Risk factors indicating the need for cranial CT scans in elderly patients with head trauma: an Austrian trial and comparison with the Canadian CT Head Rule

2014 ◽  
Vol 120 (2) ◽  
pp. 447-452 ◽  
Author(s):  
Harald Wolf ◽  
Wolfgang Machold ◽  
Sophie Frantal ◽  
Mathias Kecht ◽  
Gholam Pajenda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Elderly Patients ◽  
Head Trauma ◽  
Skull Fracture ◽  
Loss Of Consciousness ◽  
Cranial Ct ◽  
Ct Head ◽  
Gcs Score ◽  
Neurosurgical Intervention

Object This study presents newly defined risk factors for detecting clinically important brain injury requiring neurosurgical intervention and intensive care, and compares it with the Canadian CT Head Rule (CCHR). Methods This prospective cohort study was conducted in a single Austrian Level-I trauma center and enrolled a consecutive sample of mildly head-injured adults who presented to the emergency department with witnessed loss of consciousness, disorientation, or amnesia, and a Glasgow Coma Scale (GCS) score of 13–15. The studied population consisted of a large number of elderly patients living in Vienna. The aim of the study was to investigate risk factors that help to predict the need for immediate cranial CT in patients with mild head trauma. Results Among the 12,786 enrolled patients, 1307 received a cranial CT scan. Four hundred eighty-nine patients (37.4%) with a mean age of 63.9 ± 22.8 years had evidence of an acute traumatic intracranial lesion on CT. Three patients (< 0.1%) were admitted to the intensive care unit for neurological observation and received oropharyngeal intubation. Seventeen patients (0.1%) underwent neurosurgical intervention. In 818 patients (62.6%), no evidence of an acute trauma-related lesion was found on CT. Data analysis showed that the presence of at least 1 of the following factors can predict the necessity of cranial CT: amnesia, GCS score, age > 65 years, loss of consciousness, nausea or vomiting, hypocoagulation, dementia or a history of ischemic stroke, anisocoria, skull fracture, and development of a focal neurological deficit. Patients requiring neurosurgical intervention were detected with a sensitivity of 90% and a specificity of 67% by using the authors' analysis. In contrast, the use of the CCHR in these patients detected the need for neurosurgical intervention with a sensitivity of only 80% and a specificity of 72%. Conclusions The use of the suggested parameters proved to be superior in the detection of high-risk patients who sustained a mild head trauma compared with the CCHR rules. Further validation of these results in a multicenter setting is needed. Clinical trial registration no.: NCT00451789 (ClinicalTrials.gov.)

scholarly journals Feline head trauma: a CT analysis of skull fractures and their management in 75 cats

2018 ◽  
Vol 21 (12) ◽  
pp. 1120-1126 ◽  
Author(s):  
Rebekah Knight ◽  
Richard L Meeson
Keyword(s):  
Risk Factors ◽  
Head Trauma ◽  
Bone Fractures ◽  
Skull Fracture ◽  
Dental Occlusion ◽  
Skull Fractures ◽  
Common Cause ◽  
Increased Risk ◽  
Multiple Regions ◽  
Upper Jaw

Objectives The aim of this study was to describe and evaluate the configurations and management of feline skull fractures and concurrent injuries following head trauma. Methods Medical records and CT images were reviewed for cats with skull fractures confirmed by CT that were managed conservatively or with surgery. Details of signalment, presentation, skull fracture configuration, management, re-examination, and complications or mortality were recorded and analysed. Results Seventy-five cats (53 males, 22 females) with a mean age of 4.8 ± 3 years met the inclusion criteria. Eighty-nine percent of cats had fractures in multiple bones of the skull, with the mandible, upper jaw (maxilla, incisive and nasal bones) and craniofacial regions most commonly affected. Temporomandibular joint injury occurred in 56% of cats. Road traffic accidents (RTAs) were the most common cause of skull fractures, occurring in 89% of cats, and caused fractures of multiple regions of the skull. RTAs were also associated with high levels of concurrent injuries, particularly ophthalmic, neurological and thoracic injuries. A more limited distribution of injuries was seen in non-RTA cats. Equal numbers of cats were managed conservatively or surgically (47%). Mortality rate was 8% and complications were reported in 22% of cats. Increasing age at presentation and presence of internal upper jaw fractures were risk factors for development of complications. No risk factors were identified for mortality. Conclusions and relevance RTAs were the most common cause of feline skull fractures and resulted in fractures in multiple regions of the skull and concurrent injuries occurred frequently. Problems with dental occlusion were uncommon post-treatment. An increased risk of implant loosening and malocclusion was seen with palatine and pterygoid bone fractures and hard palate injuries. This study provides useful additional information regarding feline skull fractures, concurrent injuries and management techniques following head trauma.

Head Trauma

2018 ◽  
pp. 8-11
Author(s):  
Todd W. Thomsen
Keyword(s):  
Blood Pressure ◽  
Head Injury ◽  
Key Management ◽  
Rapid Assessment ◽  
Decision Rules ◽  
Clinical Decision ◽  
Loss Of Consciousness ◽  
Ct Head ◽  
Neurosurgical Intervention

Head injury is often associated with other serious trauma. Clinical decision rules such as the Canadian CT Head Rule can guide clinicians in the judicious use of neuroimaging, which can then guide the appropriate course of treatment. Rapid assessment of patients requiring neurosurgical intervention is critical, as is appropriate management of blood pressure and hypoxia. This chapter considers a case study of blunt head injury with loss of consciousness of a skier in the backcountry, The author addresses patient history, physical exam, differential diagnoses, clinical course, and key management steps. The patient’s condition relative to the Canadian CT Head Rule is specifically discussed.

scholarly journals Risk factors of frailty and death or only frailty after intensive care in non-frail elderly patients: a prospective non-interventional study

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Yoann Launey ◽  
Hervé Jacquet ◽  
Matthieu Arnouat ◽  
Chloe Rousseau ◽  
Nicolas Nesseler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Elderly Patients ◽  
Interventional Study ◽  
Old Patients ◽  
Ventilation Duration ◽  
Frail Patients ◽  
Mechanical Ventilation Duration

Abstract Background Frailty status is recognized as an important parameter in critically ill elderly patients, but nothing is known about outcomes in non-frail patients regarding the development of frailty or frailty and death after intensive care. The aim of this study was to determine risk factors for frailty and death or only frailty 6 months after intensive care unit (ICU) admission in non-frail patients ≥ 65 years. Methods A prospective non-interventional study performed in an academic ICU from February 2015 to February 2016 included non-frail ≥ 65-year-old patients hospitalized for > 24 h in the ICU. Frailty was assessed by calculating the frailty index (FI) at admission and 6 months later. Patients who remained non-frail (FI < 0.2) were compared to patients who presented frailty (FI ≥ 0.2) and those who presented frailty and death at 6 months. Results Among 974 admissions, 136 patients were eligible for the study and 88 patients were analysed at 6 months (non-frail n = 34, frail n = 29, death n = 25). Multivariable analysis showed that mechanical ventilation duration was an independent risk factor for frailty/death at 6 months (per day of mechanical ventilation, odds ratio [OR] = 1.11; 95% confidence interval [CI] 1.04–1.19, p = 0.002). When excluding patients who died, mechanical ventilation duration remained the sole risk factor for frailty at 6 months (OR = 1.19; 95% CI 1.07–1.33, p = 0.001). Conclusion Mechanical ventilation duration was the sole predictive factor of frailty and death or only frailty 6 months after ICU hospitalization in initially non-frail patients.

Prospective Study of Validity of Neurologic Signs in Predicting Positive Cranial Computed Tomography following Minor Head Trauma

2010 ◽  
Vol 25 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Yassir S. Abdul Rahman ◽  
Ahmed Sami S. Al Den ◽  
Kimball I. Maull
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Prospective Study ◽  
Head Trauma ◽  
Clinical Findings ◽  
Cranial Computed Tomography ◽  
Loss Of Consciousness ◽  
Mild Head Injury ◽  
Cranial Ct ◽  
Ct Findings

AbstractIntroduction:The ability to discriminate among a large number of patients with mild head injury to detect those most likely to have an intracranial abnormality may offer an advantage in mass-casualty situations and when clinical needs exceed diagnostic capabilities.Hypothesis:In patients with mild head injury (Glasgow Coma Scale score = 13−15), the likelihood of intracranial abnormality, as defined by cranial computed tomography (CT), varies according to presenting neurologic signs and symptoms.Methods:This prospective study consisted of 152 patients with blunt head trauma and one or more of the following: initial loss of consciousness (LOC), headache, vomiting, convulsions, or amnesia. All underwent cranial CT within one hour of presentation. Positive CT findings were defined as cerebral contusion, extra-axial hematoma, intra-ventricular or subarachnoid hemorrhage, brain edema, and skull fracture. Clinical findings were tabulated and compared with CT findings.Results:The most common symptoms were headache (61%) followed by followed by LOC (45%), vomiting (39%), amnesia (29%), and convulsions (4%). Convulsions were the most predictive of a CT positive finding (80%); history of LOC was least predictive (29%). The presence of two or more clinical findings tended to increase the likelihood of intracranial abnormality, but the association was neither consistent nor additive.Conclusions:Convulsions occurring in a patient with mild head injury are highly predictive of a positive intracranial finding on CT. Headache, amnesia, and vomiting are each likely to show positive findings in approximately 40–45% of cases. Although the least predictive of the neurologic findings studied, loss of consciousness still correlates with a positive cranial CT in 29% of cases. More than one sign or symptom increases the likelihood of concurrent brain injury.

Predicting Outcome and Conservative Treatment Failure in Patients with Skull Fracture after Traumatic Brain Injury: A Retrospective Cohort Study

2019 ◽  
Vol 80 (06) ◽  
pp. 460-469
Author(s):  
Ernest J. Bobeff ◽  
Bartłomiej J. Posmyk ◽  
Katarzyna Ł. Bobeff ◽  
Jan Fortuniak ◽  
Karol Wiśniewski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Conservative Treatment ◽  
Treatment Failure ◽  
Epidural Hematoma ◽  
Skull Fracture ◽  
Mass Effect ◽  
Independent Risk Factors ◽  
Neurosurgical Intervention

Abstract Objective Traumatic brain injury (TBI) remains a major cause of morbidity and mortality worldwide. The prognostic value of skull fracture (SF) remains to be clearly defined. To evaluate the need for neurosurgical intervention and determine the risk factors of conservative treatment failure (CTF), we retrieved from the hospital database the records of patients with SF after TBI. Methods We analyzed 146 consecutive patients (mean age: 49.8 ± 17.5 years) treated at the department of neurosurgery in a 5-year period. Clinical data, radiologic reports, and laboratory results were evaluated retrospectively. Results A total of 63% of patients were treated conservatively, 21.9% were operated on immediately, and 15.1% experienced CTF. Overall, 73.3% had a favorable outcome; the mortality rate was 13%. Intracranial bleeding occurred in 96.6% of cases, basilar SF in 61%, and cerebrospinal fluid (CSF) leak in 2.8%. The independent risk factors for outcome were Glasgow Coma Scale (GCS) score, age, and platelet count (PCT). The independent risk factors for CTF were epidural hematoma, subdural hematoma, mass effect, edema, international normalized ratio, PCT, mean platelet volume, and CSF leakage. The consensus decision tree algorithm used at the accident and emergency department indicated patients with no need for neurosurgical intervention with an accuracy of 91.7%, sensitivity of 88.9%, and featured the importance of mass effect, GCS, and epidural hematoma. Conclusions Tests included in the complete blood count appeared useful for predicting the course in patients with SF, although the most important factors were age and neurologic status, as well as radiologic findings. Our decision tree requires further validation before it can be used in everyday practice.

Factors and Outcomes of Intensive Care Unit Readmission in Elderly Patients

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Song-I Lee ◽  
Younsuck Koh ◽  
Jin Won Huh ◽  
Sang-Bum Hong ◽  
Chae-Man Lim
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Hospital ◽  
Medical Reason ◽  
Chronic Heart Disease

<b><i>Introduction:</i></b> An increase in age has been observed among patients admitted to the intensive care unit (ICU). Age is a well-known risk factor for ICU readmission and mortality. However, clinical characteristics and risk factors of ICU readmission of elderly patients (≥65 years) have not been studied. <b><i>Methods:</i></b> This retrospective single-center cohort study was conducted in a total of 122-bed ICU of a tertiary care hospital in Seoul, Korea. A total of 85,413 patients were enrolled in this hospital between January 1, 2007, and December 31, 2017. The odds ratio of readmission and in-hospital mortality was calculated by logistic regression analysis. <b><i>Results:</i></b> Totally, 29,503 patients were included in the study group, of which 2,711 (9.2%) had ICU readmissions. Of the 2,711 readmitted patients, 472 patients were readmitted more than once (readmitted 2 or more times to the ICU, 17.4%). In the readmitted patient group, there were more males, higher sequential organ failure assessment (SOFA) scores, and hospitalized for medical reasons. Length of stay (LOS) in ICU and in-hospital were longer, and 28-day and in-hospital mortality was higher in readmitted patients than in nonreadmitted patients. Risk factors of ICU readmission included the ICU admission due to medical reason, SOFA score, presence of chronic heart disease, diabetes mellitus, chronic kidney disease, transplantation, use of mechanical ventilation, and initial ICU LOS. ICU readmission and age (over 85 years) were independent predictors of in-hospital mortality on multivariable analysis. The delayed ICU readmission group (&#x3e;72 h) had higher in-hospital mortality than the early readmission group (≤72 h) (20.6 vs. 16.2%, <i>p</i> = 0.005). <b><i>Conclusions:</i></b> ICU readmissions occurred in 9.2% of elderly patients and were associated with poor prognosis and higher mortality.

scholarly journals Medical necessity of routine admission of children with mild traumatic brain injury to the intensive care unit

2017 ◽  
Vol 19 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Jared D. Ament ◽  
Krista N. Greenan ◽  
Patrick Tertulien ◽  
Joseph M. Galante ◽  
Daniel K. Nishijima ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Stepwise Logistic Regression ◽  
Mild Tbi ◽  
Misclassification Cost ◽  
Gcs Score

OBJECTIVEApproximately 475,000 children are treated for traumatic brain injury (TBI) in the US each year; most are classified as mild TBI (Glasgow Coma Scale [GCS] Score 13–15). Patients with positive findings on head CT, defined as either intracranial hemorrhage or skull fracture, regardless of severity, are often transferred to tertiary care centers for intensive care unit (ICU) monitoring. This practice creates a significant burden on the health care system. The purpose of this investigation was to derive a clinical decision rule (CDR) to determine which children can safely avoid ICU care.METHODSThe authors retrospectively reviewed patients with mild TBI who were ≤ 16 years old and who presented to a Level 1 trauma center between 2008 and 2013. Data were abstracted from institutional TBI and trauma registries. Independent covariates included age, GCS score, pupillary response, CT characteristics, and Injury Severity Score. A composite outcome measure, ICU-level care, was defined as cardiopulmonary instability, transfusion, intubation, placement of intracranial pressure monitor or other invasive monitoring, and/or need for surgical intervention. Stepwise logistic regression defined significant predictors for model inclusion with p < 0.10. The authors derived the CDR with binary recursive partitioning (using a misclassification cost of 20:1).RESULTSA total of 284 patients with mild TBI were included in the analysis; 40 (14.1%) had ICU-level care. The CDR consisted of 5 final predictor variables: midline shift > 5 mm, intraventricular hemorrhage, nonisolated head injury, postresuscitation GCS score of < 15, and cisterns absent. The CDR correctly identified 37 of 40 patients requiring ICU-level care (sensitivity 92.5%; 95% CI 78.5–98.0) and 154 of 244 patients who did not require an ICU-level intervention (specificity 63.1%; 95% CI 56.7–69.1). This results in a negative predictive value of 98.1% (95% CI 94.1–99.5).CONCLUSIONSThe authors derived a clinical tool that defines a subset of pediatric patients with mild TBI at low risk for ICU-level care. Although prospective evaluation is needed, the potential for improved resource allocation is significant.

scholarly journals Incidence, risk factors and outcome of nosocomial pneumonia in patients with central nervous system infections

2011 ◽  
Vol 139 (7-8) ◽  
pp. 476-480 ◽  
Author(s):  
Olgica Gajovic ◽  
Zoran Todorovic ◽  
Zeljko Mijailovic ◽  
Predrag Canovic ◽  
Ljiljana Nesic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Mechanical Ventilation ◽  
Nervous System ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nosocomial Pneumonia ◽  
Central Nervous System Infections ◽  
Mechanical Ventilation Duration ◽  
Gcs Score

Introduction. Pneumonia is the most frequent nosocomial infection in intensive care units. The reported frequency varies with definition, the type of hospital or intensive care units and the population of patients. The incidence ranges from 6.8-27%. Objective. The objective of this study was to determine the frequency, risk factors and mortality of nosocomial pneumonia in intensive care patients. Methods. We analyzed retrospectively and prospectively the collected data of 180 patients with central nervous system infections who needed to stay in the intensive care unit for more than 48 hours. This study was conducted from 2003 to 2009 at the Clinical Centre of Kragujevac. Results. During the study period, 54 (30%) patients developed nosocomial pneumonia. The time to develop pneumonia was 10?6 days. We found that the following risk factors for the development of nosocomial pneumonia were statistically significant: age, Glasgow Coma Scale (GCS) score <9, mechanical ventilation, duration of mechanical ventilation, tracheostomy, presence of nasogastric tube and enteral feeding. The most commonly isolated pathogens were Klebsiella-Enterobacter spp. (33.3%), Pseudomonas aeruginosa (24.1%), Acinetobacter spp. (16.6%) and Staphylococcus aureus (25.9%). Conclusion. Nosocomial pneumonia is the major cause of morbidity and mortality of patients with central nervous system infections. Patients on mechanical ventilation are particularly at a high risk. The mortality rate of patients with nosocomial pneumonia was 54.4% and it was five times higher than in patients without pneumonia.

scholarly journals Progressive Epidural Hematoma in Patients with Head Trauma: Incidence, Outcome, and Risk Factors

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Hao Chen ◽  
Yan Guo ◽  
Shi-Wen Chen ◽  
Gan Wang ◽  
He-Li Cao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Head Trauma ◽  
Epidural Hematoma ◽  
Skull Fracture ◽  
Ct Scanning ◽  
Ct Scans ◽  
Time Interval ◽  
Secondary Brain Injury ◽  
Trauma Patients ◽  
Increased Risk

Progressive epidural hematoma (PEDH) after head injury is often observed on serial computerized tomography (CT) scans. Recent advances in imaging modalities and treatment might affect its incidence and outcome. In this study, PEDH was observed in 9.2% of 412 head trauma patients in whom two CT scans were obtained within 24 hours of injury, and in a majority of cases, it developed within 3 days after injury. In multivariate logistic regression, patient gender, age, Glasgow Coma Scale (GCS) score at admission, and skull fracture were not associated with PEDH, whereas hypotension (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17–0.84), time interval of the first CT scanning (OR 0.42, 95% CI 0.19–0.83), coagulopathy (OR 0.36, 95% CI 0.15–0.85), or decompressive craniectomy (DC) (OR 0.46, 95% CI 0.21–0.97) was independently associated with an increased risk of PEDH. The 3-month postinjury outcome was similar in patients with PEDH and patients without PEDH (χ2=0.07,P=0.86). In conclusion, epidural hematoma has a greater tendency to progress early after injury, often in dramatic and rapid fashion. Recognition of this important treatable cause of secondary brain injury and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

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