Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries

2014 ◽  
Vol 120 (3) ◽  
pp. 773-777 ◽  
Author(s):  
Shahid Shafi ◽  
Sunni A. Barnes ◽  
D Millar ◽  
Justin Sobrino ◽  
Rustam Kudyakov ◽  
...  
Keyword(s):  
Scale Score ◽  
Brain Injuries ◽  
Injury Severity ◽  
Compliance Rate ◽  
Traumatic Brain Injuries ◽  
Evidence Based ◽  
Clinical Practices ◽  
Severe Tbi ◽  
Level I ◽  
Evidence Based Guidelines

Object Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. Methods This was a retrospective study of blunt TBI (11 Level I trauma centers, study period 2008–2009, n = 2056 patients). Inclusion criteria were an admission Glasgow Coma Scale score ≤ 8 and a CT scan showing TBI, excluding patients with nonsurvivable injuries—that is, head Abbreviated Injury Scale score of 6. The authors measured compliance with 6 nonoperative EBM processes (endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure monitoring, maintaining cerebral perfusion pressure ≥ 50 cm H2O, and discharge to rehabilitation). Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. Results The overall compliance rate was 73%, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80%. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate (OR 0.88; 95% CI 0.81–0.96, p < 0.005). Conclusions Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.

scholarly journals Study of Traumatic Brain Injury Due To Recent Earthquake in Manipal Teaching Hospital

2016 ◽  
Vol 12 (2) ◽  
pp. 63-66
Author(s):  
Bal G Karmacharya ◽  
Brijesh Sathian
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Teaching Hospital ◽  
Brain Injuries ◽  
Injury Severity ◽  
Traumatic Brain Injuries ◽  
The Body ◽  
Mild Head Injury ◽  
Associated Injuries

The objective of this study was to review the demographics, causes injury, severity, treatment and outcome of traumatic brain injuries in victims of the April 2015 earthquake who were admitted in Manipal Teaching Hospital, Pokhara. A total of 37 patients was admitted under Neurosurgery Services. Collapse of buildings was the commonest cause of head injury. The majority of them had mild head injury. Associated injuries to other parts of the body were present in 40.54% patients.Nepal Journal of Neuroscience 12:63-66, 2015

Long-Term Anesthetic-Dependent Hypoactivity after Repetitive Mild Traumatic Brain Injuries in Adolescent Mice

2016 ◽  
Vol 38 (3) ◽  
pp. 220-238 ◽  
Author(s):  
Bridgette D. Semple ◽  
Raha Sadjadi ◽  
Jaclyn Carlson ◽  
Yiran Chen ◽  
Duan Xu ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Vasogenic Edema ◽  
Head Injuries ◽  
Traumatic Brain Injuries ◽  
Return To Play ◽  
Brain Maturation ◽  
Long Term Outcomes ◽  
Mild Traumatic Brain Injuries

Recent evidence supports the hypothesis that repetitive mild traumatic brain injuries (rmTBIs) culminate in neurological impairments and chronic neurodegeneration, which have wide-ranging implications for patient management and return-to-play decisions for athletes. Adolescents show a high prevalence of sports-related head injuries and may be particularly vulnerable to rmTBIs due to ongoing brain maturation. However, it remains unclear whether rmTBIs, below the threshold for acute neuronal injury or symptomology, influence long-term outcomes. To address this issue, we first defined a very mild injury in adolescent mice (postnatal day 35) as evidenced by an increase in Iba-1- labeled microglia in white matter in the acutely injured brain, in the absence of indices of cell death, axonal injury, and vasogenic edema. Using this level of injury severity and Avertin (2,2,2-tribromoethanol) as the anesthetic, we compared mice subjected to either a single mTBI or 2 rmTBIs, each separated by 48 h. Neurobehavioral assessments were conducted at 1 week and at 1 and 3 months postimpact. Mice subjected to rmTBIs showed transient anxiety and persistent and pronounced hypoactivity compared to sham control mice, alongside normal sensorimotor, cognitive, social, and emotional function. As isoflurane is more commonly used than Avertin in animal models of TBI, we next examined long-term outcomes after rmTBIs in mice that were anesthetized with this agent. However, there was no evidence of abnormal behaviors even with the addition of a third rmTBI. To determine whether isoflurane may be neuroprotective, we compared the acute pathology after a single mTBI in mice anesthetized with either Avertin or isoflurane. Pathological findings were more pronounced in the group exposed to Avertin compared to the isoflurane group. These collective findings reveal distinct behavioral phenotypes (transient anxiety and prolonged hypoactivity) that emerge in response to rmTBIs. Our findings further suggest that selected anesthetics may confer early neuroprotection after rmTBIs, and as such mask long-term abnormal phenotypes that may otherwise emerge as a consequence of acute pathogenesis.

scholarly journals Evidence of Prolonged Monitoring of Trauma Patients Admitted via Trauma Resuscitation Unit without Primary Proof of Severe Injuries

2020 ◽  
Vol 9 (8) ◽  
pp. 2516 ◽  
Author(s):  
Martin Heinrich ◽  
Matthias Lany ◽  
Lydia Anastasopoulou ◽  
Christoph Biehl ◽  
Gabor Szalay ◽  
...  
Keyword(s):  
Injury Severity ◽  
Treatment Completion ◽  
Trauma Patients ◽  
Trauma Resuscitation ◽  
Abbreviated Injury Scale ◽  
Severely Injured Patients ◽  
Severe Injuries ◽  
Level I ◽  
Evidence Based Guidelines ◽  
Injured Patients

Introductio: Although management of severely injured patients in the Trauma Resuscitation Unit (TRU) follows evidence-based guidelines, algorithms for treatment of the slightly injured are limited. Methods: All trauma patients in a period of eight months in a Level I trauma center were followed. Retrospective analysis was performed only in patients ≥18 years with primary TRU admission, Abbreviated Injury Scale (AIS) ≤ 1, Maximum Abbreviated Injury Scale (MAIS) ≤ 1 and Injury Severity Score (ISS) ≤3 after treatment completion and ≥24 h monitoring in the units. Cochran’s Q-test was used for the statistical evaluation of AIS and ISS changes in units. Results: One hundred and twelve patients were enrolled in the study. Twenty-one patients (18.75%) reported new complaints after treatment completion in the TRU. AIS rose from the Intermediate Care Unit (IMC) to Normal Care Unit (NCU) 6.2% and ISS 6.9%. MAIS did not increase >2, and no intervention was necessary for any patient. No correlation was found between computed tomography (CT) diagnostics in TRU and AIS change. Conclusions: The data suggest that AIS, MAIS and ISS did not increase significantly in patients without a severe injury during inpatient treatment, regardless of the type of CT diagnostics performed in the TRU, suggesting that monitoring of these patients may be unnecessary.

scholarly journals Does Mode of Transport Confer a Mortality Benefit in Trauma Patients? Characteristics and Outcomes at an Ontario Lead Trauma Hospital

CJEM ◽  
2016 ◽  
Vol 18 (5) ◽  
pp. 363-369 ◽  
Author(s):  
Ian M. Buchanan ◽  
Angela Coates ◽  
Niv Sne
Keyword(s):  
Injury Severity ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Rotor Wing ◽  
Observational Cohort ◽  
Level I ◽  
Mode Of Transport ◽  
Evidence Based Guidelines ◽  
The Relationship

AbstractObjectivesEvidence-based guidelines regarding the optimal mode of transport for trauma patients from scene to trauma centre are lacking. The purpose of this study was to investigate the relationship between trauma patient outcomes and mode of transport at a single Ontario Level I Trauma Centre, and specifically to investigate if the mode of transport confers a mortality benefit.MethodsA historical, observational cohort study was undertaken to compare rotor-wing and ground transported patients. Captured data included demographics, injury severity, temporal and mortality variables. TRISS-L analysis was performed to examine mortality outcomes.Results387 rotor-wing transport and 2,759 ground transport patients were analyzed over an 18-year period. Rotor-wing patients were younger, had a higher Injury Severity Score, and had longer prehospital transport times. Mechanism of injury was similarly distributed between groups. After controlling for heterogeneity with TRISS-L analysis, the mortality of rotor-wing patients was found to be lower than predicted mortality, whereas the converse was found with ground patients.ConclusionRotor-wing and ground transported trauma patients represent heterogeneous populations. Accounting for these differences, rotor-wing patients were found to outperform their predicted mortality, whereas ground patients underperformed predictions.

Clinical presentation of the posttraumatic stress disorder with and without traumatic brain injuries

2011 ◽  
Vol 26 (S2) ◽  
pp. 1070-1070 ◽  
Author(s):  
M.M. Simonović ◽  
M.M. Radisavljević ◽  
G.B. Grbeša
Keyword(s):  
Psychological Distress ◽  
Sleep Disturbances ◽  
Brain Injuries ◽  
Stress Disorder ◽  
Clinical Presentation ◽  
Traumatic Brain Injuries ◽  
Mild Tbi ◽  
History Of ◽  
Severe Tbi ◽  
The Difference

The aim of the investigation was to determine the difference between the severities of the symptom's in PTSD with and without the history of TBI.The estimation of the PTSD in 60 patients was performed using the CAPS-DX. The estimation of the TBI was performed using the Glasgow Coma Scale. The data were analysed using ANOVA and PostHoc analysis.Severity of the reexperiencing symptoms were higher in PTSD with TBI vs PTSD w/o TBI: in nightmares, reexperiencing, psychological distress (p < 0,05), in intrusive recollections and in total score of reexperiencing symptoms (p < 0,01). PostHoc analysis showed higher scores of intrusive recollections (p < 0,01) and psychological distress (p < 0,05) in PTSD with moderate/severe TBI vs PTSD w/o TBISeverity of the avoidance symptoms were higher in PTSD with moderate/severe TBI vs PTSD w/o TBI: in avoidance of thoughts, avoidance of activities (p < 0,05), in detachment and in total avoidance symptom's scores in PTSD with moderate/severe TBI vs PTSD w/o TBI. PostHoc analysis showed higher score of detachment in PTSD with mild TBI vs PTSD w/o TBI.Severity of hyperarousal symptoms were higher in PTSD with TBI: in sleep disturbances, difficulty concentrating (p < 0,05), and in total huperarousal symptom's score (p < 0,01). PostHoc analysis showed greater severity of sleep disturbances in PTSD with moderate/severe TBI vs PTSD with mild TBI (p < 0,05), and in PTSD without TBI (p < 0,01), and greater score of difficulties concentrating (p < 0,01) and total huperarousal symptom's (p < 0,05) in PTSD with mild TBI vs PTSD without TBI.

325 Thrombocytosis as a Predictor of Outcome In Severe TBI

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 271-271
Author(s):  
William J Ares ◽  
Joshua S Bauer ◽  
David O Okonkwo
Keyword(s):  
Platelet Count ◽  
Brain Injuries ◽  
Traumatic Brain Injuries ◽  
Secondary Outcome ◽  
Exclusion Criteria ◽  
Platelet Counts ◽  
Trauma Population ◽  
Severe Tbi ◽  
Hospital Stays ◽  
Post Traumatic

Abstract INTRODUCTION Post-traumatic development of thrombocytosis is felt to be secondary to a reactive process associated with cytokine release during the global inflammatory state and has been demonstrated in a general trauma population to be associated with decreased mortality. This has not been investigated in patients with severe traumatic brain injuries. METHODS This study included 120 consecutive patients with severe TBI (GCS<8) presenting to our institution between 6/2010 and 9/2012. Clinical data was retrospectively collected; clinical outcomes were part of a prospective registry. Exclusion criteria included non-survival to hospital discharge and lack of follow up data. Thrombocytosis was defined as peak platelet count greater than 600 × 103/mm3. Primary outcome was Glascow Outcome Score at 6 months. Secondary outcome was mortality at 6 months. RESULTS >Forty-four patients were available for analysis after applying exclusion criteria. All patients demonstrated an increase in platelet counts when compared to admission levels. Twenty-one (47%) patients developed thrombocytosis during their hospital stay with an average platelet count of 752 × 103/mm3 and an average time to peak of 17 days. Patients who developed thrombocytosis had a trend towards decreased GOS at 6 months (3.3 vs 3.8, p = .08) and towards longer hospital stays (37.5 vs 21.5, p = .08). Six-month mortality was unchanged between the two groups (4% vs 4%, P = 1). Additionally, patients with peak platelet counts that were greater than 200% of admission baseline had lower GOS at 6 months when compared to those that remained below 200% of baseline (3.4 vs 4.1, p = .03). CONCLUSION The development of post-traumatic thrombocytosis, while associated with lower mortality in the overall trauma population, may be associated with worse outcomes and longer hospital stays in patients with severe traumatic brain injuries. Relative reactive thrombocytosis greater than 200% of baseline may be more predictive of poor outcome than strictly defined laboratory cutoffs.

Bicycle Helmets save More than Heads: Experience from a Pediatric Level I Trauma Hospital

2017 ◽  
Vol 83 (9) ◽  
pp. 1007-1011 ◽  
Author(s):  
Patrick D. Michael ◽  
Daniel L. Davenport ◽  
John M. Draus
Keyword(s):  
Brain Injuries ◽  
Injury Severity ◽  
Demographic Data ◽  
Private Insurance ◽  
Hospital Costs ◽  
Study Cohort ◽  
Level I ◽  
Minor Injuries ◽  
Trauma Activation ◽  
Activation Criteria

We studied pediatric bicycle accident victims (age ≤ 15 years) who were treated at our pediatric Level I trauma center during a 10-year period. Demographic data, injury severity, hospital course, and hospital cost data were collected. We compared the children who were helmeted to those who were unhelmeted. Our study cohort consisted of 516 patients. Patients were mostly male (70.2%) and white (84.7%); the median age was nine years. There were 101 children in the helmet group and 415 children in the unhelmeted group. Helmeted children were more likely to have private insurance (68.3% vs 35.9%, P < 0.001). Unhelmeted children were more likely to sustain multiple injuries (40% vs 25.7%, P = 0.008), meet our trauma activation criteria (45.5% vs 16.8%, P < 0.001), and be admitted to the hospital (42.4% vs 14.9%, P < 0.001). Helmeted children were less likely to sustain brain injuries (15.8% vs 25.8%, P = 0.037), skull fractures (1% vs 10.8%, P = 0.001), and facial fractures (1% vs 6%, P = 0.040). Median hospital costs were more expensive in the unhelmeted group. Helmet usage was suboptimal. Although most children sustained relatively minor injuries, the unhelmeted children had more injuries and higher costs than those who used helmets. Injury prevention programs are warranted.

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