scholarly journals Factors influencing the outcome of patients with acute extradural haematomas undergoing surgery

1970 ◽  
Vol 10 (2) ◽  
pp. 112-120 ◽  
Author(s):  
MJ Islam ◽  
SK Saha ◽  
MF Elahy ◽  
KMT Islam ◽  
SU Ahamed
Keyword(s):  
Glasgow Coma Scale ◽  
Glasgow Outcome Scale ◽  
Road Traffic ◽  
Medical Science ◽  
Extradural Haematoma ◽  
Common Cause ◽  
Coma Scale ◽  
Male Predominance ◽  
Factors Influencing ◽  
Gcs Score

Background: Acute extradural haematoma (EDH) remains most common cause of mortality and disability resulting from traumatic brain injury. In the last three decades, improvements in rescue, neuromonitoring, diagnostic procedure and intensive care have led to better outcomes. The purpose of this study was to evaluate the factors influencing the outcome in patients with EDH undergoing surgery treated in a tertiary hospital in Bangladesh. Methods: In this retrospective study, 102 consecutive patients with acute EDH who underwent craniotomy were included. The study was carried out from July 2003 to December 2005. The diagnosis was made clinically and radiologically by CT scan. Patients were grouped on the basis of Glasgow Coma Scale (GCS) and operative outcomes were evaluated by Glasgow Outcome Scale (GOS) Results: More than half sampled respondents’ (57%) age were more than 20 years while rests of the patients below 20 years with male predominance (Male: Female -12:1). About 7 in 10 respondents (70.6%) were working. Similarly, majority of the respondents (79.4%) had lost more than 30 ml blood. A notable proportion of the respondents (73.5%) had good GCS score (9-15 score) during admission. Similarly majority of the respondents (70.6%) had GCS score 9-15 and 29.4% had GCS score 3-8 before surgery. Road Traffic Accident (RTA) (65%) is the most common cause of EDH followed by assault (20%) and fall from height (12%). Temporal and temporo-parietal locations were the most common site of EDH (56%). Patients with good GCS before surgery had significantly better outcome (89%) compare to those who had bad GCS (10%). Conclusion: Level of consciousness before surgery is the most important factor affecting the outcome. Hence, early diagnosis and surgical intervention is very essential. Key words: Acute Extradural Haematoma (EDH); Glasgow Coma Scale (GCS); Glasgow Outcome Scale (GOS). DOI: http://dx.doi.org/10.3329/bjms.v10i2.7806 Bangladesh Journal of Medical Science Vol.10 No.2 Apr’11 pp.112-120

scholarly journals A study of correlation of degree of midline shift on computed tomography scan and Glasgow coma scale in patients of acute traumatic head injury

2021 ◽  
Vol 8 (10) ◽  
pp. 3075
Author(s):  
A. K. Chaurasia ◽  
Lalit Dhurve ◽  
Rajneesh Gour ◽  
Rajpal Kori ◽  
Avias K. Ahmad
Keyword(s):  
Computed Tomography ◽  
Head Injury ◽  
Glasgow Coma Scale ◽  
Severe Head Injury ◽  
Road Traffic ◽  
Midline Shift ◽  
Traumatic Head Injury ◽  
Cross Sectional ◽  
Common Cause ◽  
Coma Scale

Background: Traumatic brain injury is one of most common cause of death in road traffic accident. Most of these classified as mild injury, with approximately 20% classified as moderate to severe. Approximate 50% of the 150,000 trauma deaths every year are caused by head injury.Methods: A prospective cross-sectional study was conducted on 150 patients with a head injury admitted in the Hamidia hospital, Bhopal. The assessment of the severity of head injury using Glasgow coma scale (GCS) at the time of admission, follow up on 5 days and 15 days respectively. The collected data were transformed into variables, coded and entered in Microsoft excel. Data were analyzed and statistically evaluated using statistical package for the social sciences (SPSS)-PC-21 version.Results: Out of 150, a total of 115 patients had no midline shift while 35 patients were having midline shift. Severe head injury patients (GCS 3-8) were having more morbidity and mortality. Moderate head injury (GCS 9-13) was associated with good prognosis and low mortality. A greater degree of midline shift of (more than 5 mm) is indicated severe head injury and is significantly associated with morbid outcome and higher mortality.Conclusions: In our study, road traffic accidents is the most common cause of head injury, with males being affected more than females. The degree of midline shift on computed tomography (CT) scan head in patients with head injuries was found to be significantly associated with high mortality and morbidity.

Coma with Glasgow Coma Scale Score 3 at Admission following Acute Head Injury: Experiencing the Complete Recovery Supported through Ayurveda – A Case Report

2019 ◽  
Vol 26 (5) ◽  
pp. 353-360
Author(s):  
Sanjeev Rastogi
Keyword(s):  
Glasgow Coma Scale ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Complete Recovery ◽  
Neurological Deficits ◽  
Mortality And Morbidity ◽  
Coma Scale ◽  
Acute Head Injury ◽  
Gcs Score ◽  
The Brain

Road traffic accidents (RTAs) are a common cause of untimely death, particularly of youth. RTA mortality and morbidity are predominantly associated with trauma to the brain tissue resulting in traumatic brain injury (TBI). The Glasgow Coma Scale (GCS) is commonly employed to predict the prognosis of such cases at the time of hospital admission. A lower GCS score is invariably found to be associated with poor prognosis, often resulting in death or severely com­promised recovery. A 17-year-old male suffering from TBI due to a RTA was treated with Ayurveda after initially been kept under modern neurological care. The whole course of Ayurvedic therapy began 2 weeks after the initial trauma, continued for about 3 months, and resulted in coma reversal with near complete recovery. This case is one among few reports describing a complete recovery despite presence of bad prognostic predictors in TBI. This is the first such case reported where Ayurveda was used as the intervention in case of TBI, resulting in coma reversal and near complete recovery of neurological deficits.

scholarly journals Comparison of Glasgow Outcome Scale (GOS) and Glasgow Coma Scale (GCS) between Surgical and Conservative Management of Spontaneous Supratentorial Intracerebral Hemorrhage Patients: A Randomized Control Trial

2018 ◽  
Vol 5 (2) ◽  
pp. 49-54 ◽  
Author(s):  
Mohammad Rafiqul Islam ◽  
Md Shafiqul Kabir Khan ◽  
Md Mahfuzur Rahman ◽  
Moajjam Hossain Talukder ◽  
Md Rezaul Karim ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Conservative Management ◽  
Glasgow Outcome Scale ◽  
Randomized Control Trial ◽  
Coma Scale ◽  
Group I ◽  
Randomized Control ◽  
Gcs Score

Background: Glasgow outcome scale (GOS) and Glasgow Coma Scale (GCS) were the important parameter for the proper management of spontaneous supratentorialintracerebral hemorrhage patients.Objective: The purpose of the present study was to compare the GOS and GCS between surgical and conservative management of spontaneous supratentorialintracerebral hemorrhage patients.Methodology: This randomized control trial was conducted in the Department of Neurosurgery at Dhaka Medical College and Hospital from January 2010 to October 2011 for a period of one year and ten months. All hypertensive patients with spontaneous supratentorial intracerebral hemorrhage who were admitted within 48 hours of stroke in Neurosurgery Department during the study period were considered as a study population. Patients underwent surgery was considered as group I and patients those who did not give the consent for operation were treated conservatively was considered as group II.Result: A total of 31 patients were enrolled in this study of which 14 patients underwent surgical evacuation and 17 patients were selected for conservative therapy. Significant positive correlation was found between the GCS score on admission and GOS at 30 days follow-up in surgery group (r=0.649; p<0.05). But a positive significant correlation (r=0.613; P=0.020) was between GCS follow up with GCS on admission in surgery patients and (r=0.575; P=0.016) in conservative group.Conclusion: In conclusion both GOS and GCS are essential during the management of surgical and conservative spontaneous supratentorialintracerebral hemorrhage patients.Journal of Current and Advance Medical Research 2018;5(2):49-54

scholarly journals Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury

2021 ◽  
Vol 11 (8) ◽  
pp. 1044
Author(s):  
Cristina Daia ◽  
Cristian Scheau ◽  
Aura Spinu ◽  
Ioana Andone ◽  
Cristina Popescu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Severe Traumatic Brain Injury ◽  
Functional Independence ◽  
Unresponsive Wakefulness Syndrome ◽  
Coma Scale ◽  
Severe Tbi ◽  
Neuroprotective Treatment ◽  
Gcs Score

Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI.

Missile injury to the pediatric brain in conflict zones

2011 ◽  
Vol 7 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Abrar A. Wani ◽  
Altaf U. Ramzan ◽  
Nayil K. Malik ◽  
Abdul Qayoom ◽  
Furqan A. Nizami ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Pediatric Population ◽  
Developed Countries ◽  
Multinomial Regression ◽  
Chi Square ◽  
Conflict Zones ◽  
Coma Scale ◽  
Hemodynamic Status ◽  
Missile Injury ◽  
Gcs Score

Object This study was conducted both prospectively and retrospectively at one center over a period of 8 years. The population consisted of all patients with both an age 18 years or younger and a diagnosed penetrating missile injury (PMI) during the study interval. The authors analyzed factors determining outcome and demographic trends in this population, and they compared them with those in the more developed world Methods Fifty-one patients were the victims of armed conflict, although no one was directly a party to any battle. This mechanism of injury is in strong opposition to data in the literature from developed countries, in which most missile injuries are the result of suicide or homicide or are even sports related. Moreover, all previous studies on the pediatric population have considered only injuries from gunshots, but authors of the current study have included injuries from other penetrating missiles as well. Results On cross tabulation analysis using the chi-square test, the factors shown to correlate with outcome included the Glasgow Coma Scale (GCS) score, pupillary abnormalities, patient age, hemodynamic status, and bihemispheric damage. On multinomial regression analysis, the two strongest predictors of death were GCS score and pupillary abnormalities. The GCS score and hemodynamic status were the strongest predictors of disability. Conclusions There was no difference in the prognostic factors for PMI between developing or more developed countries. Glasgow Coma Scale score, pupillary abnormalities, and hemodynamic status were the strongest predictors of outcome. In conflict zones in developing countries the victims were mostly innocent bystanders, whereas in the more developed countries homicides and suicides were the leading etiological factors.

Вплив рівня свідомості та неврологічного дефіциту в дебюті субарахноїдально-го крововиливу на ранній вихід пацієнта

2019 ◽  
Vol 60 (2) ◽  
pp. 31-36
Author(s):  
Є.І. Цьома ◽  
В.І. Смоланка
Keyword(s):  
Glasgow Coma Scale ◽  
Glasgow Outcome Scale ◽  
World Federation ◽  
Coma Scale

Вступ. У структурі цереброваскулярних захворювань геморагічний інсульт займає 20%, з яких 6–8% – це частка, що припадає на субарахноїдальний крововилив, внаслідок розриву артеріальних аневризм [1,3]. 10–15% субарахноїдальних крововиливів є фатальними, тобто пацієнти помирають ще до поступлення в медичний стаціонар [5]. Виявлення факторів, які впливають на перебіг цього захворювання та розвиток ускладнень дозволить покращити надання допомоги цим пацієнтам, створить можливість ідентифікувати групи пацієнтів для раннього чи відтермінованого оперативного втручання (кліпування аневризми) чи ендоваскулярного її закриття. Мета. Проаналізувати всі випадки нетравматичного САК, у пацієнтів що перебували на лікуванні в ОКЦНН із січня 2013 р. по грудень 2016 р. та з’ясувати вплив рівня свідомості та фокального неврологічного дефіциту в дебюті захворювання, оціненого за валідизованими шкалами на ранній вихід пацієнтів. Матеріали та методи. Проведено оцінку за валідизованими шкалами (HuntHess, WFNS та шкалою коми Глазго (GCS) та аналіз цих даних у 127 пацієнтів із субарахноїдальним крововиливом внаслідок розриву аневризми переднього півкільця артеріального кола головного мозку, що перебували на лікуванні в Обласному клінічному центрі нейрохірургії та неврології м. Ужгород за період з січня 2013 по грудень 2016 рік (включно). Результати досліджень та їх обговорення. Провівши статистичний аналіз у досліджуваних групах, ми виявили, що вищий бал за шкалами HuntHess, WFNS та шкалою коми Глазго (GCS) в дебюті САК є достовірним предиктором доброго раннього виходу, тоді як рівень III–V асоціювався з високою смертністю (p<0.001). Достовірної різниці між чутливістю шкал щодо прогнозу при САК нами не знайдено. Дані, визначені за допомогою всіх цих шкал мали тісний кореляційний з’язок зі шкалою GOS, що свідчить про їх прямий вплив на показник раннього виходу після САК. Висновки. Таким чином, аналізуючи наші дані, можемо стверджувати, що клінічні шкали, є високочутливим інструментом у прогнозуванні раннього перебігу САК, що співпадає з даними літератури і внесено в рекомендації ведення пацієнтів такого профілю. Рівень IV за HuntHess та IV–V за WFNS, а також нижчий рівень свідомості при поступленні в стаціонар за Glasgow Coma Scale – мають вкрай несприятливий прогноз. Ключові слова: субарахноїдальний крововилив (САК), мішковидна аневризма, комп’ютерна томографія, World Federation Neurosergical Society Scale (WFNS), Glasgow Coma Scale (GCS), HuntHess Scale, Glasgow Outcome Scale (GOS).

scholarly journals Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity

2018 ◽  
Vol 128 (6) ◽  
pp. 1612-1620 ◽  
Author(s):  
Paul M. Brennan ◽  
Gordon D. Murray ◽  
Graham M. Teasdale
Keyword(s):  
Patient Outcome ◽  
Mortality Rate ◽  
Glasgow Coma Scale ◽  
Brain Damage ◽  
Unfavorable Outcome ◽  
Simple Arithmetic ◽  
Coma Scale ◽  
Pupil Response ◽  
Gcs Score ◽  
Complex Methods

OBJECTIVEGlasgow Coma Scale (GCS) scores and pupil responses are key indicators of the severity of traumatic brain damage. The aim of this study was to determine what information would be gained by combining these indicators into a single index and to explore the merits of different ways of achieving this.METHODSInformation about early GCS scores, pupil responses, late outcomes on the Glasgow Outcome Scale, and mortality were obtained at the individual patient level by reviewing data from the CRASH (Corticosteroid Randomisation After Significant Head Injury; n = 9,045) study and the IMPACT (International Mission for Prognosis and Clinical Trials in TBI; n = 6855) database. These data were combined into a pooled data set for the main analysis.Methods of combining the Glasgow Coma Scale and pupil response data varied in complexity from using a simple arithmetic score (GCS score [range 3–15] minus the number of nonreacting pupils [0, 1, or 2]), which we call the GCS-Pupils score (GCS-P; range 1–15), to treating each factor as a separate categorical variable. The content of information about patient outcome in each of these models was evaluated using Nagelkerke’s R2.RESULTSSeparately, the GCS score and pupil response were each related to outcome. Adding information about the pupil response to the GCS score increased the information yield. The performance of the simple GCS-P was similar to the performance of more complex methods of evaluating traumatic brain damage. The relationship between decreases in the GCS-P and deteriorating outcome was seen across the complete range of possible scores. The additional 2 lowest points offered by the GCS-Pupils scale (GCS-P 1 and 2) extended the information about injury severity from a mortality rate of 51% and an unfavorable outcome rate of 70% at GCS score 3 to a mortality rate of 74% and an unfavorable outcome rate of 90% at GCS-P 1. The paradoxical finding that GCS score 4 was associated with a worse outcome than GCS score 3 was not seen when using the GCS-P.CONCLUSIONSA simple arithmetic combination of the GCS score and pupillary response, the GCS-P, extends the information provided about patient outcome to an extent comparable to that obtained using more complex methods. The greater range of injury severities that are identified and the smoothness of the stepwise pattern of outcomes across the range of scores may be useful in evaluating individual patients and identifying patient subgroups. The GCS-P may be a useful platform onto which information about other key prognostic features can be added in a simple format likely to be useful in clinical practice.

How should a subarachnoid hemorrhage grading scale be determined? A combinatorial approach based solely on the Glasgow Coma Scale

1999 ◽  
Vol 90 (4) ◽  
pp. 680-687 ◽  
Author(s):  
Kiyoshi Takagi ◽  
Akira Tamura ◽  
Tadayoshi Nakagomi ◽  
Hitoshi Nakayama ◽  
Osamu Gotoh ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Glasgow Coma Scale ◽  
Treatment Modalities ◽  
Combinatorial Approach ◽  
Content Type ◽  
Coma Scale ◽  
Break Points ◽  
Grading Scale ◽  
Gcs Score ◽  
Fine Print

Object. The purpose of this study was to present a combinatorial approach used to develop a subarachnoid hemorrhage (SAH) grading scale based on the patient's preoperative Glasgow Coma Scale (GCS) score.Methods. There are 4094 different combinations that can be used to compress the 13 scores of the GCS into two to 12 grades. Break points, the positions in the scale in which two adjacent scores connote a significantly different outcome, are obtained by a direct comparison of the GCS and the Glasgow Outcome Scale (GOS). Guided by the break points, the number of combinations to be considered can be limited. All possible combinations are statistically analyzed with respect to intergrade differences in outcome. Single combinations, with the maximum number of grades having maximum intergrade outcome differences for each corresponding set of adjacent grades, must be selected. The authors verified the validity of this combinatorial approach by retrospectively analyzing 1398 consecutive patients with aneurysmal SAH who underwent surgery within 7 days of the last hemorrhage episode. The patients' GCS scores were assessed just before surgery and their GOS scores were estimated 6 months post-SAH. The combinatorial approach yields only one acceptable grading scale: I (GCS Score 15); II (GCS Scores 11–14); III (GCS Scores 8–10); IV (GCS Scores 4–7); and V (GCS Score 3).Conclusions. The combinatorial approach, guided by the break points, is so simple and systematic that it can be used again in the future when revision of the grading scale becomes necessary after development of new and effective treatment modalities that improve patients' overall outcome.

Sign in / Sign up

Export Citation Format

Share Document