scholarly journals A study of prognostic score for predicting the outcome in cases of traumatic brain injury

2020 ◽  
Vol 7 (4) ◽  
pp. 1218
Author(s):  
Sudhir Singh Pal ◽  
Ashay Rathore
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Prognostic Score ◽  
Medical College ◽  
New Methods ◽  
Observational Prospective Cohort Study ◽  
The Mean ◽  
Gandhi Medical College ◽  
The Impact ◽  
Pro Forma

Background: Glasgow coma scale (GCS) and the Glasgow outcome scale help us with confident predictions after 24 h following the injury, but not on admission. The IMPACT and CRASH studies provided new methods for performing prognostic studies of traumatic brain injury. And this prognostic scoring system has been studied in our study.Methods: This is an observational prospective cohort study performed at the department of surgery, Gandhi medical college and Hamidia hospital, Bhopal on 87 patients during a period of 2 years. A preformed pro-forma was filled for each patient after 6 hours of resuscitation which included all the details of the patients like name, age, sex, CR no., and GCS after resuscitation, mode of injury, the clinical evaluation score used by IMPACT trial and neurological finding, management details, CT scan was done as soon as possible for all patients and findings were included in the pro-forma. The final outcome was recorded at the time of discharge.Results: Among Patients with mean total prognostic score of 0-4, 97% patients discharged without deficit, 3% discharged with deficit with no mortality. Among score of 15-20, only 7 % can be discharged without deficit and 7% could be discharged without deficit, while 86 % patient died.Conclusions: The mean total prognostic score of discharged groups was significantly lower than the patients in discharged group. We concluded that this prognostic model helps us to individually identify patients who will succumb to death and early need for surgical intervention.

Prognostic Factors after Acute Subdural Hematoma

2021 ◽  
Vol 15 (11) ◽  
pp. 2979-2981
Author(s):  
Ali Akbar ◽  
Safdar Hussain Arain ◽  
Mumtaz Ali Narejo ◽  
Najmus Saqib Ansari
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Midline Shift ◽  
College Hospital ◽  
Medical College ◽  
Significant Difference ◽  
The Mean ◽  
Computed Topography

Background: Acute subdural hematoma is a lesion caused by traumatic brain injury. Computed topography, hematoma thickness and midline shift analysis are important factors in evaluating its prognosis. Aim: To evaluate the factors involved in prognosis of acute subdural hematoma. Study design: Retrospective study Place and duration of study: Department of Neurosurgery, Chandka Medical College Hospital, Larkana from 1st October 2020 to 30the June 2021. Methodology: One hundred patients from both genders and between age 18-55 years were enrolled. Clinical examination and radiological complete examination was done in each patient. Zumkeller Index (ZI) was calculated and Glasgow scoring was performed. Results: The mean age were 44.1±15.8 years with 87% males having major reasoning of head injury as a motor cycle accident. Traumatic brain injury was recorded as >3mm ZI in 10 cases. The mean midline shift was 12.4±6.06 mm with a significant difference between three categories. Conclusion: Midline shift and hematoma thickness are useful predictors of prognosis related to acute subdural hematoma. Keywords: Prognostic factor, Acute subdural hematoma, Computed tomography (CT)

scholarly journals Brain death rates in severe blunt traumatic brain injury: comparison of decompressive craniectomy to a medically managed cohort

2015 ◽  
Vol 42 (S1) ◽  
pp. S17-S17
Author(s):  
FA Zeiler ◽  
J Teitelbaum
Keyword(s):  
Traumatic Brain Injury ◽  
Cardiac Arrest ◽  
Brain Injury ◽  
Brain Death ◽  
Cause Of Death ◽  
Decompressive Craniectomy ◽  
Matched Cohort ◽  
Severity Scores ◽  
The Mean ◽  
The Impact

Introduction: Decompressive craniectomy (DC) in severe traumatic brain injury (TBI) is controversial. The impact DC on cause of death is unclear in the literature to date. Methods: We performed an institutional retrospective review, from June 2003 to June 2013, of patients with severe blunt TBI undergoing DC whom subsequently died. We compared this group to a retrospectively matched cohort based: age, pre-hospital mRS, Marshall diffuse and TBI grades, Injury Severity Scores, and admission laboratory values. The goal was to determine the cause of death between those receiving DC and those managed medically. Results: Nineteen patients received DC and were compared to 16 retrospectively matched patients. The mean age of the DC and matched cohort were 47.1 and 43.6 years, respectively. The mean admission GCS/Marshall diffuse CT grades were 5.8/3.4 for the DC group, and 4.1/3.1 for the matched medical cohort. Overall, in the DC group 94.7% of the deaths occurred secondary to cardiac arrest after withdrawal of life sustaining treatment (WLST), with only 5.3% progressing to brain death. Alternatively, in the matched cohort 62.5% died of cardiac arrest post WLST, with 37.5% progressing to brain death. Conclusions: Progression to brain death appears to be more common in those severe blunt TBI patients treated medically compared to those undergoing DC.

scholarly journals OUTCOME OF THE UNIDENTIFIED/UNACCOMPANIED PATIENT OF TRAUMATIC BRAIN INJURY IN TRAUMA UNIT OF GANDHI MEDICAL COLLEGE AND ASSOCIATED HAMIDIA HOSPITAL BHOPAL (INDIA)

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. I. D. Chaurasia ◽  
Dr. Shikha Shukla ◽  
Dr. Aryish Gupta ◽  
Dr. Rajat Maheshwari ◽  
Dr. Mahim Koshariya ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Decompressive Craniectomy ◽  
Neurological Status ◽  
Age Group ◽  
Common Cause ◽  
Medical College ◽  
Trauma Unit ◽  
Gandhi Medical College

All unidentified / unaccompanied & unknown TBI patients admitted in department of neurosurgery, Gandhi Medical College Bhopal from June 2016 to May 2019 were enrolled in this study. Management of unidentified and unaccompanied patients is difficult in any health care setup due to challenges in managing their day to day care. Traumatic brain injury is the most common cause of death in trauma patients.  We analyzed demography, mode of injury, clinical presentation & condition at admission, treatment given, hospital stay, outcome & factors affecting outcome of the patients. Very few studies in world literature are available on this subgroup of patients. We analyzed data pertaining to 100 consecutive patients at our hospital. Aim and Objectives: The aim and objective of this study is to determine the outcome of traumatic Brain Injury in patients who were admitted in trauma unit/ Neurosurgery unit of Gandhi medical College Bhopal India from June 2016 to May 2019. As unaccompanied / unknown/ unidentified. In this study we collected the data of unknown/ unidentified patients of TBI to analyze the outcome. Material and Methods: It was a prospective study of all unaccompanied/ unknown patients who were admitted in the trauma unit/ Neurosurgery unit of surgery department of Gandhi Medical College & Associated Hamidia Hospital Bhopal India from June 2016 to May 2019 a total number of 100 unidentified /unaccompanied patients were admitted whose data were collected and analyzed Departmental staff, social workers, police and media persons help were take in for relocation of unknown patients to their home or non government organization shelter homes . Results: There were total 100 consecutive patient enrolment in this study, 87% of the patients were male. Most common age group was 40-59 years, 48% patients falls in this age group. Most common cause of trauma was road traffic accident (48%), followed by Cause Unknown (36%). Overall mortality was 39%. Others clinical characteristic and type of lesion in traumatic brain injury of unidentified and unaccompanied patients is given in detail in. Out of 100 patients, 43 (43%) patients were managed conservatively based on CT head findings and neurological status & 57 (57%) were operated. Decompressive Craniectomy was most common operative procedure depending on the clinical & neurological status. Overall complication rate during hospital stay was 26%. Keywords: TBI, Unidentified Patient & Unaccompanied & Decompressive Craniectomy, Rehabilitation.

scholarly journals A qualitative study of pulmonary function tests between smokers and non smokers in Telangana state

2021 ◽  
Vol 8 (3) ◽  
pp. 219-225
Author(s):  
Farzana Mustafa ◽  
Abdul Hai Mohammad
Keyword(s):  
Qualitative Study ◽  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
Medical College ◽  
Quit Smoking ◽  
The Mean ◽  
Telangana State ◽  
Gandhi Medical College ◽  
The Impact

 In a few examinations, low spirometric levels have been displayed to expand the achievement paces of smoking discontinuance, while different investigations have demonstrated that aspiratory work affects stopping smoking. Given the way that there are conflicting outcomes regarding this matter, we expected to research the impact of distinguishing aviation route obstacle by means of spirometry and its clarification to subjects on the achievement pace of smoking discontinuance temporarily. The current study was led in Gandhi Medical College, Hyderabad, India, Subjects who were conceded to the smoking discontinuance out-patient facility, went through pneumonic capacity tests (PFTs) and finished somewhere around 90 days of the suspension program following their induction were remembered for the investigation. The mean age of the 563 subjects was 41.9 ± 12.1 y 340 subjects (60.4%) were male. An aggregate of 162 subjects (28.8%) went to the subsequent visits following the primary meeting. The accomplishment of smoking suspension for 90 days was 11.3% for all subjects and 39.5% for subjects who came to follow-up visits. Of the subjects with impediment on PFT; 22.8% quit smoking, while 8.4% of the subjects without block did as such (P < .001). The level of subjects with impediment on PFT was altogether higher (P < .001) and the FEV1 % (P = .005), FEV1/FVC (P < .001), and constrained expiratory stream 25–75% (P = .008) levels were fundamentally lower in the weaklings contrasted and the non-slackers. Strategic relapse investigation showed that age (P = .001) and the presence of impediment on pft (p = .029) were autonomous factors. Old age and the presence of impediment on PFT increment the accomplishment of smoking end. Aspiratory work tests ought to be performed on all patients who apply to smoking end out-patient facilities, and patients ought to be educated with regards to their condition.

Temporal trends and volume-outcome associations after traumatic brain injury: a 12-year study in Taiwan

2013 ◽  
Vol 118 (4) ◽  
pp. 732-738 ◽  
Author(s):  
Hon-Yi Shi ◽  
Shiuh-Lin Hwang ◽  
King-Teh Lee ◽  
Chih-Lung Lin
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Temporal Trends ◽  
High Volume ◽  
Adverse Outcomes ◽  
Hospitalization Cost ◽  
The Mean ◽  
Low Volume ◽  
The Impact ◽  
Very High

Object The purpose of this study was to evaluate temporal trends in traumatic brain injury (TBI); the impact of hospital volume and surgeon volume on length of stay (LOS), hospitalization cost, and in-hospital mortality rate; and to explore predictors of these outcomes in a nationwide population in Taiwan. Methods This population-based patient cohort study retrospectively analyzed 16,956 patients who had received surgical treatment for TBI between 1998 and 2009. Bootstrap estimation was used to derive 95% confidence intervals for differences in effect sizes. Hierarchical linear regression models were used to predict outcomes. Results Patients treated in very-high-volume hospitals were more responsive than those treated in low-volume hospitals in terms of LOS (−0.11; 95% CI −0.20 to −0.03) and hospitalization cost (−0.28; 95% CI −0.49 to −0.06). Patients treated by high-volume surgeons were also more responsive than those treated by low-volume surgeons in terms of LOS (−0.19; 95% CI −0.37 to −0.01) and hospitalization cost (−0.43; 95% CI −0.81 to −0.05). The mean LOS was 24.3 days and the average LOS for very-high-volume hospitals and surgeons was 61% and 64% shorter, respectively, than that for low-volume hospitals and surgeons. The mean hospitalization cost was US $7,292.10, and the average hospitalization cost for very-high-volume hospitals and surgeons was 19% and 22% lower, respectively, than that for low-volume hospitals and surgeons. Advanced age, male sex, high Charlson Comorbidity Index score, treatment in a low-volume hospital, and treatment by a low-volume surgeon were significantly associated with adverse outcomes (p < 0.001). Conclusions The data suggest that annual surgical volume is the key factor in surgical outcomes in patients with TBI. The results improve the understanding of medical resource allocation for this surgical procedure, and can help to formulate public health policies for optimizing hospital resource utilization for related diseases.

scholarly journals Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome

2021 ◽  
Author(s):  
Gopal Krishna ◽  
Varun Aggarwal ◽  
Ishwar Singh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Clinical Outcome ◽  
Road Traffic ◽  
Statistical Significance ◽  
Platelet Counts ◽  
Coagulation Abnormalities ◽  
The Mean ◽  
D Dimer

Abstract Introduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis. Design Prospective study. Methods The study included 50 patients of isolated TBI with cohorts of moderate (MHI) and severe head injury (SHI). Coagulopathy was graded according to the values of parameters in single laboratory. The incidence of coagulopathy according to the severity of TBI and correlation with disseminated intravascular coagulation (DIC) score, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen was observed. The comparison was also made between expired and discharged patients within each group. It also compared coagulation derailments with clinical presentation (Glasgow Coma Scale [GCS]) and outcome (Glasgow Outcome Scale [GOS]). Results Road traffic accident was the primary (72%) mode of injury. Fifty-two percent had MHI and rest had SHI. Eighty-four percent of cases were managed conservatively. The mean GCS was 12.23 and 5.75 in MHI and SHI, respectively. Sixty-two percent of MHI and 96% of the patients with SHI had coagulation abnormalities. On statistical analysis, DIC score (p < 0.001) strongly correlated with the severity of head injury and GOS. PT and APTT were also significantly associated with the severity of TBI. In patients with moderate TBI, D-dimer and platelet counts showed association with clinical outcome. Fibrinogen levels did not show any statistical significance. The mean platelet counts remained normal in both the groups of TBI. The mean GOS was 1.54 and 4.62 in SHI and MHI, respectively. Conclusion Coagulopathy is common in isolated TBI. The basic laboratory parameters are reliable predictors of coagulation abnormalities in TBI. Coagulopathy is directly associated with the severity of TBI, GCS, and poor outcome.

Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Fleur Lorton ◽  
Jeanne Simon-Pimmel ◽  
Damien Masson ◽  
Elise Launay ◽  
Christèle Gras-Le Guen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
University Hospital ◽  
S100b Protein ◽  
Research Network ◽  
Ct Scans ◽  
Intermediate Risk ◽  
Protein Assay ◽  
The Impact

AbstractObjectivesTo evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children.MethodsA before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15 years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013–2014) and after (2014–2015) implementation of a modified PECARN rule including the S100B protein assay.ResultsWe included 1,062 children with mTBI (median age 4.5 years, sex ratio [F/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013–2014 and 568 (53.5%) during 2014–2015. During 2014–2015, S100B protein was measured in 451 (79.4%) children within 6 h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9–40.5% (p<0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013–2014 and 2014–2015. All children with ciTBI were identified by the rules.ConclusionsThe implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI.

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

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