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1.
Medicine (Baltimore) ; 100(6): e24438, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578536

RESUMO

ABSTRACT: Despite its public health significance, TBI management across US healthcare institutions and patient characteristics with an emphasis on utilization and outcomes of TBI-specific procedures have not been evaluated at the national level.We aimed to characterize top 10 procedure codes among hospitalized adults with TBI as primary diagnosis by injury severity.A Cross-sectional study was conducted using 546, 548 hospitalization records from the 2004 to 2014 Nationwide Inpatient Sample were analyzed.Data elements of interest included injury, patient, hospital characteristics, procedures, in-hospital death and length of stay.Ten top procedure codes were "Closure of skin and subcutaneous tissue of other sites", "Insertion of endotracheal tube", "Continuous invasive mechanical ventilation for less than 96 consecutive hours", "Venous catheterization (not elsewhere classified)", "Continuous invasive mechanical ventilation for 96 consecutive hours or more", "Transfusion of packed cells", "Incision of cerebral meninges", "Serum transfusion (not elsewhere classified)", "Temporary tracheostomy", and "Arterial catherization". Prevalence rates ranged between 3.1% and 15.5%, with variations according to injury severity and over time. Whereas "Closure of skin and subcutaneous tissue of other sites" was associated with fewer in-hospital deaths and shorter hospitalizations, "Temporary tracheostomy" was associated with fewer in-hospital deaths among moderate-to-severe TBI patients, and "Continuous invasive mechanical ventilation for less than 96 consecutive hours" was associated with shorter hospitalizations among severe TBI patients. Other procedures were associated with worse outcomes.Nationwide, the most frequently reported hospitalization procedure codes among TBI patients aimed at homeostatic stabilization and differed in prevalence, trends, and outcomes according to injury severity.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/patologia , Estudos Transversais , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Classificação Internacional de Doenças , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
2.
J Surg Res ; 257: 101-106, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818778

RESUMO

BACKGROUND: Penetrating traumatic brain injury (pTBI) is the most lethal form of TBI, with mortality rates as high as 90%. This high mortality rate leads many providers to feel that the treatment of pTBI is futile. Contrary to this point of view, several studies have shown that victims of pTBI who present with a Glasgow Coma Scale (GCS) ≥6 have a reasonable chance of a meaningful outcome. This study sought to investigate outcomes of pTBI patients based on GCS score who underwent neurosurgical intervention (craniotomy or craniectomy) and compare them with patients who did not undergo surgical intervention. MATERIALS AND METHODS: The study represents a secondary analysis of the data that were collected from 2006 to 2016 from 17 institutions as part of a multi-center study, investigating clinical outcomes for adult patients sustaining pTBI and surviving >72 h. Patients were divided into those with GCS 3-5 and those with GCS ≥6. Within these groups, patients were stratified by whether they received surgical intervention, compared with standard non-surgical care. Patient level data (age and gender), clinical data (Injury Severity Score and Abbreviated Injury Score), GCS on admission, post-op infection rates, and outcomes data (mortality, length of stay [LOS], intensive care unit LOS) were collected. Both groups were compared using independent sample t-test or chi-squared test. RESULTS: Seven hundred twenty patients with pTBI were identified over 11 y, out of which 336 (46.7%) underwent surgery. The mean Injury Severity Score and Abbreviated Injury Score on admission were higher in the surgical intervention group than their non-surgical counterpart in patients with a GCS ≥6 (P < 0.0001). Patients with GCS of 3-5 with surgical intervention demonstrated a higher survival rate than non-surgical patients (P < 0.0001). In the GCS ≥6 group, surgical intervention did not impact near-term mortality. Intensive care unit LOS was significantly longer in the surgical intervention group in patients with GCS ≥ 6 (P < 0.0001) and GCS of 3-5 (P < 0.0001), as was total hospital LOS (P < 0.0001). Patients with a GCS 3-5 and ≥6 who underwent surgical intervention were more likely to develop a central nervous system infection (P = 0.016; P = 0.017). CONCLUSIONS: Surgical intervention in pTBI patients with GCS 3-5 results in improved mortality but comes at a cost of increased resource utilization in the form of longer LOS and higher infection rate. On the other hand, in patients with GCS ≥6, surgery does not provide significant benefits in patient survival. Future prospective studies providing insight as to the impact of surgery on the resource utilization and quality of survival would be beneficial in determining the need for surgical intervention in this population.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Lesões Encefálicas Traumáticas/terapia , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/terapia , Adulto , Lesões Encefálicas Traumáticas/mortalidade , Craniotomia , Feminino , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
3.
J Surg Res ; 257: 493-500, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32916502

RESUMO

BACKGROUND: Blood pressure alterations in patients with traumatic brain injury (TBI) have been shown to be associated with increased mortality. However, there is paucity of data describing the optimal emergency department (ED) systolic blood pressure (SBP) target during the initial evaluation. The aim of our study was to assess the association between SBP on presentation and mortality in patients with TBI. METHODS: We performed a retrospective (2015-2016) review of the American College of Surgeons Trauma Quality Improvement Program database and included all adult (age ≥18y) trauma patients who had TBI on presentation. The outcome measure was in-hospital mortality at different ED-SBP values. A subanalysis by age and TBI severity in accordance with the Glasgow Coma Scale (GCS) was performed (mild (GCS ≥13), moderate (GCS 9-12), and severe (≤8)). Multivariate logistic regression analysis was performed. RESULTS: A total of 94,411 adult trauma patients with TBI were included. Mean age was 59 ± 21y, 62% were male, and median GCS was 15 [14-15]. Mean SBP was 147 ± 28 mmHg, and overall mortality was 8.6%. The lowest rate of mortality was noticed at ED SBP between 110 and 149 mmHg, whereas the highest mortality was at admission SBP <90 mmHg and SBP >190 mmHg. On regression analysis, SBP between 130 and 149 mmHg (odds ratio = 0.92; P = 0.68) was not associated with increased odds of mortality relative to SBP between 110 and 129 mmHg. On subanalysis based on severity of TBI (mild 80.9%, moderate 5.3%, and severe 13.8%), patients with SBP between 110 and 149 mmHg were less likely to die across all TBI groups. CONCLUSIONS: The optimal ED-SBP range for patients with TBI seems to be age and severity dependent. The optimum range might guide clinicians in developing resuscitation protocols for managing patients with TBI. LEVEL OF EVIDENCE: Level III Prognostic.


Assuntos
Pressão Sanguínea , Lesões Encefálicas Traumáticas/mortalidade , Sistema de Registros , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/fisiopatologia , Serviço Hospitalar de Emergência/normas , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos/epidemiologia
4.
BMC Med Inform Decis Mak ; 20(1): 336, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33317528

RESUMO

BACKGROUND: The study aimed to introduce a machine learning model that predicts in-hospital mortality in patients on mechanical ventilation (MV) following moderate to severe traumatic brain injury (TBI). METHODS: A retrospective analysis was conducted for all adult patients who sustained TBI and were hospitalized at the trauma center from January 2014 to February 2019 with an abbreviated injury severity score for head region (HAIS) ≥ 3. We used the demographic characteristics, injuries and CT findings as predictors. Logistic regression (LR) and Artificial neural networks (ANN) were used to predict the in-hospital mortality. Accuracy, area under the receiver operating characteristics curve (AUROC), precision, negative predictive value (NPV), sensitivity, specificity and F-score were used to compare the models` performance. RESULTS: Across the study duration; 785 patients met the inclusion criteria (581 survived and 204 deceased). The two models (LR and ANN) achieved good performance with an accuracy over 80% and AUROC over 87%. However, when taking the other performance measures into account, LR achieved higher overall performance than the ANN with an accuracy and AUROC of 87% and 90.5%, respectively compared to 80.9% and 87.5%, respectively. Venous thromboembolism prophylaxis, severity of TBI as measured by abbreviated injury score, TBI diagnosis, the need for blood transfusion, heart rate upon admission to the emergency room and patient age were found to be the significant predictors of in-hospital mortality for TBI patients on MV. CONCLUSIONS: Machine learning based LR achieved good predictive performance for the prognosis in mechanically ventilated TBI patients. This study presents an opportunity to integrate machine learning methods in the trauma registry to provide instant clinical decision-making support.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Mortalidade Hospitalar , Aprendizado de Máquina , Respiração Artificial/efeitos adversos , Adulto , Lesões Encefálicas Traumáticas/diagnóstico , Estudos de Coortes , Previsões , Humanos , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Modelos Estatísticos , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
5.
Cochrane Database Syst Rev ; 10: CD006811, 2020 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-33126293

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and disability, with an estimated 5.5 million people experiencing severe TBI worldwide every year. Observational clinical studies of people with TBI suggest an association between raised body temperature and unfavourable outcome, although this relationship is inconsistent. Additionally, preclinical models suggest that reducing temperature to 35 °C to 37.5 °C improves biochemical and histopathological outcomes compared to reducing temperature to a lower threshold of 33 °C to 35 °C. It is unknown whether reducing body temperature to 35 °C to 37.5 °C in people admitted to hospital with TBI is beneficial, has no effect, or causes harm. This is an update of a review last published in 2014. OBJECTIVES: To assess the effects of pharmacological interventions or physical interventions given with the intention of reducing body temperature to 35 °C to 37.5 °C in adults and children admitted to hospital after TBI. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and PubMed on 28 November 2019. We searched clinical trials registers, grey literature and references lists of reviews, and we carried out forward citation searches of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) with participants of any age admitted to hospital following TBI. We included interventions that aimed to reduce body temperature to 35 °C to 37.5 °C: these included pharmacological interventions (such as paracetamol, or non-steroidal anti-inflammatory drugs), or physical interventions (such as surface cooling devices, bedside fans, or cooled intravenous fluids). Eligible comparators were placebo or usual care. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion, extracted data, and assessed risks of bias. We assessed the certainty of the evidence with GRADE. MAIN RESULTS: We included one RCT with 41 participants. This study recruited adult participants admitted to two intensive care units in Australia, and evaluated a pharmacological intervention. Researchers gave participants 1 g paracetamol or a placebo intravenously at four-hourly intervals for 72 hours. We could not be certain whether intravenous paracetamol influenced mortality at 28 days (risk ratio 2.86, 95% confidence interval 0.32 to 25.24). We judged the evidence for this outcome to be very low certainty, meaning we have very little confidence in this effect estimate, and the true result may be substantially different to this effect. We downgraded the certainty for imprecision (because the evidence was from a single study with very few participants), and study limitations (because we noted a high risk of selective reporting bias). This study was otherwise at low risk of bias. The included study did not report the primary outcome for this review, which was the number of people with a poor outcome at the end of follow-up (defined as death or dependency, as measured on a scale such as the Glasgow Outcome Score), or any of our secondary outcomes, which included the number of people with further intracranial haemorrhage, extracranial haemorrhage, abnormal intracranial pressure, or pneumonia or other serious infections. The only other completed trial that we found was of a physical intervention that compared advanced fever control (using a surface cooling device) versus conventional fever control in 12 participants. The trial was published as an abstract only, with insufficient details to allow inclusion, so we have added this to the 'studies awaiting classification' section, pending further information from the study authors or publication of the full study report. We identified four ongoing studies that will contribute evidence to future updates of the review if they measure relevant outcomes and, in studies with a mixed population, report data separately for participants with TBI. AUTHORS' CONCLUSIONS: One small study contributed very low-certainty evidence for mortality to this review. The uncertainty is largely driven by limited research into reduction of body temperature to 35 °C to 37.5 °C in people with TBI. Further research that evaluates pharmacological or physical interventions, or both, may increase certainty in this field. We propose that future updates of the review, and ongoing and future research in this field, incorporate outcomes that are important to the people receiving the interventions, including side effects of any pharmacological agent (e.g. nausea or vomiting), and discomfort caused by physical therapies.


Assuntos
Acetaminofen/administração & dosagem , Antipiréticos/administração & dosagem , Temperatura Corporal , Lesões Encefálicas Traumáticas/terapia , Hipotermia Induzida/métodos , Adulto , Viés , Temperatura Corporal/efeitos dos fármacos , Lesões Encefálicas Traumáticas/mortalidade , Humanos , Hipotermia Induzida/mortalidade , Injeções Intravenosas , Placebos
6.
Acta Neurochir (Wien) ; 162(11): 2715-2724, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32974834

RESUMO

BACKGROUND: To ensure adequate intensive care unit (ICU) capacity for SARS-CoV-2 patients, elective neurosurgery and neurosurgical ICU capacity were reduced. Further, the Finnish government enforced strict restrictions to reduce the spread. Our objective was to assess changes in ICU admissions and prognosis of traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH) during the Covid-19 pandemic. METHODS: Retrospective review of all consecutive patients with TBI and aneurysmal SAH admitted to the neurosurgical ICU in Helsinki from January to May of 2019 and the same months of 2020. The pre-pandemic time was defined as weeks 1-11, and the pandemic time was defined as weeks 12-22. The number of admissions and standardized mortality rates (SMRs) were compared to assess the effect of the Covid-19 pandemic on these. Standardized mortality rates were adjusted for case mix. RESULTS: Two hundred twenty-four patients were included (TBI n = 123, SAH n = 101). There were no notable differences in case mix between TBI and SAH patients admitted during the Covid-19 pandemic compared with before the pandemic. No notable difference in TBI or SAH ICU admissions during the pandemic was noted in comparison with early 2020 or 2019. SMRs were no higher during the pandemic than before. CONCLUSION: In the area of Helsinki, Finland, there were no changes in the number of ICU admissions or in prognosis of patients with TBI or SAH during the Covid-19 pandemic.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Infecções por Coronavirus , Hospitalização/estatística & dados numéricos , Pandemias , Pneumonia Viral , Hemorragia Subaracnóidea/epidemiologia , Adulto , Idoso , Betacoronavirus , Lesões Encefálicas Traumáticas/mortalidade , Cuidados Críticos , Feminino , Finlândia/epidemiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Neurocirurgia , Procedimentos Neurocirúrgicos , Prognóstico , Estudos Retrospectivos , Hemorragia Subaracnóidea/mortalidade
7.
Chin J Traumatol ; 23(5): 284-289, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32928607

RESUMO

PURPOSE: Traumatic brain injury (TBI) is one of the leading causes of disability and death in modern times, whose evaluation and prognosis prediction have been one of the most critical issues in TBI management. However, the existed models for the abovementioned purposes were defective to varying degrees. This study aims to establish an ideal brain injury state clinical prediction model (BISCPM). METHODS: This study was a retrospective design. The six-month outcomes of patients were selected as the end point event. BISCPM was established by using the split-sample technology, and externally validated via different tests of comparison between the observed and predicted six-month mortality in validating group. TBI patients admitted from July 2006 to June 2012 were recruited and randomly divided into establishing model group and validating model group. Twenty-one scoring indicators were included in BISCPM and divided into three parts, A, B, and C. Part A included movement, pupillary reflex and diameter, CT parameters, and secondary brain insult factors, etc. Part B was age and part C was medical history of the patients. The total score of part A, B and C was final score of BISCPM. RESULTS: Altogether 1156 TBI patients were included with 578 cases in each group. The score of BISCPM from validating group ranged from 2.75 to 31.94, averaging 13.64 ± 5.59. There was not statistical difference between observed and predicted mortality for validating group. The discrimination validation showed that the BISCPM is superior to international mission for prognosis and analysis of clinical trials (IMPACT) lab model. CONCLUSION: BISCPM is an effective model for state evaluation and prognosis prediction of TBI patients. The use of BISCPM could be of great significance for decision-making in management of TBI.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/mortalidade , Modelos Estatísticos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas Traumáticas/fisiopatologia , Criança , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Prognóstico , Reflexo Pupilar , Estudos Retrospectivos , Adulto Jovem
8.
Am Surg ; 86(7): 826-829, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32916072

RESUMO

BACKGROUND: The need to reverse the coagulation impairment caused by chronic antiplatelet agents in traumatic brain injury (TBI) patients with acute traumatic intracerebral hemorrhage (TICH) remains controversial. We sought to determine whether emergent platelet transfusion reduces the incidence of hemorrhage expansion, mortality, or need for neurosurgical intervention such as intracranial pressure (ICP) monitoring, burr holes, or craniotomy. METHODS: All adult blunt TICH patients (age ≥16 years) over a 4-year period were retrospectively reviewed. Patients with penetrating TBI, blunt TBI without TICH on admission computed tomography (CT), receiving warfarin, not on antiplatelet agents, or requiring immediate operative intervention were excluded. Patients were divided into 2 groups depending on whether they received a platelet transfusion: reversal group (RV) versus no reversal group (NR). Patient outcomes were analyzed using Mann-Whitney U and Fisher's exact tests. RESULTS: 169 blunt TBI patients on chronic antiplatelet therapy were studied (102 RV group, 67 NR group). The groups were well matched with regard to age, Injury Severity Score, Abbreviated Injury Scale-head, Glasgow Coma Score, mechanism of injury, need for intubation, time to initial CT scan, and hospital length of stay. Immediate platelet transfusion did not alter the occurrence of TICH extension on follow-up CT (26% vs 21%, P = .71), TBI-specific mortality (9% vs 13%, P = .45), need for ICP monitor (2% vs 3%, P = 1.0), burr hole (1% vs 3%, P = .56), or craniotomy (1% vs 3%, P = .56). DISCUSSION: Immediate platelet transfusion is unnecessary in blunt TBI patients on chronic antiplatelet therapy who do not require immediate craniotomy.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Hemorragia Cerebral Traumática/prevenção & controle , Inibidores da Agregação de Plaquetas/administração & dosagem , Transfusão de Plaquetas , Ferimentos não Penetrantes/terapia , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Hemorragia Cerebral Traumática/epidemiologia , Craniotomia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/mortalidade , Adulto Jovem
9.
JAMA ; 324(10): 961-974, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32897344

RESUMO

Importance: Traumatic brain injury (TBI) is the leading cause of death and disability due to trauma. Early administration of tranexamic acid may benefit patients with TBI. Objective: To determine whether tranexamic acid treatment initiated in the out-of-hospital setting within 2 hours of injury improves neurologic outcome in patients with moderate or severe TBI. Design, Setting, and Participants: Multicenter, double-blinded, randomized clinical trial at 20 trauma centers and 39 emergency medical services agencies in the US and Canada from May 2015 to November 2017. Eligible participants (N = 1280) included out-of-hospital patients with TBI aged 15 years or older with Glasgow Coma Scale score of 12 or less and systolic blood pressure of 90 mm Hg or higher. Interventions: Three interventions were evaluated, with treatment initiated within 2 hours of TBI: out-of-hospital tranexamic acid (1 g) bolus and in-hospital tranexamic acid (1 g) 8-hour infusion (bolus maintenance group; n = 312), out-of-hospital tranexamic acid (2 g) bolus and in-hospital placebo 8-hour infusion (bolus only group; n = 345), and out-of-hospital placebo bolus and in-hospital placebo 8-hour infusion (placebo group; n = 309). Main Outcomes and Measures: The primary outcome was favorable neurologic function at 6 months (Glasgow Outcome Scale-Extended score >4 [moderate disability or good recovery]) in the combined tranexamic acid group vs the placebo group. Asymmetric significance thresholds were set at 0.1 for benefit and 0.025 for harm. There were 18 secondary end points, of which 5 are reported in this article: 28-day mortality, 6-month Disability Rating Scale score (range, 0 [no disability] to 30 [death]), progression of intracranial hemorrhage, incidence of seizures, and incidence of thromboembolic events. Results: Among 1063 participants, a study drug was not administered to 96 randomized participants and 1 participant was excluded, resulting in 966 participants in the analysis population (mean age, 42 years; 255 [74%] male participants; mean Glasgow Coma Scale score, 8). Of these participants, 819 (84.8%) were available for primary outcome analysis at 6-month follow-up. The primary outcome occurred in 65% of patients in the tranexamic acid groups vs 62% in the placebo group (difference, 3.5%; [90% 1-sided confidence limit for benefit, -0.9%]; P = .16; [97.5% 1-sided confidence limit for harm, 10.2%]; P = .84). There was no statistically significant difference in 28-day mortality between the tranexamic acid groups vs the placebo group (14% vs 17%; difference, -2.9% [95% CI, -7.9% to 2.1%]; P = .26), 6-month Disability Rating Scale score (6.8 vs 7.6; difference, -0.9 [95% CI, -2.5 to 0.7]; P = .29), or progression of intracranial hemorrhage (16% vs 20%; difference, -5.4% [95% CI, -12.8% to 2.1%]; P = .16). Conclusions and Relevance: Among patients with moderate to severe TBI, out-of-hospital tranexamic acid administration within 2 hours of injury compared with placebo did not significantly improve 6-month neurologic outcome as measured by the Glasgow Outcome Scale-Extended. Trial Registration: ClinicalTrials.gov Identifier: NCT01990768.


Assuntos
Antifibrinolíticos/administração & dosagem , Lesões Encefálicas Traumáticas/tratamento farmacológico , Ácido Tranexâmico/administração & dosagem , Adulto , Antifibrinolíticos/efeitos adversos , Encefalopatias/etiologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/mortalidade , Método Duplo-Cego , Serviços Médicos de Emergência , Feminino , Seguimentos , Escala de Coma de Glasgow , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Gravidade do Paciente , Análise de Sobrevida , Tempo para o Tratamento , Ácido Tranexâmico/efeitos adversos
10.
Artigo em Português | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1145668

RESUMO

Introdução: O traumatismo cranioencefálico (TCE) é definido por agressão de ordem traumática, que pode ser classificado como leve, moderado e grave, pela Escala de Coma de Glasgow (ECG). No Brasil, o traumatismo tem grande importância pela alta incidência e morbimortalidade. Objetivo: Analisar o perfil epidemiológico dos pacientes internados devido à TCE no Brasil. Método: Trata-se de estudo descritivo, cujos dados foram obtidos através de abordagem documental do Departamento de Informática do Sistema Único de Saúde (DATASUS). Para o estudo epidemiológico foram utilizados dados da prevalência da morbidade no Brasil, no período de 2010 a 2019. Resultados: O número de internações foi predominante no sexo masculino (76,23%), na faixa etária entre 20 e 29 anos (17,65%); em relação à permanência hospitalar, foi obtido uma média de 6,2 dias de internação; os índices de mortalidade foram maiores no sexo masculino (10,06%), assim como o valor gasto com os pacientes, com 81,39% para esse sexo. Conclusão: A partir do presente estudo foi possível observar que no Brasil os jovens do sexo masculino, vítimas de TCE, são os que mais internam e geram custos à saúde, permitindo evidenciar essa parcela populacional como grupo de risco. Os pacientes, vítimas de TCE, tem prognóstico relacionado a fatores como a idade, gravidade do trauma, tipo de lesão, dentre outros fatores que possam estar associados. Desse modo, torna-se fundamental a análise do perfil epidemiológico do TCE para uma melhor intervenção, buscando cuidados constantes, evitando-se complicações, permitindo uma conduta mais adequada e resolutiva e, consequentemente, um melhor prognóstico


Introduction: The traumatic brain injury is defined by traumatic aggression, which can be classified as mild, moderate and severe, by the Glasgow Coma Scale. In Brazil, trauma is of great importance due to its high incidence and morbidity and mortality. Objective: To analyze the epidemiological profile of hospitalized patients due to traumatic brain injury in Brazil. Method: This is a descriptive study, whose data were obtained through a documentary approach by the Department of Informatics of the Unified Health System. For the epidemiological study, data on the prevalence of morbidity in Brazil, from 2010 to 2019 were used. Results: The number of hospitalizations was predominant in the male gender (76.23%) and in the age group between 20 and 29 years old (17.65%); in relation to hospital stay, an average of 6.2 days was obtained; mortality rates were higher in males (10.06%); and the amount spent on patients, were significantly higher in males (81.39%). Conclusion: The present study made it possible to observe that, in Brazil, young men are the ones who intern the most and generate health costs through the traumatic brain injury, allowing to show this population as a risk group. Patients, victims of this injury, have a prognosis related to factors such as age, trauma severity, type of injury, among other factors that may be associated, it is essential to analyze the epidemiological profile for intervention seeking constant care to avoid complications , allow appropriate and resolutive conduct and consequently seek a better prognosis


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Lesões Encefálicas Traumáticas , Brasil/epidemiologia , Lesões Encefálicas Traumáticas/economia , Lesões Encefálicas Traumáticas/mortalidade
11.
Am Surg ; 86(9): 1124-1128, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32841047

RESUMO

INTRODUCTION: Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality. The purpose of this study is to examine outcomes after discharge and identify factors from the index admission that may contribute to long-term mortality. METHODS: The study population is composed of patients who survived to discharge from a previously published study examining TBI. Demographics, injury severity, and length of stay were abstracted from the index study. Phone surveys of surviving patients were performed to evaluate each patient's Glasgow Outcome Scale-Extended (GOSE). Patients who were deceased at the time of the survey were compared with those who were alive. RESULTS: 1615 patients were alive at the end of the first study period and 211 (13%) comprised the study population. Overall, the median age was 54 years, and the majority were male (74%). The median time to follow-up was 80 months. The population was severely injured, with a median injury severity score (ISS) of 25 and a median head abbreviated injury score (AIS) of 4. Overall mortality was 57%. The group that survived at the time of the survey was younger, more injured, less likely to have received beta-blockers (BB) during the index admission, and had a longer time to follow-up. After adjusting for ISS, age, base deficit, and BB, age was the only variable predictive of mortality (HR 1.03; HL 1.02-1.04). CONCLUSION: Despite being more severely injured, younger patients were more likely to survive to follow-up. Further investigation is needed to determine if aggressive care in older TBI patients in the acute phase leads to good long-term outcomes.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Centros de Traumatologia , Adulto , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/mortalidade , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
12.
Lancet Neurol ; 19(8): 670-677, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32702336

RESUMO

BACKGROUND: Large-scale studies are required to better characterise traumatic brain injury (TBI) and to identify the most effective treatment approaches for TBI. However, evidence is scarce and mostly originates from high-income countries. We aimed to describe the existing care for patients with TBI and the outcomes in China. METHODS: The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) China registry is a prospective, multicentre, longitudinal, observational study done in 56 neurosurgical centres across China. We collected data of patients who were admitted to hospital with a clinical diagnosis of TBI and an indication for CT. Patients who were discharged directly from the emergency room were excluded. The primary endpoint was survival on discharge. Prognostic analyses were applied to identify predictors of mortality. Variations in mortality were compared between centres and provinces within China. Mortality was compared with expected mortality, estimated using the CRASH basic model. This study was registered with ClinicalTrials.gov, NCT02210221. FINDINGS: From Dec 22, 2014, to Aug 1, 2017, 13 627 patients with TBI from 56 centres were enrolled in the registry. Data from 13 138 patients from 52 hospitals in 22 provinces of China were analysed. Most patients were male (9782 [74%]), with a median age of 48 years (IQR 33-61). The median Glasgow Coma Scale (GCS) score was 13 (IQR 9-15), and the leading cause of injury was road-traffic incident (6548 [50%]). Overall, 637 (5%) patients died, including 552 (20%) patients with severe TBI. Age, GCS score, injury severity score, pupillary light reflex, CT findings (compressed basal cistern and midline shift ≥5 mm), presence of hypoxia, systemic hypotension, altitude higher than >500 m, and GDP per capita were significantly associated with survival in all patients with TBI. Variation in mortality existed between centres and regions. The expected 14-day mortality was 1116 (13%), but 544 (7%) deaths within 14 days were observed (observed to expected ratio 0·49 [95% CI 0·45-0·53]). INTERPRETATION: The results show differences in mortality between centres and regions across China, which indicates potential for identifying best practices through comparative effectiveness research. The risk factors identified in prognostic analyses might contribute to developing benchmarks for assessing quality of care. FUNDING: None.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/diagnóstico , China , Feminino , Escala de Coma de Glasgow , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
13.
Medicine (Baltimore) ; 99(27): e21020, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629724

RESUMO

As a catabolic product of hemoglobin, bilirubin has been confirmed playing an important role in the development of various central nervous system disease. The aim of this study is to explore the correlation between serum bilirubin level and mortality in patients with traumatic brain injury (TBI).Patients admitted with traumatic brain injury (TBI) in our hospital between January 2015 and January 2018 were enrolled in this study. Clinical and laboratory data of 361 patients were retrospectively collected to explore the independent risk factors of mortality.The comparison of baseline characteristics showed that non-survivors had lower Glasgow Coma Scale (GCS) (P < .001) and higher level of serum total bilirubin (TBIL) (P < .001) and direct bilirubin (DBIL) (P < .001). We found that only GCS (P < .001), glucose (P < .001), lactate dehydrogenase (LDH) (P = .042) and DBIL (P = .005) were significant risk factors in multivariate logistic regression analysis. GCS and DBIL had comparable AUC value (0.778 vs 0.750, P > .05) on predicting mortality in TBI patients. The AUC value of the combination of GCS and DBIL is higher than the single value of these two factors (P < .05). Moreover, predictive model 1 consisted of GCS, glucose, LDH and DBIL had the highest AUC value of 0.894.DBIL is a significant risk factor of mortality in TBI patients. Assessing the level of DBIL is beneficial for physicians to evaluate severity and predict outcome for TBI patients.


Assuntos
Bilirrubina/sangue , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/mortalidade , Doenças do Sistema Nervoso Central/metabolismo , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Estudos de Casos e Controles , China/epidemiologia , Feminino , Escala de Coma de Glasgow/tendências , Humanos , L-Lactato Desidrogenase/metabolismo , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
14.
Medicine (Baltimore) ; 99(26): e20922, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590803

RESUMO

Traumatic brain injury (TBI), due to its high mortality and morbidity, is an important research topic. Apoptosis plays a pathogenic role in a series of neurological disorders, from neurodegenerative diseases to acute neurological lesions.In this study, we analyzed the association between apoptosis and the Glasgow Outcome Scale (GOS), to examine the potential of apoptosis as a biomarker for a TBI outcome. Patients with severe TBI were recruited at the Department of Neurosurgery, Wujin Hospital Affiliated with Jiangsu University, between January 2018 and December 2019. As a control group, healthy subjects were recruited. The concentrations of caspase-3, cytochrome c, sFas, and caspase-9 in the cerebrospinal fluid (CSF) were analyzed by enzyme-linked immunosorbent assay (ELISA). The association between the GOS and the clinical variables age, sex, initial Glasgow Coma Scale (GCS) score, intracranial pressure (ICP), cerebral perfusion pressure (CPP), initial computed tomography (CT) findings, and apoptotic factors was determined using logistic regression. The area under the receiver operator characteristic (ROC) curve (AUC), and thus the sensitivity and specificity of each risk factor, were obtained.The levels of caspase-3, cytochrome c, sFas, and caspase-9 in the TBI group were significantly higher than those in the control group (P < .05). The logistic regression results showed that ICP and caspase-3 were significant predictors of outcome at 6 months post-TBI (P < .05). The AUC was 0.925 and 0.888 for ICP and caspase-3, respectively. However, the AUC for their combined prediction was 0.978, with a specificity and sensitivity of 96.0% and 95.2%, respectively, showing that the combined prediction was more reliable than that of the 2 separate factors.We demonstrated that caspase-3, cytochrome C, sFas, and caspase-9 were significantly increased in the CSF of patients following severe TBI. Furthermore, we found that ICP and caspase-3 were more reliable for outcome prediction in combination, rather than separately.


Assuntos
Apoptose/fisiologia , Biomarcadores/análise , Lesões Encefálicas Traumáticas/complicações , Líquido Cefalorraquidiano/microbiologia , Adulto , Área Sob a Curva , Biomarcadores/líquido cefalorraquidiano , Lesões Encefálicas Traumáticas/mortalidade , Caspase 3/análise , Caspase 3/líquido cefalorraquidiano , Caspase 9/análise , Caspase 9/líquido cefalorraquidiano , Líquido Cefalorraquidiano/metabolismo , Citocromos c/análise , Citocromos c/líquido cefalorraquidiano , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Receptor fas/análise
15.
World Neurosurg ; 140: 142-147, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32360917

RESUMO

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality worldwide. Several prognostic factors have been developed to predict functional outcomes and mortality rate in patients with TBI. Neutrophil-to-lymphocyte ratio (NLR) is an objective, available, low-cost, and reproducible indicator of inflammation. It is also a marker of extensive secondary damage caused by neutrophils and their products to the cerebral tissue. Accordingly, NLR has been proposed as a valuable outcome predictor in patients with TBI. Evidence emerging from several studies shows that higher NLR value is an independent predictor of poorer functional outcomes and higher mortality rate in patients with severe TBI. Further, higher NLR value is in correlation with lower Glasgow Coma Scale scores. Thus its role as a complementary index to other factors, such as Glasgow Coma Scale, in predicting outcomes after TBI is under investigation. This review aims at gathering the most recent data on the prognostic value of NLR in patients with TBI.


Assuntos
Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/mortalidade , Linfócitos , Neutrófilos , Biomarcadores/sangue , Humanos , Prognóstico , Taxa de Sobrevida
16.
Scand J Trauma Resusc Emerg Med ; 28(1): 44, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460867

RESUMO

BACKGROUND: The use of machine learning techniques to predict diseases outcomes has grown significantly in the last decade. Several studies prove that the machine learning predictive techniques outperform the classical multivariate techniques. We aimed to build a machine learning predictive model to predict the in-hospital mortality for patients who sustained Traumatic Brain Injury (TBI). METHODS: Adult patients with TBI who were hospitalized in the level 1 trauma center in the period from January 2014 to February 2019 were included in this study. Patients' demographics, injury characteristics and CT findings were used as predictors. The predictive performance of Artificial Neural Networks (ANN) and Support Vector Machines (SVM) was evaluated in terms of accuracy, Area Under the Curve (AUC), sensitivity, precision, Negative Predictive Value (NPV), specificity and F-score. RESULTS: A total of 1620 eligible patients were included in the study (1417 survival and 203 non-survivals). Both models achieved accuracy over 91% and AUC over 93%. SVM achieved the optimal performance with accuracy 95.6% and AUC 96%. CONCLUSIONS: for prediction of mortality in patients with TBI, SVM outperformed the well-known classical models that utilized the conventional multivariate analytical techniques.


Assuntos
Lesões Encefálicas Traumáticas/mortalidade , Aprendizado de Máquina , Adulto , Área Sob a Curva , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Sistema de Registros , Sensibilidade e Especificidade
18.
Transplant Proc ; 52(4): 1053-1055, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32249053

RESUMO

INTRODUCTION: In 2003, the Glasgow 7 Quality Guarantee Program was put into effect in Argentina with the objective of standardizing the donation and transplant process throughout the country, establishing the observation and registration of all neurocritical patients with a score on the Glasgow Coma Scale of 7 of 15 or less admitted to critical beds of selected establishments. MATERIALS AND METHODS: The following study is retrospective, observational, and cohort-based. It was developed in the Central Hospital of Mendoza, in the critical units, including guard, coronary, cardiovascular surgery recovery, and intensive care therapy. The inclusion criteria were admission to the institution with a score on the Glasgow Coma Scale of 7 or less with a structural cause of coma. Data collection was carried out in the national online database SINTRA. RESULTS: From January 1, 2008, to December 31, 2018, 1757 patients were enrolled at the Central Hospital of Mendoza, Argentina with Glasgow scores of 7 or less. The most frequent cause of coma was brain trauma (934 patients; 53%), followed by stroke (614 patients; 35%). Of those who scored 3 of 15 in the GCS upon admission, 65% progressed to brain death, whereas 72% of those who scored 7 were discharged. Of all these patients, 270 became donors, accounting for 43% of all brain deaths, whereas 187 had refused to become organ donors (30.6%). Of the total real donors, 55% were multiorganic (150 donors).


Assuntos
Morte Encefálica/diagnóstico , Seleção do Doador/normas , Escala de Coma de Glasgow , Doadores de Tecidos , Adulto , Argentina/epidemiologia , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/mortalidade , Estudos de Coortes , Coma/epidemiologia , Coma/mortalidade , Seleção do Doador/métodos , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doadores de Tecidos/estatística & dados numéricos
19.
J Trauma Acute Care Surg ; 89(1): 80-86, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32251265

RESUMO

BACKGROUND: Early identification of traumatic intracranial hemorrhage (ICH) has implications for triage and intervention. Blood-based biomarkers were recently approved by the Food and Drug Administration (FDA) for prediction of ICH in patients with mild traumatic brain injury (TBI). We sought to determine if biomarkers measured early after injury improve prediction of mortality and clinical/radiologic outcomes compared with Glasgow Coma Scale (GCS) alone in patients with moderate or severe TBI (MS-TBI). METHODS: We measured glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and microtubule-associated protein-2 (MAP-2) on arrival to the emergency department (ED) in patients with blunt TBI enrolled in the placebo arm of the Prehospital TXA for TBI Trial (prehospital GCS score, 3-12; SPB, > 90). Biomarkers were modeled individually and together with prehospital predictor variables [PH] (GCS score, age, sex). Data were divided into a training data set and test data set for model derivation and evaluation. Models were evaluated for prediction of ICH, mass lesion, 48-hour and 28-day mortality, and 6-month Glasgow Outcome Scale-Extended (GOS-E) and Disability Rating Scale (DRS). Area under the curve (AUC) was evaluated in test data for PH alone, PH + individual biomarkers, and PH + three biomarkers. RESULTS: Of 243 patients with baseline samples (obtained a median of 84 minutes after injury), prehospital GCS score was 8 (interquartile range, 5-10), 55% had ICH, and 48-hour and 28-day mortality were 7% and 13%, respectively. Poor neurologic outcome at 6 months was observed in 34% based on GOS-E of 4 or less, and 24% based on DRS greater than or equal to7. Addition of each biomarker to PH improved AUC in the majority of predictive models. GFAP+PH compared with PH alone significantly improved AUC in all models (ICH, 0.82 vs. 0.64; 48-hour mortality, 0.84 vs. 0.71; 28-day mortality, 0.84 vs. 0.66; GOS-E, 0.78 vs. 0.69; DRS, 0.84 vs. 0.81, all p < 0.001). CONCLUSION: Circulating blood-based biomarkers may improve prediction of neurological outcomes and mortality in patients with MS-TBI over prehospital characteristics alone. Glial fibrillary acidic protein appears to be the most promising. Future evaluation in the prehospital setting is warranted. LEVEL OF EVIDENCE: Prospective, Prognostic and Epidemiological, level II.


Assuntos
Biomarcadores/sangue , Lesões Encefálicas Traumáticas/complicações , Hemorragias Intracranianas/etiologia , Adulto , Antifibrinolíticos/uso terapêutico , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/tratamento farmacológico , Lesões Encefálicas Traumáticas/mortalidade , Método Duplo-Cego , Serviço Hospitalar de Emergência , Feminino , Escala de Coma de Glasgow , Proteína Glial Fibrilar Ácida/sangue , Humanos , Hemorragias Intracranianas/sangue , Hemorragias Intracranianas/mortalidade , Hemorragias Intracranianas/prevenção & controle , Masculino , Proteínas Associadas aos Microtúbulos/sangue , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Ácido Tranexâmico/uso terapêutico , Ubiquitina Tiolesterase/sangue
20.
J Trauma Acute Care Surg ; 88(6): 742-751, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32195992

RESUMO

BACKGROUND: The mechanisms of aberrant circulating platelet behavior following injury remain unclear. Platelets retain megakaryocyte immature ribonucleic acid (RNA) splicing and protein synthesis machinery to alter their functions based on physiologic signals. We sought to identify fluctuating platelet-specific RNA transcripts in cell-free plasma (CFP) from traumatic brain injury (TBI) patients as proof-of-concept for using RNA sequencing to improve our understanding of postinjury platelet behavior. We hypothesized that we could identify differential expression of activated platelet-specific spliced RNA transcripts from CFP of patients with isolated severe fatal TBI (fTBI) compared with minimally injured trauma controls (t-controls), filtered by healthy control (h-control) data sets. METHODS: High-read depth RNA sequencing was applied to CFP from 10 patients with fTBI (Abbreviated Injury Scale [AIS] for head ≥3, AIS for all other categories <3, and expired) and five t-controls (Injury Severity Score ≤1, and survived). A publicly available CFP RNA sequencing data set from 23 h-controls was used to determine the relative steady state of splice-form RNA transcripts discoverable in CFP. Activated platelet-specific spliced RNA transcripts were derived from studies of ex vivo platelet activation and identified by splice junction presence greater than 1.5-fold or less than 0.67-fold ex vivo nonactivated platelet-specific RNA transcripts. RESULTS: Forty-two differentially spliced activated platelet-specific RNA transcripts in 34 genes were altered in CFP from fTBI patients (both upregulated and downregulated). CONCLUSION: We have discovered differentially expressed activated platelet-specific spliced RNA transcripts present in CFP from isolated severe fTBI patients that are upregulated or downregulated compared with minimally injured trauma controls. This proof-of-concept suggests that a pool of immature platelet RNAs undergo splicing events after injury for presumed modulation of platelet protein products involved in platelet function. This validates our exploration of injury-induced platelet RNA transcript modulation as an upstream "liquid biopsy" to identify novel postinjury platelet biology and treatment targets for aberrant platelet behavior. LEVEL OF EVIDENCE: Diagnostic tests, level V.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Plaquetas/patologia , Lesões Encefálicas Traumáticas/sangue , Ácidos Nucleicos Livres/isolamento & purificação , RNA-Seq , Adulto , Transtornos da Coagulação Sanguínea/sangue , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/patologia , Plaquetas/metabolismo , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/mortalidade , Estudos de Casos e Controles , Feminino , Humanos , Escala de Gravidade do Ferimento , Biópsia Líquida/métodos , Estudos Longitudinais , Masculino , Ativação Plaquetária/genética , Agregação Plaquetária/genética , Estudo de Prova de Conceito , Estudos Prospectivos , Processamento de RNA , Adulto Jovem
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