Initial Management of Traumatic Brain Injury : To Reduce Preventable Trauma Death

Abstract Background Head trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines. Methods We applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: “Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study” by Kuppermann et al. (Lancet 374(9696):1160–1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted. Results We analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group. Conclusion Children with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

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Traumatic Brain Injury, Initial Management

Encyclopedia of Intensive Care Medicine ◽

10.1007/978-3-642-00418-6_863 ◽

2012 ◽

pp. 2311-2317

Author(s):

William G. Cioffi ◽

Michael D. Connolly ◽

Charles A. Adams ◽

Mechem C. Crawford ◽

Aaron Richman ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Initial Management

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Initial management of traumatic brain injury in the rural setting

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.105607 ◽

2013 ◽

Vol 04 (01) ◽

pp. 33-38 ◽

Cited By ~ 1

Author(s):

Stephen Honeybul ◽

Paul Woods

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Medical Management ◽

Healthcare Workers ◽

Management Strategies ◽

Rural Setting ◽

Initial Management ◽

Head Injured ◽

Conscious Level ◽

Injured Patients

ABSTRACTHealthcare workers in the rural setting face unique problems when dealing with head injured patients however the basic principle of medical management are the same in any situation. The key initial elements remain aggressive early resuscitation followed by a comprehensive assessment of conscious level and either early consultation or transfer to a neurosurgical facility. What has improved considerably over recent years is the understanding of the pathophysiology of traumatic brain injury and as such some of the medical management strategies have changed. A basic understanding of some of these concepts is useful in the clinical setting and serves to emphasis the importance of effective early medical management. Thereafter consideration must be given to which patients require radiological investigations and possible discussion with or transfer to a neurosurgical facility.

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Validation of the Scandinavian guidelines for initial management of minimal, mild and moderate traumatic brain injury in adults

BMC Medicine ◽

10.1186/s12916-015-0533-y ◽

2015 ◽

Vol 13 (1) ◽

Cited By ~ 55

Author(s):

Linda Undén ◽

Olga Calcagnile ◽

Johan Undén ◽

Peter Reinstrup ◽

Jeff Bazarian

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Initial Management ◽

Moderate Traumatic Brain Injury

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Traumatic Brain Injury and C-Spine Management

10.1093/med/9780190850036.003.0020 ◽

2018 ◽

Author(s):

Matthew Wecksell ◽

Kenneth Fomberstein

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cellular Responses ◽

Older Patient ◽

Initial Management ◽

Helmet Use ◽

Different Types ◽

Secondary Injuries ◽

Injury Falls ◽

Primary Injury

Traumatic brain injury encompasses two different types of pathology: that caused at the time of the initial physical insult, called primary injury, and then further, secondary injury caused by either host cellular responses such as oxidative injury and inflammation or by physiological insults such as ischemia, hypoxia, hypo- or hypercapnia, intracranial hypertension, and hypo- or hyperglycemia. While primary injury falls to the realm of public health (e.g., encouraging helmet use for sports, discouraging impaired driving, etc.), many secondary injuries are avoidable with proper medical management. As the stem case for this chapter, an older patient experiences a fall and is incoherent on presentation to the emergency room. This case concerns her initial management, stabilization, diagnosis, and airway management. With progression of her traumatic brain injury, the authors discuss intracranial pressure management, surgical management, and resuscitation as well as likely postoperative sequelae.

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Trends in Management of Traumatic Brain Injury by Emergency Physicians in Colombia

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1074 ◽

2013 ◽

Vol 2 (3) ◽

pp. 134-138 ◽

Cited By ~ 1

Author(s):

Andres M Rubiano ◽

Hernando Raphael Alvis-Miranda ◽

Gabriel Alcalá-Cerra ◽

Luis Rafael Moscote-Salazar ◽

Claudia Navas ◽

...

Keyword(s):

Patient Outcome ◽

Traumatic Brain Injury ◽

Critical Care ◽

Brain Injury ◽

Emergency Services ◽

Study Data ◽

Electronic Format ◽

Emergency Physicians ◽

Initial Management ◽

Common Cause

ABSTRACT Background Traumatic brain injury is a common cause of death in Colombia. The aim of this study was to evaluate the management of traumatic brain injury patients in Colombia. Materials and methods This study was conducted through a survey sent to 100 general practitioners in Colombia through an electronic format. Results Over the period of the study, data collected were about 59 physicians consecutively. The 31% of the respondents knew protocols for the management of traumatic brain injury. Conclusion Traumatic brain injury is one of the most important reasons for consultations in the emergency services in Colombia. We observed significant differences in the initial management of patients with this kind of injury. It requires the establishment of standard protocols and transmission thereof. The implementation of these strategies will contribute to a better patient outcome in Colombia. How to cite this article Alvis-Miranda HR, Navas C, Villa- Delgado R, Rubiano AM, Alcala-Cerra G, Moscote-Salazar LR. Trends in Management of Traumatic Brain Injury by Emergency Physicians in Colombia. J Trauma Critical Care Emerg Surg 2013;2(3):134-138.

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Traumatic Brain Injury, Initial Management

10.1007/springerreference_225187 ◽

2012 ◽

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Initial Management

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Cognitive control constrains memory attributions

Behavioral and Brain Sciences ◽

10.1017/s0140525x19001869 ◽

2019 ◽

Vol 42 ◽

Author(s):

Colleen M. Kelley ◽

Larry L. Jacoby

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Control

Abstract Cognitive control constrains retrieval processing and so restricts what comes to mind as input to the attribution system. We review evidence that older adults, patients with Alzheimer's disease, and people with traumatic brain injury exert less cognitive control during retrieval, and so are susceptible to memory misattributions in the form of dramatic levels of false remembering.

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Lessons Learned From Coaching Postsecondary Students With Traumatic Brain Injury

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00092 ◽

2020 ◽

Vol 5 (1) ◽

pp. 88-96

Author(s):

Mary R. T. Kennedy

Keyword(s):

College Students ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Sense Of Self ◽

Scientific Evidence ◽

Sudden Onset ◽

Lessons Learned ◽

Speech Language Pathologists ◽

The Brain ◽

Exhaustive List

Purpose The purpose of this clinical focus article is to provide speech-language pathologists with a brief update of the evidence that provides possible explanations for our experiences while coaching college students with traumatic brain injury (TBI). Method The narrative text provides readers with lessons we learned as speech-language pathologists functioning as cognitive coaches to college students with TBI. This is not meant to be an exhaustive list, but rather to consider the recent scientific evidence that will help our understanding of how best to coach these college students. Conclusion Four lessons are described. Lesson 1 focuses on the value of self-reported responses to surveys, questionnaires, and interviews. Lesson 2 addresses the use of immediate/proximal goals as leverage for students to update their sense of self and how their abilities and disabilities may alter their more distal goals. Lesson 3 reminds us that teamwork is necessary to address the complex issues facing these students, which include their developmental stage, the sudden onset of trauma to the brain, and having to navigate going to college with a TBI. Lesson 4 focuses on the need for college students with TBI to learn how to self-advocate with instructors, family, and peers.

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The Speech-Language Pathologists' Role in Mild Traumatic Brain Injury for Middle and High School–Age Children: Viewpoints on Guidelines From the Centers for Disease Control and Prevention

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0296 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1363-1370 ◽

Cited By ~ 2

Author(s):

Jessica Brown ◽

Katy O'Brien ◽

Kelly Knollman-Porter ◽

Tracey Wallace

Keyword(s):

High School ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Disease Control ◽

Mild Traumatic Brain Injury ◽

School Age Children ◽

School Age ◽

Speech Language Pathologists ◽

Control And Prevention ◽

Centers For Disease Control

Purpose The Centers for Disease Control and Prevention (CDC) recently released guidelines for rehabilitation professionals regarding the care of children with mild traumatic brain injury (mTBI). Given that mTBI impacts millions of children each year and can be particularly detrimental to children in middle and high school age groups, access to universal recommendations for management of postinjury symptoms is ideal. Method This viewpoint article examines the CDC guidelines and applies these recommendations directly to speech-language pathology practices. In particular, education, assessment, treatment, team management, and ongoing monitoring are discussed. In addition, suggested timelines regarding implementation of services by speech-language pathologists (SLPs) are provided. Specific focus is placed on adolescents (i.e., middle and high school–age children). Results SLPs are critical members of the rehabilitation team working with children with mTBI and should be involved in education, symptom monitoring, and assessment early in the recovery process. SLPs can also provide unique insight into the cognitive and linguistic challenges of these students and can serve to bridge the gap among rehabilitation and school-based professionals, the adolescent with brain injury, and their parents. Conclusion The guidelines provided by the CDC, along with evidence from the field of speech pathology, can guide SLPs to advocate for involvement in the care of adolescents with mTBI. More research is needed to enhance the evidence base for direct assessment and treatment with this population; however, SLPs can use their extensive knowledge and experience working with individuals with traumatic brain injury as a starting point for post-mTBI care.

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