scholarly journals Factors Associated with the Development of Coagulopathy after Open Traumatic Brain Injury

2021 ◽  
Vol 11 (1) ◽  
pp. 185
Author(s):  
Yuhui Chen ◽  
Jun Tian ◽  
Bin Chi ◽  
Shangming Zhang ◽  
Liangfeng Wei ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Poor Prognosis ◽  
Clinical Characteristics ◽  
International Normalized Ratio ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Factors Associated ◽  
Gcs Score ◽  
The Relationship

Background: The incidence of coagulopathy after open traumatic brain injury (TBI) is high. Coagulopathy can aggravate intracranial hemorrhage and further increase morbidity and mortality. The purpose of this study was to determine the clinical characteristics of coagulopathy after open TBI and its relationship with the prognosis. Methods: This study retrospectively evaluated patients with isolated open TBI from December 2018 to December 2020. Coagulopathy was defined as international normalized ratio (INR) > 1.2, activated thromboplastin time (APTT) > 35 s, or platelet count <100,000/μL. We compared the relationship between the clinical, radiological, and laboratory parameters of patients with and without coagulopathy, and the outcome at discharge. Logistic regression analysis was used to evaluate the risk factors associated with coagulopathy. We then compared the effects of treatment with and without TXA in open TBI patients with coagulopathy. Results: A total of 132 patients were included in the study; 46 patients developed coagulopathy. Patients with coagulopathy had significantly lower platelet levels (170.5 × 109/L vs. 216.5 × 109/L, p < 0.001), and significantly higher INR (1.14 vs. 1.02, p < 0.001) and APTT (30.5 s vs. 24.5 s, p < 0.001) compared to those with no coagulopathy. A Low Glasgow Coma Scale (GCS) score, high neutrophil/lymphocyte ratio (NLR), low platelet/lymphocyte ratio (PLR), and hyperglycemia at admission were significantly associated with the occurrence of coagulopathy. Conclusions: Coagulopathy often occurs after open TBI. Patients with a low GCS score, high NLR, low PLR, and hyperglycemia at admission are at greater risk of coagulopathy, and therefore of poor prognosis. The efficacy of TXA in open TBI patients with coagulopathy is unclear. In addition, these findings demonstrate that PLR may be a novel indicator for predicting coagulopathy.

scholarly journals Traumatic glioblastoma: commentary and suggested mechanism

2018 ◽  
Vol 46 (6) ◽  
pp. 2170-2176
Author(s):  
Nissim Ohana ◽  
Daniel Benharroch ◽  
Dimitri Sheinis ◽  
Abraham Cohen
Keyword(s):  
Traumatic Brain Injury ◽  
Transcription Factors ◽  
Brain Injury ◽  
Brain Injuries ◽  
Hypoxia Inducible Factor ◽  
Subsequent Development ◽  
Factors Associated ◽  
The Relationship

The role of head trauma in the development of glioblastoma is highly controversial and has been minimized since first put forward. This is not unexpected because skull injuries are overwhelmingly more common than glioblastoma. This paper presents a commentary based on the contributions of James Ewing, who established a major set of criteria for the recognition of an official relationship between trauma and cancer. Ewing’s criteria were very stringent. The scholars who succeeded Ewing have facilitated the characterization of traumatic brain injuries since the introduction of computed tomography and magnetic resonance imaging. Discussions of the various criteria that have since developed are now being conducted, and those of an unnecessarily limiting nature are being highlighted. Three transcription factors associated with traumatic brain injury have been identified: p53, hypoxia-inducible factor-1α, and c-MYC. A role for these three transcription factors in the relationship between traumatic brain injury and glioblastoma is suggested; this role may support a cause-and-effect link with the subsequent development of glioblastoma.

scholarly journals The relationship between consciousness and the ascending reticular activating system in patients with traumatic brain injury

2020 ◽  
Author(s):  
Sung Ho Jang ◽  
YOUNGHYEON KWON
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Control Group ◽  
Impaired Consciousness ◽  
Patient Subgroup ◽  
Chronic Stage ◽  
Ascending Reticular Activating System ◽  
Reticular Activating System ◽  
Gcs Score ◽  
The Relationship

Abstract Background: We investigated the relationship between consciousness and the ascending reticular activating system(ARAS) by using diffusion tensor tractography(DTT) in patients with traumatic brain injury(TBI).Methods: Twenty-six patients with TBI and 13 healthy control subjects were recruited for this study. Glasgow Coma Scale(GCS) scores were used for evaluation of subject consciousness state at the chronic stage of TBI(at DTT scanning), According to the GCS score, the patient group was divided into two subgroups: A(14 patients;impaired consciousness:GCS score<15, and B(12 patients;intact consciousness;GCS score=15). Fractional anisotropy(FA) and tract volume(TV) values were assessed in the lower dorsal and upper ARAS.Results: The FA values of the lower dorsal ARAS and the upper ARAS in patient subgroup A were significantly lower than those in patient subgroup B and the control group(p<0.05). However, the FA and TV values for the lower dorsal ARAS and the upper ARAS were not significantly different between patient subgroup B and the control group(p>0.05). The FA value of the lower dorsal ARAS(r=0.473,p<0.05) and the TV of upper ARAS(r=0.484,p<0.05) had moderate positive correlations with the GCS score. The FA value of the upper ARAS had a strong positive correlation with the GCS score of the patient group(r=0.780,p<0.05).Conclusions: We detected a close relationship between consciousness at the chronic stage of TBI and injuries of the lower dorsal and upper ARAS(especially, the upper ARAS) in patients who showed impaired consciousness at the onset of TBI. We believe that our results can be useful during the development of therapeutic strategies for patients with impaired consciousness following TBI.

Antithrombotic agents and traumatic brain injury in the elderly population: hemorrhage patterns and outcomes

2020 ◽  
Vol 133 (2) ◽  
pp. 486-495 ◽  
Author(s):  
Pasquale Scotti ◽  
Chantal Séguin ◽  
Benjamin W. Y. Lo ◽  
Elaine de Guise ◽  
Jean-Marc Troquet ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Trauma ◽  
Ct Scanning ◽  
The Elderly ◽  
International Normalized Ratio ◽  
Trauma Patients ◽  
Risk Of Falls ◽  
Gcs Score

OBJECTIVEAmong the elderly, use of antithrombotics (ATs), antiplatelets (APs; aspirin, clopidogrel), and/or anticoagulants (ACs; warfarin, direct oral ACs [DOACs; dabigatran, rivaroxaban, apixaban]) to prevent thromboembolic events must be carefully weighed against the risk of intracranial hemorrhage (ICH) with trauma. The goal of this study was to assess the risk of sustaining a traumatic brain injury (TBI), ICH, and poorer outcomes in relation to AT use among all patients 65 years or older presenting to a single institution with head trauma.METHODSData were collected from all head trauma patients 65 years or older presenting to the authors’ supraregional tertiary trauma center over a 24-month period and included age, sex, injury mechanism, medical history, international normalized ratio, Glasgow Coma Scale (GCS) score, ICH presence and type, hospital admission, reversal therapy, surgery, discharge destination, Extended Glasgow Outcome Scale (GOSE) score at discharge, and mortality.RESULTSA total of 1365 head trauma patients 65 years or older were included; 724 were on AT therapy (413 on APs, 151 on ACs, 59 on DOACs, 48 on 2 APs, 38 on AP+AC, and 15 on AP+DOAC) and 641 were not. Among all head trauma patients, the risk of sustaining a TBI was associated with AP use after adjusting for covariates. Of the 731 TBI patients, those using ATs had higher rates of ICH (p <0.0001), functional dependency at discharge (GOSE score ≤ 4; p < 0.0001), and mortality (p < 0.0001). Elevated rates of ICH progression on follow-up CT scanning were observed in patients in the warfarin monotherapy (OR 5.30, p < 0.0001) and warfarin + AP (OR 6.15, p = 0.0011). Risk of mortality was not associated with single antiplatelet use but was notably high with 2 APs (OR 4.66, p = 0.0056), warfarin (OR 5.18, p = 0.0003), and DOAC use (OR 5.09, p = 0.0149).CONCLUSIONSElderly trauma patients on ATs, especially combination therapy, are at elevated risk of ICH and poor outcomes compared with those not on AT therapy. While both AP and warfarin use alone and in combination were associated with significantly elevated odds of sustaining an ICH among TBI patients, only warfarin use was a predictor of hemorrhage progression on follow-up scans. The use of a single AP was not associated with mortality; however, the combination of both aspirin and clopidogrel was. Warfarin and DOAC users had comparable mortality rates; however, DOAC users had lower rates of ICH progression, and fewer survivors were functionally dependent at discharge than were warfarin users. DOACs are an overall safer alternative to warfarin for patients at high risk of falls.

scholarly journals Factors associated with receipt of intracranial pressure monitoring in older adults with traumatic brain injury

2021 ◽  
Vol 6 (1) ◽  
pp. e000733
Author(s):  
Mira Ghneim ◽  
Jennifer Albrecht ◽  
Karen Brasel ◽  
Ariel Knight ◽  
Anna Liveris ◽  
...  
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intraventricular Hemorrhage ◽  
Intracranial Pressure Monitoring ◽  
Skull Fractures ◽  
Pressure Monitoring ◽  
Factors Associated ◽  
Gcs Score

BackgroundThe Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Traumatic Brain Injury (TBI) include intracranial pressure monitoring (ICPM), yet very little is known about ICPM in older adults. Our objectives were to characterize the utilization of ICPM in older adults and identify factors associated with ICPM in those who met the BTF guidelines.MethodsWe analyzed data from the American Association for the Surgery of Trauma Geriatric TBI Study, a registry study conducted among individuals with isolated, CT-confirmed TBI across 45 trauma centers. The analysis was restricted to those aged ≥60. Independent factors associated with ICPM for those who did and did not meet the BTF guidelines were identified using logistic regression.ResultsOur sample was composed of 2303 patients, of whom 66 (2.9%) underwent ICPM. Relative to Glasgow Coma Scale (GCS) score of 13 to 15, GCS score of 9 to 12 (OR 10.2; 95% CI 4.3 to 24.4) and GCS score of <9 (OR 15.0; 95% CI 7.2 to 31.1), intraventricular hemorrhage (OR 2.4; 95% CI 1.2 to 4.83), skull fractures (OR 3.6; 95% CI 2.0 to 6.6), CT worsening (OR 3.3; 95% CI 1.8 to 5.9), and neurosurgical interventions (OR 3.8; 95% CI 2.1 to 7.0) were significantly associated with ICPM. Restricting to those who met the BTF guidelines, only 43 of 240 (18%) underwent ICPM. Factors independently associated with ICPM included intraparenchymal hemorrhage (OR 2.2; 95% CI 1.0 to 4.7), skull fractures (OR 3.9; 95% CI 1.9 to 8.2), and neurosurgical interventions (OR 3.5; 95% CI 1.7 to 7.2).DiscussionWorsening GCS, intraparenchymal/intraventricular hemorrhage, and skull fractures were associated with ICPM among older adults with TBI, yet utilization of ICPM remains low, especially among those meeting the BTF guidelines, and potential benefits remain unclear. This study highlights the need for better understanding of factors that influence compliance with BTF guidelines and the risks versus benefits of ICPM in this population.Level of evidencePrognostic and epidemiological, level III.

scholarly journals The relationship between consciousness and the ascending reticular activating system in patients with traumatic brain injury

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sung Ho Jang ◽  
Young Hyeon Kwon
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Control Group ◽  
Impaired Consciousness ◽  
Patient Subgroup ◽  
Chronic Stage ◽  
Ascending Reticular Activating System ◽  
Reticular Activating System ◽  
Gcs Score ◽  
The Relationship

Abstract Background We investigated the relationship between consciousness and the ascending reticular activating system (ARAS) by using diffusion tensor tractography (DTT) in patients with traumatic brain injury (TBI). Methods Twenty-six patients with TBI and 13 healthy control subjects were recruited for this study. Glasgow Coma Scale (GCS) scores were used for evaluation of subject consciousness state at the chronic stage of TBI (at DTT scanning), According to the GCS score, the patient group was divided into two subgroups: A (14 patients;impaired consciousness: GCS score < 15, and B (12 patients;intact consciousness;GCS score = 15). Fractional anisotropy (FA) and tract volume (TV) values were assessed in the lower dorsal and upper ARAS. Results The FA values of the lower dorsal ARAS and the upper ARAS in patient subgroup A were significantly lower than those in patient subgroup B and the control group(p <  0.05). However, the FA and TV values for the lower dorsal ARAS and the upper ARAS were not significantly different between patient subgroup B and the control group(p > 0.05). The FA value of the lower dorsal ARAS(r = 0.473,p <  0.05) and the TV of upper ARAS(r = 0.484,p <  0.05) had moderate positive correlations with the GCS score. The FA value of the upper ARAS had a strong positive correlation with the GCS score of the patient group(r = 0.780,p <  0.05). Conclusions We detected a close relationship between consciousness at the chronic stage of TBI and injuries of the lower dorsal and upper ARAS (especially, the upper ARAS) in patients who showed impaired consciousness at the onset of TBI. We believe that our results can be useful during the development of therapeutic strategies for patients with impaired consciousness following TBI. Trial registration YUMC 2019–06–032-003. Retrospectively registered 06 Jun 2020.

scholarly journals The relationship between consciousness and the ascending reticular activating system in patients with traumatic brain injury

2020 ◽  
Author(s):  
Sung Ho Jang ◽  
Younghyeon Kwon
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Control Group ◽  
Impaired Consciousness ◽  
Patient Subgroup ◽  
Chronic Stage ◽  
Ascending Reticular Activating System ◽  
Reticular Activating System ◽  
Gcs Score ◽  
The Relationship

Abstract Background: We investigated the relationship between consciousness and the ascending reticular activating system(ARAS) by using diffusion tensor tractography(DTT) in patients with traumatic brain injury(TBI).Methods: Twenty-six patients with TBI and 13 healthy control subjects were recruited for this study. Glasgow Coma Scale(GCS) scores were used for evaluation of subject consciousness state at the chronic stage of TBI(at DTT scanning), According to the GCS score, the patient group was divided into two subgroups: A(14 patients;impaired consciousness:GCS score<15, and B(12 patients;intact consciousness;GCS score=15). Fractional anisotropy(FA) and tract volume(TV) values were assessed in the lower dorsal and upper ARAS.Results: The FA values of the lower dorsal ARAS and the upper ARAS in patient subgroup A were significantly lower than those in patient subgroup B and the control group(p<0.05). However, the FA and TV values for the lower dorsal ARAS and the upper ARAS were not significantly different between patient subgroup B and the control group(p>0.05). The FA value of the lower dorsal ARAS(r=0.473,p<0.05) and the TV of upper ARAS(r=0.484,p<0.05) had moderate positive correlations with the GCS score. The FA value of the upper ARAS had a strong positive correlation with the GCS score of the patient group(r=0.780,p<0.05).Conclusions: We detected a close relationship between consciousness at the chronic stage of TBI and injuries of the lower dorsal and upper ARAS(especially, the upper ARAS) in patients who showed impaired consciousness at the onset of TBI. We believe that our results can be useful during the development of therapeutic strategies for patients with impaired consciousness following TBI.Trial registration: YUMC 2019-06-032-003. retrospectively registered 06 Jun 2020.

scholarly journals Cardiac arrest after severe traumatic brain injury can be survivable with good outcomes

2021 ◽  
Vol 6 (1) ◽  
pp. e000638
Author(s):  
Zirun Zhao ◽  
Justine J Liang ◽  
Zhe Wang ◽  
Nathan J Winans ◽  
Matthew Morris ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cardiac Arrest ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Clinical Characteristics ◽  
Diffuse Axonal Injury ◽  
Neurological Function ◽  
University Hospital ◽  
Pupil Reactivity ◽  
Gcs Score

BackgroundResuscitation for traumatic cardiac arrest (TCA) in patients with severe traumatic brain injury (sTBI) has historically been considered futile. There is little information on the characteristics and outcomes of these patients to guide intervention and prognosis. The purpose of the current study is to report the clinical characteristics, survival, and long-term neurological outcomes in patients who experienced TCA after sTBI and analyze the factors contributing to survival.MethodsA retrospective review identified 42 patients with TCA from a total of 402 patients with sTBI (Glasgow Coma Scale (GCS) score ≤8) who were admitted to Stony Brook University Hospital, a level I trauma center, from January 2011 to December 2018. Patient demographics, clinical characteristics, survival, and neurological functioning during hospitalization and at follow-up visits were collected.ResultsOf the 42 patients, the average age was 45 years and 21.4% were female. Eight patients survived the injury (19.0%) to discharge and seven survived with good neurological function. Admission GCS score and bilateral pupil reactivity were found to be significant indicators of survival. The mean GCS score was 5.3 in survivors and 3.2 in non-survivors (p=0.020). Age, Injury Severity Score, or cardiac rhythm was not associated with survival. Frequent neuroimaging findings included subarachnoid hemorrhage, subdural hematoma, and diffuse axonal injury.DiscussionTCA after sTBI is survivable and seven out of eight patients in our study recovered with good neurological function. GCS score and pupil reactivity are the best indicators of survival. Our results suggest that due to the possibility of recovery, resuscitation and neurosurgical care should not be withheld from this patient population.Level of evidenceLevel IV, therapeutic/care management.

NEUROPSYCHOLOGICAL CHANGES IN PATIENTS WITH A CONSEQUENCE OF TRAUMATIC BRAIN INJURY

2020 ◽  
Vol 3 (1) ◽  
pp. 44-46
Author(s):  
Istatillo Shodjalilov ◽  
◽  
Saoda Igamova ◽  
Aziza Djurabekova
Keyword(s):  
Traumatic Brain Injury ◽  
Cognitive Impairment ◽  
Brain Injury ◽  
Neuropsychological Testing ◽  
Anxiety And Depression ◽  
Psychopathological Symptoms ◽  
Neuropsychological Changes ◽  
The Relationship

The incidence of cognitive impairment in TBI is high, depending on the severity. At the same time, psychopathological symptoms in the form of asthenia, increased anxiety and depression are encountered among patients with TBI. The work studied the relationship between cognitive and psychopathological symptoms in patients with TBI using neuropsychological testing on scales.

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