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

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/

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

2017 ◽  
Vol 04 (02) ◽  
pp. 085-090
Author(s):  
Sonia Bansal ◽  
Rohini Surve ◽  
Madhusudhan Rao ◽  
Bhadri Narayan ◽  
Mariamma Philip ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Platelet Count ◽  
Brain Injury ◽  
Blood Loss ◽  
Hospital Stay ◽  
Point Of Care ◽  
Length Of Hospital Stay ◽  
Liver Function Tests ◽  
Intraoperative Blood Loss ◽  
Gcs Score

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.

Transfusions and long-term functional outcomes in traumatic brain injury

2010 ◽  
Vol 113 (3) ◽  
pp. 539-546 ◽  
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.

scholarly journals Prognostic Value of Leucocytosis in Paediatric Traumatic Brain Injury

Neurosurgery ◽  
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.

FP2-1 Prognostic value of leucocytosis in paediatric traumatic brain injury

2019 ◽  
Vol 90 (3) ◽  
pp. e25.3-e24
Author(s):  
S Mukherjee ◽  
G Sivakumar ◽  
J Goodden ◽  
A Tyagi ◽  
P Chumas
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Prognostic Value ◽  
Prediction Models ◽  
Cerebral Performance Category ◽  
Length Of Hospital Stay ◽  
Multivariate Regression Analysis ◽  
Computed Tomographic ◽  
Ct Findings

ObjectivesWe assessed leucocytosis and evaluated its prognostic value in isolated paediatric traumatic brain injury (TBI).DesignRetrospective analysis.Subjects106 consecutive paediatric patients with isolated TBI admitted between June 2008 and June 2016.MethodsInitial blood leucocyte count (WCC), Glasgow Coma Score (GCS), computed tomographic (CT) findings, duration of hospital stay, and Paediatric Cerebral Performance Category Scale (PCPCS) scores were analysed.ResultsMean age was 4.2 years. 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<0.01). Length of hospital stay, extent of midline shift on CT and poor 6 month PCPCS rating were each significantly correlated with WCC (p<0.05). Multivariate regression analysis revealed a cut-off WCC of 16.1 × 109/L, 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 as a risk factor.ConclusionsHigh initial leucocytosis (>16.1×109/L) is predictive for poor GCS, severe CT findings, lengthy hospital stay and poor PCPCS in isolated paediatric TBI. Incorporating WCC into TBI prediction models may increase the accuracy of prognostication.

scholarly journals B.01 Neonatal Neuro-Critical Care (NNCC) program associated with improved short term outcomes in neonates significant Hypoxic Ischemic Encephalopathy (HIE)

2018 ◽  
Vol 45 (s2) ◽  
pp. S12-S11
Author(s):  
S Roychoudhury ◽  
M Esser ◽  
J Buchhalter ◽  
L Bello-Espinosa ◽  
H Zein ◽  
...  
Keyword(s):  
Brain Injury ◽  
Hospital Stay ◽  
Primary Outcome ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Clinical Staging ◽  
Short Term ◽  
Mortality And Morbidity ◽  
Short Term Mortality ◽  
The Impact

Background: Despite advances in neonatal care, neonates with moderate to severe HIE are at high risk of mortality and morbidity. we report the impact of a dedicated NNCC team on short term mortality and morbidities. Methods: A retrospective cohort study on neonates with moderate to serve HIE between July 1st 2008 and December 31st 2017. primary outcome : a composite of death and/or brain injury on MRI. Secondary outcomes: rate of cooling, length of hospital stay, anti-seizure medication burden, and use of inotropes. A regression analysis was done adjusting for gestational age, birth weight, gender, out-born status, Apgar score at 10 minutes, cord blood pH, and HIE clinical staging Results: 216 neonates were included, 109 before NNCC implementation, and 107 thereafter. NNCC program resulted in reduction in the primary outcome (AOR: 0.28, CI: 0.14-0.54, p<0.001) and brain injury (AOR: 0.28, CI: 0.14-0.55, p<0.001). It decreased average length of stay/infants by 5 days (p=0.03), improved cooling rate (73% compared to 93% , p <0.001), reduced: seizure misdiagnosis (71% compared to 23%, P <0.001), anti-seizure medication burden (P = 0.001), and inotrope use (34% compared to 53%, p=0.004) Conclusions: NNCC program decreased mortality and brain injury , shortened the length of hospital stay and improved care of neonates with significant HIE.

A Comparison of Rehabilitation Outcome Measures for Traumatic Brain Injury

2003 ◽  
Vol 23 (1) ◽  
pp. 2-9
Author(s):  
Surya Shah ◽  
Steven J. Muncer
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Rating Scale ◽  
Length Of Hospital Stay ◽  
Predictive Ability ◽  
Coefficient Of Determination ◽  
Effective Measure ◽  
Disability Rating Scale ◽  
Floor Effects

This study evaluates the appropriateness, responsiveness, and predictive ability of the Modified Barthel Index (MBI), the Disability Rating Scale (DRS), the Barry Rehabilitation In-patient Screening of Cognition (BRISC), and the Glasgow Coma Scale (GCS) for 78 patients with traumatic brain injury referred for in-patient rehabilitation. Appropriateness was evaluated by examining means, standard deviations, coefficients of variation, and ceiling and floor effects. Responsiveness was determined by examining paired t-test results for admission and discharge scores, and on the basis of an effect size calculation. Predictive power was evaluated by performing two stepwise regressions with length of rehabilitation and total length of hospital stay. The results suggest that although the DRS and GCS have some advantages, notably in low ceiling and floor effects, overall the MBI is the most effective measure, particularly for prediction, with a moderate coefficient of determination (r2 = 0.42) and no significant differences between predicted and real length of hospital stay.

scholarly journals Influence of severity of traumatic brain injury at hospital admission on clinical outcomes

2018 ◽  
Vol 25 (1) ◽  
pp. 3-8
Author(s):  
Thiago Henrique da Silva ◽  
Thais Massetti ◽  
Talita Dias da Silva ◽  
Laercio da Silva Paiva ◽  
Denise Cardoso Ribeiro Papa ◽  
...  
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Medical Records ◽  
Length Of Hospital Stay ◽  
Public Health Problem ◽  
Prolonged Hospital Stay ◽  
Severe Tbi ◽  
Prolonged Hospital

ABSTRACT Traumatic brain injury (TBI) is a public health problem with high mortality and socioeconomic repercussions. We aimed to investigate the influence of TBI severity on the length of mechanical ventilation (MV) stay and length of hospital stay and on the prevalence of tracheostomy, pneumonia, neurosurgery and death. This retrospective, observational study evaluated medical records of 67 patients with TBI admitted to Irmandade da Santa Casa de Misericórdia de São Paulo. Severity was determined according to the Glasgow Coma Scale (GCS): mild (13-15 points; 36 patients; 53.7%), moderate (9-12 points; 14 patients; 20.9%) or severe (3-8 points; 17 patients; 25.4%). Severe TBI patients had higher prevalence of tracheostomy, pneumonia and neurosurgery. No significant differences were observed between TBI severity, mortality and length of MV stay. However, TBI severity influenced the length of hospital stay. TBI severity at admission, evaluated according to the GCS, influenced the prevalence of tracheostomy, pneumonia, neurosurgery and was associated to prolonged hospital stay.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Sign in / Sign up

Export Citation Format

Share Document