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1.
J Clin Neurosci ; 90: 345-350, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275573

RESUMO

ABO blood groups are associated with genetically predisposed variations in von Willebrand factor (VWF) resulting in higher risks of thrombotic events in non-O blood types and bleeding complications in blood type O. The role of ABO blood groups in progression of traumatic intracranial hemorrhage (TICH) is unknown. Given statistically lower VWF levels in blood type O in the general population, we hypothesized that blood type O patients have a higher risk of such progression. A retrospective review of adult trauma patients with isolated TICH admitted to a Level 1 trauma center over eight years was conducted. Patients were categorized with blood type O and non-O (types A, B, AB) delineation. The primary outcome was radiological progression of TICH during the first 24 h. Secondary outcomes included surgical intervention after follow-up computed tomography (CT), complications, days on mechanical ventilation (DMV), intensive care unit (ICU) length of stay (LOS), hospital LOS, and mortality. Of 949 patients, 432 (45.5%) had blood type O. When comparing O and non-O groups, no significant differences were found in gender, age, race, admission vital signs, Glasgow Coma Scale, coagulation profile, TICH type, or Injury Severity Score. No difference in TICH progression was found between O and non-O groups: 73 (17%) vs 80 (15%), respectively, p = 0.55. Blood type O mortality was 12 (3% vs. 23 (4%), p = 0.174). Rate of TICH surgical intervention after follow-up CT, DMV, complications, and ICU and hospital LOS did not differ. No association between ABO blood types and radiological progression of TICH was identified.


Assuntos
Sistema ABO de Grupos Sanguíneos , Hemorragia Intracraniana Traumática/sangue , Adulto , Idoso , Cuidados Críticos , Progressão da Doença , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Hemorragia Intracraniana Traumática/diagnóstico por imagem , Hemorragia Intracraniana Traumática/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Respiração Artificial , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fator de von Willebrand
2.
Ulus Travma Acil Cerrahi Derg ; 27(4): 427-433, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34212990

RESUMO

BACKGROUND: In this study, we aimed to evaluate the outcomes of patients transported by Helicopter Emergency Medical Services in East Azerbaijan Province. METHODS: This retrospective cross-sectional study was conducted on patients transported by the HEMS centre of Tabriz from August 2014 to March 2017. Records of the centre were used to collect data. Statistical analysis was performed by SPSS software version 20; the statistical significance level was considered below 0.05. RESULTS: In this study, 268 patients were transferred to Tabriz hospitals by 167 missions performed. The mean age of patients was 34.26±19.43, and 173 (65%) patients were male. The most common reason for call-out was the need for professional care (91.4%). The target of the majority of missions was on countryside routes. The mean distance of destinations was about 99.13±35.9 Kms, with a mean transference time of 54.68±14.17 minutes, while the mean estimated ground route time was 86.38±26.26 minutes. The most prevalent diagnosis was trauma; The Glasgow Coma Scale (GCS) and vital signs of the majority of patients were above 13 and stable, respectively. About 98 percent of patients received fluid therapy, and 71 percent were immobilized, and only 6 percent needed intubation. Also, 28 percent of patients needed Intensive Care Unit (ICU), 56 percent of whom passed away later. CONCLUSION: Our results suggest that Tabriz HEMS missions have reduced the patient transport time and also made the mortality rate closer to international standards.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Ferimentos e Lesões , Adolescente , Adulto , Azerbaijão/epidemiologia , Estudos Transversais , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia , Adulto Jovem
3.
Medicine (Baltimore) ; 100(25): e26458, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160445

RESUMO

ABSTRACT: The aim of this study was to investigate the associations between the levels of neuron-specific enolase (NSE) and S100B protein and coma duration, and evaluate the optimal cut-off values for prediction coma duration ≥ 72 hours in patients with acute carbon monoxide poisoning (ACOP).A total of 60 patients with ACOP were divided into 3 following groups according to their status of consciousness and coma duration at admission: Awake group [Glasgow Coma Scale score (GCS score) ≥ 13 points], Coma < 72 hours group (GCS score < 13 points and coma duration < 72 h), and Coma ≥ 72 hours group (GCS score < 13 points and coma duration ≥ 72 h). The levels of serum NSE and S100B protein were measured after admission.There were significant differences in GCS score, carbon monoxide (CO) exposure time, NSE, and S100B levels between the Coma ≥ 72 h group and the Awake group, and between the Coma < 72 h group and the Awake group. Significant differences in GCS score, NSE, and S100B levels were also found between Coma ≥ 72 h group and Coma < 72 h group. Correlation analysis showed that NSE and S100B were positively correlated (rs = 0.590, P < .01); NSE and S100B were negatively correlated with GCS score (rs = -0.583, rs = -0.590, respectively, both P < .01). The areas under the curve (AUCs) of NSE, S100B, and GCS score to predict the coma duration ≥ 72 hours were 0.754, 0.791, and 0.785, respectively. Pairwise comparisons did not show differences among the 3 groups (all P > .05). The sensitivity and specificity of NSE prediction with a cut-off value of 13 µg/L were 80% and 64%, respectively, and those of S100B prediction with a cut-off value of 0.43 µg/L were 70% and 88%, respectively.The NSE and S100B protein levels were significantly correlated with the degree of impaired consciousness and had the same clinical value in predicting coma duration of ≥ 72 hours in patients with ACOP.


Assuntos
Intoxicação por Monóxido de Carbono/complicações , Coma/diagnóstico , Fosfopiruvato Hidratase/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Doença Aguda , Adulto , Biomarcadores/sangue , Intoxicação por Monóxido de Carbono/sangue , Intoxicação por Monóxido de Carbono/diagnóstico , Carboxihemoglobina/análise , Coma/sangue , Coma/etiologia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Valores de Referência , Fatores de Tempo
4.
J Clin Neurosci ; 89: 51-55, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119294

RESUMO

The goal of this study is to develop a model based on previously used prognostic predictors in traumatic brain injury (TBI) patients with polytrauma, which will facilitate the decision-making of whether to clear these patients for non-cranial surgery. Data of eligible patients was obtained from a trauma database at a Level I trauma and academic tertiary referral center in the United States. The number of days seen by the neurosurgical service prior to clearance, injury severity score (ISS), post-trauma day 0 (PTD 0) of Glasgow Coma Score (GCS), intracranial pressure (ICP) score and computed tomography (CT) score, as well as the changes in GCS, ICP score and CT score between PTD 0 and day of clearance were the variables used in developing the model. The Neurosurgical Clearance Model (NCM) was developed using data from 50 patients included in the study. Patients were cleared by neurosurgeons 1.6 days later than it would appear possible based on a retrospective review of the patients' clinical conditions. A single model equation was developed, the ultimate result of which is a clearance probability value. The best cutoff clearance probability value was found to be 0.584 (or 58.4%) using Receiver Operator Characteristic curve analysis. Our data suggests that neurosurgeons are risk-averse in clearing polytrauma patients for non-cranial surgery. This pilot NCM, if reproduced and validated by other groups and in larger prospective studies, may become a useful tool to assist clinicians in this often-difficult decision-making process.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/cirurgia , Escala de Gravidade do Ferimento , Traumatismo Múltiplo/diagnóstico por imagem , Traumatismo Múltiplo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/tendências , Adulto Jovem
5.
BMJ Case Rep ; 14(6)2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34140326

RESUMO

A 45-year-old Caucasian man was admitted to hospital following a collapse at home. On admission, this patient was noted to have a Glasgow Coma Scale (GCS) Score of 9 out of 15, fever and tachypnoea. The patient was identified to have bilateral limb weakness, predominately on the left side, with associated dysphagia. Radiological imaging demonstrated bilateral multifocal intracranial haemorrhage and subarachnoid haemorrhage. Neurosurgical input was sought; the outcome of this was a decision to manage the patient conservatively, without surgical intervention. Of note, his urine drug testing revealed a positive result for a cocktail of drugs including cocaine, benzoylecgonine (cocaine metabolite), methadone, heroin, norbuprenorphine and benzodiazepine. Throughout the admission, the patient was monitored in an intensive care setting. The patient received support with feeding, speech and mobilisation. The patients' GCS improved throughout the admission. Following a 30-day admission, the patient walked home.


Assuntos
Cocaína , Hemorragia Subaracnóidea , Escala de Coma de Glasgow , Humanos , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Resultado do Tratamento
6.
Lancet Neurol ; 20(7): 548-558, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34146513

RESUMO

BACKGROUND: The indications for intracranial pressure (ICP) monitoring in patients with acute brain injury and the effects of ICP on patients' outcomes are uncertain. The aims of this study were to describe current ICP monitoring practises for patients with acute brain injury at centres around the world and to assess variations in indications for ICP monitoring and interventions, and their association with long-term patient outcomes. METHODS: We did a prospective, observational cohort study at 146 intensive care units (ICUs) in 42 countries. We assessed for eligibility all patients aged 18 years or older who were admitted to the ICU with either acute brain injury due to primary haemorrhagic stroke (including intracranial haemorrhage or subarachnoid haemorrhage) or traumatic brain injury. We included patients with altered levels of consciousness at ICU admission or within the first 48 h after the brain injury, as defined by the Glasgow Coma Scale (GCS) eye response score of 1 (no eye opening) and a GCS motor response score of at least 5 (not obeying commands). Patients not admitted to the ICU or with other forms of acute brain injury were excluded from the study. Between-centre differences in use of ICP monitoring were quantified by using the median odds ratio (MOR). We used the therapy intensity level (TIL) to quantify practice variations in ICP interventions. Primary endpoints were 6 month mortality and 6 month Glasgow Outcome Scale Extended (GOSE) score. A propensity score method with inverse probability of treatment weighting was used to estimate the association between use of ICP monitoring and these 6 month outcomes, independently of measured baseline covariates. This study is registered with ClinicalTrial.gov, NCT03257904. FINDINGS: Between March 15, 2018, and April 30, 2019, 4776 patients were assessed for eligibility and 2395 patients were included in the study, including 1287 (54%) with traumatic brain injury, 587 (25%) with intracranial haemorrhage, and 521 (22%) with subarachnoid haemorrhage. The median age of patients was 55 years (IQR 39-69) and 1567 (65%) patients were male. Considerable variability was recorded in the use of ICP monitoring across centres (MOR 4·5, 95% CI 3·8-4·9 between two randomly selected centres for patients with similar covariates). 6 month mortality was lower in patients who had ICP monitoring (441/1318 [34%]) than in those who were not monitored (517/1049 [49%]; p<0·0001). ICP monitoring was associated with significantly lower 6 month mortality in patients with at least one unreactive pupil (hazard ratio [HR] 0·35, 95% CI 0·26-0·47; p<0·0001), and better neurological outcome at 6 months (odds ratio 0·38, 95% CI 0·26-0·56; p=0·0025). Median TIL was higher in patients with ICP monitoring (9 [IQR 7-12]) than in those who were not monitored (5 [3-8]; p<0·0001) and an increment of one point in TIL was associated with a reduction in mortality (HR 0·94, 95% CI 0·91-0·98; p=0·0011). INTERPRETATION: The use of ICP monitoring and ICP management varies greatly across centres and countries. The use of ICP monitoring might be associated with a more intensive therapeutic approach and with lower 6-month mortality in more severe cases. Intracranial hypertension treatment guided by monitoring might be considered in severe cases due to the potential associated improvement in long-term clinical results. FUNDING: University of Milano-Bicocca and the European Society of Intensive Care Medicine.


Assuntos
Lesões Encefálicas/fisiopatologia , Pressão Intracraniana/fisiologia , Monitorização Fisiológica/métodos , Adulto , Idoso , Lesões Encefálicas/metabolismo , Lesões Encefálicas Traumáticas/terapia , Estudos de Coortes , Cuidados Críticos , Feminino , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Unidades de Terapia Intensiva , Hipertensão Intracraniana , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Artigo em Russo | MEDLINE | ID: mdl-34156207

RESUMO

BACKGROUND: The risk and benefits of early neurosurgical intervention in patients with non-traumatic intracerebral hematoma (NICH) are still unclear. OBJECTIVE: To evaluate an effectiveness of early surgery in patients with NICH compared to primary conservative therapy. MATERIAL AND METHODS: There were 115 patients with indications for surgery. The indications were supratentorial NICH over 30 cm3 and GCS score >7 points. All patients were divided into 2 groups: the main group (n=59) - NICH removal within 24 hours; the control group (n=56) - conservative treatment only. Both groups were comparable by the main clinical, demographic and neuroimaging characteristics. We analyzed survival rates and functional status using Glasgow outcome scale extended (GOSE) 6 months later. RESULTS: Median survival in the main group was 71 days vs. 11 days in the control group (p<0.05); cumulative 6-month survival - 46% and 34%, respectively (p>0.05). Surgical treatment resulted higher number of patients with severe (13% vs. 5%) and moderate disability (29% vs. 23%). There were 2% of patients with good recovery in the group of surgical treatment and 4% of patients after conservative management. However, between-group differences were not significant (p>0.05). CONCLUSION: Early surgical evacuation of non-traumatic intracerebral hematoma is accompanied by less early postoperative mortality. There were no significant between-group differences in functional outcomes and survival rates after 6 months.


Assuntos
Tratamento Conservador , Hematoma , Hemorragia Cerebral , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Resultado do Tratamento
8.
Clin Chim Acta ; 520: 101-107, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34102135

RESUMO

BACKGROUND: Calprotectin plays an important role during inflammation. We intended to explore the prognostic value of serum calprotectin levels in patients with severe traumatic brain injury (sTBI). METHODS: In this prospective cohort study of 149 sTBI patients, we determined the relationship between serum calprotectin levels and 90-day overall survival plus poor outcome (Glasgow outcome scale score of 1-3) after sTBI, and analyzed its associations with Rotterdam computerized tomography (CT) scores, Glasgow coma scale (GCS) scores and two markers of inflammatory reaction including serum C-reactive protein levels and blood leucocyte count. RESULTS: Serum calprotectin levels were significantly correlated with Rotterdam CT scores, GCS scores, serum C-reactive protein levels and blood leucocyte count. Patients with poor outcome at 90 days displayed higher serum calprotectin levels than the other remainders. Serum calprotectin appeared as an independent predictor for 90-day overall survival and poor outcome. Under receiver operating characteristic curve, serum calprotectin levels exhibited an efficient discrimination capacity for 90-day poor outcome. CONCLUSIONS: Serum calprotectin levels are significantly correlated with inflammation, trauma severity and poor outcome at 90 days in sTBI patients, suggesting that serum calprotectin may be a biomarker for providing complementary prognostic information to identify patients at risk of poor outcome after sTBI.


Assuntos
Lesões Encefálicas Traumáticas , Complexo Antígeno L1 Leucocitário , Lesões Encefálicas Traumáticas/diagnóstico , Escala de Coma de Glasgow , Humanos , Prognóstico , Estudos Prospectivos
9.
Scand J Trauma Resusc Emerg Med ; 29(1): 75, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078435

RESUMO

BACKGROUND: The biomarker serum S100 calcium-binding protein B (S100B) is used in in-hospital triage of adults with mild traumatic brain injury to rule out intracranial lesions. The biomarker glial fibrillary acidic protein (GFAP) is suggested as a potential diagnostic biomarker for traumatic brain injury. The aim of this study was to investigate the diagnostic accuracy of early prehospital S100B and GFAP measurements to rule out intracranial lesions in adult patients with mild traumatic brain injury. METHODS: Prehospital and in-hospital blood samples were drawn from 566 adult patients with mild traumatic brain injury (Glasgow Coma Scale Score 14-15). The index test was S100B and GFAP concentrations. The reference standard was endpoint adjudication of the traumatic intracranial lesion based on medical records. The primary outcome was prehospital sensitivity of S100B in relation to the traumatic intracranial lesion. RESULTS: Traumatic intracranial lesions were found in 32/566 (5.6%) patients. The sensitivity of S100B > 0.10 µg/L was 100% (95%CI: 89.1;100.0) in prehospital samples and 100% (95% CI 89.1;100.0) in in-hospital samples. The specificity was 15.4% (95%CI: 12.4;18.7) in prehospital samples and 31.5% (27.5;35.6) in in-hospital samples. GFAP was only detected in less than 2% of cases with the assay used. CONCLUSION: Early prehospital and in-hospital S100B levels < 0.10 µg/L safely rules out traumatic intracranial lesions in adult patients with mild traumatic brain injury, but specificity is lower with early prehospital sampling than with in-hospital sampling. The very limited cases with values detectable with our assay do not allow conclusions to be draw regarding the diagnostic accuracy of GFAP. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02867137 .


Assuntos
Concussão Encefálica/sangue , Concussão Encefálica/diagnóstico , Proteína Glial Fibrilar Ácida/sangue , Subunidade beta da Proteína Ligante de Cálcio S100/sangue , Idoso , Biomarcadores/sangue , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/diagnóstico , Estudos de Coortes , Serviços Médicos de Emergência , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos
10.
Medicine (Baltimore) ; 100(19): e25815, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106620

RESUMO

ABSTRACT: There are many grading scales that attempt to predict outcome following aneurysmal subarachnoid hemorrhage (aSAH). Most scales used to assess outcome are based on the neurological status of the patient. Here, we propose a new scale for aSAH patients that combines the Glasgow Coma Scale (GCS) and the modified Fisher scale (mFS).Five hundred ninety-seven patients with aSAH who were treated at our institution between January 2008 and December 2017 were retrospectively analyzed. Initial GCS score, Hunt and Hess scale, World Federation of Neurosurgical Societies scale, mFS, and modified Rankin Scale were obtained by reviewing data. Incidence of vasospasm was investigated. Factors found to be significant on a multivariable regression analysis were used to develop a scale that was compared with other grading systems using the area under the curve (AUC) calculated from receiver operating characteristic curve.The GCS score and mFS were related to outcomes in patients with aSAH. A simple score, which we call the GCS-F score, was calculated using these initial data. The GCS-F score had an AUC of 90.5% for unfavorable outcome prediction, and 88.4% for in-hospital mortality prediction. On the receiver operating characteristic curve analysis for vasospasm, the AUC for World Federation of Neurosurgical Societies, mFS and GCS-F scores were 0.912, 0.704, and 0.936, respectively.A simple arithmetic combination of the GCS score and mFS, the GCS-F score, includes the radiographic status as well as the clinical status of the patient, so that the state of the patient can be known in more detail than other single scales. The GCS-F score may be a useful scale for predicting outcome and the occurrence of vasospasm in patients with aSAH.


Assuntos
Escala de Coma de Glasgow , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Hemorragia Subaracnóidea/mortalidade
11.
Medicine (Baltimore) ; 100(22): e26258, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087916

RESUMO

ABSTRACT: We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%-77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%-78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%-16.5%, P = 0.07, Fisher Exact test).Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.


Assuntos
Acidentes por Quedas/prevenção & controle , Serviços de Saúde para Idosos/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controle , Acidentes por Quedas/mortalidade , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Escala de Coma de Glasgow/normas , Escala de Coma de Glasgow/estatística & dados numéricos , Serviços de Saúde para Idosos/tendências , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Estudos Prospectivos , Sistema de Registros , Emirados Árabes Unidos/epidemiologia , Ferimentos e Lesões/mortalidade
12.
BMJ Open ; 11(6): e047305, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108167

RESUMO

INTRODUCTION: Severe traumatic brain injury (TBI) is a catastrophic neurological condition with significant economic burden. Early in-hospital mortality (<48 hours) with severe TBI is estimated at 50%. Several clinical examinations exist to determine brain death; however, most are difficult to elicit in the acute setting in patients with severe TBI. Having a definitive assessment tool would help predict early in-hospital mortality in this population. CT perfusion (CTP) has shown promise diagnosing early in-hospital mortality in patients with severe TBI and other populations. The purpose of this study is to validate admission CTP features of brain death relative to the clinical examination outcome for characterizing early in-hospital mortality in patients with severe TBI. METHODS AND ANALYSIS: The Early Diagnosis of Mortality using Admission CT Perfusion in Severe Traumatic Brain Injury Patients study, is a prospective cohort study in patients with severe TBI funded by a grant from the Canadian Institute of Health Research. Adults aged 18 or older, with evidence of a severe TBI (Glasgow Coma Scale score ≤8 before initial resuscitation) and, on mechanical ventilation at the time of imaging are eligible. Patients will undergo CTP at the time of first imaging on their hospital admission. Admission CTP compares with the reference standard of an accepted bedside clinical assessment for brainstem function. Deferred consent will be used. The primary outcome is a binary outcome of mortality (dead) or survival (not dead) in the first 48 hours of admission. The planned sample size for achieving a sensitivity of 75% and a specificity of 95% with a CI of ±5% is 200 patients. ETHICS AND DISSEMINATION: This study has been approved by the University of Manitoba Health Research Ethics Board. The findings from our study will be disseminated through peer-reviewed journals and presentations at local rounds, national and international conferences. The public will be informed through forums at the end of the study. TRIAL REGISTRATION NUMBER: NCT04318665.


Assuntos
Lesões Encefálicas Traumáticas , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Canadá , Diagnóstico Precoce , Escala de Coma de Glasgow , Humanos , Perfusão , Estudos Prospectivos , Tomografia Computadorizada por Raios X
13.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(5): 609-612, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34112303

RESUMO

OBJECTIVE: To examine whether the combination of quantitative regional apparent diffusion coefficient (ADC) and amplitude-integrated electroencephalogram (aEEG) can predict the outcome of comatose patients with severe traumatic brain injury (sTBI). METHODS: A prospective study was conducted. The patients with coma caused by sTBI [Glasgow coma scale (GCS) < 8] admitted to Suqian First Hospital from January 2016 to June 2019 were enrolled. All patients underwent aEEG examination and magnetic resonance imaging (MRI) scan within 1 week after emergency treatment. The ADC values of 9 regions of interest (frontal gray matter and white matter, parietal gray matter and white matter, temporal gray matter and white matter, caudate nucleus of basal ganglia, lenticular nucleus and thalamus) were measured by head MRI, and the mean ADC values of frontal lobe, parietal lobe, temporal lobe and basal ganglia were calculated respectively. According to the follow-up results after 12 months, the differences of each index between patients with poor prognosis [Glasgow outcome score (GOS) 1-2] and patients with good prognosis (GOS 3-5) were compared; the receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive ability of aEEG and ADC for the good prognosis of patients with sTBI, and the predictive value of the combination of aEEG and ADC. RESULTS: A total of 52 patients with sTBI were enrolled, with mean age of (36.7±13.9) years old, 35 of whom were male. Within 12 months follow-up, 29 patients had achieved favorable outcomes and 23 patients had unfavorable outcome. There were 21, 17 and 14 patients with aEEG, and grade, respectively, and 19, 10 and 0 patients had good prognosis respectively. ADC values of 9 regions of interest in patients with good prognosis were significantly higher than those in patients with poor prognosis (×10-6 mm2/s: 924±107 vs. 531±87 in frontal gray matter, 804±95 vs. 481±74 in frontal white matter, 831±93 vs. 683±72 in temporal gray matter, 726±87 vs. 654±63 in temporal white matter, 767±79 vs. 690±75 in parietal gray matter, 716±84 vs. 642±62 in parietal white matter, 689±70 vs. 465±68 in caudate nucleus, 723±84 vs. 587±71 in lenticular nucleus, 807±79 vs. 497±67 in thalamus, all P < 0.01). ROC curve analysis showed that the area under ROC curve (AUC) of aEEG for predicting good prognosis of sTBI patients was 0.826, when the cut-off value of aEEG was < 1.5, the sensitivity was 94.7% and the specificity was 72.8%. Among the ADC value prediction abilities in the interested areas, the prediction of ADC value in frontal lobe and basal ganglia area were better than that in sTBI patients. AUC was 0.817 and 0.903 respectively. The best cut-off values were > 726×10-6 mm2/s and > 624×10-6 mm2/s respectively, the sensitivity of predicting prognosis were both 100%, and the specificity was 63.4% and 61.8%. A model combining frontal ADC and basal ganglia ADC with aEEG was 91.0% sensitive and 93.7% specific for favorable outcome of sTBI patients. CONCLUSIONS: Combination of the quantitative measurement of regional ADC and aEEG may be useful for predicting the outcome of the patients with sTBI.


Assuntos
Lesões Encefálicas Traumáticas , Coma , Adulto , Encéfalo , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Coma/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Eletroencefalografia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Adulto Jovem
14.
BMJ Open ; 11(6): e045771, 2021 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-34088707

RESUMO

OBJECTIVES: Since 2000/2001, no large-scale prospective studies addressing traumatic brain injury (TBI) epidemiology in Germany have been published. Our aim was to look for a possible shift in TBI epidemiology described in other European countries, to look for possible changes in TBI management and to identify predictors of 1-year outcome especially in patients with mild TBI. DESIGN: Observational cohort study. SETTING: All patients suffering from a TBI of any degree between 1 October 2014 and 30 September 2015, and who arrived in one of the seven participating BG hospitals within 24 hours after trauma, were included. PARTICIPANTS: In total, 3514 patients were included. OUTCOME MEASURES: Initial care, acute hospital care and rehabilitation were documented using standardised documentation forms. A standardised telephone interview was conducted 3 and 12 months after TBI in order to obtain information on outcome. RESULTS: Peaks were identified in males in the early 20s and mid-50s, and in both sexes in the late 70s, with 25% of all patients aged 75 or older. A fall was the most frequent cause of TBI, followed by traffic accidents (especially bicyclists). The number of head CT scans increased, and the number of conventional X-rays of the skull decreased compared with 2000/2001. Besides, more patients were offered rehabilitation than before. Though most TBI were classified as mild, one-third of the patients participating in the telephone interview after 12 months still reported troubles attributed to TBI. Negative predictors in mild TBI were female gender, intracranial bleeding and Glasgow Coma Scale (GCS) 13/14. CONCLUSION: The observed epidemiologic shift in TBI (ie, elderly patients, more falls, more bicyclists) calls for targeted preventive measures. The heterogeneity behind the diagnosis 'mild TBI' emphasises the need for defining subgroups not only based on GCS.


Assuntos
Lesões Encefálicas Traumáticas , Idoso , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/terapia , Estudos de Coortes , Europa (Continente) , Feminino , Alemanha/epidemiologia , Escala de Coma de Glasgow , Hospitais , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
15.
Seizure ; 89: 81-84, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34023655

RESUMO

PURPOSE: The aim of the current study was to investigate the risk factors for post-traumatic epilepsy (PTE) in a large cohort of patients after severe non-penetrating civilian traumatic brain injury (TBI). METHODS: This was a longitudinal study. All patients with a severe non-penetrating TBI, who were admitted at the neuro-intensive care unit of Shahid Rajaee Trauma Hospital, affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, from 2015 until 2019, were studied. Severe TBI was defined as a Glasgow Coma Scale-Motor score below six. Post-traumatic epilepsy was defined as any seizures that occurred after being discharged from the hospital. RESULTS: In total, 803 patients with severe non-penetrating TBI were studied; 82 patients (10.2%) reported any late post-traumatic seizures (PTSs). A higher Glasgow outcome scale (extended) at discharge was significantly inversely associated with PTE [Odds Ratio (OR)= 0.76, 95% Confidence Interval (CI): 0.65-0.87; p = 0.0001]. Depressed skull fracture (OR= 1.88, 95% CI: 0.92-3.80; p = 0.081), epi­dural hematoma (OR= 1.67, 95% CI: 0.93-2.97; p = 0.083), and sub-dural hematoma (OR= 1.64, 95% CI: 0.96-2.78; p = 0.068) were associated with PTE as trends. CONCLUSION: Our study adds to the literature on the risk of PTE after severe non-penetrating civilian TBI. Our large sample size and also the application of a logistic regression analysis model may suggest that other variables (e.g., depressed skull fracture and intracranial hematoma) are indeed associated with the Glasgow outcome scale (extended) at discharge and that is why they lost their significance in the model.


Assuntos
Epilepsia Pós-Traumática , Epilepsia Pós-Traumática/epidemiologia , Epilepsia Pós-Traumática/etiologia , Escala de Coma de Glasgow , Humanos , Irã (Geográfico)/epidemiologia , Estudos Longitudinais , Fatores de Risco
16.
Clin Chim Acta ; 519: 142-147, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33932407

RESUMO

BACKGROUND: Annexin A1 might be neuroprotective and serum annexin A1 concentrations were markedly declined after severe traumatic brain injury. We determine dthe ability of serum annexin A1 to assess severity and predict prognosis after aneurysmal subarachnoid hemorrhage (aSAH). METHODS: We included 157 aSAH patients and 157 healthy subjects. Serum annexin A1 measurements were measured. A poor outcome was designated as Glasgow outcome scale score of 1-3. Multivariate logistic regression analysis was applied to identify predictors of a poor 6-month outcome. RESULTS: Serum annexin A1 concentrations were significantly lower in patients than in controls. Annexin A1 concentrations were strongly correlated with the World Federation of Neurological Surgeons scale (WFNS) score, Hunt-Hess score, Glasgow coma scale score and modified Fisher score. A total of 59 patients (37.6%) experienced a poor outcome. Serum annexin A1, WFNS score and modified Fisher score emerged as the 3 independent predictors for a poor outcome after aSAH. Under ROC curve analysis, serum annexin A1 had a fair accuracy to predict a poor outcome, AUC of serum annexin A1 concentration was equivalent to those of WFNS score and modified Fisher score and AUC of combination of the 3 factors significantly exceeded that of each one alone. CONCLUSIONS: Annexin A1 may be involved in the occurrence and progression of secondary brain injury after aSAH. Detection of serum annexin A1 may have certain ability for assessment of severity and prediction of long-term prognosis following aSAH.


Assuntos
Anexina A1 , Hemorragia Subaracnóidea , Escala de Coma de Glasgow , Humanos , Prognóstico , Curva ROC , Hemorragia Subaracnóidea/diagnóstico
17.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(4): 543-548, 2021 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-33963713

RESUMO

OBJECTIVE: To explore the value of Glasgow Coma Scale (GCS) score and CT score combined with serum S100B protein level for evaluation of injury severity and predicting early prognosis of acute traumatic brain injury (TBI). OBJECTIVE: A total of 108 patients with TBI admitted within 24 h after injury in the Emergency Department of West China Hospital from May, 2019 to May, 2020 were enrolled in this study. The clinical data, laboratory test results, CT examination, GCS score, Full Outline of Unresponsiveness score, Fisher CT classification, Rotterdam CT score, and serum S100B protein level of the patients were collected upon admission. The patients were followed up for 28 days and divided based on their Glasgow Outcome Scale (GOS) scores into poor prognosis group (GOS 1-3) and good prognosis group (GOS 4-5). The indexes related to poor prognosis were analyzed for their efficacy for predicting the patinets' prognosis. According to the results of head CT, the patients were divided into CT- positive (CT+) group and CT- negative (CT-) group, and the efficacy of serum S100B protein level for predicting CT positivity was evaluated. OBJECTIVE: Compared with those with favorable prognosis, the patients with poor prognosis had significantly lower GCS scores (P < 0.01) and higher Rotterdam CT score and serum S100B protein levels (P < 0.01). Among the 3 index, serum S100B protein level had the highest AUC value (0.79); among the combined indexes, GCS score combined with serum S100B protein had the highest AUC value (0.80). Serum S100B protein level was significantly higher in CT+ group than in CT - group (P < 0.05) with a significant correlation with Rotterdam CT score (r=0.26, P < 0.01). OBJECTIVE: Serum S100B protein level, GCS score, and Rotterdam CT score can be used as indicators for evaluating the severity of acute TBI, and they are all closely related with early prognosis of the patients. The combination of serum S100B protein, GCS score and Rotterdam CT score has better performance than any of the 3 indexes alone for predicting early prognosis of the patients. Serum S100B protein level is correlated with head imaging findings of patients with acute TBI, but its value in selection of appropriate imaging modalities awaits further investigation.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas Traumáticas/diagnóstico por imagem , China , Escala de Coma de Glasgow , Humanos , Prognóstico , Subunidade beta da Proteína Ligante de Cálcio S100 , Tomografia Computadorizada por Raios X
18.
Niger J Clin Pract ; 24(5): 667-673, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34018975

RESUMO

Objective: : We aimed to study the factors affecting the mortality of trauma patients who underwent whole-body computerized tomography (CT) on Emergency department (ED) time frames in a developing emergency care system. Materials and Methods: This is a retrospective analysis of adult patients who received WBCT from August to November for two consecutive years (2014 and 2015). Non-parametric statistical methods were used to compare the patients who died and survived. The Backward logistic regression model was used to define factors significantly affecting mortality. Results: : During 2014, 200 patients out of 827 (24.1%) received WBCT. During 2015, 263 patients out of 951 (27.6%) received WBCT. Four hundred sixteen patients were entered into the analysis. The overall mortality was 3.4% (7% in 2014 and 1% in 2015, P = 0.002). Significant factors found in backward logistic regression model defining factors affecting mortality were ISS (p < 0.0001), Glasgow Coma Scale (GCS) (p = 0.001). CT location (outside the ED in 2014, inside the ED in 2015) showed a very strong trend for affecting mortality (p = 0.054). Patients who had WBCT in the ED had lower ISS (p < 0.0001). CT imaging in the ED decreased ED to CT time 15.5 minutes (p < 0.0001), but admission time was 75.5 minutes longer. Conclusions: ISS and GCS were the main factors predicting mortality in patients who received WBCT. Patients received more WBCT imaging and physicians showed a tendency to order WBCT for less severe patients when the CT located in the ED. CT location did not show a significant effect on mortality, but on some operational time frames.


Assuntos
Tomografia Computadorizada por Raios X , Imagem Corporal Total , Adulto , Serviço Hospitalar de Emergência , Escala de Coma de Glasgow , Humanos , Estudos Retrospectivos
19.
Medicine (Baltimore) ; 100(20): e26032, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011113

RESUMO

ABSTRACT: Smoking is a well-known risk factor for cardio-cerebrovascular disease. However, several studies have reported the "smoker's paradox" whereby smokers have a better prognosis for cardio-cerebrovascular diseases. Similar to cardio-cerebrovascular diseases, hypoxia is one of the major mechanisms of injury in carbon monoxide (CO) poisoning. This study investigated the association between smoking and delayed neuropsychiatric sequelae (DNS) in acute CO poisoning.This study involved patients with CO poisoning treated at a university hospital in Bucheon, Korea between September 2017 and March 2020. The exclusion criteria were age <18 years, discharge against medical advice, loss to follow-up, persistent neurological symptoms at discharge, transfer from another hospital 24 hours after exposure, and transfer from another hospital after hyperbaric oxygen therapy. Logistic regression analysis was performed to find factors associated with DNS.Two hundred sixty three patients visited the hospital due to CO poisoning and of these, 54 were excluded. DNS was evaluated up to 3 months after discharge, and until this time, DNS occurred in 35 (16.8%) patients. And the incidence rate of DNS was lower in smokers than non-smokers (15, 12% vs 20, 23.8%, P = .040). Multivariable logistic regression analysis revealed that CO exposure time (odds ratio [OR] 1.003; confidence interval [CI] 1.001-1.005; P = .003), the Glasgow coma scale (GCS) (OR 0.862; CI 0.778-0.956; P = .005), and pack-years (OR 0.947; CI 0.903-0.993; P = .023) were statistically significant for DNS development.These results indicate that more pack-years smoked were associated with reduced risk of the development of DNS in acute CO poisoning, and that CO exposure time and GCS is a predictive factor for DNS occurrence.


Assuntos
Intoxicação por Monóxido de Carbono/psicologia , Transtornos Mentais/epidemiologia , Fumar , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Transtornos Mentais/prevenção & controle , Pessoa de Meia-Idade , Estudos Prospectivos , República da Coreia , Fatores de Risco
20.
J Neurol Sci ; 426: 117480, 2021 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-33984548

RESUMO

BACKGROUND AND PURPOSE: Blood pressure (BP) control is an integral part in the management of spontaneous nontraumatic intracerebral haemorrhage. The aim of this study is to propose a novel concept of blood pressure control measured as 'Time in Range'(TiR) and assess its relationship to neurological deterioration. METHOD: Retrospective study of 120 patients with Intracerebral haemorrhage who were admitted within 6 h of the symptom onset. The hourly BP readings for initial 24 h were studied in the form of time in range (TiR). TiR was defined as the percentage of readings with 'in range' systolic BP (SBP 110-140mmHG) during a unit time period. TiR was correlated with mean SBP at 6,12,18 and 24 h. It was categorized dichotomously as controlled (more than 50%) or not controlled (equal to or less than 50%) and analyzed with the change in Glasgow coma scale (drop of ≥2 units) at 24 h. RESULTS: Correlation of TiR with mean SBP at 6 and 24 h showed significant negative correlation [r = -0.71 (at 6 h); r = -0.88 (at 24 h); p < 0.001]. The association of TiR with neurological deterioration(ND) was measured by change in GCS; with lower TiR associated with higher chances of neurological deterioration at 12 h interval [OR 4.5(1.2-16.8); p = 0.025], but not at 24 h interval [OR 1.4 (0.34-5.44); p = 0.670]. CONCLUSION: Our novel concept of 'Time in Range'(TiR) was found to be relevant in our study. Its association with mean SBP reflect its potential to be a modality of expressing control of SBP in Spontaneous Nontraumatic Intracerebral Haemorrhage.


Assuntos
Hipertensão , Pacientes Internados , Pressão Sanguínea , Hemorragia Cerebral/complicações , Escala de Coma de Glasgow , Humanos , Hipertensão/complicações , Estudos Retrospectivos
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