scholarly journals Avaliação neurológica a partir da Escala de Coma de Glasgow em vítimas de traumatismo cranioencefálico / Neurological evaluation from the Glasgow Coma Scale in cranio-brain trauma victims

2021 ◽  
Vol 4 (5) ◽  
pp. 23591-23602
Author(s):  
Taís Carpes Lanes ◽  
Alessandra Suptitz Carneiro ◽  
Camila Milene Soares Bernardi ◽  
Camila Antunez Villagran
Keyword(s):  
Glasgow Coma Scale ◽  
Brain Trauma ◽  
Coma Scale ◽  
Neurological Evaluation ◽  
Trauma Victims

scholarly journals Highlighting intracranial pressure monitoring in patients with severe acute brain trauma

1995 ◽  
Vol 53 (3a) ◽  
pp. 390-394 ◽  
Author(s):  
Antonio L. E Falcão ◽  
Venâncio P. Dantas Filho ◽  
Luiz A. C. Sardinha ◽  
Elizabeth M. A. B. Quagliato ◽  
Desanka Dragosavac ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intracranial Pressure ◽  
Glasgow Coma Scale ◽  
Brain Trauma ◽  
Intracranial Pressure Monitoring ◽  
Ct Scans ◽  
Icp Monitoring ◽  
Pressure Monitoring ◽  
Focal Lesions ◽  
Coma Scale

Intracranial pressure (ICP) monitoring was carried out in 100 patients with severe acute brain trauma, primarily by means of a subarachnoid catheter. Statistical associations were evaluated between maximum ICP values and: 1) Glasgow Coma Scale (GCS) scores; 2) findings on computed tomography (CT) scans of the head; and 3) mortality. A significant association was found between low GCS scores (3 to 5) and high ICP levels, as well as between focal lesions on CT scans and elevated ICP. Mortality was significantly higher in patients with ICP > 40 mm Hg than in those with ICP < 20 mm Hg.

scholarly journals Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems

2017 ◽  
Vol 6 (3) ◽  
pp. 160-168
Author(s):  
Danilo M Razente ◽  
Bruno D Alvarez ◽  
Daniel AM Lacerda ◽  
João MDS Biscardi ◽  
Marcia Olandoski ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Blunt Trauma ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Coma Scale ◽  
Significant Difference ◽  
Trauma Scoring ◽  
The Mean ◽  
Trauma Victims

ABSTRACT Background This study aims to compare mortality prediction capabilities of three different physiological trauma scoring systems (TSS): Revised Trauma Score (RTS) Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) and Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP). Study design A descriptive, cross-sectional study of trauma victims admitted to the emergency service between December-2013 and February-2014. Clinical and epidemiological information were gathered at admission and three TSS were calculated: RTS, GAP, and MGAP. The follow-up period to assess length of hospitalization and mortality lasted until August-2014. Two groups were created — survivals (S) and deaths (D) — and compared. P < 0.05 was considered statistically significant. Results A total of 668 trauma victims were analyzed. The mean age was 37 ± 18 and 69.8% were males. Blunt trauma prevailed (90.6%). The mean scores of RTS, GAP, and MGAP for group S (n = 657; 98.4%) were 7.77 ± 0.33, 22.8 ± 1.7, and 27.4 ± 2.3 respectively (p < 0.001), whereas group D (n = 11, 1.6%) achieved mean scores of 4.57 ± 2.95, 13 ± 7, and 15.5 ± 7 (p < 0.001). Regarding the Receiver Operating Characteristics (ROC) analysis, the areas under the curve were 0.926 (RTS), 0.941 (GAP), and 0.981 (MGAP). The three TSS demonstrated significant mortality prediction capabilities (p < 0.001). There was no statistically significant difference between the three ROC curves (p = 0.138). The MGAP achieved the highest sensitivity (100%), while GAP and RTS sensitivities were 81.8% (59—100%), and 90.9% (73.9—100%) respectively (p < 0.001). The observed specificities were 96.2% (94.77—97.7%) for GAP, 91.6% (89.5—93.7%) for MGAP, and 87.2% (84.7—89.8%) for RTS (p < 0.001). Age (p = 0.049), Glasgow Coma Scale (GCS) (p < 0.001), and trauma mechanism (p < 0.001) were different between the two groups. Conclusion Most patients were young males and victims of blunt trauma. The three TSS demonstrated reliability regarding mortality prediction. The MGAP achieved the highest sensitivity and GAP was the most specific score, which may indicate a potential use of both as valuable alternatives to RTS. How to cite this article Razente DM, Alvarez BD, Lacerda DAM, Biscardi JMDS, Olandoski M, Bahten LCV. Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems. Panam J Trauma Crit Care Emerg Surg 2017;6(3):160-168.

scholarly journals Mannitol dosing error during interfacility transfer for intracranial emergencies

2015 ◽  
Vol 123 (5) ◽  
pp. 1166-1169 ◽  
Author(s):  
Cameron A. Elliott ◽  
Mark MacKenzie ◽  
Cian J. O’Kelly
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Severe Traumatic Brain Injury ◽  
Glasgow Coma Scale Score ◽  
Brain Trauma ◽  
Coma Scale ◽  
Dosing Error ◽  
Brain Trauma Foundation

OBJECT Mannitol is commonly used to treat elevated intracranial pressure (ICP). The authors analyzed mannitol dosing errors at peripheral hospitals prior to or during transport to tertiary care facilities for intracranial emergencies. They also investigated the appropriateness of mannitol use based on the 2007 Brain Trauma Foundation guidelines for severe traumatic brain injury. METHODS The authors conducted a retrospective review of the Shock Trauma Air Rescue Society (STARS) electronic patient database of helicopter medical evacuations in Alberta, Canada, between 2004 and 2012, limited to patients receiving mannitol before transfer. They extracted data on mannitol administration and patient characteristics, including diagnosis, mechanism, Glasgow Coma Scale score, weight, age, and pupil status. RESULTS A total of 120 patients with an intracranial emergency received a mannitol infusion initiated at a peripheral hospital (median Glasgow Coma Scale score 6; range 3–13). Overall, there was a 22% dosing error rate, which comprised an underdosing rate (< 0.25 g/kg) of 8.3% (10 of 120 patients), an overdosing rate (> 1.5 g/kg) of 7.5% (9 of 120), and a nonbolus administration rate (> 1 hour) of 6.7% (8 of 120). Overall, 72% of patients had a clear indication to receive mannitol as defined by meeting at least one of the following criteria based on Brain Trauma Foundation guidelines: neurological deterioration (11%), severe traumatic brain injury (69%), or pupillary abnormality (25%). CONCLUSIONS Mannitol administration at peripheral hospitals is prone to dosing error. Strategies such as a pretransport checklist may mitigate this risk.

Outcome of brain trauma patients who have a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils in the field

2009 ◽  
Vol 16 (3) ◽  
pp. 153-158 ◽  
Author(s):  
Walter Mauritz ◽  
Johannes Leitgeb ◽  
Ingrid Wilbacher ◽  
Marek Majdan ◽  
Ivan Janciak ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Brain Trauma ◽  
Trauma Patients ◽  
Coma Scale

Naloxon – Medizinische Grundlagen und internationale Erfahrungen

2019 ◽  
Vol 65 (5) ◽  
pp. 335-342
Author(s):  
Norbert Wodarz ◽  
Jörg Wolstein ◽  
Heike Wodarz-von Essen ◽  
Oliver Pogarell
Keyword(s):  
Randomized Controlled Trial ◽  
Glasgow Coma Scale ◽  
Controlled Trial ◽  
Cochrane Library ◽  
Coma Scale ◽  
International Standard ◽  
Trial Number ◽  
Randomized Controlled ◽  
Opioid Crisis ◽  
Lebensrettende Basismaßnahmen

Zusammenfassung. Hintergrund: Die Abhängigkeit von Opioiden ist mit erheblichen gesundheitlichen Gefährdungen der Betroffenen und einer hohen Mortalität assoziiert. Derzeit werden insbesondere die dramatisch gestiegenen Mortalitätsraten in den USA diskutiert (‚opioid crisis‘), aber auch in Deutschland war in den letzten Jahren ein kontinuierlicher Anstieg der Drogentoten, überwiegend verursacht durch Opioide, zu verzeichnen. Die Risiken einer Opioid Überdosierung bzw. Intoxikation resultiert vor allem aus der hemmenden Wirkung der Opioide auf den Atemantrieb, die durch andere gleichzeitig konsumierte Substanzen noch verstärkt werden kann. Neben Erstmaßnahmen (Notruf, lebensrettende Basismaßnahmen der Ersten Hilfe) kommt auch der Einsatz des Opioidantagonisten Naloxon in Betracht. Methode: Literaturrecherche in PubMed, Cochrane Library und im International Standard Randomized Controlled Trial Number (ISRCTN) Register. Ergebnisse: Auch aus ethischen Gründen liegen bislang eher wenig systematische Untersuchungen zum nicht-ärztlichen Einsatz von Naloxon bei Opioidüberdosierung vor. Trotzdem kann nach aktuellem Stand geschlussfolgert werden, dass die intranasale Verabreichung vergleichbar wirksam mit einer intramuskulären Anwendung zu sein scheint. Bei Überdosierten, die nach erfolgreichem Naloxon-Einsatz aus unterschiedlichen Gründen nicht in einer Klinik gebracht wurden, wurden in ca. 1 %. Todesfälle dokumentiert. Falls 60 min nach Naloxongabe unauffällige Vitalparameter und auf der Glasgow Coma Scale mind. 15 Punkte erreicht werden, besteht wohl ein sehr niedriges Rebound-Risiko. Im Vergleich dazu ist das Auftreten von Naloxon-induzierten Entzugssyndromen deutlich häufiger, hängen jedoch von der Dosis und dem konsumierten Opioid ab, wie auch von der verabreichten Naloxon-Dosis. Schlussfolgerungen: Naloxon kann mittlerweile auch in Deutschland als zugelassenes Nasalspray verabreicht werden und ist daher im Prinzip auch für den Einsatz durch Ersthelfer geeignet. Verbesserte Rahmenbedingungen, wie z. B. spezifische Schulungen könnten dazu beitragen, Take-Home Naloxon als erfolgreichen Baustein zur Reduktion von Drogentod zu implementieren.

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.

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