scholarly journals Sodium Imbalance as a Marker of Prognosis of Outcome in Patients with Traumatic Brain Injury

2020 ◽  
Vol 17 (3) ◽  
pp. 25-30
Author(s):  
Bikesh Khambhu ◽  
Rajiv Jha ◽  
Prakash Bista
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Outcome Scale ◽  
Sodium Level ◽  
P Value ◽  
Maximum Serum ◽  
Mortality And Morbidity ◽  
Icu Stay ◽  
Discharge From Hospital

Introduction: Sodium imbalance in post-traumatic brain injury is not uncommon. It’s early detection and treatment is vital as it increases morbidity and mortality if not treated on time. We study the effect of Sodium imbalance as a predictor of outcome in these patients. Methods and Materials: Patients diagnosed with traumatic brain injury (TBI) admitted to Neurosurgery department were included in this study. Traumatic brain injury cases managed between 1st Baisakh 2074 B.S. and 29th Chaitra 2074 B.S. were analyzed prospectively.  Glasgow Coma Scale, Computed Tomography scan of head, duration of hospital and Intensive Care Unit (ICU) stay, and Glasgow Outcome Scale in relation to sodium imbalance measured within 24 hours of injury were assessed. Mortality and morbidity were measured using Glasgow Outcome Scale (GOS). Results: A total of 100 patients with traumatic brain injury admitted in the Neurosurgery department of Bir Hospital were included in this study. Sixty seven cases were categorized as mild, 18 as moderate and 15 as severe according to the severity of TBI. The maximum serum sodium level observed was 168 and lowest was 110 mmol/l. The association of sodium imbalance with severity of head injury was found to be statistically significant. The sensitivity of sodium imbalance measured within 24 hours of injury in prognosticating outcome of patient till death or before discharge from hospital on the basis of GOS and Neuro ICU stay day is significant with p value <0.05. Conclusion: Sodium imbalance is an independent prognostic factor outcome in TBI. Continuous monitoring of sodium level in the neurosurgical ICU setting is mandatory to manage patients with head injury with or without undergoingneurosurgical intervention as it has prognostic value with outcome measures like GOS and ICU stay days.

scholarly journals Correlation of D-Dimer level with outcome in traumatic brain injury

2016 ◽  
Vol 17 (1) ◽  
pp. 21-30
Author(s):  
Pradip Prasad Subedi ◽  
Sushil Krishna Shilpakar
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Glasgow Outcome Scale ◽  
Significant Proportion ◽  
Duration Of Hospital Stay ◽  
Icu Stay ◽  
The Mean ◽  
Hospital Stay Duration ◽  
D Dimer

Introduction: Traumatic brain injury (TBI) is a common neurosurgical emergency and a common public health problem with high mortality and long term morbidity. The cost incurred by TBI is immense. The major determinant of outcome following TBI is the severity of the primary injury. However, secondary injuries including coagulopathy are treatable prognostic factors. Many studies have revealed that coagulopathy of trauma depicted by increasing level of D-dimer is associated with poor prognosis in TBI. So, early dectection and correction of such abnormality is very important in management of TBI.Methods: This is a prospective observational study conducted at Department of Surgery TUTH (Tribhuvan University Teaching Hospital), Kathmandu,Nepal over a period of one year. One hundred and forty eight patients of TBI were included in the study. Clinical profile of the patients and D-dimer level were monitored during the hospital course. D-dimer level was correlated with outcome variables including duration of hospital stay, duration of Intensive care unit (ICU) stay and Glasgow outcome scale (GOS).Results: A total of 194 patients were admitted with the diagnosis of traumatic brain injury during the study period and out of them 148 patients were enrolled for the study. Out of 148 patients one hundred and twenty (81.1%) were males and twenty eight (18.9%) were females. The mean age was 29.71±18.07 and the age ranged from 1 to 78 years. Seventy (47.3%) patient were between 21 to 40 years of age. The mean duration of hospital stay was 9.83±13.58 days and the mean duration of ICU stay was 3.78±7.06 days. Contusion was the most common lesion in our patients. Of the patients studied 111 patients (75%)  had good recovery with GOS of 5, 9  patients (6.1%)  had GOS of 4, 6 patients (4.1%)  had GOS of 3, 1 patients (0.7%)  had GOS of 2 and 21 patients (14.1%)  had GOS of 1. Normal D-dimer was seen in 102 patients (68.9%) and elevated D-dimer in 46 patients (31.1%). Man –Whitney test shows higher D-dimer levels positively correlated with duration of hospital stay, duration of ICU stay and Glasgow Outcome Scale. Pearson chi-square test revealed higher levels of D-dimer correlated with grade of injury but not with mode of injury.Conclusion: D-dimer is elevated in significant proportion of patients with TBI and abnormal D-dimer level is associated with poor outcome in TBI.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 21-30

scholarly journals Manajemen Anestesia pada Evakuasi Epidural Haemorrhage (EDH) dengan Pendarahan Masif

2021 ◽  
Vol 10 (1) ◽  
pp. 29-39
Author(s):  
Nurul Huda ◽  
◽  
Buyung Hartiyo Laksono
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Brain Injuries ◽  
Good Condition ◽  
Massive Bleeding ◽  
Red Blood Cell Transfusion ◽  
Mortality And Morbidity ◽  
Hemodynamic Status ◽  
Poor Outcome

Traumatic brain injury causes mortality and morbidity worldwide. Epidural Haemorrhage (EDH) is a form of head injury where time is an indicator that must be considered in its management. The main focus during traumatic brain injury management is patient stabilization and control of intracranial pressure, as well as maintaining brain oxygenation and perfusion. Subsequently, surgical decompression was performed. Evacuation and bleeding control should be done in a short time to avoid further injury. The practice of neuroanesthesia, as a support in the management of traumatic brain injuries, is often associated with blood loss that results in anemia during the intraoperative and postoperative periods. Although anemia correlates with poor outcome in brain-injured patients, red blood cell transfusion to correct anemia also correlates with poor outcome in patients. There are still no clear recommendations regarding the administration of transfusions, whether restrictive or massive, regarding the benefits provided. Male patient, age 51 years with complaints of decreased consciousness and vomiting, referred from the previous hospital with a diagnosis of moderate head injury 225 with 96cc temporoparietal EDH, 11mm midline shift to the right, and cerebral edema. During the operation period, there was massive bleeding that interfered with the hemodynamic status so that blood components were transfused until a stable hemodynamic status was obtained. In postoperative care in the ICU, the patient is relatively in good condition.

scholarly journals Relationship of The Degree of Head Injury Based on Glasgow Coma Scale (GCS) with the Arrival of Acute Post Concussion Syndrome (PCS) Onset in Post-Head Injury Patients in General Hospital Dr.M.Djamil Padang

2021 ◽  
Vol 7 (1) ◽  
pp. 153-169
Author(s):  
Muhammad Reza Azriyantha ◽  
Syaiful Saanin ◽  
Hesty Lidya Ningsih
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Cause Of Death ◽  
Head Injuries ◽  
Acute Onset ◽  
P Value ◽  
Coma Scale ◽  
Post Concussion Syndrome

A B S T R A C TBackground: Traumatic brain injury is the main cause of death in the populationunder the age of 45 years, and the fourth leading cause of death in the entire ofpopulation. Based on the degree of traumatic brain injury, it is commonly categorizedbased on the Glasgow Coma Scale (GCS). Post-Concussion Syndrome (PCS) is theset of somatic, emotional / behavioral and cognitive symptoms that occur after atraumatic brain injury. The aim of this study was to find out the prevalence andcorrelation of the degree of traumatic brain injury based on the Glasgow Coma Scale(GCS) and the emersion of Post-Concussion Syndrome (PCS) acute onset in patientswith head injuries Method: This study was a cross-sectional analytic study ofpatients who experienced Post-Concussion Syndrome (PCS) after traumatic braininjury at DR. M. Djamil Hospital Padang in 2020 from June to November 2020. Datawere collected by filling in a questionnaire (The Rivermead Post ConcussionSymptoms Questionnaire) and medical record data of neurosurgical patients thatmet the inclusion and exclusion criteria. Result: : It indicated that 70 patients wereincluded in the inclusion criteria of this study. A total of 38 (54.3) respondents didnot undergo the acute onset of PCS, meanwhile respondents who experienced acuteonset of PCS were 32 (45.7) respondents. The results showed that 25 (67.6%)respondents with mild traumatic brain injury had PCS acute onset, while 4 (17.4%)respondents with moderate degree of traumatic brain injury had PCS acute onset,and 4 (17.4%) respondents had PCS acute onset PCS 3 (30%) respondentsexperienced severe traumatic brain injury with acute onset PCS and statistically thedifference in the proportion of data from each of these variables was significant witha p-value of 0.0001. The results of statistical tests showed that p value> 0.05 on thecorrelation between PCS and GCS, thus, it can be concluded that there was nocorrelation between the direction of the relationship between PCS and GCS.Conclusion There was no correlation between the degree of traumatic brain injurybased on GCS and the incidence of PCS acute onset, either it was unidirectional orvice versa in patients with head injuries at RSUP M. Djamil Padang.

CORRELATION OF RADIOLOGICAL FINDINGS WITH SHORT-TERM CLINICAL OUTCOME IN PATIENTS OF TRAUMATIC BRAIN INJURY AT A PUBLIC HOSPITAL IN NORTH INDIA.

2021 ◽  
pp. 10-12
Author(s):  
Rekha Gupta ◽  
Dollphy Garg ◽  
Upinderjeet Singh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Outcome ◽  
Glasgow Outcome Scale ◽  
Brain Injuries ◽  
North India ◽  
P Value ◽  
Physical Force ◽  
General Measure ◽  
Surgery Outcome

BACKGROUND: Traumatic brain injury is dened as an aggression to the brain caused by an external physical force producing a state of diminished or altered consciousness leading to decreased cognitive abilities and physical functioning. The Glasgow Outcome Scale (GOS) is a general measure widely used in TBI management and surgery outcome studies. The Rotterdam Computed Tomography (CT) score of traumatic brain injury is a relatively recently described classication aimed at improving prognostic evaluation of patients admitted with acute traumatic brain injuries. OBJECTIVE: Aim of our study is to correlate the severity of traumatic brain injury using CT Rotterdam criterion with clinical outcome at 3 months using Glasgow Outcome Scale (GOS). MATERIAL AND METHODS: This was a hospital based observational study conducted in Department of radiology from May 2020 to February 2021. All patients with history of traumatic brain injury who underwent NCCT in department were contacted telephonically 3 months after the date of CT scan and a verbal questionnaire in vernacular language was asked telephonically to calculate the nature of their disability after the inciting event of trauma. The CT severity score was then correlated with GOS at 3 months. RESULTS: GOS and CT Rotterdam score are negatively related to each other with a value of -0.284 but are signicantly associated to each other with p value of 0.009 thereby indicating that the patients with a higher modied Rotterdam score demonstrated poorer recovery 3 months after the traumatic insult in form of lower Glasgow outcome score. CONCLUSION: Use of CT based Rotterdam criteria in routine reporting is critical in the initial evaluation and can also predict the prognosis of patients with TBI.

scholarly journals Correlation between neutrophil lymphocyte count ratio and outcomes of severe traumatic head injury

2021 ◽  
Vol 9 (1) ◽  
pp. 10
Author(s):  
Tamajyoti Ghosh ◽  
Subir Dey
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Severe Traumatic Brain Injury ◽  
Univariate Analysis ◽  
P Value ◽  
Traumatic Head Injury ◽  
Neutrophil Lymphocyte Ratio ◽  
Traumatic Head

Background: Raised peripheral neutrophil lymphocyte ratio is associated with poorer outcomes in conditions such as severe brain injury, ICH, cardiovascular conditions, cancer.Methods: Retrospective analysis of 96 severe Traumatic Brain injury data treated at our institute over a period of 1 year. The patients were followed up for a period of at least 1 month. The primary outcome of the study was 1 month GOS and the various variables which may be associated with the poor GOS at 1 month follow up. Model based analysis was done for NLCR <24 hrs at 48 hrs and GCS at the time of presentation and discriminative ability of the models were studied by the Area under the curve.Results: Univariate analysis were done of 96 patients of severe traumatic brain injury for various variables such as age, sex, mode of head injury, type of head injury, presenting GCS and NLCR at 24 hrs and 48 hrs to that of GOS at 1 month follow up. Initial GCS <7 (p=0.0138) with AUC=0.6689 and peak NLCR (<24 hr) of > 9.6 (AUC=0.931) with a p value of <0.001 with sensitivity of 100% and specificity of 79.27% and peak NLCR (48 hrs) of >12.4 (AUC= 0.973) with a p value of <0.001 with sensitivity of 100% and specificity of 89.02% were associated with unfavourable outcome.Conclusions: High NLCR and initial poor GCS are independent unfavourable prognostic factors in 1 month GOS following severe traumatic head injury.

scholarly journals Outcome of traumatic head injury in unknown patients

2018 ◽  
Vol 5 (2) ◽  
pp. 633
Author(s):  
Ankit Ahuja ◽  
Siddhartha Verma ◽  
Aditya Narayan Chaudhary
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Head Injuries ◽  
Traumatic Head Injury ◽  
Organ Systems ◽  
Traumatic Head ◽  
Gcs Score ◽  
Discharge From Hospital ◽  
Time Of Admission

Background: Traumatic brain injury is the most common cause of death in trauma victims accounting for about half of deaths at the accident site. Most commonly, traumatic brain injury occurs in the presence of additional injuries to other major organ systems, but it can also occur in isolation. Complications from closed head injuries are the single largest cause of morbidity and mortality in patients who reach the hospital alive. The objective of this study was to determine the outcome of traumatic head injury in patients admitted in the Department of Neurosurgery as unknown.Methods: All patients admitted as “unknown” to Neurosurgery department with traumatic head injury were studied retrospectively. Data was collected regarding demography, mode of injury, clinical presentation at the time of admission, management and outcome of these patients.Results: Data pertaining to 107 unknown patients were collected. Most patients were found to be males in 3rd decade of their lives with vehicular accidents as the common mode of injury. Patients presenting with Glasgow coma scale (GCS) score <8 at the time of admission had poor outcome and associated with higher mortality. Intra-cranial hemorrhage were predominantly found on CT scan. Only one-third of the patients were discharged after treatment while half of them suffered untimely death.Conclusions: Outcome of these neglected patients is poorer in comparison to patients who are accompanied by their relatives. Their management from pre-hospital to treatment and discharge from hospital is fraught with challenges. They need special care from trained nursing staff as well as help from social workers for recovery and rehabilitation.

scholarly journals The application of adult traumatic brain injury models in a pediatric cohort

2016 ◽  
Vol 18 (5) ◽  
pp. 558-564 ◽  
Author(s):  
Adam M. H. Young ◽  
Mathew R. Guilfoyle ◽  
Helen Fernandes ◽  
Matthew R. Garnett ◽  
Shruti Agrawal ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Receiver Operating Curve ◽  
Individual Risk ◽  
Standardized Mortality Ratio ◽  
P Value ◽  
Adult Head ◽  
Injury Models ◽  
The Impact

OBJECTIVE There is increasing interest in the use of predictive models of outcome in adult head injury. Two international models have been identified to be reliable modalities for predicting outcome: the Corticosteroid Randomisation After Significant Head Injury (CRASH) model, and the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT) model. However, these models are designed only to identify outcomes in adult populations. METHODS A retrospective analysis was performed on pediatric patients with severe traumatic brain injury (TBI) admitted to the pediatric intensive care unit (PICU) of Addenbrooke's Hospital between January 2009 and December 2013. The individual risk of 14-day mortality was calculated using the CRASH-Basic and -CT models, and the risk of 6-month mortality calculated using the IMPACT-Core and -Extended (including CT findings) models. Model accuracy was determined by standardized mortality ratio (SMtR; observed/expected deaths), discrimination was evaluated as the area under the receiver operating curve (AUROC), and calibration assessed using the Hosmer-Lemeshow χ2 test. RESULTS Ninety-four patients with an average age of 7.3 years were admitted to the PICU with a TBI. The mortality rate was 12.7% at 14 days and at 6 months. For the CRASH-Basic model, the SMtR was 1.42 and both calibration (χ2 = 6.1, p = 0.64) and discrimination (AUROC = 0.92) were good. For the IMPACT-Core model, the SMtR was 1.03 and the model was also well calibrated (χ2 = 8.99, p = 0.34) and had good discrimination (AUROC = 0.85). Poor outcome was observed in 17% of the cohort and identified with the CRASH-Basic and IMPACT-Core models to varying degrees: standardized morbidity ratio = 0.89 vs 0.67, respectively; calibration = 6.5 (χ2) and 0.59 (p value) versus 8.52 (χ2) and 0.38 (p value), respectively; and discrimination (AUROC) = 0.92 versus 0.83, respectively. CONCLUSIONS Adult head injury models may be applied with sufficient accuracy to identify predictors of morbidity and mortality in pediatric TBI.

Epidemiology of head injury and outcome after head injury

2019 ◽  
pp. 475-482
Author(s):  
Nabeel Alshafai ◽  
Andrew Maas
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Elderly Patients ◽  
Classification Systems ◽  
World Health ◽  
Prognostic Models ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Health Organization

Traumatic brain injury (TBI) constitutes a major cause of death and disability, and the World Health Organization (WHO) has projected that traumatic brain injury will be one of the leading causes of mortality and morbidity by 2020. In low- and middle-income countries the incidence of TBI is increasing, subsequent to increased motorization. It is, however, particularly vulnerable road users (pedestrians, cyclists) where the risk is greatest. In higher income countries, children, young adults, and elderly patients have the highest rate of TBI and a substantial increase in incidence of TBI in elderly patients as a result of falls has been noted. Nevertheless, TBI is a disease that affects the population of all ages and is referred to as ‘a silent epidemic’. Knowledge of the epidemiology of TBI is essential to inform healthcare planning and to target prevention campaigns appropriately. In this chapter we will summarize global TBI epidemiological perspectives and reflect on the burden that TBI imposes on health economics and society. We will review current classification systems, outcome measures, and prognostic models for TBI.

scholarly journals The identification of key factors predictive of traumatic brain injury in paediatric patients with a minor blunt head injury

2019 ◽  
Vol 27 (4) ◽  
pp. 211-216
Author(s):  
Cheng Hee Song ◽  
Mohammad Zikri Ahmad ◽  
Ab Hamid Siti-Azrin ◽  
Wan Adnan Wan-Nor-Asyikeen
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Multiple Logistic Regression Analysis ◽  
Minor Head Injury ◽  
Health Concern ◽  
Mortality And Morbidity ◽  
Clinical Variables ◽  
Paediatric Patients ◽  
A Minor

Introduction: Traumatic brain injury (TBI) is a major public health concern, and contributes significantly to mortality and morbidity in paediatric patients. Objective: The study is aimed to identify the factors predictive of TBI in paediatric patients with a minor blunt head injury. Methods: This was a retrospective cohort study conducted on 274 paediatric patients with a minor head injury and registered to Hospital Universiti Sains Malaysia (USM) from the year 2009 to 2013. Patients with a minor blunt head injury aged less than 18 years who underwent computed tomography (CT) of the brain were included, while the patients with penetrating head injuries were excluded from the study. Simple and multiple logistic regression analysis were performed. Results: TBI occurred in 49% of the patients. Headache (adjusted odd ratio (AOR): 2.24; 95% confidence interval (CI): 1.24, 4.05, p = 0.008), dizziness (AOR: 3.08, 95% CI: 1.27, 7.51, p = 0.013) and the presence of scalp haematoma (AOR: 2.93, 95% CI: 1.60, 5.34, p < 0.001) were the most important clinical variables for predicting TBI following a minor blunt head injury in paediatric populations. Conclusion: Headache, dizziness and scalp haematoma were identified as important clinical variables that can be used to predict TBI on a CT scan of paediatric minor head injury. The presence of these factors should alert emergency physicians to the need to monitor such children closely.

scholarly journals A study of vasospasm in traumatic brain injury with subarachnoid hemorrhage

2021 ◽  
Vol 2 (1) ◽  
pp. 19-23
Author(s):  
Shyam Babu Prasad ◽  
Suresh Bishokarma ◽  
Sagar Koirala ◽  
Dinesh Nath Gongal
Keyword(s):  
Traumatic Brain Injury ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Head Injury ◽  
Cross Sectional Study ◽  
P Value ◽  
Mean Flow ◽  
Cross Sectional ◽  
Highly Correlated ◽  
Gcs Score

 Introduction: Cerebral vasospasm (CV) is common following subarachnoid hemorrhage (SAH). However, its impact on neurological outcome, especially in head trauma, has not been yet elucidated. Controversy exists about the true relationship between TBI, SAH and Traumatic Vasospasm. Hence, this study aims to determine the association of vasospasm in TBI with SAH. Methods: This is Observational cross-sectional study with 124 head injury patients. 31 patients were excluded. Transcranial Doppler ultrasonography (TCD) was conducted on daily bases in all patients with traumatic brain injury (TBI). Vasospasm in the MCA and ACA was defined by a mean Flow velocity (FV) exceeding 120 cm/s and three times the mean FV of the ipsilateral ICA. Results: Among 93 included patients, 72 (77%) were male and 21 (23%) were female. Mean age was (35+10) years. Mean GCS score was (11+4.1). 61 (66%) patients suffered with severe head injury. Vasospasm was detected in 45 % (42) of the total patients. Vasospasm was severe among 4.3% (4 patients), and moderate among 65.6% (61 patients). Association was found between severity of trauma and the severity of vasospasm in MCA (r= 0.41 and 0.38, p value< 0.005) and in ACA (r =0.25, p value < 0.005). The presence of SAH is highly correlated with an amplified incidence of vasospasm. The patients who developed vasospasm, 55% (23) had SAH whereas 45% (19) didn’t have SAH, the corresponding p value is 0.04 which is significant. Conclusion: The high incidence of vasospasm is associated with SAH in severe TBI patients. Further studies are recommended to determine predictors of vasospasm in TBI patients with SAH.

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