The incidence and effect of coagulopathy on short-term outcomes in patients undergoing craniotomy following traumatic brain injury

Abstract Background: Coagulopathy in isolated traumatic brain injury (TBI) is well-known, and studies have found an association between coagulopathy and unfavourable outcomes. This study was conducted to determine the incidence and causes of coagulopathy in patients with TBI undergoing craniotomy and its effect on post-operative outcome. Materials and Methods: The data collected was demographics, computed tomography diagnosis, post-resuscitation Glasgow Coma Scale (GCS) score, pre- and post-operative platelet count, liver function tests, intraoperative blood loss and transfusion, fluids infused and incidence of redo surgery. Point of care (Coaguchek XS) monitor was used to obtain prothrombin time and international normalised ratio (INR) at 24 h and 72 h of injury. Coagulopathy was defined as INR ≥1.3 and thrombocytopenia as platelet count ≤100,000/mcL. Outcome measures assessed were the length of hospital stay, GCS at discharge and in-hospital mortality. Results: In 166 patients, the average pre-operative GCS was 8.8 ± 3.6. The incidence of coagulopathy was 42.8% and increased to 55.6% on the 3rd day, and thrombocytopenia from 3.5% in the first 24 h increased to 14.7% at 72 h. Patients with coagulopathy had lower pre-operative admission GCS (median 7 vs. 9, P = 0.03), greater intraoperative blood loss and received more intravenous fluids. There was no difference in the incidence of post-operative haematomas, length of hospital stay and GCS at discharge or mortality. Conclusion: In patients with TBI, the incidence of coagulopathy increased at the end of 72 h. In this study, there was no difference in outcomes in patients who underwent craniotomy with deranged coagulation.

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Transfusions and long-term functional outcomes in traumatic brain injury

Journal of Neurosurgery ◽

10.3171/2009.12.jns091337 ◽

2010 ◽

Vol 113 (3) ◽

pp. 539-546 ◽

Cited By ~ 54

Author(s):

Matthew A. Warner ◽

Terence O'Keeffe ◽

Premal Bhavsar ◽

Rashmi Shringer ◽

Carol Moore ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Stay ◽

Glucose Level ◽

Functional Outcomes ◽

Length Of Hospital Stay ◽

Number Of Patients ◽

Transfusion Volume ◽

Gcs Score

Object In this paper, the authors' goal was to examine the relationship between transfusion and long-term functional outcomes in moderately anemic patients (lowest hematocrit [HCT] level 21–30%) with traumatic brain injury (TBI). While evidence suggests that transfusions are associated with poor hospital outcomes, no study has examined transfusions and long-term functional outcomes in this population. The preferred transfusion threshold remains controversial. Methods The authors performed a retrospective review of patients who were admitted with TBI between September 2005 and November 2007, extracting data such as HCT level, status of red blood cell transfusion, admission Glasgow Coma Scale (GCS) score, serum glucose, and length of hospital stay. Outcome measures assessed at 6 months were Glasgow Outcome Scale-Extended score, Functional Status Examination score, and patient death. A multivariate generalized linear model controlling for confounding variables was used to assess the association between transfusion and outcome. Results During the study period, 292 patients were identified, and 139 (47.6%) met the criteria for moderate anemia. Roughly half (54.7%) underwent transfusions. Univariate analyses showed significant correlations between outcome score and patient age, admission GCS score, head Abbreviated Injury Scale score, number of days with an HCT level < 30%, highest glucose level, number of days with a glucose level > 200 mg/dl, length of hospital stay, number of patients receiving a transfusion, and transfusion volume. In multivariate analysis, admission GCS score, receiving a transfusion, and transfusion volume were the only variables associated with outcome (F = 2.458, p = 0.007; F = 11.694, p = 0.001; and F = 1.991, p = 0.020, respectively). There was no association between transfusion and death. Conclusions Transfusions may contribute to poor long-term functional outcomes in anemic patients with TBI. Transfusion strategies should be aimed at patients with symptomatic anemia or physiological compromise, and transfusion volume should be minimized.

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Open cystectomy is still alive and well: Outcomes from a single-centre 6-year review

Journal of Clinical Urology ◽

10.1177/2051415818759366 ◽

2018 ◽

Vol 12 (3) ◽

pp. 239-245

Author(s):

Alexios Dosis ◽

Blessing Dhliwayo ◽

Patrick Jones ◽

Iva Kovacevic ◽

Jonathan Yee ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radical Cystectomy ◽

Length Of Hospital Stay ◽

Categorical Variables ◽

Complication Rates ◽

Intraoperative Blood Loss ◽

Single Centre ◽

Significant Difference ◽

Duration Of Surgery

Objectives: To compare perioperative and oncological outcomes between open and laparoscopic radical cystectomy in a single-centre setting. Materials and methods: This study was a retrospective cohort (level 2b evidence) non-randomised review of 228 radical cystectomies that were performed between January 2010 and February 2016. Primary outcome measures were operative time, complications, blood loss and length of hospital stay. Statistical analysis was performed using the SPSS v21.0. Quantitative values were compared with Student’s t-test; categorical variables with the chi-square test. Statistical significance was considered a result of an alpha value less than 0.05. A Kaplan–Meier survival analysis was also conducted. Results: Intraoperative blood loss was lower in laparoscopic surgery (855±673 vs. 716±570 mL, P=0.15), which had a significant impact on transfusion rates ( P=0.02). Operative times were lower in open surgery (339±52.9 vs. 353.1±67.1 minutes, P=0.10), while hospital stay was lower in the laparoscopic group (14.2±11.2 vs. 16.0±13.6 days, P=0.28). Five-year survival rates were superior for patients who underwent an open procedure but were not statistically significant ( P=0.10). Conclusion: This is, so far, the largest cohort to compare laparoscopic and open radical cystectomy. The laparoscopic approach can reduce the need for transfusion; however, there was no statistically significant difference in complication rates, duration of surgery, length of hospital stay or intraoperative blood loss, survival and margin positivity. Level of evidence: Not applicable for this multicentre audit.

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Intraoperative blood loss during decompressive craniectomy for intractable intracranial hypertension after severe traumatic brain injury in children

Child s Nervous System ◽

10.1007/s00381-014-2417-4 ◽

2014 ◽

Vol 30 (8) ◽

pp. 1393-1398 ◽

Cited By ~ 8

Author(s):

François-Pierrick Desgranges ◽

Etienne Javouhey ◽

Carmine Mottolese ◽

Anne Migeon ◽

Alexandru Szathmari ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Blood Loss ◽

Intracranial Hypertension ◽

Decompressive Craniectomy ◽

Severe Traumatic Brain Injury ◽

Intraoperative Blood Loss

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Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

BioMed Research International ◽

10.1155/2019/8280358 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Yulin Guo ◽

Feng Cao ◽

Yixuan Ding ◽

Haichen Sun ◽

Shuang Liu ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Meta Analysis ◽

Gastrointestinal Surgery ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Pulmonary Complications ◽

Cochrane Library ◽

Chronic Obstructive ◽

Intraoperative Blood Loss

Background. Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay. However, it remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. The present study was conducted to review and assess the safety and feasibility of laparoscopic major abdominal surgery for patient with COPD. Materials and Methods. Databases including PubMed, EmBase, Cochrane Library, and Wan-fang were searched for all years up to Jul 1, 2018. Studies comparing perioperative results for COPD patients undergoing major gastrointestinal surgery between laparoscopic and open approaches were enrolled. Results. Laparoscopic approach was associated with less intraoperative blood loss (MD = -174.03; 95% CI: −232.16 to -115.91, P < 0.00001; P < 0.00001, I2=93% for heterogeneity) and shorter length of hospital stay (MD = -3.30; 95% CI: −3.75 to -2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity). As for pulmonary complications, laparoscopic approach was associated with lower overall pulmonary complications rate (OR = 0.58; 95% CI: 0.48 to 0.71, P < 0.00001; P = 0.42, I2=0% for heterogeneity) and lower postoperative pneumonia rate (OR = 0.53; 95% CI: 0.41 to 0.67, P < 0.00001; P = 0.57, I2=0% for heterogeneity). Moreover, laparoscopic approach was associated with lower wound infection (OR = 0.51; 95% CI: 0.42 to 0.63, P < 0.00001; P = 0.99, I2=0% for heterogeneity) and abdominal abscess rates (OR = 0.59; 95% CI: 0.44 to 0.79, P < 0.0004; P = 0.24, I2=30% for heterogeneity). Conclusions. Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits.

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Hemiarthroplasty for the Management of unstable femoral intertrochanteric fractures in elderly patients over 75 years old: a retrospective matched comparative study

10.21203/rs.3.rs-20822/v1 ◽

2020 ◽

Author(s):

Juncheng Ge ◽

Jinhui Ma ◽

Bailiang Wang ◽

Yu Zhou ◽

Debo Yue ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Average Length ◽

Length Of Hospital Stay ◽

Proximal Femoral Nail ◽

Intertrochanteric Fractures ◽

Intraoperative Blood Loss ◽

Femoral Nail ◽

Proximal Femoral Nail Antirotation ◽

Partial Weight

Abstract Background To compare and analyze the therapeutic effect of Proximal Femoral Nail Antirotation and hemiarthroplasty on intertrochanteric fracture. Methods 45 patients with intertrochanteric fractures (17 males and 28 females) admitted to our hospital from January 2016 to January 2018 were collected. The mean age was 84.82 ± 0.73 years. All injuries were caused by falls during daily activities. Patients were divided into two groups according to the surgical method: the first group was the hemiarthroplasty group, referred to as the hemiarthroplasty group, with a total of 22 patients, and the average length of hospital stay was 13.09 ± 5.03 days. According to the improved Evans-Jensen classification [5], there were 1 cases of III, 9 cases of IV, and 12 cases of V12.The second group was the Proximal Femoral Nail Antirotation group, and the average length of hospital stay was 13.09 ± 6.97 days. According to the Evans-Jensen classification, 1 patient was III, 16 patients were IV, and 6 patients were V. Results Intraoperative blood loss was higher in the The Proximal Femoral Nail Antirotation group than in the hemiarthroplasty group(P=0.034).In the postoperative recovery of the two groups, the time from operation to partial weight-bearing of the hemiarthroplasty group was shorter than that of the PFNA group༈p༝0.000༉, and the postoperative HHS of the hemiarthroplasty group was also better than the latter (p ༝0.0005). In terms of total cost during hospitalization, the Hemiarthroplasty group was less than the PFN group(p ༝ 0.017). One year after surgery, the mortality rate increased to 34% in the PNFA group and 9% in the hemiarthroplasty group( P = 0.038), which was statistically significant. Conclusion Hemiarthroplasty for intertrochanteric fractures in the elderly can reduce intraoperative blood loss, achieve early recovery, improve survival rates, and reduce the economic burden on patients

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A Randomised Interventional Study to Compare Autologous and Nonautologous Dural Substitutes Among Traumatic Brain Injury (TBI) Patients

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1717216 ◽

2020 ◽

Author(s):

Vir Abhimanyu Pandit ◽

Rajesh Kumar Sharma ◽

Suryanarayanan Bhaskar ◽

Amanjeet Singh Kindra ◽

Ajay Choudhary ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Blood Loss ◽

Hospital Stay ◽

Csf Leak ◽

P Value ◽

Dural Substitute ◽

Dural Graft ◽

Study Population ◽

Dural Patch

Abstract Objectives To determine and compare the effectiveness and safety of galea-pericranium autologous dural graft with nonautologous polypropylene (G-patch) dural substitute among traumatic brain injury (TBI) patients. Methods A prospective interventional randomized comparative study was conducted at the Department of Neurosurgery from November 2013 to March 2015 after obtaining approval from the Institutional Ethical Committee. The study population included 50 cases of TBI which were divided into two groups of 25 each by the randomization technique and were treated either with autologous duraplasty (galea-pericranium) or nonautologous polypropylene (G-patch) dural substitute. The outcomes measured were time to duraplasty, blood loss, hospital stay, and the incidence of complications with the two techniques. The data were entered in a MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A p value of < 0.05 was considered statistically significant. Results The average time to harvest galea-pericranium was 5 minutes. Compared with the patients undergoing G-patch, the patients in group pericranium had comparable duraplasty time (minutes) (34.32 vs. 27.80, p = 0.44), significantly lower drain output (54.8 vs. 74.5, p = 0.017), comparable blood loss (322 vs. 308, p = 0.545), comparable blood transfusion (24% vs. 16%, p = 0.48), significantly lesser duration of hospital stay (8.6 vs. 10.44, p = 0.028), comparable wound infection (8% vs. 16%, p = 0.384), and comparable cerebrospinal fluid (CSF) leak (0% vs. 8%, p = 0.149). Conclusion The study showed that galea-pericranium and polypropylene dural patch are equally effective and safe dural substitutes in providing a dural seal to minimize the CSF leaks and infections among posttraumatic brain injury patients.

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Prognostic Value of Leucocytosis in Paediatric Traumatic Brain Injury

Neurosurgery ◽

10.1093/neuros/nyz310_343 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Soumya Mukherjee ◽

Gnanamurthy Sivakumar ◽

John Goodden ◽

Atul Tyagi ◽

P D Chumas

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Stay ◽

Prognostic Value ◽

Leucocyte Count ◽

Prediction Models ◽

Cerebral Performance Category ◽

Length Of Hospital Stay ◽

Mass Effect ◽

Ct Findings

Abstract INTRODUCTION Prognostic factors in paediatric traumatic brain injury (TBI) remain unclear. This study assessed the prognostic value of leucocytosis in paediatric isolated TBI METHODS A total of 106 paediatric isolated TBI patients treated at our institution between June 2008 and June 2016 were retrospectively analysed. Data collected included initial blood leucocyte count (WCC), presenting Glasgow Coma Score (GCS), computed tomography (CT), hospital stay, and Paediatric Cerebral Performance Category Scale (PCPCS), and their relationship with WCC were statistically evaluated. RESULTS A total of 39, 37, and 30 patients had severe, moderate, and mild TBI, respectively. For patients with GCS 3-8, 9-13, and 14-15, WCC was 20, 15.9, and 10.7 × 109/L, respectively. Differences in WCC were significant between the different GCS groups (P < .01). WCC was greatest and smallest in patients with CT findings demonstrating significant mass effect (Marshall grading V-VI) and minimal mass effect (Marshall grading I-II), respectively (P < .05). Length of hospital stay and extent of midline shift on CT each significantly correlated with WCC (P < .05). In addition, higher WCC counts were associated with a poorer 6-mo PCPCS rating (P < .05). Multivariate regression analysis revealed a cut-off leucocyte count of 16.1 × 109/L, and Neutrophil-to-Lymphocyte ratio (NLR) of 5.2, above which GCS, CT findings, length of hospital stay and PCPCS were less favourable. Application of the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT) adult TBI prediction model to our paediatric cohort, using area under the operating curve (AUROC) and coefficient analyses, demonstrated increased accuracy with incorporation of WCC count as a risk factor. CONCLUSION High leucocyte count (>16.1 × 109/L) and NLR > 5.2 each have a predictive value for poor GCS, severe CT findings, lengthy hospital stay and poor PCPCS in isolated paediatric TBI. Incorporating initial leucocyte count into TBI prediction models may increase the accuracy of prognostication.

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Prognostic value of leukocytosis in pediatric traumatic brain injury

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.7.peds19627 ◽

2020 ◽

pp. 1-11

Author(s):

Soumya Mukherjee ◽

Gnanamurthy Sivakumar ◽

John R. Goodden ◽

Atul K. Tyagi ◽

Paul D. Chumas

Keyword(s):

Traumatic Brain Injury ◽

Risk Factor ◽

Brain Injury ◽

Hospital Stay ◽

Neutrophil Count ◽

Prognostic Value ◽

Independent Risk Factor ◽

Leukocyte Count ◽

Poor Outcome ◽

Gcs Score

OBJECTIVEThe purpose of this study was to assess leukocytosis and its prognostic value in pediatric isolated traumatic brain injury (TBI).METHODSTwo hundred one children with isolated TBI admitted to the authors’ institution between June 2006 and June 2018 were prospectively followed and their data retrospectively analyzed. Initial blood leukocyte count (i.e., white cell count [WCC]), Glasgow Coma Scale (GCS) score, CT scans, duration of hospital stay, and Pediatric Cerebral Performance Category Scale (PCPCS) scores were analyzed.RESULTSThe mean age was 4.2 years (range 0.2–16 years). Seventy-four, 70, and 57 patients had severe (GCS score 3–8), moderate (GCS score 9–13), and mild (GCS score 14–15) TBI, respectively, with associated WCC of 20, 15.9, and 10.7 × 109/L and neutrophil counts of 15.6, 11.3, and 6.1 × 109/L, respectively (p < 0.01). Higher WCC and neutrophil counts were demonstrated in patients with increased intracranial mass effect on CT, longer hospital stay, and worse 6-month PCPCS score (p < 0.05). Multivariate regression revealed a cutoff leukocyte count of 16.1 × 109/L, neutrophil count of 11.9 × 109/L, and neutrophil-to-lymphocyte ratio (NLR) of 5.2, above which length of hospital stay and PCPCS scores were less favorable. Furthermore, NLR was the second most important independent risk factor for a poor outcome (after GCS score). The IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) adult TBI prediction model applied to this pediatric cohort demonstrated increased accuracy when WCC was incorporated as a risk factor.CONCLUSIONSIn the largest and first prospective study of isolated pediatric head injury to date, the authors have demonstrated that WCC > 16.1 × 109/L, neutrophil count > 11.9 × 109/L and NLR > 5.2 each have predictive value for lengthy hospital stay and poor PCPCS scores, and NLR is an independent risk factor for poor outcome. Incorporating the initial leukocyte count into TBI prediction models may improve prognostication.

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Traumatic brain injury from ground level fall in the elderly: a systematic review

10.5327/1516-3180.149 ◽

2021 ◽

Author(s):

Luiz Ricardo Avelino Rodrigues ◽

Ana Elisa Chves de Vasconcelos ◽

Matheus Duarte Rodrigues ◽

Tobias Mosart Sobrinho ◽

Wagner Gonçalves Horta

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Stay ◽

Average Length ◽

Length Of Hospital Stay ◽

Ground Level ◽

The Elderly ◽

Antiarrhythmic Agents ◽

Geriatric Population

Background: Traumatic Brain Injury (TBI) is an anatomical or functional injury that affects the skull or brain and other associated structures. When analyzing the occurrence of TBI in the geriatric population, Ground Level Fall (GLF) is the main mechanism of trauma. Objectives: To understand the scenario of TBI from GLF in the elderly, characterizing it, in order to point out associated factors and its consequences. Desing and setting: Systematic review at the University of Pernambuco in Recife city. Methods: This is a systematic review of articles indexed in the MEDLINE/ Pubmed, LILACS, BDENF and BINACIS databases and two other works from Google Scholar in April 2021. Original articles in Portuguese and English that met the objectives of this review and were published in the last ten years (2011-2021) were included. Results: Four articles were included. The mean age of elderly who developed TBI from GLF was around 80 years, with a higher prevalence in females. In ad- dition, it was observed that most victims already had associated comorbidities and medications, such as anticoagulants, antiplatelet agents and antiarrhythmic agents. Patients had an average length of hospital stay from 2 to 7.7 days. Limbs and Face injuries were observed. Conclusions: TBI from GLF in the elderly is frequent and even though the length of hospital stay and deaths related to this trauma were low, physical and psychological consequences are also associated to this injury. Clinical Trial or Systematic Review Registration: 254698, https://www.crd.york. ac.uk/prospero/

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723 Neuroendoscopy versus Craniotomy in Basal Ganglia Haemorrhage: A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab258 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

T K Tan ◽

J Merola ◽

M Zaben ◽

W Gray ◽

P Leach

Keyword(s):

Systematic Review ◽

Basal Ganglia ◽

Mortality Rate ◽

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Endoscopic Approach ◽

Intraoperative Blood Loss

Abstract Aim Basal ganglia haemorrhage (BGH) is the most common type of intracerebral bleed with high morbidity and mortality rate. The efficacy between craniotomy and endoscopic approach in BGH is still debatable and advancement in minimally invasive technique has made endoscopic approach the preferred option. The aim of this systematic review and meta-analysis was to evaluate the outcomes of craniotomy and endoscopic approach in BGH. Method Databases of PubMed, EMBASE, MEDLINE and CENTRAL were systematically searched from its inception until December 2020. All randomized clinical trials and observational studies comparing craniotomy versus endoscopic approach in BGH were included. Results Twelve studies enrolling 1297 patients (craniotomy:675, endoscopy:632) were included for qualitative and quantitative analysis. Endoscopic approach was associated with significantly lower postoperative mortality (OR:0.35, P < 0.00001), higher haematoma evacuation rate (MD:4.95, P = 0.0002), shorter operative time (MD:-117.03, P < 0.00001), lesser intraoperative blood loss (MD:-328.47, P < 0.00001), higher postoperative Glasgow Coma Scale (GCS) (MD:1.14, P = 0.01), higher postoperative Glasgow Outcome Scale (GOS) (MD:0.44, P = 0.05), shorter length of hospital stay (MD:-2.90, P < 0.00001), lower complication rate (OR:0.30, P = 0.0004), lower infection rate (OR:0.29, P < 0.00001) and lower modified Rankin Scale (mRS) (MD:-0.57, P = 0.004) compared to craniotomy. No significant difference was detected in reoperation, intracranial infection, re-bleeding. Conclusions The best available evidence suggest that endoscopic approach has better outcomes in mortality rate, operative time, haematoma evacuation rate, intraoperative blood loss, length of hospital stay, mRS, postoperative GCS and GOS compared with craniotomy in the management of BGH. However, there is a need for high quality randomised controlled trials with large sample size for definite conclusions.

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