scholarly journals HEMORRHAGIC PROGRESSION OF CONTUSION IN PATIENTS WITH MILD TRAUMATIC BRAIN INJURY ON THE ROUTINE REPEAT HEAD COMPUTED TOMOGRAPHY

2020 ◽  
Vol 3 ◽  
pp. 20-26
Author(s):  
Mykola Polishchuk ◽  
Mykola Vyval ◽  
Dmytro Shchehlov
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mortality Rate ◽  
Average Duration ◽  
Clinical Deterioration ◽  
Average Volume ◽  
Duration Of Treatment ◽  
Mild Tbi ◽  
Brain Contusion

Computed tomography (CT) scan is a standard for the diagnosis of intracranial pathology after traumatic brain injury (TBI). Hemorrhagic progression of contusion (HPC) is frequently seen on repeat CT, but its clinical and radiological significance in case of mild TBI is not well define. The aim of the study: to evaluate the result of routine repeat head CT in patients with mild TBI and brain contusions. Materials and methods: retrospective analysis of management of patients with mild TBI (Glasgow Coma Scale (GCS) score – 13 to 15) and cerebral contusion. All patients were treated at the Kyiv City Clinical Emergency Hospital between 2016 and 2017. Results: within 202 patients with mild TBI, 87 (43.1 %) met the inclusion criteria and were selected for detailed analysis. There were 69 (79.3 %) men and 18 (20.7 %) women. The mean age of the patients was 43.8±12.7 years (17–82 years). The average time between trauma and CT was 3.3 hours. The average volume of contusion on the initial CT was 1.9±0.6 cm3 (0.2–9.6 cm3). The average time of routine CT was 6.8 hours (range 4–24 hours) after the initial scans. HPC was found in 24 (30.7 %) of 87 cases. The average volume of brain contusion on the repeat CT was 2.3±0.5 cm3 (0.2-17.1 cm3). In 3 (3.4 %) patients the size of the hematoma increased. Clinical deterioration occurred in 10 (11.5 %) patients. Six (6.9 %) patients were operated after a CT scan due to HPC with midline shift in 4 cases and increasing of subdural hematoma – 2 cases. Four of these patients had clinical deterioration, and 2 patients were neurological stable. Patients with HPC at admission had lower points of GCS, fractures of the skull (both p <0.001), subdural blood collection (p=0.002), a higher average duration of treatment 8.1±4.2 vs 14.3±5.2 days (p=0.0001), and mortality rate 0 vs. 3 (12.5 %) (p=0.02). Conclusions: Routine repeat CT in patients with mild TBI with brain contusions is aimed to find a patients with s high risk for clinical deterioration. One third of patients with mild TBI and brain contusion experienced HPC. Patients with HPC often have unfavorable clinical course with higher average duration of treatment, delay surgical treatment and mortality rate.

Neutrophil to lymphocyte ratio as a predictive biomarker for computed tomography scan use in mild traumatic brain injury

2020 ◽  
Vol 14 (12) ◽  
pp. 1085-1090
Author(s):  
George A Alexiou ◽  
Georgios D Lianos ◽  
Aggeliki Tzima ◽  
Athanasios Sotiropoulos ◽  
Anastasios Nasios ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Characteristic Curve ◽  
Predictive Biomarker ◽  
Health Concern ◽  
Mild Tbi ◽  
Ct Findings ◽  
The Mean

Aim: Traumatic brain injury (TBI) is a serious health concern. We set out to investigate the role of neutrophil-to-lymphocytes ratio (NLR) at admission for predicting the need for computed tomography (CT) in mild-TBI. Materials & methods: A retrospective study of adult patients who presented with mild-TBI Results: One hundred and thirty patients met the inclusion criteria. Seventy-four patients had positive CT-findings. The mean NLR-levels at presentations were 5.6 ± 4.8. Patients with positive CT-findings had significant higher NLR-levels. Receiver operating characteristic curve analysis was conducted and the threshold of NLR-levels for detecting the cases with positive CT-findings was 2.5, with 78.1% sensitivity and 63% specificity Conclusion: To the best of our knowledge no previous study has assessed the value of NLR-levels for predicting the need for CT in mild-TBI.

scholarly journals MULTISLICE COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF MIXED TRAUMATIC BRAIN INJURY

2018 ◽  
Vol 99 (3) ◽  
pp. 119-124
Author(s):  
A. V. Semenov ◽  
N. V. Monakov ◽  
E. I. Balkhanova ◽  
A. A. Raznobarskiy ◽  
T. A. Mamonova
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multislice Computed Tomography ◽  
Whole Body ◽  
Cross Sectional ◽  
Mild Tbi ◽  
Decompressive Craniotomy ◽  
Group 2 ◽  
Student’S T

Objective: to study changes in the cross sectional optic nerve diameter (OND), by using multislice computed tomography (MSCT), in patients with mild traumatic brain injury  (TBI), as well as those with severe (including mixed) TBI before and  after craniotomy; to assess whether this technique can be integrated with a whole-body MSCT protocol in severe mixed TBI (MTBI).Material and methods. OND was retrospectively studied in two  selected groups of patients with injuries (a total of 51 patients):  Group 1 (n = 40) included 2 subgroups (n = 20 in each) with mild  TBI or severe MTBI; Group 2 (n = 11) comprised 2 subgroups with  severe TBI who had undergone decompressive (n = 6) or  osteoplastic (n = 5) craniotomy with subsequent OND measurement  after 12–18 hours. Results.Primary brain MSCT showed that the average OND was  6.12±1,01 mm in severe MTBI and 4.4±0.19 mm in mild TBI (Student’s t = 5.707). After decompressive craniotomy, there  was a decrease in OND from 6.26±0.27 to 5.38±0.22 mm (Student’s t = 2.486).Conclusion. Among the patients with severe MTBI, the OND at  primary MSCT is significantly greater than that in patients with mild  TBI, which may be due to elevated intracranial pressure, as shown  by the literature data. There is a statistically significant decrease in  OND after decompressive craniotomy and removal of the brain  compressive factor. Whole-body MSCT revealed no technical  obstacles to the application of an OND measurement technique.

scholarly journals Necessity of In-hospital Neurological Observation for Mild Traumatic Brain Injury Patients with Negative Computed Tomography Brain Scans

2020 ◽  
Author(s):  
Chin Taweesomboonyat ◽  
Anukoon Kaewborisutsakul ◽  
Thara Tunthanathip ◽  
Sakchai Saeheng ◽  
Thakul Oearsakul
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Intracranial Injury ◽  
Mild Tbi ◽  
Brain Scans ◽  
Brain Scan ◽  
Ct Brain ◽  
Neurosurgical Intervention

Objective: The authors aimed to evaluate the necessity of in-hospital neurological observation for mild traumatic brain injury (TBI) patients, who did not have any evidence of intracranial injury from initial computed tomography (CT) brain scans. Material and Methods: We retrospectively reviewed mild TBI patients with initial negative CT brain scans, receiving treatment at Songklanagarind hospital between January and December, 2018. All patients were observed in the emergency department short stay observation unit for 24 hours after injury. Patients’ medical records, initial and official CT brain scan interpretation were collected and analyzed. Results: This study included 493 cases. No patient deteriorated from intracranial injury, while one patient deteriorated from hypoglycemia, associated with his underlying adrenal insufficiency. However, one patient was admitted to the in patient ward, due to a missed diagnosis of acute subdural hematoma from his initial CT interpretation. The incidence of missed intracranial injury from initial CT brain scan interpretation was 1.6%. The need for neurosurgical intervention (in-patient ward admission, anticonvulsant and repeat brain imaging) was 0.2% (1/493). No patient required surgical intervention.Conclusion: Mild TBI patients, with initial negative CT brain scans, have very low risk for deterioration or need of neurosurgical intervention. Patient's underlying major comorbidity may be considered as an indication for in-hospital observation.

scholarly journals Development of prognostic models for Health-Related Quality of Life following traumatic brain injury

2021 ◽  
Author(s):  
Isabel R. A. Retel Helmrich ◽  
David van Klaveren ◽  
Simone A. Dijkland ◽  
Hester F. Lingsma ◽  
Suzanne Polinder ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Model Performance ◽  
Prognostic Models ◽  
Health Related Quality ◽  
Mild Tbi ◽  
Related Quality ◽  
Health Related

Abstract Background Traumatic brain injury (TBI) is a leading cause of impairments affecting Health-Related Quality of Life (HRQoL). We aimed to identify predictors of and develop prognostic models for HRQoL following TBI. Methods We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Core study, including patients with a clinical diagnosis of TBI and an indication for computed tomography presenting within 24 h of injury. The primary outcome measures were the SF-36v2 physical (PCS) and mental (MCS) health component summary scores and the Quality of Life after Traumatic Brain Injury (QOLIBRI) total score 6 months post injury. We considered 16 patient and injury characteristics in linear regression analyses. Model performance was expressed as proportion of variance explained (R2) and corrected for optimism with bootstrap procedures. Results 2666 Adult patients completed the HRQoL questionnaires. Most were mild TBI patients (74%). The strongest predictors for PCS were Glasgow Coma Scale, major extracranial injury, and pre-injury health status, while MCS and QOLIBRI were mainly related to pre-injury mental health problems, level of education, and type of employment. R2 of the full models was 19% for PCS, 9% for MCS, and 13% for the QOLIBRI. In a subset of patients following predominantly mild TBI (N = 436), including 2 week HRQoL assessment improved model performance substantially (R2 PCS 15% to 37%, MCS 12% to 36%, and QOLIBRI 10% to 48%). Conclusion Medical and injury-related characteristics are of greatest importance for the prediction of PCS, whereas patient-related characteristics are more important for the prediction of MCS and the QOLIBRI following TBI.

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