The Value of Immediate Computerized Tomography Following Emergency Surgery for Traumatic Brain Injury: Experience in A Tertiary Center in Egypt

Abstract Background The prognosis of penetrating traumatic brain injury (pTBI) is poor yet highly variable. Current computerized tomography (CT) severity scores are commonly not used for pTBI prognostication but may provide important clinical information in these cohorts. Methods All consecutive pTBI patients from two large neurotrauma databases (Helsinki 1999–2015, Stockholm 2005–2014) were included. Outcome measures were 6-month mortality and unfavorable outcome (Glasgow Outcome Scale 1–3). Admission head CT scans were assessed according to the following: Marshall CT classification, Rotterdam CT score, Stockholm CT score, and Helsinki CT score. The discrimination (area under the receiver operating curve, AUC) and explanatory variance (pseudo-R2) of the CT scores were assessed individually and in addition to a base model including age, motor response, and pupil responsiveness. Results Altogether, 75 patients were included. Overall 6-month mortality and unfavorable outcome were 45% and 61% for all patients, and 31% and 51% for actively treated patients. The CT scores’ AUCs and pseudo-R2s varied between 0.77–0.90 and 0.35–0.60 for mortality prediction and between 0.85–0.89 and 0.50–0.57 for unfavorable outcome prediction. The base model showed excellent performance for mortality (AUC 0.94, pseudo-R2 0.71) and unfavorable outcome (AUC 0.89, pseudo-R2 0.53) prediction. None of the CT scores increased the base model’s AUC (p > 0.05) yet increased its pseudo-R2 (0.09–0.15) for unfavorable outcome prediction. Conclusion Existing head CT scores demonstrate good-to-excellent performance in 6-month outcome prediction in pTBI patients. However, they do not add independent information to known outcome predictors, indicating that a unique score capturing the intracranial severity in pTBI may be warranted.

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Relationship between quality-of-life after 1-year follow-up and severity of traumatic brain injury assessed by computerized tomography

Brain Injury ◽

10.3109/02699052.2016.1141434 ◽

2016 ◽

Vol 30 (4) ◽

pp. 441-451 ◽

Cited By ~ 4

Author(s):

Miguel Angel Prieto-Palomino ◽

Emilio Curiel-Balsera ◽

Maria Dolores Arias-Verdú ◽

Monica Delange-Van Der Kroft ◽

Alfonso Muñoz-López ◽

...

Keyword(s):

Quality Of Life ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Computerized Tomography

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Evaluation of novel computerized tomography scoring systems in human traumatic brain injury: An observational, multicenter study

PLoS Medicine ◽

10.1371/journal.pmed.1002368 ◽

2017 ◽

Vol 14 (8) ◽

pp. e1002368 ◽

Cited By ~ 21

Author(s):

Eric Peter Thelin ◽

David W. Nelson ◽

Juho Vehviläinen ◽

Harriet Nyström ◽

Riku Kivisaari ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Computerized Tomography ◽

Multicenter Study ◽

Scoring Systems

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Quality of life in patients with traumatic brain injury: A single tertiary center experience

10.21203/rs.3.rs-450460/v1 ◽

2021 ◽

Author(s):

Muhammad Zafrullah Arifin ◽

Yulius Hermanto ◽

Agung Budi Sutiono

Keyword(s):

Quality Of Life ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Motor Vehicle ◽

Self Care ◽

Mobility Impairment ◽

Essential Information ◽

Tertiary Center

Abstract Introduction Traumatic brain injury (TBI) is the main cause of death in motor-vehicle accidents. Investigation on the quality of life in patients with TBI would provide essential information for the society and policy makers in seeking the optimum ways to manage this devastating injury. Methods A total 178 of patients were involved in this study, consists of 97 patients with TBI and 81 non-TBI patients. The patients’ quality of life was evaluated by using Euroqol 5D (EQ-5D) up to 3 months of follow up. Then, the results of EQ-5D were analyzed. ResultsImpairment in mobility was more profound in patients with TBI compared to non-TBI patients (23.38% vs 9.38%, p = 0.0414). In line with the impaired mobility, impairment of self-care was also more frequently observed in patients with TBI compared to non-TBI patients (25.97% vs 12.50%, p = 0.0459). Meanwhile, the other dimensions of EQ-5D were not distinct between patients with TBI and non-TBI patients (p > 0.05). There was a trend of quality of life improvement in patients with TBI during the follow up. ConclusionPatients with TBI are more likely to experience impairment in mobility and self-care compared to non-TBI patients. Hence, TBI potentially affect quality of life.

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Posttraumatic hydrocephalus: Lessons learned from management and evaluation at a tertiary institute with review of literature

Romanian Neurosurgery ◽

10.1515/romneu-2017-0058 ◽

2017 ◽

Vol 31 (3) ◽

pp. 356-363

Author(s):

Ashok Kumar ◽

Pavan Kumar ◽

Gaurav Jaiswal ◽

Tarun Kumar Gupta

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Decompressive Craniectomy ◽

Road Traffic ◽

Favourable Outcome ◽

Lessons Learned ◽

Common Finding ◽

Acute Subdural Hematoma ◽

Tertiary Center ◽

Post Traumatic

Abstract Background: Post traumatic hydrocephalus (PTH) is a commonest treatable complication of severe traumatic brain injury that’s leads to failure of improvement and worsening of the outcome. Incidence of posttraumatic hydrocephalus is 0.7%-29% reported in different literature. We have observed the development of PTH frequently seen in patients with severe head injury and after decompressive craniectomy (DC). Pathophysiology includes inflammatory changes and adhesion of arachnoid granulation, cerebral ischemia and alteration in cerebrospinal fluid (CSF) dynamics. We studied 35 cases of PTH diagnosed and treated at our institute from May 2008 to May 2017. Material and methods: This is hospital based retrospective and prospective study conducted in tertiary center on the basis of neuro-radiological examination of the patient. Clinical biodata and radiological profile of the patients was studied at initial presentation with trauma, and when the patient worsened with symptoms of raised intracranial pressure (ICP) in state of established PTH. These cases were treated by medium pressure ventriculoperitoneal shunt (V.P shunt) and outcome was evaluated. Results: Incidence of PTH in our study is (2.3%). Out of 35 cases 24 (68.57%) were male and 11(31.4%) were female. Road traffic accident (RTA) was the most common mode of injury (82.85%), acute subdural hematoma (SDH) was the most common finding on C.T scan in 15 cases (42.8 %). Decompressive craniectomy was performed in 77% at time of initial trauma. PTH had favourable outcome with V.P. shunting in 91.42%. Conclusion: Patients with traumatic brain injury present with many complications but PTH is most frequent sequeale that can present in form of various neurological symptoms after trauma and decompressive craniectomy. C.T. scan brain is the investigation of choice for diagnosis of PTH. Outcome was favourable after V.P. shunt in PTH.

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Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury

Journal of Neurosurgery ◽

10.3171/jns.2006.104.5.731 ◽

2006 ◽

Vol 104 (5) ◽

pp. 731-737 ◽

Cited By ~ 100

Author(s):

Magdalena Hiler ◽

Marek Czosnyka ◽

Peter Hutchinson ◽

Marcella Balestreri ◽

Peter Smielewski ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Ct Scan ◽

Computerized Tomography ◽

Reactivity Index ◽

Monitoring Period ◽

Pressure Reactivity ◽

Severe Tbi ◽

Ct Scan Classification

Object The authors explored the relationship between computerized tomography (CT) scan findings and intracranial pressure (ICP) measurements obtained in the first 24 hours of monitoring to identify parameters predicting outcome in patients with severe traumatic brain injury (TBI). Methods Intracranial pressure, mean arterial blood pressure, cerebral perfusion pressure (CPP), and pressure reactivity index were measured continuously in 126 patients with severe TBI who were admitted to a neuroscience critical care unit. Mean values in the initial 24 hours of monitoring and in the total period of monitoring were compared with types of injury categorized on the basis of the initial CT scan according to the classification of Marshall, et al., and with Glasgow Outcome Scale scores. The initial CT scan classification correlated significantly but weakly with ICP measured during the first 24 hours of monitoring (p = 0.036) but not with mean ICP over the total time of intensive care. Both midline shift and the ratio of frontal horn diameter to internal diameter correlated with ICP in the first 24 hours (p < 0.007) and with ICP over the total monitoring period (p < 0.03). Outcome score correlated with initial CT scan findings (p = 0.018), ICP over the total monitoring period (p < 0.0023), pressure reactivity over the total monitoring period (p < 0.0002), and pressure reactivity in the first 24 hours (p < 0.0001) but not with ICP in the first 24 hours. Patients with disturbed pressure reactivity in the first 24 hours after injury had a significantly higher mortality rate than patients with intact pressure reactivity (28.6% compared with 9.5%; p < 0.001). Conclusions Patients with severe TBI who have early loss of autoregulation have a worse prognosis. Mean ICP values in patients with diffuse TBI cannot be predicted by using the Marshall CT scan classification.

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