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

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.

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DIAGNOSIS AND MANAGEMENT OF COMPUTED TOMOGRAPHY IN HEAD INJURY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i6.708 ◽

2019 ◽

Vol 3 (6) ◽

Author(s):

Dr. Dileep Kumar Jha ◽

Dr. Rajnikant Narsinhbhai Chauhan

Keyword(s):

Computed Tomography ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Head Trauma ◽

Severe Head Injury ◽

Mild Head Injury ◽

Age Group ◽

Ct Findings ◽

Craniocerebral Injuries

Introduction: In human body there are many causes of the injuries. Among all the injuries head injury is also one of the most important injuries which may cause morbidity and mortality. Craniocerebral injuries or Traumatic brain injury (TBI) is defined as any structural skull traumatic injury with alterations of cerebral physiology as a result of an external force either in the form of chemical energy, mechanical energy, electrical energy or thermal heating. Globally craniocerebral injuries or Traumatic brain injury (TBI)is cause of disability in young patients, especially those <40 years of age. TBI is classified as mild, with most showing adequate and quick recovery. Nevertheless there are some kinds of TBI which showed persistent disabling symptoms that interrupt with their normal daily routine activities. Brain imaging is very important for the patients who suffer traumatic brain injury. In the emergency services Computed tomography (CT) is recommended as first assessment that provides initial information and diagnosis to identify the need of surgery. It also helps in the following of the patient and the evolution of pathology. Many studies suggest that CT can be used to predict patient outcomes. Computed tomography (CT) is an imaging technique which uses as dynamics of injected contrast material, allows rapid quantitative and qualitative evaluation of cerebral perfusion by generating cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT) maps providing clinically important information with stroke subarachnoid hemorrhage (SAH)and head injury. Aim: The main aim of this study is to evaluate the computed tomography findings sustaining head injury and role of computed tomography scan in head injury. Material and Methods: During the study total 90 patients with head injury were included with different age group from 20 to 70 years old. Glasgow coma score (GCS) range 4–15 (mild head injury: GCS >14; moderate head injury: GCS = 9–13; severe head injury GCS <8) were also included in this study. For all the patients with head injury Computed tomography (CT) image were performed with siemen's somatom spirit dual slice spiral CT machine and a protocol of contiguous axial 5-mm sections through the posterior fossa and a contiguous 10 mm axial sequential scans for the rest of the brain and thinner cuts were also taken whenever required. For visualize any fractures of the skull bone algorithms with wide window settings were studied. After initial resuscitation, severity of the cranio-cerebral trauma was graded with the help of Glasgow Coma Scale (GCS) into mild head injury (GCS13- 15), moderate head injury (GCS 9-12) and severe head injury (GCS 3-8). Result: Among total patients sixty five (72.2%) patients were male and twenty five (27.8 %) were female with age range from 20 to 70 years old. In the age group 31-50 year group showed highest frequency of head trauma. The most common causes of head injury were RTA (65.6%) followed by fall injuries (20%) and physical assaults (14.4%). Among patients with head injuries Loss of consciousness and vomiting were the commonest clinical features brought to emergency. Out of 90 cases 59 (65.5%) cases showed mild head injury followed by 14(15.6%) cases sustained moderate head injury and 17(18.9%) had severe head injury. In all types of severity of head injury RTA was the prime etiological factor. Out of total cases 31(34.4%) had normal CT findings and 59(65.6%) had abnormal CT findings. Abnormal CT findings were seen in 59(65.6%) sustaining mild head injury and in all the patients with moderate and severe head injury. Out of 90 cases 13 cases with severe head injury had mortality. The most common mode of injury to cause the mortality was RTA. Five patients with severe head injury also had cervical spine injury Conclusion: This study concludes that use of CT in head trauma can finds high prevalence of head trauma related to CT. Therefore CT should be done when clinically necessary that helps to reduce cost and avoids unnecessary exposure to radiation. Keywords: Head injury, Traumatic brain injury (TBI), computed tomography (CT), Glasgow coma scale (GCS)

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MULTISLICE COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF MIXED TRAUMATIC BRAIN INJURY

Journal of radiology and nuclear medicine ◽

10.20862/0042-4676-2018-99-3-119-124 ◽

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.

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P17 Evaluation of new orleans criteria for cranial CT scan in mild traumatic brain injury at an emergency trauma unit of a developing country

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.95 ◽

2019 ◽

Vol 90 (3) ◽

pp. e30.2-e30

Author(s):

AS Yusuf ◽

MR Mahmud ◽

NK Dalhat ◽

AI Olayiwola ◽

JD Alfin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

New Orleans ◽

Developing Country ◽

Mild Traumatic Brain Injury ◽

Compliance Rate ◽

Mild Tbi ◽

Cranial Ct ◽

Ct Findings

ObjectivesTo assess compliance to New Orleans Criteria for cranial CT scan and its predictive value for intracranial pathology in mild TBI.DesignA retrospective review.SubjectsAll patients with mild traumatic brain injury presenting at the emergency unit of a National Trauma Centre of a Developing Country over 24 months.MethodsPatients information were retrieved from medical record and entered into SPSS spreadsheet. The New Orleans Criteria (NOC) was used to determine indications for brain CT scan. Compliance to the criteria was determined. The CT scan findings were evaluated in all patients that had scan and the findings were compared between those met NOC and those who did not.ResultsOne-hundred and eighteen patients were studied. Majority were males 92 (82%) with mean age of 27 year. Most injuries (66.9%) resulted from road traffic crashes. Among 65 (55.1%) patients who met NOC only 41 (63.1%) had CT scan while 25 (47.2%) patients who did not had CT giving a compliance rate of 58.5%. Twenty three (56.1%) patients who met NOC had abnormal CT compared to 9 (36%) patients that did not. The most common abnormal CT findings in both groups were skull vault fractures (9 for NOC group and 2 for non NOC group) only two patients had surgical intervention and both met NOC criteria.ConclusionsThe compliance for NOC guideline was below average in our Centre. NOC guideline is useful in predicting abnormal CT findings. There is a need for continuous education of emergency physicians to ensure optimal CT scan utilisation in mild TBI.

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Prediction of cognitive sequelae based on abnormal computed tomography findings in children following mild traumatic brain injury

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/6/461 ◽

2008 ◽

Vol 1 (6) ◽

pp. 461-470 ◽

Cited By ~ 70

Author(s):

Harvey S. Levin ◽

Gerri Hanten ◽

Garland Roberson ◽

Xiaoqi Li ◽

Linda Ewing-Cobbs ◽

...

Keyword(s):

Computed Tomography ◽

Traumatic Brain Injury ◽

Working Memory ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Longitudinal Design ◽

Ct Scans ◽

Body Regions ◽

Ct Findings ◽

Prospective Longitudinal

Object The aim of this study was to determine whether the presence of intracranial pathophysiology on computed tomography (CT) scans obtained within 24 hours of mild traumatic brain injury (MTBI) in children adversely affects neuropsychological outcome during the 1st year postinjury. Methods A prospective longitudinal design was used to examine the neuropsychological outcomes in children (ages 5–15 years) who had been treated for MTBI, which was defined as a loss of consciousness for up to 30 minutes and a lowest Glasgow Coma Scale (GCS) score of 13–15. Exclusion criteria included any preinjury neurological disorder. Outcome assessments were performed within 2 weeks and at 3, 6, and 12 months postinjury. Outcomes were compared between patients with MTBI whose postinjury CT scans revealed complications of brain pathophysiology (32 patients, CMTBI group) and those with MTBI but without complications (48 patients, MTBI group). Results Significant interactions confirmed that the pattern of recovery over 12 months after injury differed depending on the intracranial pathology, presence and severity of injuries to body regions other than the head, preinjury attention-deficit hyperactivity disorder (ADHD), and socioeconomic status. Children in the CMTBI group had significantly poorer episodic memory, slower cognitive processing, diminished recovery in managing cognitive interference, and poorer performance in calculating and reading than patients in the MTBI group. Among the patients with mild or no extracranial injury, visuomotor speed was slower in those in the CMTBI group; and among patients without preinjury ADHD, working memory was worse in those in the CMTBI group. Conclusions Neuropsychological recovery during the 1st year following MTBI is related to the presence of radiographically detectable intracranial pathology. Children with intracranial pathology on acute CT performed more poorly in several cognitive domains when compared with patients whose CT findings were normal or limited to a linear skull fracture. Depending on the presence of preinjury ADHD and concomitant extracranial injury, working memory and visuomotor speed were also diminished in patients whose CT findings revealed complications following MTBI. Computed tomography within 24 hours postinjury appears to be useful for identifying children with an elevated risk for residual neuropsychological changes.

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Prevalence of Post Traumatic Amnesia after Mild Closed Traumatic Brain Injury by Galveston Orientation and Amnesia Test

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v23i3.354 ◽

2019 ◽

Vol 23 (3) ◽

pp. 157-162

Author(s):

SYED SHAHZAD HUSSAIN ◽

USMAN AHMAD KAMBOH ◽

MUHAMMAD ASIF RAZA ◽

MUHAMMAD SHAHZAD ◽

SAMAN SHAHID ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Loss Of Consciousness ◽

Mild Tbi ◽

Male And Female ◽

Traumatic Amnesia ◽

Post Traumatic ◽

Male Patients ◽

The Mean ◽

Time Since Injury

Objective: We evaluated the frequency of post traumatic amnesia (PTA) in close mild traumatic brain injury (TBI) via. Galveston Orientation and Amnesia Test (GOAT).Materials & Methods: A total of 115 patients with mild TBI, both male and female, aged between 14 to 60 years and presenting within the first 6 hours were included. Assessment with the GOAT was performed within 6 hours of admission. Post traumatic amnesia was recorded.Results: Patients’ mean age was 39.21 years. Majority of the patients (64.34%) were between 36- 60 years of age. Prevalence of post traumatic amnesia (PTA) in closed mild TBI was found in 27.83% patients, whereas, there was no post traumatic amnesia in 72.17% patients. Mean admission GCS was 14.54 and the mean GOAT score was 83.89 in all patients GCS 14/15. There was more prevalence of PTA in age 36-60 years, in male patients and “time since injury” in >3 hours. Mean GOAT was 68.3 in patients (30.19%) with PTA with GCS 14, whereas, mean GOAT was 74.8 in patients (25.80%) with PTA with GCS 15.Conclusion: 30.19% patients with GCS 14, were positive for PTA (GOAT: 68.3). Overall, 28% patients were positive for PTA. This study concluded that prevalence of post traumatic amnesia in mild TBI is relatively high in our study as compared to other recent reports.Abbreviations: TBI: Traumatic Brain Injury. PTA: Post Traumatic Amnesia. GOAT: Galveston Orientation and Amnesia Test. GCS: Glaucoma Outcome Scale. LOC: Loss of Consciousness. CT: Computed Tomography.

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A comparison of Canadian Head CT rule and New Orleans criteria in mild TBI (Traumatic Brain Injury) patients in a Tertiary Hospital in Karachi, Pakistan.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.11.3496 ◽

2020 ◽

Vol 27 (10) ◽

pp. 2030-2035

Author(s):

Ramesh Kumar ◽

Qazi Muhammad Zeeshan ◽

Shiraz Ahmed Ghori ◽

Atiq Ahmed Khan ◽

Asim Rehmani ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Multivariate Analysis ◽

Brain Injury ◽

New Orleans ◽

Care Facility ◽

P Value ◽

Mild Tbi ◽

Head Ct ◽

Ct Findings ◽

Specificity And Sensitivity

Objectives: The aim of our study is to compare the Canadian Head CT rule to New Orleans Criteria, to find a more efficient guideline in predicting the important CT findings in mild Traumatic Brain Injury (TBI) cases. Study Design: Observational study. Setting: Tertiary Health Care Facility in Karachi, Pakistan. Period: 6 months from June 2017 to December 2017. Material & Methods: We divided a sample of 150 mild TBI patients into two groups of Glasgow coma scale (GCS) scores of 13-14 and GCS score of 15. Then using a separate scoring system for both the CCHR and NOC, we evaluated their accuracy and efficiency in predicting mild TBI through a total of 7 major clinical items. Specificity and sensitivity were calculated to compare both the scoring systems and results were compared through univariate and multivariate analysis. A p value of less than 0.05 was considered to be statistically significant. Results: We analyzed the relation between clinical items and important CT findings and found that the CCHR, through multivariate analysis, was more closely associated with important CT findings. We also found that the factors of age, and the Glasgow comma scale score were also strong indicators of important CT findings regardless of which guideline was used. Conclusion: In our study, we found CCHR to be a stronger predictor of important CT findings than the NOC. We found that CCHR performed significantly higher than the NOC.

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

EUREKA Health Sciences ◽

10.21303/2504-5679.2020.001283 ◽

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.

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