Posttraumatic cerebral infarction after decompressive craniectomy for traumatic brain injury: incidence, risk factors and outcome

Abstract INTRODUCTION Post traumatic seizures (PTS) are the most common complication following a traumatic brain injury (TBI). The nationwide incidence, risk factors, and outcomes associated with PTS in pediatric TBI are not well understood. METHODS We queried the Kids Inpatient Database (2003, 2006, 2009, 2012) using ICD-9-CM codes to identify all patients (age <21) that had a primary diagnosis of TBI (850.xx 854.xx) and a secondary diagnosis of a PTS (780.33, 780.39). Severity of TBI was determined by level of consciousness and nature of the injury (open/closed). Variables included demographics, comorbidity, hospital type, and TBI type. level of consciousness (LOC), open/closed wound, and surgical management. Risk factors for PTS were identified in univariate and multivariable analysis (alpha set at <0.05). RESULTS >The rate of PTS was 6.9% among 124,444 patients hospitalized for TBI. The rate was impacted by LOC: no LOC (6.3%), brief LOC (7.5%), moderate LOC (10.6%), prolonged LOC w/baseline return (13.9%), or prolonged LOC w/no return (6.4%). The rate also varied by type of TBI: subdural hematoma (12.0%), cerebral laceration (7.4%), subarachnoid hemorrhage (6.5%), concussion (6.0%), and epidural hematoma (4.0%). In multivariable analysis, risk factors for PTS included age 0–5 (compared to 6–10, 11–15, 16–20), African American race, 2 + pre-existing comorbidities, cerebral contusion/laceration, subdural hematoma, closed wound, brief LOC, moderate LOC, and prolonged LOC w/baseline return (all P < 0.05). Surgically managed patients were more likely to suffer PTS (10.7% vs. 6.5%, P < 0.0001) unless treated within 24 hours of admission (6.7% vs. 9.6%, P < 0.0001). CONCLUSION PTS is common in children with TBI and is impacted by age, comorbidity, race, and severity/type of injury. Patients with mild to moderate TBI are at the highest risk and prompt surgery is associated with decreased risk of PTS.

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Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution

Journal of Neurosurgery ◽

10.3171/2016.4.jns152600 ◽

2017 ◽

Vol 127 (1) ◽

pp. 16-22 ◽

Cited By ~ 30

Author(s):

Pierre Esnault ◽

Mickaël Cardinale ◽

Henry Boret ◽

Erwan D'Aranda ◽

Ambroise Montcriol ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Anticoagulation Therapy ◽

Spine Injury ◽

Hemorrhagic Complication ◽

Injury Incidence ◽

Severe Tbi ◽

Systemic Anticoagulation

OBJECTIVEBlunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI.METHODSThe authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation.RESULTSIn total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9–34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7–80.9), cervical spine injury (OR 13.5, 95% CI 3.1–59.4), thoracic trauma (OR 7.3, 95% CI 1.1–51.2), and hepatic lesion (OR 13.3, 95% CI 2.1–84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication.CONCLUSIONSBlunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.

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