &gt; or =4 yr) children with TBI. Methods After University of Washington's institutional review board approval, a retrospective analysis of prospectively collected data (May 2002 and June 2007) was performed. Eligibility criteria included age 16 yr or younger, moderate to severe (admission Glasgow Coma Scale score &lt;13) TBI, TBI on computed tomography scan, and tracheal intubation. Cerebral autoregulation testing was performed within 72 h after TBI, and autoregulation was quantified using the autoregulatory index. An autoregulatory index less than 0.4 represents impaired cerebral autoregulation. The 12-month Glasgow outcome score was measured. Data are presented as mean +/- SD or range. Results Thirty-seven children (8.9 +/- 5.1 yr; 0.8-16 yr) were enrolled. Children younger than 4 yr had a higher incidence of impaired cerebral autoregulation (8 of 10 vs. 7 of 27; P = 0.006) and worse 12-month outcome (Glasgow outcome score 3.0 +/- 1.0 vs. 4.0 +/- 1.0; P = 0.02) than older children. Age less than 4 yr (adjusted odds ratio, 12.2; 95% confidence interval, 1.5-98.5) and low Glasgow Coma Scale score (adjusted odds ratio for higher Glasgow Coma Scale, 0.53; 95% confidence interval, 0.30-0.96) were independently associated with impaired cerebral autoregulation. Conclusions Age less than 4 yr was a risk factor for impaired cerebral autoregulation, independent of TBI severity. Age-related factors may play a role in the mechanisms maintaining or worsening cerebral autoregulation in children after TBI.

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