scholarly journals Outcome of Head Injury Patients Undergoing Surgical Management: A Tertiary Level Experience

2012 ◽  
Vol 9 (4) ◽  
pp. 283-285
Author(s):  
A Shrestha ◽  
R M Joshi ◽  
A Thapa ◽  
U P Devkota ◽  
D N Gongal
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Surgical Intervention ◽  
Head Injuries ◽  
Glasgow Outcome Score ◽  
Injury Mortality ◽  
Outcome Score ◽  
Injury Group ◽  
Neurosurgical Patient ◽  
Severity Of Injury

Background Head injury is the major cause of death in a neurosurgical patient. Objective To find the outcome, and treatment modality affecting the outcome in patients with head injury. Methods Nine hundred eighty seven patients presenting to National Institute of Neurological and Allied Sciences, Kathmandu, with head injury from September 2009 to October 2010 were included in the study. Patients were categorized according to post resuscitation Glasgow Coma Score. Outcome was assessed at discharge using Glasgow Outcome Score and analyzed for any correlation with modality of treatment and severity of injury. Results Among 987 patients with head injury,152 (15.4%) had severe, 126 (12.8%) had moderate and 709 (71.8%) had mild head injuries. Three hundred twelve (31.6%) patients required definitive and supportive surgical intervention. One hundred eighty two required cranial surgical intervention. Overall mortality was 10% (99), 137 patients (13.9%) had unfavorable outcome and 850 (86.1%) had favorable Glasgow Outcome Score of 4 and 5. Mortality was 53.2%, 9.5% and 0.8% in severe, moderate and mild head injury group respectively. Mortality rate was significantly higher (64.6%) in severe head injury group managed conservatively than those in same group treated with supportive and definite surgical intervention (44.8%) (p=0.016). Conclusion Mortality in head injury patients depend upon severity of injury. Mortality in severe head injury group can be reduced by supportive and definite surgical intervention.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6345 Kathmandu Univ Med J 2011;9(4):283-5

A prospective study of children with head injuries: II. Cognitive sequelae

1981 ◽  
Vol 11 (1) ◽  
pp. 49-61 ◽  
Author(s):  
Oliver Chadwick ◽  
Michael Rutter ◽  
Gillian Brown ◽  
David Shaffer ◽  
Michael Traub
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Reading Ability ◽  
Head Injuries ◽  
Specific Pattern ◽  
Control Group ◽  
Severe Injuries ◽  
Injury Group ◽  
Severity Of Injury ◽  
Cognitive Sequelae

SYNOPSISA 2¼-year prospective study of children suffering head injury is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia (PTA) of at least 7 days; (b) an individually matched control group of 28 children with hospital treated orthopaedic injuries; and (c) 29 children with ‘mild’ head injuries resulting in a PTA exceeding 1 hour but less than 1 week. Individual psychological testing was carried out as soon as the child recovered from PTA, and then again 4 months, 1 year, and 2¼ years after the injury. A shortened version of the Wechsler Intelligence Scale for Children (WISC), the Neale Analysis of Reading Ability and a battery of tests of specific cognitive functions were employed. The mild head injury group had a mean level of cognitive functioning below the control group, but the lack of any recovery during the follow-up period indicated that the intellectual impairment was not a consequence of the injury. In the severe head injury group, the presence of cognitive recovery and a ‘dose—response’ relationship with the degree of brain injury showed that the intellectual deficits were caused by brain damage. Some degree of cognitive impairment was common following head injuries giving rise to a PTA of at least 2 weeks. Conversely no cognitive sequelae, transient or persistent, could be detected when the PTA was less than 24 hours. The results were less consistent in the 1-day to 2-week PTA range, but the evidence suggested that a broadly defined threshold for impairment operated at about that level of severity of injury. Timed measures of visuo-spatial and visuo-motor skills tended to show more impairment than verbal skills but otherwise there was no suggestion of a specific pattern of cognitive deficit. Recovery was most rapid in the early months after injury, but substantial recovery continued for 1 year with some improvement continuing in the second year in some children, especially those with the most severe injuries. Age, sex and social class showed no significant effects on the course of recovery.

scholarly journals Outcome after severe head injury: focal surgical lesions do not imply a better Glasgow Outcome Score than diffuse injuries at 3 months

2009 ◽  
Vol 3 (1) ◽  
Author(s):  
Paul Leach ◽  
Omar N Pathmanaban ◽  
Hiren C Patel ◽  
Julian Evans ◽  
Raphael Sacho ◽  
...  
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Glasgow Outcome Score ◽  
Outcome Score

Influence of the type of intracranial lesion on outcome from severe head injury

1982 ◽  
Vol 56 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Thomas A. Gennarelli ◽  
Gerri M. Spielman ◽  
Thomas W. Langfitt ◽  
Philip L. Gildenberg ◽  
Timothy Harrington ◽  
...  
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Acute Subdural Hematoma ◽  
Good Recovery ◽  
Content Type ◽  
Injury Group ◽  
Lesion Type ◽  
Severity Of Injury ◽  
Gcs Score ◽  
Injured Patients

✓ Recent studies attempting to define the outcome from severe head injury have implied, directly or indirectly, that the severity of injury (as determined by the Glasgow Coma Scale (GSC)) is the sole determinant of outcome. Little attention has been focused on the type of lesion that causes the low GCS score, and there exists an unstated hypothesis that the lesion type is not an important determinant of outcome. No attempt has been made to determine whether patients who have the same GCS score caused by different lesions have the same or different outcomes. Since this is impossible to test without a large number of cases, data were obtained from seven head-injury centers on patients who fulfilled the Glasgow criteria for severe head injury (GCS ≤ 8 for at least 6 hours). Patients were categorized according to a simple classification system comprising seven lesion types, each of which was further subdivided into two GCS score ranges (3 to 5 and 6 to 8). Of 1107 patients, the overall mortality was 41%, but ranged from 9% to 74% among the different lesion categories. Conversely, 26% had good recovery (at 3 months), but among the different lesion groups the range was 6% to 68%. Acute subdural hematoma with GCS scores of 3 to 5 was uniformly the worst problem (74% mortality and 8% good recovery), whereas diffuse injury coma of 6 to 24 hours with GCS scores of 6 to 8 had 9% mortality and 68% incidence of good recovery. Results of this study demonstrate marked heterogeneity within this severe head-injury group and point out that patients with the same GCS score have markedly different outcomes, depending on the causative lesion. The type of lesion is thus as important a factor in determining outcome as is the GCS score, and both must be considered when describing severely head-injured patients.

The outcome of severe closed head injury

1991 ◽  
Vol 75 (Supplement) ◽  
pp. S28-S36 ◽  
Author(s):  
Lawrence F. Marshall ◽  
Theresa Gautille ◽  
Melville R. Klauber ◽  
Howard M. Eisenberg ◽  
John A. Jane ◽  
...  
Keyword(s):  
Head Injury ◽  
Mortality Rate ◽  
Severe Head Injury ◽  
Closed Head Injury ◽  
Data Bank ◽  
Content Type ◽  
Severity Of Injury ◽  
Gcs Score ◽  
Fine Print ◽  
Overall Mortality

✓ The outcome of severe head injury was prospectively studied in patients enrolled in the Traumatic Coma Data Bank (TCDB) during the 45-month period from January 1, 1984, through September 30, 1987. Data were collected on 1030 consecutive patients admitted with severe head injury (defined as a Glasgow Coma Scale (GCS) score of 8 or less following nonsurgical resuscitation). Of these, 284 either were brain-dead on admission or had a gunshot wound to the brain. Patients in these two groups were excluded, leaving 746 patients available for this analysis. The overall mortality rate for the 746 patients was 36%, determined at 6 months postinjury. As expected, the mortality rate progressively decreased from 76% in patients with a postresuscitation GCS score of 3 to approximately 18% for patients with a GCS score of 6, 7, or 8. Among the patients with nonsurgical lesions (overall mortality rate, 31%), the mortality rate was higher in those having an increased likelihood of elevated intracranial pressure as assessed by a new classification of head injury based on the computerized tomography findings. In the 276 patients undergoing craniotomy, the mortality rate was 39%. Half of the patients with acute subdural hematomas died — a substantial improvement over results in previous reports. Outcome differences between the four TCDB centers were small and were, in part, explicable by differences in patient age and the type and severity of injury. This study describes head injury outcome in four selected head-injury centers. It indicates that a mortality rate of approximately 35% is to be expected in such patients admitted to experienced neurosurgical units.

A prospective analysis of the recovery of attention following pediatric head injury

1999 ◽  
Vol 5 (1) ◽  
pp. 48-57 ◽  
Author(s):  
CATHY CATROPPA ◽  
VICKI ANDERSON ◽  
ROBYN STARGATT
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Closed Head Injury ◽  
Prospective Analysis ◽  
Speed Of Processing ◽  
Pediatric Head Injury ◽  
Injury Group ◽  
Closed Head ◽  
Ongoing Development ◽  
Over Time

Little is known about specific attentional sequelae following a closed head injury, their pattern of recovery or their interaction with ongoing development. The present study examined attentional abilities in a group of children who had sustained a mild, moderate, or severe head injury. Results showed that the severe head injury group exhibited greater deficits on a number of attentional measures at acute and 6 months postinjury phases, in comparison to children in the mild and moderate head injury groups. Specifically, deficits were most evident on timed tasks where speed of processing was an integral component. Difficulties persisted to at least 6 months postinjury and so may lead to cumulative deficits over time. (JINS, 1999, 5, 48–57.)

Thyroid function in severely traumatized patients with or without head injury

1988 ◽  
Vol 117 (1) ◽  
pp. 80-86 ◽  
Author(s):  
R. L. Chioléro ◽  
T. Lemarchand-Béraud ◽  
Y. Schutz ◽  
N. de Tribolet ◽  
M. Bayer-Berger ◽  
...  
Keyword(s):  
Head Injury ◽  
Thyroid Function ◽  
Severe Head Injury ◽  
Severe Trauma ◽  
Primary Hypothyroidism ◽  
Multiple Injury ◽  
Multiple Injuries ◽  
Group I ◽  
Injury Group ◽  
Tsh Levels

Abstract. The pattern of thyroid function changes following severe trauma was assessed prospectively in 35 patients during the first 5 days after injury. Patients were divided into 2 groups to evaluate the effect of head injury: group I, patients with severe head injury; group II, patients with multiple injuries without head injury. The results demonstrate a low T3 and low T4 syndrome throughout the study, with decreases in both total and free levels of T3 and T4, normal or increased rT3 levels, and normal TSH levels. The presence of severe head injury was associated with lower levels of TSH and free T3. Mortality was 37%. Survival was associated with higher TSH and T3 levels, but not with higher T4 levels. TSH levels exceeding 1 mU/l on the first day were only observed in survivors. These findings show that a typical low T3 and low T4 syndrome is present after severe trauma in patients with multiple injury as well as with head injury. Primary hypothyroidism can be excluded, pituitary or hypothalamic hypothyroidism is likely in these patients.

Cause of decline in head-injury mortality rate in San Diego County, California

1985 ◽  
Vol 62 (4) ◽  
pp. 528-531 ◽  
Author(s):  
Melville R. Klauber ◽  
Lawrence F. Marshall ◽  
Belinda M. Toole ◽  
Sharen L. Knowlton ◽  
Sharon A. Bowers
Keyword(s):  
Head Injury ◽  
San Diego ◽  
Head Injuries ◽  
Mortality Rates ◽  
San Diego County ◽  
Content Type ◽  
Severity Of Injury ◽  
Prehospital Emergency ◽  
Injured Patients ◽  
Number Of Individuals

✓ Even with an increasing population, there were 100 fewer deaths due to head injury in San Diego County, California, in 1982 compared to 1980. During the 5 years from 1976 to 1980 there was nearly a constant death rate from head injuries, followed in the next 2 years by a decline of 24%. The number of deaths at the scene of injury declined 28%, and the number of individuals listed as dead on arrival at the hospital declined 68%. Mortality rates in the emergency room increased slightly and later death rates declined slightly. Mortality rates of hospitalized patients, adjusted for severity of injury, did not vary materially by year. This decline in deaths due to head injury followed a marked improvement in the county's emergency ground and prehospital air evacuation services. The data strongly suggest that advanced prehospital emergency medical services can substantially reduce mortality rates in head-injured patients. The authors postulate that some patients who ordinarily “would die now talk” because of early airway and circulatory management by highly trained paramedical personnel and airborne trauma specialists. Despite a search for other factors that might explain these observations, no satisfactory alternatives could be identified.

scholarly journals S-A-6. Importance of Cerebral Carotid Angiography in Severe Head Injury, as an Indication of Surgical Intervention

1967 ◽  
Vol 9 ◽  
pp. 247b-248
Author(s):  
Seiya SHIRAKATA ◽  
Shigekiyo FUJITA ◽  
Kiyoto TAKAO ◽  
Seiji SHINMARU ◽  
Hideji HIROMOTO ◽  
...  
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Surgical Intervention ◽  
Carotid Angiography

scholarly journals Acute arterial infarcts in patients with severe head injuries

2012 ◽  
Vol 01 (02) ◽  
pp. 126-129
Author(s):  
Anil Garg ◽  
Deepak Agrawal
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Head Injuries ◽  
Arterial Injury ◽  
Superior Cerebellar Artery ◽  
Post Injury ◽  
Closed Head Injuries ◽  
Cerebellar Artery ◽  
Ct Head ◽  
The Mean

Abstract To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Patients with severe head injury (Glasgow coma score (GCS) ≤8) presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT) head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS) at 1 month post-injury or at death (whichever came earlier). Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1%) had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3–85 years). Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1–3) was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21) in patients with severe head injury without arterial infarct. A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-à-vis patient without these findings

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