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management of acute severe traumatic brain injury

David Salisbury, Simon J Driver, Megan Reynolds, Monica Bennett, Laura B Petrey, Anne Marie Warren
OBJECTIVE: To investigate trends of hospital-based health care utilization after admission to a Level 1 trauma center following acute traumatic brain injury (TBI). DESIGN: Retrospective review. SETTING: Large urban trauma hospital and a hospital council data registry consisting of 88 member institutions (>150 hospitals) covering 15,000 square miles. PARTICIPANTS: All patients admitted to a Level I trauma center between January 2006 - June 2014 who experienced an acute TBI based on ICD-9 coding...
October 6, 2016: Archives of Physical Medicine and Rehabilitation
Simin Babaie Kafaki, Kamaledin Alaedini, Ashkan Qorbani, Leila Asadian, Kaveh Haddadi
OBJECTIVES: Management of hyperglycemia during an acute sickness in adults is accompanied by improved outcomes. We have designed a prospective study with meticulous attention to exclude all diabetes patients by checking hemoglobin A1c (HbA1c or glycated hemoglobin) to avoid the ill-effects of hyperglycemia in patients with traumatic head injury admitted to the intensive care unit (ICU). METHODS: This prospective study included adults with traumatic primary brain injury with a Glasgow coma score of ≤8 necessitating mechanical ventilation treated in the period 2012-2015...
2016: Clinical Medicine Insights. Endocrinology and Diabetes
Juan Antonio Llompart-Pou, Mario Chico-Fernández, Marcelino Sánchez-Casado, Fermín Alberdi-Odriozola, Francisco Guerrero-López, María Dolores Mayor-García, Javier González-Robledo, María Ángeles Ballesteros-Sanz, Rubén Herrán-Monge, Rafael León-López, Lucía López-Amor, Ana Bueno-González
BACKGROUND: Injury patterns may differ in trauma patients when age is considered. This information is relevant in the management of trauma patients and for planning preventive measures. METHODS: We included in the study all patients admitted for traumatic disease in the participating ICUs from November 23(rd), 2012 to July 31(st), 2015 with complete records. Data on epidemiology, injury patterns, severity scores, acute management, resources utilisation and outcome were recorded and compared in the following groups of age: ≤55years (young adults), 56-65 years (adults), 66-75 years (elderly), >75years (very elderly)...
September 2016: Injury
Soumaya Boudokhane, Amine Kalai, Aymen Haj Salah, Houda Migaou, Sana Salah, Anis Jellad, Mourad Gahbiche, Zohra Ben Salah Frih
OBJECTIVE: The aim of our study was to determine the demographic characteristics and the pathway of severe traumatic brain injury (STBI) victims in the Tunisian population. MATERIAL/PATIENTS AND METHODS: Our study included 26 patients victims of STBI hospitalized in intensive care unit, among 450 traumatic head injuries admitted to the Teaching Hospital of Fattouma Bourguiba in Monastir during the year 2014. The studied parameters were: demographic characteristics of the population, circumstances of the accident, transport modalities to the hospital, assessments of the injury types, duration of coma, length of hospitalization in the Intensive Care Unit (ICU) and finally the discharge mode after the ICU stay (transfer to neurosurgery ward, to rehabilitation unit, or home discharged)...
September 2016: Annals of Physical and Rehabilitation Medicine
H Binder, M Majdan, T M Tiefenboeck, A Fochtmann, M Michel, S Hajdu, W Mauritz, J Leitgeb
BACKGROUND: Traumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children. HYPOTHESIS: We hypothese that due to adequate treatment of EDH in children and adolescence excellent clinical and functional outcome can be reached. PURPOSE: To evaluate retrospectively our treatment process of EDH and to elucidate the relationship between trauma mechanism, injury pattern, radiological presentation, subsequent therapy and functional outcome...
October 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Alexander V Glushakov, Olena Y Glushakova, Sylvain Doré, Paul R Carney, Ronald L Hayes
Posttraumatic epilepsy (PTE) is one of the most common and devastating complications of traumatic brain injury (TBI). Currently, the etiopathology and mechanisms of PTE are poorly understood and as a result, there is no effective treatment or means to prevent it. Antiepileptic drugs remain common preventive strategies in the management of TBI to control acute posttraumatic seizures and to prevent the development of PTE, although their efficacy in the latter case is disputed. Different strategies of PTE prophylaxis have been showing promise in preclinical models, but their translation to the clinic still remains elusive due in part to the variability of these models and the fact they do not recapitulate all complex pathologies associated with human TBI...
2016: Methods in Molecular Biology
D Kacy Cullen, James P Harris, Kevin D Browne, John A Wolf, John E Duda, David F Meaney, Susan S Margulies, Douglas H Smith
Unique from other brain disorders, traumatic brain injury (TBI) generally results from a discrete biomechanical event that induces rapid head movement. The large size and high organization of the human brain makes it particularly vulnerable to traumatic injury from rotational accelerations that can cause dynamic deformation of the brain tissue. Therefore, replicating the injury biomechanics of human TBI in animal models presents a substantial challenge, particularly with regard to addressing brain size and injury parameters...
2016: Methods in Molecular Biology
Bridgette D Semple, Raha Sadjadi, Jaclyn Carlson, Yiran Chen, Duan Xu, Donna M Ferriero, Linda J Noble-Haeusslein
Recent evidence supports the hypothesis that repetitive mild traumatic brain injuries (rmTBIs) culminate in neurological impairments and chronic neurodegeneration, which have wide-ranging implications for patient management and return-to-play decisions for athletes. Adolescents show a high prevalence of sports-related head injuries and may be particularly vulnerable to rmTBIs due to ongoing brain maturation. However, it remains unclear whether rmTBIs, below the threshold for acute neuronal injury or symptomology, influence long-term outcomes...
2016: Developmental Neuroscience
F I Alyev
347 patients were analyzed and role of vagoinsular and enteric endocrine systems in acute gastroduodenal erosion and ulcers formation in severe traumatic brain injury were assessed depending on the combination of TBI with various organs and systems damage. It was revealed that activation ofvagoinsular and enteric endocrine systems due to microcirculatory disorders and hypoxia associated with severe TBI plays a crucial role in increasing the frequency of manifestations of erosions and ulcers in gastroduodenal mucosa...
March 2016: Anesteziologiia i Reanimatologiia
Sophie Brassel, Belinda Kenny, Emma Power, Elise Elbourn, Skye McDonald, Robyn Tate, Brian MacWhinney, Lyn Turkstra, Audrey Holland, Leanne Togher
PRIMARY OBJECTIVE: To investigate the nature and patterns of conversational topics discussed by individuals with severe TBI and familiar communication partners at 3 and 6 months post-injury, and to examine changes occurring in conversational topics during sub-acute recovery. RESEARCH DESIGN: Qualitative content analysis was used to explore the nature of topics and generate conversational themes. Topic analysis provided an understanding of conversational topic management by identifying patterns of topic initiation and maintenance...
2016: Brain Injury: [BI]
Gwen B Effgen, Barclay Morrison
Clinical studies suggest that athletes with a history of concussion may be at risk for additional mild traumatic brain injury (mTBI), and repetitive exposure to mTBI acutely increases risk for more significant and persistent symptoms and increases future risk for developing neurodegenerative diseases. Currently, symptoms of mTBI are managed with rest and pain medication; there are no drugs approved by the Food and Drug Administration (FDA) that target the biochemical pathology underlying mTBI to treat or prevent acute and long-term effects of repetitive mTBI...
August 8, 2016: Journal of Neurotrauma
Joseph Carnevale, David J Segar, Benjamin Drapcho, Cody Doberstein, John F Morrison, Wael Asaad
INTRODUCTION: Annually in the United States, an estimated 1.7 million people experience traumatic brain injury (TBI), resulting in 1.4 million emergency department visits, 270 000 hospitalizations, and 53 000 deaths. The most common mass lesions associated with TBI are hematomas and contusions. Currently, there is no proven treatment protocol for contusion management. This retrospective study seeks to provide a more comprehensive assessment of the hemorrhagic progressions of contusions (HPC) by analyzing the rate at which contusions blossom depending on a variety of factors...
August 2016: Neurosurgery
Marlene Fischer, Alois Schiefecker, Peter Lackner, Raimund Helbok, Ronny Beer, Bettina Pfausler, Erich Schmutzhard, Gregor Broessner
Fever is common in neurocritical care patients and is associated with poor outcome. Targeted temperature management (TTM), i.e. therapeutic hypothermia or controlled normothermia, after acute brain injury has been studied as a neuroprotectant for several decades. In contrast to pharmacological agents with specific targets TTM affects multiple pathophysiological mechanisms and is primarily thought to attenuate secondary brain injury. Most promising results have been obtained from experimental studies on cerebral ischemia or traumatic brain injury showing beneficial effects of hypothermia on structural and functional outcome...
July 3, 2016: Current Drug Targets
Thomas A van Essen, Godard C W de Ruiter, Kuan H Kho, Wilco C Peul
Several recent global traumatic brain injury (TBI) initiatives rely on practice variation in diagnostic and treatment methods to answer effectiveness questions. One of these scientific dilemmas, the surgical management of the traumatic acute subdural hematoma (ASDH) might be variable among countries, among centers within countries, and even among neurosurgeons within a center, and hence be amenable for a comparative effectiveness study. The aim of our questionnaire, therefore, was to explore variations in treatment for ASDH among neurosurgeons in similar centers in a densely populated geographical area...
August 2, 2016: Journal of Neurotrauma
Shaun E Gruenbaum, Alexander Zlotnik, Benjamin F Gruenbaum, Denise Hersey, Federico Bilotta
INTRODUCTION: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. The deleterious effects of secondary brain injury may be attenuated by early pharmacological therapy in the emergency room and intensive care unit (ICU). Current medical management of acute TBI is primarily supportive, aimed at reducing intracranial pressure (ICP) and optimizing cerebral perfusion. There are no pharmacological therapies to date that have been unequivocally demonstrated to improve neurological outcomes after TBI...
September 2016: CNS Drugs
Stefania Mondello, Firas Kobeissy, Annarita Vestri, Ronald L Hayes, Patrick M Kochanek, Rachel P Berger
Objective reliable markers to assess traumatic brain injury (TBI) and predict outcome soon after injury are a highly needed tool for optimizing management of pediatric TBI. We assessed serum concentrations of Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-Terminal Hydrolase-L1 (UCH-L1) in a cohort of 45 children with clinical diagnosis of TBI (Glasgow Coma Scale [GCS] 3-15) and 40 healthy subjects, evaluated their associations with clinical characteristics and outcomes, and compared their performance to previously published data on two well-studied blood biomarkers, S100B and MBP...
2016: Scientific Reports
Vilaas S Shetty, Martin N Reis, Joseph M Aulino, Kevin L Berger, Joshua Broder, Asim F Choudhri, A Tuba Kendi, Marcus M Kessler, Claudia F Kirsch, Michael D Luttrull, Laszlo L Mechtler, J Adair Prall, Patricia B Raksin, Christopher J Roth, Aseem Sharma, O Clark West, Max Wintermark, Rebecca S Cornelius, Julie Bykowski
Neuroimaging plays an important role in the management of head trauma. Several guidelines have been published for identifying which patients can avoid neuroimaging. Noncontrast head CT is the most appropriate initial examination in patients with minor or mild acute closed head injury who require neuroimaging as well as patients with moderate to severe acute closed head injury. In short-term follow-up neuroimaging of acute traumatic brain injury, CT and MRI may have complementary roles. In subacute to chronic traumatic brain injury, MRI is the most appropriate initial examination, though CT may have a complementary role in select circumstances...
June 2016: Journal of the American College of Radiology: JACR
Edward Needham, Charles McFadyen, Virginia Newcombe, Anneliese J Synnot, Marek Czosnyka, David Menon
Traumatic brain injury (TBI) frequently triggers a disruption of cerebral autoregulation. The cerebral perfusion pressure (CPP) at which autoregulation is optimal ("CPPopt") varies between individuals, and can be calculated based on fluctuations between arterial blood pressure and intracranial pressure. This review assesses the effect of individualizing CPP targets to pressure reactivity index (a measure of autoregulation) in patients with TBI. Cochrane Central Register of Controlled Trials, MEDLINE®, Embase, and Cumulative Index of Nursing and Allied Health Literature were searched in March 2015 for studies assessing the effect of targeting CPPopt in TBI...
June 27, 2016: Journal of Neurotrauma
Jonathan E Kurz, Samuel M Poloyac, Nicholas S Abend, Anthony Fabio, Michael J Bell, Mark S Wainwright
OBJECTIVES: Early posttraumatic seizures may contribute to worsened outcomes after traumatic brain injury. Evidence to guide the evaluation and management of early posttraumatic seizures in children is limited. We undertook a survey of current practices of continuous electroencephalographic monitoring, seizure prophylaxis, and the management of early posttraumatic seizures to provide essential information for trial design and the development of posttraumatic seizure management pathways...
July 2016: Pediatric Critical Care Medicine
Stine B Lund, Kari H Gjeilo, Kent G Moen, Kari Schirmer-Mikalsen, Toril Skandsen, Anne Vik
BACKGROUND: Patients with moderate traumatic brain injury (TBI) are a heterogeneous group with great variability in clinical course. Guidelines for monitoring and level of care in the acute phase are lacking. The main aim of this observational study was to describe injury severity and the acute phase course during the first three days post-injury in a cohort of patients with moderate TBI. Deviations from defined parameters in selected physiological variables were also studied, based on guidelines for severe TBI during the same period...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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