Determinants of hyponatremia following a traumatic brain injury.

BACKGROUND: Hyponatremia is common in patients with central nervous system disease. It may prolong hospitalization and increase morbidity and mortality. However, the incidence and risks factors remain largely unknown in traumatic brain injury (TBI). The objectives of this study are to characterize hyponatremia in TBI patients and find its main risk factors. METHODS: All patients admitted with a diagnosis of acute TBI over a 1-year period were included, except patients with known chronic hyponatremia, those who died within 72 h, and those receiving hyperosmolar therapy to treat their intracranial hypertension. Sodium levels throughout hospitalization were collected. Post-traumatic hyponatremia was defined as follows: borderline (1-2 points below normal and 1-2 days duration) and significant (more than 2 points below normal and/or more than 2 days duration). Demographic data, GCS, mechanism of injury, and CT findings were collected. These factors were correlated to the incidence of hyponatremia. RESULTS: Hyponatremia was found in 29% of the 283 included patients and was significant in 2/3 of the cases. Significant hyponatremia had a narrower peak, between 7 and 11 days, while borderline hyponatremia started earlier and was more distributed in time. Factors associated with hyponatremia were greater age (p = 0.004), worse ISS (p = 0.017), worse Marshall Grade on CT (p = 0.007), and a diffuse pattern of injury on CT (p < 0.001). Significant hyponatremia was associated with: a diffuse pattern of injury on CT (p = 0.032), the presence of intracerebral hemorrhage (p = 0.027), and multiple lesions on CT (p = 0.043). CONCLUSIONS: Post-traumatic hyponatremia is common and can lead to serious consequences in TBI patients. Adequate monitoring and treatment are therefore important. Older patients and those with more significant injury on CT are more at risk.

The Saudi Public’s Knowledge Level of Spinal Injury: A Novel Risk Prediction Scoring System

Objective: The aims of this study are to assess the Saudi public’s knowledge of the spinal cord injuries (SCI) and to establish a knowledge-based risk prediction scoring system. Methods: This cross-sectional survey was conducted between October 2016 and February 2017 using a self-administered questionnaire that was distributed electronically through social media. The questionnaire was designed to assess the Saudi public’s knowledge of different aspects of SCI. Results: A total of 501 participants completed the survey. Most of the participants were knowledgeable about the basic structures of the spine; however, less than half (45.9%) knew about the clinical features of SCI. Males were significantly at a higher risk for SCI (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.15-3.39, p=0.012). Additionally, males were more likely to provide incorrect answers to the question that assessed participants’ knowledge of the loss of motor and sensory functions (OR 3.54, 95% CI 1.86-6.73, p=0.001). The respondents’ level of education was significantly associated with their knowledge of the anatomy of the spine. Participants who had completed only primary and secondary school were less likely to know the basic structure of the spine (p=0.019), the causes of SCI (p<0.001), and the symptoms of SCI (p=0.010). a knowledge-based spine injury risk prediction scoring system was developed. Conclusion: Younger males lacked knowledge of spinal cord structure and injury. The spinal injury risk prediction scoring system may be used and needs further evaluations.