Outcome and rehabilitation of patients following aneurysmal subarachnoid haemorrhage

AbstractAneurysmal subarachnoid haemorrhage (SAH) is a dreaded neurosurgical disorder. Although the mortality has been declining in the past three decades, the disability after SAH is still significant. The main determinants of outcome are age, clinical grade, amount of SAH and size of aneurysm. Both neurophysical deficits and neuropsychological impairments are determinants of functional outcome after SAH. Patients should be assessed using outcome measures for both traumatic brain injury and stroke. Early rehabilitation after SAH improves not only physical outcome but also cognitive and functional outcome.

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The impact of hypopituitarism on function and performance in subjects with recent history of traumatic brain injury and aneurysmal subarachnoid haemorrhage

Brain Injury ◽

10.1080/02699050902970778 ◽

2009 ◽

Vol 23 (7-8) ◽

pp. 639-648 ◽

Cited By ~ 26

Author(s):

Lakshmi Srinivasan ◽

Brian Roberts ◽

Tamara Bushnik ◽

Jeffrey Englander ◽

David A. Spain ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Subarachnoid Haemorrhage ◽

Recent History ◽

Aneurysmal Subarachnoid Haemorrhage ◽

History Of ◽

And Performance ◽

The Impact

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Impact of pituitary dysfunction on cognitive and global outcome after traumatic brain injury and aneurysmal subarachnoid haemorrhage

Journal of Rehabilitation Medicine ◽

10.2340/16501977-2531 ◽

2019 ◽

Vol 51 (4) ◽

pp. 264-272

Author(s):

A Tölli ◽

C Höybye ◽

B Bellander ◽

J Borg

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Subarachnoid Haemorrhage ◽

Aneurysmal Subarachnoid Haemorrhage ◽

Pituitary Dysfunction

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The pig as a preclinical traumatic brain injury model: current models, functional outcome measures, and translational detection strategies

Neural Regeneration Research ◽

10.4103/1673-5374.245334 ◽

2019 ◽

Vol 14 (3) ◽

pp. 413 ◽

Cited By ~ 16

Author(s):

FranklinD. West ◽

HollyA. Kinder ◽

EmilyW. Baker

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Outcome Measures ◽

Traumatic Brain Injury Model ◽

Injury Model ◽

Functional Outcome Measures ◽

Detection Strategies

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One-year costs of intensive care in pediatric patients with traumatic brain injury

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.6.peds20189 ◽

2021 ◽

Vol 27 (1) ◽

pp. 79-86

Author(s):

Era D. Mikkonen ◽

Markus B. Skrifvars ◽

Matti Reinikainen ◽

Stepani Bendel ◽

Ruut Laitio ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Intensive Care ◽

Brain Injury ◽

Social Security ◽

Functional Outcome ◽

Injury Severity ◽

Pediatric Population ◽

Favorable Outcome ◽

Index Hospitalization ◽

Pediatric Tbi

OBJECTIVETraumatic brain injury (TBI) is a major cause of death and disability in the pediatric population. The authors assessed 1-year costs of intensive care in pediatric TBI patients.METHODSIn this retrospective multicenter cohort study of four academic ICUs in Finland, the authors used the Finnish Intensive Care Consortium database to identify children aged 0–17 years treated for TBI in ICUs between 2003 and 2013. The authors reviewed all patient health records and head CT scans for admission, treatment, and follow-up data. Patient outcomes included functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4–5) and death within 6 months. Costs included those for the index hospitalization, rehabilitation, and social security up to 1 year after injury. To assess costs, the authors calculated the effective cost per favorable outcome (ECPFO).RESULTSIn total, 293 patients were included, of whom 61% had moderate to severe TBI (Glasgow Coma Scale [GCS] score 3–12) and 40% were ≥ 13 years of age. Of all patients, 82% had a favorable outcome and 9% died within 6 months of injury. The mean cost per patient was €48,719 ($54,557) (95% CI €41,326–€56,112). The index hospitalization accounted for 66%, rehabilitation costs for 27%, and social security costs for 7% of total healthcare costs. The ECPFO was €59,727 ($66,884) (95% CI €52,335–€67,120). A higher ECPFO was observed among patients with clinical and treatment-related variables indicative of parenchymal swelling and high intracranial pressure. Lower ECPFO was observed among patients with higher admission GCS scores and those who had epidural hematomas.CONCLUSIONSGreater injury severity increases ECPFO and is associated with higher postdischarge costs in pediatric TBI patients. In this pediatric cohort, over two-thirds of all resources were spent on patients with favorable functional outcome, indicating appropriate resource allocation.

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Faculty Opinions recommendation of Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.7264956.7513054 ◽

2010 ◽

Author(s):

Jonathan Rhodes

Keyword(s):

Traumatic Brain Injury ◽

Randomized Controlled Trial ◽

Brain Injury ◽

Functional Outcome ◽

Severe Traumatic Brain Injury ◽

Controlled Trial ◽

Rapid Sequence Intubation ◽

Randomized Controlled ◽

Rapid Sequence

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GCS-Pupil Score Has a Stronger Association with Mortality and Poor Functional Outcome than GCS Alone in Pediatric Severe Traumatic Brain Injury

Pediatric Neurosurgery ◽

10.1159/000517330 ◽

2021 ◽

pp. 1-8

Author(s):

Binod Balakrishnan ◽

Heather VanDongen-Trimmer ◽

Irene Kim ◽

Sheila J. Hanson ◽

Liyun Zhang ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Cerebral Performance Category ◽

Regression Tree ◽

Classification And Regression Tree ◽

Continuous Variables ◽

Poor Functional Outcome ◽

Severity Scores ◽

Pupil Reactivity

Background: The Glasgow Coma Scale (GCS), used to classify the severity of traumatic brain injury (TBI), is associated with mortality and functional outcomes. However, GCS can be affected by sedation and neuromuscular blockade. GCS-Pupil (GCS-P) score, calculated as GCS minus Pupil Reactivity Score (PRS), was shown to better predict outcomes in a retrospective cohort of adult TBI patients. We evaluated the applicability of GCS-P to a large retrospective pediatric severe TBI (sTBI) cohort. Methods: Admissions to pediatric intensive care units in the Virtual Pediatric Systems (VPS, LLC) database from 2010 to 2015 with sTBI were included. We collected GCS, PRS (number of nonreactive pupils), cardiac arrest, abusive head trauma status, illness severity scores, pediatric cerebral performance category (PCPC) score, and mortality. GCS-P was calculated as GCS minus PRS. χ2 or Fisher’s exact test and Mann-Whitney U test compared categorical and continuous variables, respectively. Classification and regression tree analysis identified thresholds of GCS-P and GCS along with other independent factors which were further examined using multivariable regression analysis to identify factors independently associated with mortality and unfavorable PCPC at PICU discharge. Results: Among the 2,682 patients included in the study, mortality was 23%, increasing from 4.7% for PRS = 0 to 80% for PRS = 2. GCS-P identified more severely injured patients with GCS-P scores 1 and 2 who had worse outcomes. GCS-P ≤ 2 had higher odds for mortality, OR = 68.4 (95% CI = 50.6–92.4) and unfavorable PCPC, OR = 17.3 (8.1, 37.0) compared to GCS ≤ 5. GCS-P ≤ 2 also had higher specificity and positive predictive value for both mortality and unfavorable PCPC compared to GCS ≤ 5. Conclusions: GCS-P, by incorporating pupil reactivity to GCS scoring, is more strongly associated with mortality and poor functional outcome at PICU discharge in children with sTBI.

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Early versus late decompressive craniectomy in traumatic brain injury: A retrospective comparative case study

Trauma ◽

10.1177/1460408620935766 ◽

2020 ◽

pp. 146040862093576

Author(s):

Nida Fatima ◽

Mujeeb-Ur-Rehman ◽

Samia Shaukat ◽

Ashfaq Shuaib ◽

Ali Raza ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Regression Analysis ◽

Brain Injury ◽

Functional Outcome ◽

Decompressive Craniectomy ◽

Univariate Analysis ◽

Timing Of Surgery ◽

Comparative Case Study ◽

Outcome Parameters ◽

Good Functional Outcome

Objectives Decompressive craniectomy is a last-tier therapy in the treatment of raised intracranial pressure after traumatic brain injury. We report the association of demographic, radiographic, and injury characteristics with outcome parameters in early (<24 h) and late (≥24 h) decompressive craniectomy following traumatic brain injury. Methods We retrospectively identified 204 patients (158 (early decompressive craniectomy) and 46 (late decompressive craniectomy)), with a median age of 34 years (range 2–78 years) between 2015 and 2018. The primary endpoint was Glasgow Outcome Scale Extended (GOSE) at 60 days, while secondary endpoints included Glasgow Coma Score (GCS) at discharge, mortality at 30 days, and length of hospital stay. Regression analysis was used to assess the independent predictive variables of functional outcome. Results With a clinical follow-up of 60 days, the good functional outcome (GOSE = 5–8) was 73.5% versus 74.1% (p = 0.75) in early and late decompressive craniectomy, respectively. GCS ≥ 9 at discharge was 82.2% versus 91.3% (p = 0.21), mortality at 30 days was 10.8% versus 8.7% (p = 0.39), and length of stay in the hospital was 21 days versus 28 days (p = 0.20), respectively, in early and late decompressive craniectomy groups. Univariate analysis identified that GCS at admission (0.07 (0.32–0.18; < 0.05)) and indication for decompressive craniectomy (3.7 (1.3–11.01; 0.01)) are significantly associated with good functional outcome. Multivariate regression analysis revealed that GCS at admission (<9/≥9) (0.07 (0.03–0.16; <0.05)) and indication for decompressive craniectomy (extradural alone/ other hematoma) (1.75 (1.09–3.25; 0.02)) were significant independent predictors of good functional outcome irrespective of the timing of surgery. Conclusions Our results corroborate that the timing of surgery does not affect the outcome parameters. Furthermore, GCS ≥ 9 and/or extra dural hematoma are associated with relatively good clinical outcome after decompressive craniectomy.

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