Traumatic Head Injury
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2021 ◽  
Vol 8 (12) ◽  
pp. 3583
Author(s):  
Fahad Ansari ◽  
Arvind Rai

Background: The Glasgow coma scale (GCS) is the most commonly used scale while the full outline of unresponsiveness (FOUR) score is a new validated coma scale in the evaluation of the level of consciousness in head injury patients. The aim of the study was to compare and assess the effectiveness of the FOUR score and the GCS in patients of traumatic head injury.Methods: This was a prospective observational study conducted in the department of surgery, Gandhi medical college, Bhopal during a 2 year period in which 100 patients of traumatic head injury were evaluated. The FOUR score and GCS score of these patients were assessed on admission and outcome followed for 2 weeks.Results: The mean age group of 100 patients was 25-45 years with 79% male and 21% female patients. The FOUR scale was found to have a marginally higher sensitivity of 65.6% while the GCS had a sensitivity of 64.2%. The FOUR scale however had a higher specificity of 71.5% compared to 66.4% of GCS. The Youden index showed that FOUR scale (46%) has a better prediction for death than GCS (35%). FOUR had a higher accuracy of 75% than GCS with an accuracy of 65%.Conclusions: Both FOUR score and GCS are valuable scales in assessment of traumatic head injury. The FOUR scale however is more accurate than the GCS in predicting outcome of head injury patients. 


2021 ◽  
Vol 10 (40) ◽  
pp. 3511-3514
Author(s):  
Srinivas R. ◽  
Davuluri Venkata Shashank ◽  
Mohamed Mohamed

BACKGROUND Post-traumatic hydrocephalus (PTH) can occur as an outcome of moderate and severe traumatic head injury. It is one of the causes of delayed worsening of the early symptoms of head injury. A total of 18 cases of PTH diagnosed and treated at tertiary care hospitals from 2012 to 2015 were studied. The purpose of the study was to evaluate the clinicoradiological profile of patients diagnosed with posttraumatic hydrocephalus and determine the outcome of ventriculoperitoneal (VP) shunting in cases of post-traumatic hydrocephalus. METHODS A retrospective study was conducted in the Department of Neurosurgery in a teaching medical college. The clinicoradiological profile of patients diagnosed with PTH was studied. These cases were treated conservatively as well as by surgery. The demography, cause of trauma, GCS score and response rates were studied. RESULTS Among the 18 reviewed patients, 61.1 % were males, fall and RTA constituted the major cause of trauma. Craniotomy was done in 50 % of the patients, 88.89 % of the patients recovered and the mortality rate was 11.11 %. CONCLUSIONS Post-traumatic hydrocephalus is a consequence of traumatic head injury and can occur with various neurological symptoms after the initial trauma. CT scan of the brain is considered the choice of investigation to early diagnose PTH and the patient outcome after VP shunting is good. KEY WORDS Hydrocephalus, Head Injury, Trauma


Author(s):  
John Ong Ying Wei ◽  
Tin Chan ◽  
William Lo ◽  
Buddhika Wimalachandra

Atlantoaxial rotary subluxation (AARS) is a rare condition that may cause persistent torticollis if not treated appropriately. AARS is associated with ligamentous abnormalities, which may result from acquired or congenital disorders. We report the case of a paediatric patient with congenital Marfan syndrome and AARS due to a minor traumatic head injury. A 9-year-old boy with a known diagnosis of Marfan syndrome (and extensive family history) encountered a traumatic head injury that presented as torticollis with a typical “cock-robin” head and neck orientation. AARS was diagnosed through a head and neck CT scan. He underwent initial conservative treatment involving a muscle relaxant (diazepam) and Miami-J collar. This was followed up with manipulation under anaesthesia (MUA) and further cervical traction, which resolved the subluxation without more invasive treatment. To the best of our knowledge, AARS associated with Marfan syndrome has been rarely reported in literature. It is postulated that the ligamentous laxity associated with Marfan syndrome would increase the patient’s predisposition to AARS and more importantly, the propensity to require more invasive treatment (internal fixation). However, our patient unexpectedly responded well to conservative management, namely MUA and cervical traction. This illustrates that despite the increased ligamentous laxity in Marfan syndrome, it is still advisable to conservatively manage AARS before deciding to perform invasive internal fixation.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S15


2021 ◽  
Vol 15 (5) ◽  
pp. 1571-1575
Author(s):  
S. A. Ezzaddin

Background: Research has provided evidence that malnutrition screening tool (NUTRIC) score has a relation with interleukin-6 but not with other cytokines. In addition, the relation between malnutrition screening tool (NUTRIC) score and some nutritional parameters has not yet been studied in traumatic head injured patients. Therefore, the aim of the current study is examining the relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in the intensive care unit (ICU) of General Teaching Hospital in Sulaimani, the Kurdistan Region of Iraq in 2016-17. Methods: Using appropriate methods and tools, the patients’ (NUTRIC) score, mid-upper arm circumference (MUAC), disease severity and organ dysfunction, concentration level of serum cytokines (IL-6) were assessed within 24 hours after admission. All of the mentioned measurements except the serum interleukin were also assessed on days 6 and 13 of staying in ICU. Afterwards, in order to examine the relationship between the study’s variables, the collected data were analyzed using Mann-Whitney U test through SPSS 22.0. Results: The results of data analysis using Mann-Whitney U and independent samples T-tests revealed that there was a significant relation between malnutrition screening tool (NUTRIC) score and the studied interleukin (IL-6) within 24 hours after ICU admission. Other studied variables that had a significant association with the patients’ (NUTRIC) score within 24 hours after ICU admission were APACHE II score, SOFA score, and MUAC, this significant association has been seen on days 6 and 13 after ICU admission between malnutrition screening tool (NUTRIC) score and serum cytokines (IL-6) APACHE II, and SOFA scores. Conclusion: The results of the present study revealed that pro-inflammatory cytokines (IL-6) along with other factors such as APACHE II and SOFA had significantly higher among patients with risk of malnutrition. Keywords: pro-inflammatory cytokines, traumatic head injury (THI), nutritional score


2021 ◽  
Vol 15 (5) ◽  
pp. 1755-1759
Author(s):  
Shahow Abdulrehman Ezzaddin

Background: Research has provided evidence that malnutrition screening tool (NUTRIC) score has a relation with interleukin-6 but not with other cytokines. In addition, the relation between malnutrition screening tool (NUTRIC) score and some nutritional parameters has not yet been studied in traumatic head injured patients. Therefore, the aim of the current study is examining the relation between malnutrition screening tool (NUTRIC) score and serum pro- and anti-inflammatory cytokines levels and some nutritional parameters in patients with traumatic head injury in the intensive care unit (ICU) of General Teaching Hospital in Sulaimani, the Kurdistan Region of Iraq in 2016-17. Methods: Using appropriate methods and tools, the patients’ (NUTRIC) score, mid-upper arm circumference (MUAC), disease severity and organ dysfunction, concentration level of serum cytokines (IL-6) were assessed within 24 hours after admission. All of the mentioned measurements except the serum interleukin were also assessed on days 6 and 13 of staying in ICU. Afterwards, in order to examine the relationship between the study’s variables, the collected data were analyzed using Mann-Whitney U test through SPSS 22.0. Results: The results of data analysis using Mann-Whitney U and independent samples T-tests revealed that there was a significant relation between malnutrition screening tool (NUTRIC) score and the studied interleukin (IL-6) within 24 hours after ICU admission. Other studied variables that had a significant association with the patients’ (NUTRIC) score within 24 hours after ICU admission were APACHE II score, SOFA score, and MUAC, this significant association has been seen on days 6 and 13 after ICU admission between malnutrition screening tool (NUTRIC) score and serum cytokines (IL-6) APACHE II, and SOFA scores. Conclusion: The results of the present study revealed that pro-inflammatory cytokines (IL-6) along with other factors such as APACHE II and SOFA had significantly higher among patients with risk of malnutrition. Keywords: pro-inflammatory cytokines, traumatic head injury (THI), nutritional score


2021 ◽  
Vol 8 (16) ◽  
pp. 1047-1052
Author(s):  
Ashok Kumar Nayak ◽  
Srikanta Das ◽  
Prafullachandra Hoogar

BACKGROUND Traumatic head injury is one of the most common causes of mortality all over the world. Substantial initial assessment of head injury and its intensity in these patients is the primary goal for medical treatment. Hence, there is a necessity for a score better than GCS for the assessment of head injury patients. FOUR score, a new coma scale was published by Wijdicks in 2005. It included 4 components, motor response, eye response, brainstem reflex, and respiration. It precisely assesses the neurological activity as it includes the brain stem reflexes and eliminates the verbal component and identifies locked-in syndromes, temporal lobe herniations and third nerve dysfunctions which GCS fails to do so. We wanted to evaluate the correlation between FOUR score and GCS in evaluating the level of consciousness in patients with head injuries and evaluate the interobserver reliability of both the above-mentioned scores. METHODS This is an observational prospective study conducted on 92 patients with isolated traumatic head injury admitted to Department of General Surgery, VIMSAR, Burla, from November 2018 to October 2020. The parameters that were evaluated were clinical examination at the time of admission, were blood pressure (BP), temperature, pulse, and respiratory rate at the time of admission. Assessment of GCS and FOUR score at the time of admission, at 6 th hour, 24th hour and daily assessment till discharge. RESULTS A total of 92 isolated traumatic head injury patients were included in the study. Number of females (19.5 %) were significantly less when compared to males. The Pearson correlation coefficient between FOUR score and GCS was calculated to be 0.945, 0.962 and 0.951 respectively at the time of presentation, after 6 hours and isolated traumatic head injury. After 24 hours in patients with isolated traumatic head injury, Cohen’s weighted Kappa of GCS and FOUR score inter reliability was 0.956 and 0.985 respectively. Area under receiver operating characteristic curve (ROC) for GCS and FOUR score with Modified Rankins Score was 0.951 and 0.951. Area under ROC for mortality for GCS and FOUR score was 0.974 and 0.997 respectively. CONCLUSIONS As per our results, there is an excellent correlation between GCS and FOUR score in head injury patients. The FOUR score aims to overcome these shortcomings with a scale that is both simple to use and comprehensive in its overall neurologic assessment of the isolated traumatic head injury patients. FOUR score might prove to be a better tool to evaluate the consciousness of head injury patients and help in detection and stratification of these patients and in monitoring the efficiency of ongoing treatment. KEYWORDS Four Score, GCS, Head Injury


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