Treatment of Idiopathic Normal Pressure Hydrocephalus with a Novel Programmable Valve: Prospective Evaluation of Costs, Efficacy, and Safety.

Objective Programmable valves provide an equal or superior neurological outcome when compared with fixed pressure ones, with fewer complications, in treating idiopathic normal pressure hydrocephalus (iNPH) patients. Long-term costs of these treatments have not been properly compared in literature. We sought to compare costs, efficacy, and safety of 1-year treatment of iNPH patients with programmable valve Sphera Pro and a fixed pressure valve. Materials and Methods A prospective cohort of iNPH patients treated with programmable valve was compared with a historical cohort of iNPH patients treated with fixed pressure valve. Our primary outcome was mean direct cost of treating iNPH up to 1 year. Efficacy in treating iNPH and safety were assessed as secondary outcomes. Statistical Analysis Proportions were compared using chi-square or Fisher's exact tests. Normally distributed variables were compared using the Student's t -test or the Mann-Whitney's U test. Differences in the evolution of the variables over time were assessed using generalized estimating equations. All tests were two-sided, with an α of 0.05. Results A total of 19 patients were analyzed in each group (mean age 75 years, the majority male). Comorbidities and clinical presentation were similar between groups. Both fixed pressure and programmable valve patients had neurological improvement over time ( p < 0.001), but no difference was seen between groups ( p = 0.104). The fixed pressure valve group had more complications than the programmable valve group (52.6% vs. 10.5%, respectively, p = 0.013). Annual treatment cost per patient was US$ 3,820 ± 2,231 in the fixed pressure valve group and US$ 3,108 ± 553 in the programmable valve group. Mean difference was US$712 (95% confidence interval, 393-1,805) in favor of the programmable valve group. Conclusion The Sphera Pro valve with gravitational unit had 1 year treatment cost not higher than that of fixed pressure valve, and resulted in similar efficacy and fewer complications.

Use of an Expanded Polytetrafluoroethylene (ePTFE) Dura Substitute in Glioma Surgeries: A Technical Note

Introduction Reoperations are a common scenario among glioma patients. There is crescent evidence of its benefit in low- and high-grade gliomas. Here we discuss our experience with inert expanded polytetrafluoroethylene (ePTFE) dura substitute in glioma surgeries. Technical note We generally put the ePTFE dura substitute below the dura of the patient, even if it is intact. This membrane should be sutured in place using a tensionfree technique, with 4-0 polypropylene. Expanded polytetrafluoroethylene minimizes tissue attachment and fibrosis when performing reoperation in glioma patients. Discussion Since the literature has shown benefits in survival with reoperation in glioma patients, the use of ePTFE dura substitute can improve surgical time and minimize complications in a second surgery.

Malignant transformation of low-grade gliomas in patients undergoing adjuvant therapy.

Low-grade gliomas (LGG) comprise nearly 15-20 % of all central nervous system glial tumors. Several factors have been recognized as playing role in LGG malignant transformation (MT). A breakthrough analysis of a multidisciplinary group pointed that temozolomide may play a role in MT of LGGs. We analyzed the prevalence of MT in LGG patients submitted to adjuvant therapy (AT). We analyzed the medical charts of 43 patients with LGG submitted to surgery or biopsy and attending at Hospital do Servidor Público Estadual de São Paulo (São Paulo, Brazil), consecutively diagnosed from 1995 to 2013. 43 patients (24 women and 19 men) were evaluated, with mean age of 45.3 years. According to histology, 30 were astrocytomas (70 %), 12 (27 %) were oligodendrogliomas, and 1 (3 %) were mixed glioma. Mean follow-up time was 4.2 years with the standard deviation of 2.1. Twenty-eight patients did not receive adjuvant therapy and 15 received adjuvant therapy. From 43 patients with complete follow-up, 21 (48 %) experienced malignant transformation. Among such patients, nine were users of AT. Forty-eight percent of patients presented MT, being 60 % in the AT group and 42.8 % without AT. Our analysis revealed a high prevalence of MT in patients undergoing AT, higher than in patients without AT.

Failed Ventriculoperitoneal Shunt: Is Retrograde Ventriculosinus Shunt a Reliable Option?

BACKGROUND: Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. OBJECTIVES: In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS. RESULTS: In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus. CONCLUSIONS: We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence.

Application of a 980-nanometer diode laser in neuroendoscopy: a case series.

OBJECTIVE: Ventricular neuroendoscopy represents an important advance in the treatment of hydrocephalus. High-power (surgical) Nd:YAG laser and low-level laser therapy (using 685-nm-wavelength diode laser) have been used in conjunction with neuroendoscopy with favorable results. This study evaluated the use of surgical 980-nm-wavelength diode laser for the neuroendoscopic treatment of ventricular diseases. METHODS: Nine patients underwent a neuroendoscopic procedure with 980-nm diode laser. Complications and follow-up were recorded. RESULTS: Three in-hospital postoperative complications were recorded (1 intraventricular hemorrhage and 2 meningitis cases). The remaining 6 patients had symptom improvement after endoscopic surgery and were discharged from the hospital within 24-48 hours after surgery. Patients were followed for an average of 14 months: 1 patient developed meningitis and another died suddenly at home. The other patients did well and were asymptomatic until the last follow-up consultation. CONCLUSIONS: The 980-nm diode laser is considered an important therapeutic tool for endoscopic neurological surgeries. This study showed its application in different ventricular diseases.

Evidences in the treatment of idiopathic normal pressure hydrocephalus.

INTRODUCTION: idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment. METHODS: an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment. RESULTS: the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard. CONCLUSION: well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS.

Evidences in the treatment of idiopathic normal pressure hydrocephalus / Evidências no tratamento da hidrocefalia de pressão normal idiopática.

Summary Introduction: idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment. Methods: an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment. Results: the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard. Conclusion: well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS. .

Resumo Introdução: a hidrocefalia de pressão normal idiopática (HPNI) é caracterizada por apraxia da marcha, disfunção cognitiva e incontinência urinária. Existem duas principais opções terapêuticas: derivação ventriculoperitoneal (DVP) e terceiro ventriculostomia endoscópica (TVE). No entanto, há dúvidas sobre qual modalidade é superior e que tipo de válvula deve ser aplicada. Este artigo resume as evidências atuais no tratamento de HPNI. Métodos: uma busca eletrônica da literatura foi realizada nas bases de dados Medline, Embase, SciELO e Lilacs, de 1966 até o momento presente para revelar os dados publicados sobre o tratamento da HPNI. Resultados: o tratamento é baseado em três pilares: conservador isolado, TVE e DVP. A opção conservadora caiu em desuso depois de vários estudos revelarem bons resultados após a intervenção cirúrgica. A TVE é uma modalidade de tratamento aceitável, mas a superioridade da DVP torna-a o padrão-ouro. Conclusão: estudos com evidência de alto nível, adequados e bem desenhados, ainda são escassos. O tratamento padrão-ouro atual de HPNI é realizado com DVP. .

Upper airway dimensions in patients with craniocervical junction malformations with and without sleep apnea. A pilot case-control study.

OBJECTIVE: Patients with craniocervical junction malformations (CCJM) tend to suffer more frequently from sleep respiratory disturbances, which are more frequent and severe in patients with basilar invagination. Here we evaluate if patients with CCJM and sleep respiratory disorders (SRD) present smaller airway dimensions than patients without SRD. METHOD: Patients with CCCM with and without sleep respiratory disturbances were evaluated clinically by Bindal's score, modified Mallampati classification, full-night polysomnography and upper airway cone beam tomography. RESULTS: Eleven patients had sleep respiratory disorders (SRD), and nine patients performed control group without SRD. CCJM patients with SRD were predominantly female, older, had higher BMI, were more likely to have Mallampati grades 3 and 4 and had statistically significant smaller anteroposterior diameter of the upper airway than patients without SRD. CONCLUSION: Patients with CCJM and sleep respiratory disturbances have higher BMI, higher Mallampati score and smaller anterior posterior diameter of the upper airway.

Upper airway dimensions in patients with craniocervical junction malformations with and without sleep apnea. A pilot case-control study / Dimensões da via aérea superior em pacientes com malformações da transição craniocervical com e sem apnéia do sono. Um estudo piloto caso-controle

Objective Patients with craniocervical junction malformations (CCJM) tend to suffer more frequently from sleep respiratory disturbances, which are more frequent and severe in patients with basilar invagination. Here we evaluate if patients with CCJM and sleep respiratory disorders (SRD) present smaller airway dimensions than patients without SRD. Method Patients with CCCM with and without sleep respiratory disturbances were evaluated clinically by Bindal's score, modified Mallampati classification, full-night polysomnography and upper airway cone beam tomography. Results Eleven patients had sleep respiratory disorders (SRD), and nine patients performed control group without SRD. CCJM patients with SRD were predominantly female, older, had higher BMI, were more likely to have Mallampati grades 3 and 4 and had statistically significant smaller anteroposterior diameter of the upper airway than patients without SRD. Conclusion Patients with CCJM and sleep respiratory disturbances have higher BMI, higher Mallampati score and smaller anterior posterior diameter of the upper airway. .

Objetivo : Pacientes com malformação da transição craniocervical (MTCC) tendem a apresentar mais frequentemente distúrbios respiratórios do sono (DRS), os quais são mais intensos em pacientes com invaginação basilar. O objetivo desse estudo é avaliar se pacientes com MTCC e DRS apresentam dimensões das vias aéreas reduzidas em comparação a pacientes sem DRS. Método : Pacientes com MTCC com e sem apneia do sono foram avaliados com a escala de Bindal, classificação de Mallampati modificada, polissonografia de noite inteira e tomografia da via aérea superior. Resultados Onze pacientes tinham DRS e nove não apresentaram esses distúrbios (grupo controle). Pacientes com MTCC e DRS foram principalmente mulheres, mais velhos, apresentaram maior IMC e maior gradação na escala de Mallampati, além de menor diâmetro anteroposterior de via aérea superior do que pacientes sem DRS. Conclusão Pacientes com MTCC e DRS têm maior IMC, maior pontuação na escala de Mallampati e menor diâmtero anteroposterior da via aérea superior. .

Risk of complications in spine surgery: a prospective study.

PURPOSE: Complications are the chief concern of patients and physicians when considering spine surgery. The authors seek to assess the incidence of complications in patients undergoing spine surgery and identify risk factors for their occurrence. METHODS: Prospective study of patients undergoing spine surgery from 1 February 2013 to 1 February 2014. Epidemiological characteristics and complications during the surgical hospitalization were recorded and analyzed. RESULTS: The sample comprised 95 patients (mean age, 59 years). Overall, 23% of patients were obese (BMI =30). The mean BMI was 25.9. Approximately 53% of patients had comorbidities. Complications occurred in 23% of cases; surgical site infections were the most common (9%). There were no significant differences between patients who did and did not develop complications in terms of age (60.6 vs 59.9 years, p = 0.71), sex (56% female vs 54% female, p = 0.59), BMI (26.6 vs 27.2, p = 0.40), or presence of comorbidities (52% vs 52.8%, p = 0.87). The risk of complications was higher among patients submitted to spine instrumentation than those submitted to non-instrumented surgery (33% vs 22%), p=0.8. CONCLUSION: Just over one-quarter of patients in the sample developed complications. In this study, age, BMI, comorbidities were not associated with increased risk of complications after spine surgery. The use of instrumentation increased the absolute risk of complications.

Chronic subdural hematoma treatment with adjustment of programmable valve in idiopathic normal pressure hydrocephalus patient: a case report / Tratamento de hematoma subdural em paciente com hidrocefalia de pressão normal idiopática com ajuste da válvula programável: relato de caso

Chronic subdural hematoma (CSDH) is a common entity in daily neurosurgical practice. It is considered a benign condition. Idiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, dementia and/or urinary incontinence added to dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure. We describe an experience of a conservative treatment of subdural hematoma based in the physiopathology and ability to control the pressure in programmable valves. The adjustment of programmable valves in the treatment of INPH allow us the therapeutic control of hydrocephalus and an important tool to manage complications, especially overshunting and undershunting.

O hematoma subdural crônico é uma entidade neurocirúrgica comum, podendo ocorrer como complicação da derivação ventricular em pacientes com hidrocefalia de pressão normal idiopática. Descrevemos nossa experiência de tratamento conservador de hematoma subdural em paciente com derivação ventriculoperitoneal. O ajuste da pressão da válvula permite tanto a otimização terapêutica de pacientes com hidrocefalia de pressão normal idiopática quanto o manejo não invasivo de complicações de menor gravidade, principalmente hipodrenagem e hiperdrenagem.

Programmable valve represents an efficient and safe tool in the treatment of idiopathic normal-pressure hydrocephalus patients.

UNLABELLED: Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. METHODS: In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic) valve, following a protocol based on a positive Tap Test. RESULTS: We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. CONCLUSIONS: The Strata® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH.

Programmable valve represents an efficient and safe tool in the treatment of idiopathic normal-pressure hydrocephalus patients / Válvula de pressão programável representa uma ferramenta eficaz e segura no tratamento de pacientes com hidrocefalia de pressão normal idiopática

Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH. .

A hidrocefalia de pressão normal idiopática (iNPH) é caracterizada por alterações na marcha, demência e/ou incontinência urinária, além de dilatação dos ventrículos com pressão normal de abertura no líquido cefalorraquidiano. A cirurgia de derivação é o principal tratamento da iNHP. São recomendadas válvulas programáveis, pois a pressão de drenagem pode ser alterada. Embora as válvulas programáveis sejam utilizadas, não há protocolos para atingir a pressão adequada de cada paciente. Métodos: Neste estudo, relatamos nossa experiência com 24 pacientes com iNPH que usaram a válvula Strata® (Medtronic), seguindo protocolo baseado em um Tap test positivo. Resultados: Observamos melhora em 20 pacientes e estabilidade ou piora em 4. Ocorreram complicações em cinco pacientes, tendo um deles falecido. Houve importante melhora clínica, e as complicações ocorreram em taxa mais baixa do que as relatadas em outros estudos. Conclusões: A válvula Strata® utilizada no protocolo proposto representa uma ferramenta eficiente e segura no tratamento de iNPH. .

Paraplegia secundária a tratamento com quiropraxia em paciente com mieloma múltiplo não diagnosticado / Paraplegia following massage therapy intervention in a patient with undiagnosed multiple myeloma

Introdução: Devido à disponibilidade crescente de terapias alternativas para o tratamento de dor nas costas e acesso por vezesdifícil de avaliações médicas especializadas, há um amplo uso de terapias alternativas para o tratamento de dor nas costas.Descrição do Caso: Descrevemos um caso com uma consequência catastrófica de massagem terapêutica em um paciente comsintomas iniciais de dor nas costas, resultando em paraplegia definitiva e discutimos as necessidades de diagnóstico médico paraqualquer tratamento. Discussão e Conclusão: Discutir os danos potenciais ao paciente, ao iniciar um método de tratamentoquestionável, que são o diagnóstico retardado, dano físico direto, interferência com tratamentos tradicionais, prejuízosfinanceiros e perda de tempo. Os tratamentos alternativos são ferramentas valiosas para controlar os sintomas refratários,especialmente a dor. Mas reforçamos a necessidade do rastreio médico adequado antes de realizar terapias que podem trazer...

Introduction: Due to increased number of available alternative therapies to the treatment of back pain and sometimes a difficultaccess to specialized medical evaluations, there is a widespread use of alternative therapies for the treatment of back pain.Case Description: We describe a case with a catastrophic consequence of massage therapy in a patient with initial symptomsof back pain resulting in definitive paraplegia and discuss the needs for medical diagnosis for any treatment. Discussion andConclusion: We discuss the potencial harms to the patient when initiating a questionable treatment method, which are latediagnosis, direct physical harm, interference with tradiotional treatments, financial harm and time loss. Alternative treatmentsare valuable tools to control refractory symptoms, especially pain....

Do children with Glasgow 13/14 could be identified as mild traumatic brain injury?

OBJECTIVE: To identify in mild head injured children the major differences between those with a Glasgow Coma Scale (GCS) 15 and GCS 13/14. METHOD: Cross-sectional study accomplished through information derived from medical records of mild head injured children presented in the emergency room of a Pediatric Trauma Centre level I, between May 2007 and May 2008. RESULTS: 1888 patients were included. The mean age was 7.6 + or - 5.4 years; 93.7% had GCS 15; among children with GCS 13/14, 46.2% (p<0.001) suffered multiple traumas and 52.1% (p<0.001) had abnormal cranial computed tomography (CCT) scan. In those with GCS 13/14, neurosurgery was performed in 6.7% and 9.2% (p=0.001) had neurological disabilities. CONCLUSION: Those with GCS 13/14 had frequently association with multiple traumas, abnormalities in CCT scan, require of neurosurgical procedure and Intensive Care Unit admission. We must be cautious in classified children with GCS 13/14 as mild head trauma victims.

Do children with Glasgow 13/14 could be identified as mild traumatic brain injury? / Pacientes pediátricos com Glasgow 13 ou 14 podem ser identificados como traumatismo craniano leve?

OBJECTIVE: To identify in mild head injured children the major differences between those with a Glasgow Coma Scale (GCS) 15 and GCS 13/14. METHOD: Cross-sectional study accomplished through information derived from medical records of mild head injured children presented in the emergency room of a Pediatric Trauma Centre level I, between May 2007 and May 2008. RESULTS: 1888 patients were included. The mean age was 7.6±5.4 years; 93.7 percent had GCS 15; among children with GCS 13/14, 46.2 percent (p<0.001) suffered multiple traumas and 52.1 percent (p<0.001) had abnormal cranial computed tomography (CCT) scan. In those with GCS 13/14, neurosurgery was performed in 6.7 percent and 9.2 percent (p=0.001) had neurological disabilities. CONCLUSION: Those with GCS 13/14 had frequently association with multiple traumas, abnormalities in CCT scan, require of neurosurgical procedure and Intensive Care Unit admission. We must be cautious in classified children with GCS 13/14 as mild head trauma victims.

OBJETIVO: Identificar as principais diferenças entre os pacientes com Escala de Coma de Glasgow (GCS) 15 e aqueles com escore 13/14. MÉTODO: Estudo realizado por meio da revisão de prontuários médicos de crianças vítimas de traumatismo craniencefálico leve, admitidas em Centro de Urgências Pediátricas nível I, durante um ano. RESULTADOS: Incluídas 1888 vítimas; idade média de 7,6±5,4 anos; 93,7 por cento apresentaram pontuação 15 na GCS. Naqueles com pontuação 13/14, 46,2 por cento (p<0,001) sofreram traumas múltiplos e 52,1 por cento (p<0,001) apresentaram alterações na tomografia de crânio. Tratamento neurocirúrgico foi necessário em 6,7 por cento dos pacientes com GCS 13/14 e 9,2 por cento (p=0,001) apresentaram seqüelas neurológicas no momento da alta hospitalar. CONCLUSÃO: Crianças com escore 13/14 apresentam maior prevalência de traumas múltiplos, alterações na tomografia de crânio, necessidade de tratamento neurocirúrgico e internação em Unidade de Terapia Intensiva. Devemos ser cautelosos ao classificar crianças com pontuação 13/14 na GCS como vítimas de traumatismo craniano leve.

Acute hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury.

PURPOSE: Hyperglycemia in the acute phase after trauma could adversely affect outcome in children with severe traumatic brain injury (TBI). The goal of this study was to identify the relationship between acute spontaneous hyperglycemia and outcome in children with severe TBI at hospital discharge and 6 months later. METHODS: A retrospective analysis of blood glucose levels in children with severe TBI at a Pediatric level I Trauma Center, between January 2000 and December 2005. Hyperglycemia was considered for a cut-off value of 11.1 mmol/l (200 mg/dl). Outcome was measured with Glasgow Outcome Scale (GOS) at hospital discharge and at 6 months. A multiple logistic regression analysis, the Student's t test and the chi (2) test were done. RESULTS: Hyperglycemia was noted within the first 48 h in 34% of the patients. Mortality (70% vs 14%, p < 10(-5)) was more frequent in hyperglycemic children and bad outcome upon hospital discharge in those who remained hyperglycemic during the first 48 h of hospitalization. GOS after 6 months demonstrated that those normoglycemic children had a better outcome (95%) than those who developed hyperglycemia during the first 48 h (83%, p = 0.01) after trauma. CONCLUSION: Hyperglycemia could be considered as a marker of brain injury and when present upon admission, could reflect extensive brain damage with frequently associated mortality and bad outcome. The inability to maintain normal blood glucose levels during the first 48 h could be a predictive factor of bad outcome. Avoiding hyperglycemia in the initial phase could be a major issue in children with severe TBI.

Hyperglycemia in pediatric head trauma patients: a cross-sectional study.

OBJECTIVE: To verify the prevalence of acute hyperglycemia in children with head trauma stratified by the Glasgow coma scale (GCS). METHOD: A prospective cross-sectional study carried out with information from medical records of pediatric patients presenting with head injury in the emergency room of a referral emergency hospital during a one year period. We considered the cut-off value of 150 mg/dL to define hyperglycemia. RESULTS: A total of 340 children were included and 60 (17.6%) had admission hyperglycemia. Hyperglycemia was present in 9% of mild head trauma cases; 30.4% of those with moderate head trauma and 49% of severe head trauma. We observed that among children with higher blood glucose levels, 85% had abnormal findings on cranial computed tomography scans. CONCLUSION: Hyperglycemia was more prevalent in patients with severe head trauma (GCS <8), regardless if they had or not multiple traumas and in children with abnormal findings on head computed tomography scans.

Hyperglycemia in pediatric head trauma patients: a cross-sectional study / Hiperglicemia em pacientes pediátricos com traumatismo craniencefálico: estudo de corte transversal

OBJECTIVE: To verify the prevalence of acute hyperglycemia in children with head trauma stratified by the Glasgow coma scale (GCS). METHOD: A prospective cross-sectional study carried out with information from medical records of pediatric patients presenting with head injury in the emergency room of a referral emergency hospital during a one year period. We considered the cut-off value of 150 mg/dL to define hyperglycemia. RESULTS: A total of 340 children were included and 60 (17.6 percent) had admission hyperglycemia. Hyperglycemia was present in 9 percent of mild head trauma cases; 30.4 percent of those with moderate head trauma and 49 percent of severe head trauma. We observed that among children with higher blood glucose levels, 85 percent had abnormal findings on cranial computed tomography scans. CONCLUSION: Hyperglycemia was more prevalent in patients with severe head trauma (GCS <8), regardless if they had or not multiple traumas and in children with abnormal findings on head computed tomography scans.

OBJETIVO: Verificar a prevalência de hiperglicemia aguda em crianças vítimas de trauma craniencefálico, de acordo com a escala de coma de Glasgow (GCS). MÉTODO: Estudo prospectivo, de corte transversal realizado por meio do acompanhamento de prontuários médicos de pacientes na faixa etária pediátrica admitidos na unidade de urgência de um hospital de referência vítimas de traumatismo craniencefálico, durante um ano. Consideramos o valor de corte em 150 mg/dL para definição de hiperglicemia. RESULTADOS: 340 crianças foram incluídas no estudo e 60 (17,6 por cento) apresentaram hiperglicemia na admissão. Hiperglicemia esteve presente em 9 por cento dos casos de trauma craniano leve, 30,4 por cento daqueles com trauma craniano moderado e em 49 por cento dos pacientes com trauma craniano grave. Verificamos que, entre as crianças com níveis elevados de glicemia, 85 por cento apresentavam alterações radiológicas verificadas na tomografia computadorizada do crânio. CONCLUSÃO: A hiperglicemia foi mais prevalente em pacientes com traumatismo craniano grave (GCS <8), assim como naqueles com alterações identificadas na tomografia computadorizada do crânio, independente da presença de politraumatismo.

Skull radiographs and computed tomography scans in children and adolescents with mild head trauma.

OBJECTIVE: To identify which pediatric patients with mild head trauma are candidates for skull radiographs or cranial computed tomography (CCT) scans. METHOD: Patients with mild head trauma aged from 0 to 19 years presenting to the Emergency Department of a trauma centre from Salvador City, Brazil, between May 2007 and May 2008. RESULTS: A total of 1888 mild head trauma patients were admitted; mean age was 7.4 (+/-5.5) years. A total of 1956 skull radiographs and 734 CCT scans were performed. About 44.4% patients with Glasgow coma score (GCS) 13 and 55.4% with GCS 14 had abnormal CCT scans. In patients with multiple traumas, 16% had abnormal findings on CCT scans. CONCLUSION: We strongly recommend routine CCT studies to patients with GCS of 13 and 14 or to multiple trauma victims, independently of score. Routine screening skull radiographs were not useful in the evaluation of mild head trauma patients in this study.