Assessing the influence of non-treatment variables in a study of outcome from severe head injuries

1984 ◽  
Vol 61 (2) ◽  
pp. 254-262 ◽  
Author(s):  
A. Russell Lokkeberg ◽  
Richard M. Grimes
Keyword(s):  
Regression Analysis ◽  
Analysis Of Variance ◽  
Head Injuries ◽  
Trauma Patients ◽  
Severely Injured ◽  
Content Type ◽  
Severity Of Injury ◽  
Mode Of Transportation ◽  
The Impact ◽  
Fine Print

✓ An evaluation was made of the impact of non-treatment variables on severely injured head trauma patients. The principal findings were: 1) severity of injury was the best predictor of outcome; 2) patient's age had a statistically significant but marginally useful impact on outcome; 3) a regression analysis showed that duration of transport, up to 4 hours, had no impact on outcome; 4) time from accident to intubation had a marginal impact on outcome; and 5) one-way analysis of variance showed that mode of transportation, whether helicopter, ambulance, or other means had no impact on outcome.

Cerebral hemodynamics in patients with carotid artery occlusion and contralateral moderate or severe internal carotid artery stenosis

2001 ◽  
Vol 94 (4) ◽  
pp. 559-564 ◽  
Author(s):  
Fabrizio Vernieri ◽  
Patrizio Pasqualetti ◽  
Marina Diomedi ◽  
Patrizia Giacomini ◽  
Paolo M. Rossini ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Carotid Artery ◽  
Cerebral Hemodynamics ◽  
Cerebrovascular Reactivity ◽  
Content Type ◽  
Collateral Pathways ◽  
Collateral Vessels ◽  
Ica Stenosis ◽  
The Impact ◽  
Fine Print

Object. The purpose of this study was to evaluate cerebral hemodynamics in patients suffering from occlusion of the carotid artery (CA) and contralateral CA stenosis. Methods. Using transcranial Doppler ultrasonography, the cerebrovascular reactivity to hypercapnia in the middle cerebral arteries was evaluated by calculating the breath-holding index (BHI) of 69 symptomatic patients suffering from internal CA (ICA) occlusion and moderate or severe contralateral ICA stenosis. To evaluate which variables influenced BHIs ipsilateral to the site of ICA occlusion, a multiple stepwise linear regression analysis was performed that included the following factors: patient age, percentage of contralateral ICA stenosis, contralateral BHI, number of collateral pathways, and presence of hypertension, diabetes, smoking, and hyperlipidemia. An analysis of variance was conducted to evaluate the impact of the type of collateral vessels on the BHI. A regression analysis showed that the BHI ipsilateral to the site of ICA occlusion could be accounted for by the contralateral BHI (which was entered at the first step of the analysis, p < 0.001) and by the number of collateral pathways (which was entered at the second step, p = 0.033). Neither the degree of contralateral ICA stenosis nor the other variables could be added to improve the model. The analysis demonstrated that the absence of collateral pathways and the presence of the anterior communicating artery (ACoA) alone were associated with lower BHI values than those found in the presence of two or three collateral vessels, regardless of the presence of an anterior collateral pathway. Conclusions. On the basis of these data one can infer that the cerebral hemodynamic status of patients with occlusive disease of the CA is influenced by individual anatomical and functional characteristics. Because improvement in contralateral hemodynamics after surgical correction of an ICA stenosis can only be expected in the presence of an ACoA, the planning of strategies for influencing cerebral blood flow distal to an ICA occlusion and, in particular, the consideration of a contralateral carotid endarterectomy, should be preceded by a careful evaluation of the intracranial hemodynamic adaptive status of the patient. Particular attention should be paid to cerebrovascular reactivity and the number and type of collateral vessels that are present.

Treatment of head injuries in the American Civil War

1993 ◽  
Vol 78 (5) ◽  
pp. 838-845 ◽  
Author(s):  
Howard H. Kaufman
Keyword(s):  
Civil War ◽  
Head Injury ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Gunshot Wounds ◽  
American Civil War ◽  
Content Type ◽  
Severity Of Injury ◽  
Surgical History ◽  
Fine Print

✓ At the time of the American Civil War (1861–1865), a great deal was known about closed head injury and gunshot wounds to the head. Compression was differentiated from concussion, but localization of lesions was not precise. Ether and especially chloroform were used to provide anesthesia. Failure to understand how to prevent infection discouraged physicians from aggressive surgery. Manuals written to educate inexperienced doctors at the onset of the war provide an overview of the advice given by senior surgeons. The Union experiences in the treatment of head injury in the Civil War were discussed in the three surgical volumes of The Medical and Surgical History of the War of the Rebellion. Wounds were divided into incised and puncture wounds, blunt injuries, and gunshot wounds, which were analyzed separately. Because the patients were not stratified by severity of injury and because there was no neuroimaging, it is difficult to understand the clinical problems and the effectiveness of surgery. Almost immediately after the war, increased knowledge about cerebral localization and the development of antisepsis (and then asepsis) permitted the development of modern neurosurgery.

scholarly journals Comparative analysis between identified injuries of victims of fall from height and other mechanisms of closed trauma

2014 ◽  
Vol 41 (4) ◽  
pp. 285-291 ◽  
Author(s):  
José Gustavo Parreira ◽  
Lucas R. Kanamori ◽  
Guilherme C. J. Valinoto ◽  
Jacqueline A. Giannini Perlingeiro ◽  
Silvia Cristine Soldá ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Head Injuries ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Retroperitoneal Hemorrhage ◽  
Lower Systolic Blood Pressure ◽  
Severity Of Injury ◽  
Thoracic And Abdominal ◽  
The Impact ◽  
Group 1

OBJECTIVE:to identify predictors of death in blunt trauma patients sustaining pelvic fractures and, posteriorly, compare them to a previously reported series from the same center.METHOD: Retrospective analysis of trauma registry data, including blunt trauma patients older than 14 y.o. sustaining pelvic fractures admitted from 2008 to 2010. Patients were assigned into group 1 (dead) or 2 (survivors). We used Student's t, qui square and Fisher's tests for statistical analysis, considering p<0.05 as significant. Posteriorly, we compared predictors of death between both periods.RESULTS: Seventy-nine cases were included. Mean RTS, ISS and TRISS were, respectively, 6.44 + 2.22, 28.0 + 15.2 e 0.74 + 0.33. Nineteen patients died (24,0%). Main cause of death was hemorrhage (42,1%). Group 1 was characterized by (p<0.05) lower systolic blood pressure and Glasgow coma scale means on admission, higher heart rate, head AIS, extremity AIS and ISS means, as well as, higher frequency of severe head injuries and complex pelvic fractures. Comparing both periods, we notice that the anatomic and physiologic severity of injury increased (RTS and ISS means). Furthermore, there was a decrease in the impact of associated thoracic and abdominal injuries on the prognosis and an association of lethality with the presence of complex pelvic fractures.CONCLUSION: There were significant changes in the predictors of death between these two periods. The impact of thoracic and abdominal associated injures decreased while the importance of severe retroperitoneal hemorrhage increased. There was also an increase in trauma severity, which accounted for high lethality.

Predictive value of an early Glasgow Outcome Scale score: 15-month score changes

2005 ◽  
Vol 103 (2) ◽  
pp. 239-245 ◽  
Author(s):  
Kelly J. Miller ◽  
Karen A. Schwab ◽  
Deborah L. Warden
Keyword(s):  
Glasgow Outcome Scale ◽  
Injury Severity ◽  
Head Injuries ◽  
Score Change ◽  
Content Type ◽  
Outcome Score ◽  
Scale Scores ◽  
Initial Score ◽  
The Impact ◽  
Fine Print

Object. Does an early Glasgow Outcome Scale (GOS) assessment provide a reliable indicator of later outcome in a patient with traumatic brain injury (TBI)? The authors examined the utility of the GOS during early treatment as a predictor of outcome score 15 months postinjury by analyzing outcome score change in a group of patients with closed head injuries. Methods. Glasgow Outcome Scale scores assessed within 3 months of injury (baseline) were compared with scores obtained at 15 months postinjury in 121 patients, primarily young military personnel. Score changes between baseline and 8 months postinjury were also studied in a subgroup of 72 patients. The impact of initial injury severity (determined by the duration of unconsciousness) on score change was also explored. The GOS scores at three time points within the 15-month period—baseline (within 3 months of injury), 8, and 15 months postinjury—were examined to ascertain when the maximal GOS score had been reached. Conclusions. Baseline GOS score was a reliable predictor of outcome in patients with an initial score of 5 (no disability) or 4 (mild disability), but not in patients with an initial score of 3 (severe disability). Patients who remained unconscious for more than 24 hours did not have significantly lower outcome scores than those who experienced loss of consciousness for less than 24 hours at 15 months postinjury. Interestingly, the duration of unconsciousness did not affect the likelihood of an improved score during the study period in patients with a GOS score of 3 or 4 at baseline. An updated evaluation conducted after the early phases of treatment is needed to provide a realistic prognosis of severe TBI.

Extradural and subdural hematomas

1970 ◽  
Vol 33 (6) ◽  
pp. 632-635 ◽  
Author(s):  
Kenneth G. Jamieson
Keyword(s):  
Traffic Accidents ◽  
Head Injuries ◽  
Accident Prevention ◽  
Content Type ◽  
Subdural Hematomas ◽  
Fine Print

✓ The pattern of head injuries due to traffic accidents has changed markedly in Australia in the period since 1935. A review of autopsy cases of extradural and acute subdural hematomas shows a startling shift toward inoperable lesions. The author points out that accident prevention must now be considered the chief means of reversing man's trend toward self-destruction on the highway.

Quantitative analysis of the impact of craft worker availability on construction project safety performance

2016 ◽  
Vol 16 (3) ◽  
pp. 307-322 ◽  
Author(s):  
Hossein Karimi ◽  
Timothy R.B. Taylor ◽  
Paul M. Goodrum ◽  
Cidambi Srinivasan
Keyword(s):  
Regression Analysis ◽  
Poisson Regression ◽  
Construction Projects ◽  
Construction Project ◽  
Safety Performance ◽  
Content Type ◽  
Poisson Regression Analysis ◽  
Incident Cases ◽  
The Impact ◽  
Craft Worker

Purpose This paper aims to quantify the impact of craft worker shortage on construction project safety performance. Design/methodology/approach A database of 50 North American construction projects completed between 2001 and 2014 was compiled by taking information from a research project survey and the Construction Industry Institute Benchmarking and Metrics Database. The t-test and Mann-Whitney test were used to determine whether there was a significant difference in construction project safety performance on projects with craft worker recruiting difficulty. Poisson regression analysis was then used to examine the relationship between craft worker recruiting difficulty and Occupational Safety and Health Administration Total Number of Recordable Incident Cases per 200,000 Actual Direct Work Hours (TRIR) on construction projects. Findings The result showed that the TRIR distribution of a group of projects that reported craft worker recruiting difficulty tended to be higher than the TRIR distribution of a group of projects with no craft worker recruiting difficulty (p-value = 0.004). Moreover, the average TRIR of the projects that reported craft worker recruiting difficulty was more than two times the average TRIR of projects that experienced no craft recruiting difficulty (p-value = 0.035). Furthermore, the Poisson regression analysis demonstrated that there was a positive exponential relationship between craft worker recruiting difficulty and TRIR in construction projects (p-value = 0.004). Research limitations/implications The projects used to construct the database are heavily weighted towards industrial construction. Practical implications There have been significant long-term gains in construction safety within the USA. However, if recent craft shortages continue, the quantitative analyses presented herein indicate a strong possibility that more safety incidents will occur unless the shortages are reversed. Innovative construction means and methods should be developed and adopted to work in a safe manner with a less qualified workforce. Originality/value The Poisson regression model is the first model that quantifiably links project craft worker availability to construction project safety performance.

Cerebral oxygen and microdialysis monitoring during aneurysm surgery: effects of blood pressure, cerebrospinal fluid drainage, and temporary clipping on infarction

2002 ◽  
Vol 96 (6) ◽  
pp. 1013-1019 ◽  
Author(s):  
Rupert Kett-White ◽  
Peter J. Hutchinson ◽  
Pippa G. Al-Rawi ◽  
Marek Czosnyka ◽  
Arun K. Gupta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cerebrospinal Fluid ◽  
Brain Tissue ◽  
Total Duration ◽  
Wilcoxon Test ◽  
Fisher Exact Test ◽  
Content Type ◽  
The Impact ◽  
Temporary Clipping ◽  
Fine Print

Object. The aim of this study was to investigate potential episodes of cerebral ischemia during surgery for large and complicated aneurysms, by examining the effects of arterial temporary clipping and the impact of confounding variables such as blood pressure and cerebrospinal fluid (CSF) drainage. Methods. Brain tissue PO2, PCO2, and pH, as well as temperature and extracellular glucose, lactate, pyruvate, and glutamate were monitored in 46 patients by using multiparameter sensors and microdialysis. Baseline data showed that brain tissue PO2 decreased significantly, below a mean arterial pressure (MAP) threshold of 70 mm Hg. Further evidence of its relationship with cerebral perfusion pressure was shown by an increase in mean brain tissue PO2 after drainage of CSF from the basal cisterns (Wilcoxon test, p < 0.01). Temporary clipping was required in 31 patients, with a mean total duration of 14 minutes (range 3–52 minutes), causing brain tissue PO2 to decrease and brain tissue PCO2 to increase (Wilcoxon test, p < 0.01). In patients in whom no subsequent infarction developed in the monitored region, brain tissue PO2 fell to 11 mm Hg (95% confidence interval 8–14 mm Hg). A brain tissue PO2 level below 8 mm Hg for 30 minutes was associated with infarction in any region (p < 0.05 according to the Fisher exact test); other parameters were not predictive of infarction. Intermittent occlusions of less than 30 minutes in total had little effect on extracellular chemistry. Large glutamate increases were only seen in two patients, in both of whom brain tissue PO2 during occlusion was continuously lower than 8 mm Hg for longer than 38 minutes. Conclusions. The brain tissue PO2 decreases with hypotension, and, when it is below 8 mm Hg for longer than 30 minutes during temporary clipping, it is associated with increasing extracellular glutamate levels and cerebral infarction.

Prophylactic phenytoin in severe head injuries

1979 ◽  
Vol 51 (4) ◽  
pp. 507-509 ◽  
Author(s):  
Richard N. W. Wohns ◽  
Allen R. Wyler
Keyword(s):  
Retrospective Study ◽  
Head Injury ◽  
High Probability ◽  
Late Onset ◽  
Head Injuries ◽  
Content Type ◽  
Posttraumatic Epilepsy ◽  
Fine Print

✓ We are reporting a retrospective study of 62 patients whose head injury was sufficiently severe to cause a high probability of posttraumatic epilepsy. Of 50 patients treated with phenytoin, 10% developed epilepsy of late onset. Twelve patients not treated with phenytoin but who had head injuries of equal magnitude had a 50% incidence of epilepsy. These data from a highly selected group of patients with severe head injuries confirm the bias that treatment with phenytoin decreases the incidence of posttraumatic epilepsy.

Perceptions of nurses on the impact of accreditation on quality of care

2014 ◽  
Vol 19 (2) ◽  
pp. 69-82 ◽  
Author(s):  
Ahmet Yildiz ◽  
Sidika Kaya
Keyword(s):  
Regression Analysis ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Positive Impact ◽  
Pearson Correlation ◽  
High Rate ◽  
Content Type ◽  
Independent Variables ◽  
The Impact

Purpose – This article aims to investigate perceptions of Turkish nurses on the impact of accreditation on quality of care and the effect of accreditation on quality results. Design/methodology/approach – This study was performed as a cross-sectional, questionnaire-based survey on 258 nurses who started working in the hospital before it was accredited and continued to work during and after accrediation and who therefore knew both the hospital's pre-accrediation and post-accreditation periods. In this study, descriptive statistical analyses (means and standard deviations) were carried out to explore the views of the participants on “quality results,” “benefits of accreditation” and “participation of employees.” “Quality results” was considered to be the dependent variable, while “benefits of accreditation” and “participation of employees” were accepted as the independent variables. The relationship between the dependent variable and the independent variables was tested using Pearson correlation and multiple regression analysis. External patient satisfaction data collected by the quality department of the hospital before and after accreditation were also investigated. Findings – It was found that nurses had generally high scores for the items concerning the benefits of accreditation. There was a statistically significant positive correlation between the dependent variable (quality results) and the independent variables (benefits of accreditation and participation of employees). Regression analysis indicated that R2=0.461 and the extent to which the independent variables explained the dependent variable was 46.1 per cent, which is a high rate. Patient satisfaction scores increased after accreditation. Practical implications – Our study suggest that providing support for nurses, especially nurses with administrative responsibilities and incorporating employees into the process are important for exercising quality standards. Originality/value – Hospital accreditation has a positive impact on quality results especially on quality of care provided to patients and patient satisfaction. Study findings could guide policy makers and hospital managers in Turkey and in other countries who are preparing or implementing accreditation.

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.

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