scholarly journals Hubungan Kadar Laminin Serum dengan Klasifikasi CT Marshall dan GCS pada Pasien Cedera Otak akibat Trauma

e-CliniC ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ferry Sudarsono ◽  
Eko Prasetyo ◽  
Maximillian Ch. Oley ◽  
Fima L. F. G. Langi
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Venous Blood ◽  
Elevated Serum ◽  
Cross Sectional ◽  
Coma Scale ◽  
The Difference ◽  
And Gender ◽  
The Individual

 Abstract: Elevated serum laminin levels in patients with traumatic brain injury (TBI) have been documented, but studies on its ability to predict outcomes based on the CT Marshall and Glasgow Coma Scale (GCS) classification are still unclear. This study was aimed to evaluate the relationship between serum laminin levels and Marshall CT as well as GCS classification in COT patients. This was an observational and analytical study with a cross-sectional design. A scan was used to determine the CT Marshall and GCS classification in order to obtain the level of consciousness. Venous blood samples for laminin were drawn less than 24 hours post-trauma. Age and gender were recorded, and the variable selection was carried out gradually. Proportional regression models were used to assess changes in the CT Marshall and GCS classification associated with laminin levels. The result showed that the 32 patients with COT had a mean laminin level of 818.4 pg/mL. Patients were distributed almost uniformly in the six categories of the CT Marshall classification. Furthermore, the final regression model consisted of patients with the CT Marshall IV-VI classification having a serum laminin level of 316.74 pg/mL (95% CI 206.88; 426.60 pg/mL; p<0.001) higher than that of I-III. Meanwhile, after controlling for a number of other variables, the difference increased to 401.06 pg/mL (95% CI 264.84; 563.28 pg/ mL; p<0.001). The individual consciousness levels were measured by using GCS which consist of an inverse relationship with serum laminin levels. Each increase in the mean of GCS rate decreased the laminin value to about 49.10 pg/mL (95% CI 23.33; 74.96 pg/mL; p<0.001). In conclusion, laminin has a significant correlation with the CT Marshall and GCS classifications in patients with COT.Keywords: laminin, traumatic brain injury (TBI)  Abstrak: Peningkatan kadar serum laminin pada pasien dengan cedera otak akibat trauma (COT) telah didokumentasikan, namun studi tentang kemampuannya untuk memrediksi hasil berdasarkan klasifikasi CT Marshall dan GCS (Glasgow Coma Scale) masih terbatas. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar laminin serum dengan klasifikasi CT Marshall dan GCS pada pasien COT. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Pemeriksaan CT-scan digunakan untuk menentukan klasifikasi CT Marshall dan GCS digunakan untuk menentukan tingkat kesadaran. Sampel darah vena untuk laminin diambil kurang dari 24 jam pasca trauma. Usia dan jenis kelamin juga dicatat. Seleksi variabel dilakukan secara bertahap. Digunakan model regresi proporsional untuk menilai perubahan klasifikasi CT Marshall dan GCS terkait dengan kadar laminin. Hasil penelitian mendapatkan 32 pasien dengan COT yang masuk ke Instalasi Rawat Darurat Bedah (IRDB). Kadar rerata laminin ialah 818,4 pg/mL. Pasien didistribusikan hampir seragam dalam enam kategori dari klasifikasi CT Marshall. Model regresi akhir terdiri dari penderita dengan klasifikasi CT Marshall IV-VI rata-rata memiliki kadar laminin serum 316,74 pg/mL (95% CI 206,88; 426,60 pg/mL; p<0,001) lebih tinggi daripada mereka dengan kategori I-III. Setelah sejumlah variabel lain dikontrol, selisih tersebut bahkan naik menjadi 401,06 pg/mL (95% CI 264,84; 563,28 pg/mL; p<0,001). Tingkat kesadaran individu, diukur menggunakan GCS, sebaliknya memiliki hubungan terbalik dengan kadar laminin serum. Setiap kenaikan angka GCS rata-rata menurunkan nilai laminin hingga sekitar 49,10 pg/mL (95% CI 23,33; 74,96 pg/mL; p<0,001). Simpulan penelitian ini ialah laminin mempunyai korelasi bermakna dengan klasifikasi CT Marshall dan GCS pada pasien dengan COT.Kata kunci: laminin, cedera otak akibat trauma (COT)

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.

Identifying Posttraumatic Amnesia in Individuals With a Glasgow Coma Scale of 15 After Mild Traumatic Brain Injury

2015 ◽  
Vol 96 (5) ◽  
pp. 956-959 ◽  
Author(s):  
Susanne Meares ◽  
E. Arthur Shores ◽  
Tracy Smyth ◽  
Jennifer Batchelor ◽  
Margaret Murphy ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Mild Traumatic Brain Injury ◽  
Coma Scale ◽  
Posttraumatic Amnesia

What is a Concussion?

2014 ◽  
pp. 3-4
Author(s):  
David L Brody
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Clinical Diagnosis ◽  
Daily Basis ◽  
Coma Scale ◽  
Life Threatening ◽  
Lab Test ◽  
The Brain

A concussion is a traumatic brain injury, but not an immediately life threatening one. A traumatic brain injury occurs when a sudden force is applied to the brain from outside. But not every force causes a concussion. In fact, most do not. The scalp, skull, and dura do a pretty good job protecting our brains from most of what happens to us on a daily basis. A traumatic brain injury means that the force applied to the brain caused a disruption in the brain’s structure, an impairment of the brain’s function, or both. A CT scan or an MRI scan may be negative, but this does not mean that there has not been a concussion. Traumatic brain injury, especially concussion, is a clinical diagnosis, not based on any lab test or scan. Typically, patients with concussion have Glasgow Coma Scale between 13 and 15.

Prehospital Versus Trauma Center Glasgow Coma Scale in Pediatric Traumatic Brain Injury Patients

2019 ◽  
Vol 241 ◽  
pp. 112-118 ◽  
Author(s):  
Joseph D. Drews ◽  
Junxin Shi ◽  
Dominic Papandria ◽  
Krista K. Wheeler ◽  
Eric A. Sribnick ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Trauma Center ◽  
Pediatric Traumatic Brain Injury ◽  
Coma Scale

Blast Injury in a Civilian Trauma Setting is Associated with a Delay in Diagnosis of Traumatic Brain Injury

2008 ◽  
Vol 74 (3) ◽  
pp. 267-270 ◽  
Author(s):  
Grant V. Bochicchio ◽  
Kimberly Lumpkins ◽  
James O'Connor ◽  
Marc Simard ◽  
Stacey Schaub ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Injury Severity ◽  
Disease Process ◽  
Blast Injury ◽  
Coma Scale ◽  
The Mean

High-pressure waves (blast) account for the majority of combat injuries and are becoming increasingly common in terrorist attacks. To our knowledge, there are no data evaluating the epidemiology of blast injury in a domestic nonterrorist setting. Data were analyzed retrospectively on patients admitted with any type of blast injury over a 10-year period at a busy urban trauma center. Injuries were classified by etiology of explosion and anatomical location. Eighty-nine cases of blast injury were identified in 57,392 patients (0.2%) treated over the study period. The majority of patients were male (78%) with a mean age of 40 ± 17 years. The mean Injury Severity Score was 13 ± 11 with an admission Trauma and Injury Severity Score of 0.9 ± 0.2 and Revised Trauma Score of 7.5 ± 0.8. The mean intensive care unit and hospital length of stay was 2 ± 7 days and 4.6 ± 10 days, respectively, with an overall mortality rate of 4.5 per cent. Private dwelling explosion [n = 31 (35%)] was the most common etiology followed by industrial pressure blast [n = 20 (22%)], industrial gas explosion [n = 16 (18%)], military training-related explosion [n = 15 (17%)], home explosive device [n = 8 (9%)], and fireworks explosion [n = 1 (1%)]. Maxillofacial injuries were the most common injury (n = 78) followed by upper extremity orthopedic (n = 29), head injury (n = 32), abdominal (n = 30), lower extremity orthopedic (n = 29), and thoracic (n = 19). The majority of patients with head injury [28 of 32 (88%)] presented with a Glasgow Coma Scale score of 15. CT scans on admission were initially positive for brain injury in 14 of 28 patients (50%). Seven patients (25%) who did not have a CT scan on admission had a CT performed later in their hospital course as a result of mental status change and were positive for traumatic brain injury (TBI). Three patients (11%) had a negative admission CT with a subsequently positive CT for TBI over the next 48 hours. The remaining four patients (14%) were diagnosed with skull fractures. All patients (n = 4) with an admission Glasgow Coma Scale score of less than 8 died from diffuse axonal injury. Blast injury is a complicated disease process, which may evolve over time, particularly with TBI. The missed injury rate for TBI in patients with a Glasgow Coma Scale score of 15 was 36 per cent. More studies are needed in the area of blast injury to better understand this disease process.

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