scholarly journals Outcome of Cranioplasty Done within and Beyond 2 Months after Decompressive Craniectomy for Traumatic Brain Injury

2021 ◽  
Vol 10 (10) ◽  
pp. 711-714
Author(s):  
Khongbantabam Vyas ◽  
Khaidem Mani Singh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Categorical Variables ◽  
P Value ◽  
Consecutive Series ◽  
Complication Rates ◽  
Care Hospital

BACKGROUND Cranioplasty although a simple elective neurosurgical procedure is burdened by considerable morbidity. The timing of doing cranioplasty and a good outcome remains a topic of much debate. We wanted to compare the outcome of doing cranioplasty within (early) and beyond (late) 2 months after decompressive craniectomy for traumatic brain injury. METHODS The study was carried out in a tertiary care hospital. A 5-year retrospective study of patient records was analysed. Consecutive series of traumatic brain injury patients who underwent cranioplasty after decompressive craniectomy from a tertiary care hospital operated by a single neurosurgeon, were studied. Data was analysed using SPSS version 21, IBM. Associations of categorical variables were compared using chisquare test and of continuous variables by using unpaired 2-tailed Student t-test. RESULTS Altogether 90 patients were identified who had undergone cranioplasty after decompressive craniectomy for traumatic brain injury and were grouped into early (within 2 months; 44 patients) and late (beyond 2 months; 46 patients). Cranioplasty operative time was significantly shorter in the early (59.39 mins) than the late (77.28 mins) with a P value of 0.001. Infection rates were significantly higher in the early (4.55 %) than late (0 %), with P value 0.144. Other complication rates were postoperative haematoma (0 % early, 2.17 % late, P = 0.325), hydrocephalus (0 % early, 6.52 % late, P = 0.085), sunken brain (0 % early, 4.35 % late, P = 0.162), and bone graft resorption (0 % early, 2.17 % late, P = 0.325). These differences were not statistically significant though. CONCLUSIONS Early cranioplasty performed within 2 months of decompressive craniectomy has better outcome in the form of reduced hospital stay, decreased cost, and fewer complications. KEY WORDS Traumatic Brain Injury, Decompressive Craniectomy, Outcome, Cranioplasty

scholarly journals Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda

Neurosurgery ◽  
2018 ◽  
Vol 84 (1) ◽  
pp. 95-103 ◽  
Author(s):  
Silvia D Vaca ◽  
Benjamin J Kuo ◽  
Joao Ricardo Nickenig Vissoci ◽  
Catherine A Staton ◽  
Linda W Xu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Continuum

scholarly journals Incidence of progressive hemorrhagic injury in patients presenting with traumatic brain injury at a large tertiary care hospital in Karachi, Pakistan. A Case Series.

2020 ◽  
Vol 27 (01) ◽  
pp. 94-99
Author(s):  
Qazi Muhammad Zeeshan ◽  
Ramesh Kumar ◽  
Asim Rehmani ◽  
Muhammad Imran ◽  
Atiq Ahmed Khan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Ct Scan ◽  
Epidural Hematoma ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Case Series ◽  
Care Hospital ◽  
Progressive Hemorrhagic Injury

Objectives: Our study aims to determine the frequency of progressive hemorrhagic injury as observed on the CT scan from the initial scan performed at the time of presentation to a subsequent one in the 12 hours after the initial scan. Study Design: The type of study is a prospective observational case series. Setting: At Tertiary Care Hospital in Karachi, Pakistan. Period: 3 months from June 2018 to August 2018. Materials & Methods: All patients over 18 years of age who presented to the Accident and Emergency Department of the hospital with traumatic brain injury and had a CT scan performed within four hours of the injury were included in the study. A predesigned proforma was used to note down patient findings. CT scan findings were classified as subdural hematoma (SDH), intraparenchymal contusion (IPC) extradural hematoma (EDH) and subarachnoid hemorrhage (SAH). A repeat CT scan was performed twelve hours after the initial CT scan. Data were analyzed using IBM SPSS version 20.0, mean and frequencies were calculated for continuous variables while frequencies and percentages were calculated for categorical variables. Results: Of the n= 110 patients in our study 79 were males and 31 were female, the mean age of the patients was 34.25 years. The Glasgow Coma Scale scores at the time of arrival were between thirteen and fifteen for n= 33 (30%) of the patients, between nine and twelve for n= 54 (49.09%) of the patients, less than and equal to eight for n= 23 (20.90%) of the patients. Subarachnoid hemorrhage was present in n= 32 (29.09%) patients, intraparenchymal hematoma was present in n= 42 (38.18%) of the patients, while subdural hematoma and epidural hematoma was present in n= 14 (12.72%) and n= 22 (20%) of the patients respectively. Progressive hemorrhagic injury was found in n= 66 (60%) of the patients, while in n= 11 (10%) of the patients there was resolution of the lesion and n= 33 (33%) of the patients showed no observable changes in the repeat CT scan. Finally, our results indicate that of the 110 patients in our study PHI was seen in n= 17 (53.12%) patients with SAH, n= 18 (81.81%) patients of EDH, n= 5 (35.71%) patients of SDH and n= 26 (61.90%) patients of IPC respectively. Conclusion: According to the results of our study PHI is observed in 60% of the patients with a traumatic brain injury observed within the initial 12 hours after injury, and epidural hematoma and intraparenchymal contusions had the highest incidences of PHI among all the different types of traumatic brain injuries.

scholarly journals Pattern of drug-induced bleeding in a tertiary care hospital

2017 ◽  
Vol 5 (4) ◽  
pp. 1198 ◽  
Author(s):  
Rajinder Negi ◽  
Rajesh Kashyap ◽  
Anupam Prashar ◽  
Brij Sharma ◽  
Sanjeev Asotra ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Categorical Variables ◽  
P Value ◽  
Severe Bleeding ◽  
Care Hospital ◽  
Drug Induced ◽  
Upper Gastrointestinal

Background: It is a well-known fact that drug-induced bleeding causes considerable morbidity and mortality. Drugs that induce bleeding do so by affecting either anti-platelet Function and /or coagulation. By the frequency of their use, anti-platelet, a coagulant, thrombolytic and NSAIDs are the most commonly implicated drugs. Upper gastrointestinal bleeding is commonest adverse drug reaction associated with hospital admission. Significant number of these could be prevented if simple guidelines are followed. Spontaneous cessation of bleeding occurs in as many as 85% of cases. Early intervention is required in those if bleeding does not stop spontaneously. Objective of the study was to determine the pattern of drug induced bleeding in tertiary care hospital setting.Methods: It was a hospital based observational study conducted during one year study dura on ((June 1, 2014 to May 31, 2015) amongst all adult patients admitted to the hospital with drug induced bleeding. Statistical analysis was done by frequency measurement for categorical variables. Chi- square test was used to determine associations. A p-value of<0.05 was taken as statistically significant.Results: A total number of 110 cases with history of bleeding were enrolled. Commonest drug that caused bleeding was a platelet with 29 (26%) cases followed by combination of 2 or more drugs in 25 (23%) cases, then NSAIDs and anticoagulants in 24 (21%) and 23 (20%) cases respectively. Upper gastrointestinal bleeding was the commonest site of bleeding seen in 64 (58%) cases. The commonest drugs causing upper GI bleeding were NSAIDs seen in 24 (37.5%) cases followed by a platelet 22 (34.3%), combined drugs in 09 (14%) cases. (P<0.001) In overall severity most cases of drug induced bleeding had mild bleeding with 61 cases as compared to 38 cases of moderate and 11 cases of severe bleeding. There were significantly higher proportion of mild and moderate bleeding in upper gastrointestinal bleed cases in comparison to other sites of drug induced bleeding in this study (p<0.01). 7 (6.4%) out of 110 patients died and 103 (93.6%) patients recovered and were discharged.Conclusions: Clinical management of bleeds requires careful assessment of the patient, haemodynamic stabilisation, discontinuation of the offending medication and, where appropriate, reversal of the haemorrhagic effects and specific therapies such as endoscopic haemostatic therapy.

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