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.

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.

Comparison of mannitol regimens in patients with severe head injury undergoing intracranial monitoring

1986 ◽  
Vol 65 (6) ◽  
pp. 820-824 ◽  
Author(s):  
Harold P. Smith ◽  
David L. Kelly ◽  
Joe M. McWhorter ◽  
Darlene Armstrong ◽  
Rayetta Johnson ◽  
...  
Keyword(s):  
Severe Head Injury ◽  
Head Injuries ◽  
Randomized Study ◽  
Similar Treatment ◽  
Content Type ◽  
Group I ◽  
Head Injured ◽  
Scale Scores ◽  
Injured Patients ◽  
Fine Print

✓ Eighty patients sustaining head injuries and presenting with Glasgow Coma Scale scores of 8 or less were entered into a prospective randomized study to assess the benefit of intracranial pressure (ICP) monitoring with two regimens of mannitol administration. Group I was treated with mannitol for ICP elevations greater than 25 mm Hg, while Group II received empirical mannitol therapy irrespective of ICP readings. No statistically significant differences in mortality rate or neurological outcome were demonstrated between the two groups. These results are comparable to those of several published series of head-injured patients receiving similar treatment from 1977 to 1982. However, those series must be reassessed in light of recently published studies with treatment initiated at lower levels of ICP.

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.

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.

Outcome after complex neurosurgery: the caregiver's burden is forgotten

1999 ◽  
Vol 91 (3) ◽  
pp. 359-363 ◽  
Author(s):  
Dorothy A. Lang ◽  
Glenn Neil-Dwyer ◽  
John Garfield
Keyword(s):  
Quality Of Life ◽  
Major Change ◽  
Percutaneous Gastrostomy ◽  
Content Type ◽  
Petroclival Meningioma ◽  
Sf 36 ◽  
Permanent Neurological Deficit ◽  
The Impact ◽  
Fine Print

Object. The goals of this study were twofold: 1) to determine outcome, including quality of life, in patients who have undergone surgery for petroclival meningioma in which a standard skull base approach was used; and 2) to assess the impact of the patients' surgical treatment on their caregivers.Methods. Seventeen patients (13 women and four men ranging in age from 29 to 63 years) who underwent a transpetrosal approach for a petroclival meningioma during a 5-year period were prospectively included in this study. Pre- and postoperative data including adverse events were noted. The patients were assessed at 3, 6, and 12 months postoperatively, and annually thereafter, and they completed a postoperative SF-36 questionnaire. In addition, each patient's caregiver was interviewed to determine the effect of the patient's illness on the caregiver's life and responsibilities.Twenty-two operations were performed. A new permanent neurological deficit developed in five patients and in eight a temporary deficit or exacerbation of existing deficits occurred. Two patients underwent surgery to create a facial—hypoglossal nerve communication; five required a temporary percutaneous gastrostomy and/or tracheostomy; three required a shunt; and one underwent successful squint surgery. At 1 year postoperatively 13 patients had made a good or moderate recovery, three were severely disabled, and one had died—outcomes in keeping with other studies. By contrast, responses to the SF-36 questionnaire showed that, in all eight of its categories, between 43% and 75% of surviving patients were functioning below accepted norms. Fifty-six percent of caregivers experienced a major change in lifestyle and 38% experienced a major change with respect to their work.Conclusions. After transpetrosal excision of a petroclival meningioma, the quality of life for the patient is worse than that indicated in surgeons' reported results. The impact on the patient's caregiver is profound—a burden perhaps not fully appreciated by the surgeon.

Medication Errors in Injured Patients

2017 ◽  
Vol 83 (7) ◽  
pp. 780-785 ◽  
Author(s):  
Scott C. Dolejs ◽  
Christopher F. Janowak ◽  
Ben L. Zarzaur
Keyword(s):  
Medication Error ◽  
Patient Outcomes ◽  
Medication Errors ◽  
Injury Severity ◽  
Trauma Patients ◽  
Lengths Of Stay ◽  
Scale Scores ◽  
Level I ◽  
Injured Patients ◽  
The Impact

Trauma patients are vulnerable to medication error given multiple handoffs throughout the hospital. The purpose of this study was to assess trends in medication errors in trauma patients and the role these errors play in patient outcomes. Injured adults admitted from 2009 to 2015 to a Level I trauma center were included. Medication errors were determined based on a nurse-driven, validated, and prospectively maintained database. Multivariable logistic regression modeling was used to control for differences between groups. Among 15,635 injured adults admitted during the study period, 132 patients experienced 243 errors. Patients who experienced errors had significantly worse injury severity, lower Glasgow Coma Scale scores and higher rates of hypotension on admission, and longer lengths of stay. Before adjustment, mortality was similar between groups but morbidity was higher in the medication error group. After risk adjustment, there were no significant differences in morbidity or mortality between the groups. Medication errors in trauma patients tend to occur in significantly injured patients with long hospital stays. Appropriate adjustment when studying the impact of medical errors on patient outcomes is important.

Is routine transcranial Doppler ultrasound monitoring useful in the management of subarachnoid hemorrhage?

1998 ◽  
Vol 88 (2) ◽  
pp. 272-276 ◽  
Author(s):  
Joanna M. Wardlaw ◽  
Ruth Offin ◽  
Graham M. Teasdale ◽  
Evelyn M. Teasdale
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neurological Deficit ◽  
Transcranial Doppler ◽  
Controlled Trial ◽  
Positive Contribution ◽  
Content Type ◽  
Delayed Ischemic Neurological Deficit ◽  
Ultrasound Monitoring ◽  
The Impact ◽  
Fine Print

Object. In this prospective observational study, the authors assess the impact of routine transcranial Doppler (TCD) ultrasound monitoring on the diagnosis, management, and outcome of delayed ischemic neurological deficit complicating subarachnoid hemorrhage (SAH). Methods. Over a 10-month period 186 patients admitted to a regional neurosciences center were included in the study. Three times a week, routine TCD examinations performed by neuroradiographers made an important positive contribution to the diagnosis of delayed ischemic neurological deficit in 72% of patients with this complication and led to altered management for the benefit of the patient in 43%. In 9% of patients with recent SAH, it was believed that the outcome might have been better if the TCD result had been acted upon appropriately. The TCD results did not adversely influence management or outcome and were generally accurate when compared with those obtained on angiography. Conclusions. A routine TCD service provided by neuroradiographers is accurate and useful in diagnosing and managing elevated blood velocities and ischemic neurological deficit following SAH. In addition, it is possible that if the information gleaned from TCD findings was used more often in patient management, outcome might be improved; however, a randomized controlled trial is necessary to assess both these points definitively.

Intracranial bone marrow transplantation after traumatic brain injury improving functional outcome in adult rats

2001 ◽  
Vol 94 (4) ◽  
pp. 589-595 ◽  
Author(s):  
Asim Mahmood ◽  
Dunyue Lu ◽  
Yi Li ◽  
Jae Li Chen ◽  
Michael Chopp
Keyword(s):  
Traumatic Brain Injury ◽  
Bone Marrow ◽  
Brain Injury ◽  
Motor Function ◽  
Glial Fibrillary Acid Protein ◽  
Protein Markers ◽  
Adult Rats ◽  
Content Type ◽  
The Impact ◽  
Fine Print

Object. The authors tested the hypothesis that intracranial bone marrow (BM) transplantation after traumatic brain injury (TBI) in rats provides therapeutic benefit. Methods. Sixty-six adult Wistar rats, weighing 275 to 350 g each, were used for the experiment. Bone marrow prelabeled with bromodeoxyuridine (BrdU) was harvested from tibias and femurs of healthy adult rats. Other animals were subjected to controlled cortical impact, and BM was injected adjacent to the contusion 24 hours after the impact. The animals were killed at 4, 7, 14, or 28 days after transplantation. Motor function was evaluated both before and after the injury by using the rotarod test. After the animals had been killed, brain sections were examined using hemotoxylin and eosin and immunohistochemical staining methods. Histological examination revealed that, after transplantation, BM cells survived, proliferated, and migrated toward the injury site. Some of the BrdU-labeled BM cells were reactive, with astrocytic (glial fibrillary acid protein) and neuronal (NeuN and microtubule-associated protein) markers. Transplanted BM expressed proteins phenotypical of intrinsic brain cells, that is, neurons and astrocytes. A statistically significant improvement in motor function in rats that underwent BM transplantation, compared with control rats, was detected at 14 and 28 days posttransplantation. Conclusions. On the basis of their findings, the authors assert that BM transplantation improves neurological outcome and that BM cells survive and express nerve cell proteins after TBI.

The impact-absorbing effects of facial fractures in closed-head injuries

1987 ◽  
Vol 66 (4) ◽  
pp. 542-547 ◽  
Author(s):  
K. Francis Lee ◽  
Louis K. Wagner ◽  
Y. Eugenia Lee ◽  
Jung Ho Suh ◽  
Seung Ro Lee
Keyword(s):  
Head Injuries ◽  
Closed Head Injury ◽  
Neurological Deficits ◽  
Facial Fractures ◽  
Contingency Table Analysis ◽  
Chi Square ◽  
Content Type ◽  
Closed Head ◽  
Table Analysis ◽  
The Impact

✓ A series of 210 patients with facial fractures sufficiently severe to require cranial computerized tomography (CT) to evaluate suspected closed-head injury (CHI) was studied. The injuries were separated into five grades of severity based on neurological examination, including cranial CT. The injuries were also grouped into three categories based on facial regional involvement, using chi-square contingency table analysis. The data demonstrated that patients with upper facial fractures were at greatest risk for serious CHI. Injuries to both the mandibular and the midfacial regions with no upper facial involvement more frequently resulted in mild CHI with a modest likelihood of no neurological deficits. Trauma to only the mandibular region or to only the midfacial region was least likely to involve CHI.

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