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coma scale FOUR

Emilio Portaccio, Azzurra Morrocchesi, Anna Maria Romoli, Bahia Hakiki, Maria Pia Taglioli, Elena Lippi, Martina Di Renzone, Antonello Grippo, Claudio Macchi
OBJECTIVES: to evaluate the prognostic utility of serial assessment on the Coma Recovery Scale-Revised (CRS-R) during the first 4 weeks of intensive rehabilitation in patients surviving from severe brain injury DESIGN: prospective cohort study PARTICIPANTS: Patients consecutively admitted to the Intensive Rehabilitation Unit at the IRCCS Don Gnocchi Foundation (Florence, Italy). Inclusion criteria were diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) due to acquired brain injury, age older than 18 years...
February 8, 2018: Archives of Physical Medicine and Rehabilitation
Sherri A Braksick, J Claude Hemphill, Jay Mandrekar, Eelco F M Wijdicks, Jennifer E Fugate
BACKGROUND: The Full Outline of Unresponsiveness (FOUR) Score is a validated scale describing the essentials of a coma examination, including motor response, eye opening and eye movements, brainstem reflexes, and respiratory pattern. We incorporated the FOUR Score into the existing ICH Score and evaluated its accuracy of risk assessment in spontaneous intracerebral hemorrhage (ICH). MATERIALS AND METHODS: Consecutive patients admitted to our institution from 2009 to 2012 with spontaneous ICH were reviewed...
February 5, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Yu-Li Lin, Cheng-Chih Liao, Wen-Pin Yu, Tsung-Lan Chu, Lun-Hui Ho
BACKGROUND: Physical restraint (PR) has to be performed in a well-organized, structured, and careful manner. The safety and effectiveness of the PR procedure in clinical practice are crucial to patient care. PURPOSES: The aim of this study was to examine the effect in neurological intensive care units of a multidisciplinary PR reduction program on the overall incidence rate of PR, the monthly rate of PR, and the monthly rate of PR of more than and less than 24 hours, respectively, after controlling for associated factors...
January 31, 2018: Journal of Nursing Research: JNR
Nathan R Manley, Louis J Magnotti, Timothy C Fabian, Martin A Croce, John P Sharpe
BACKGROUND: Following venous injury, venorrhaphy can restore outflow, although it risks thrombosis and venous thromboembolism (VTE). Vein ligation is a faster option, although it potentially risks extremity edema. The purpose of this study was to evaluate the management of venous injury on VTE and extremity edema in patients with isolated lower-extremity venous injuries. METHODS: Patients with common iliac, external iliac, and femoral venous injuries over a 10-year period were stratified by age, shock, management of venous injury, injury severity, and timing and type of anticoagulation...
February 2018: Journal of Trauma and Acute Care Surgery
Elizabeth Meinert, Michael J Bell, Sandra Buttram, Patrick M Kochanek, Goundappa K Balasubramani, Stephen R Wisniewski, P David Adelson
OBJECTIVES: To understand the relationship between the timing of initiation of nutritional support in children with severe traumatic brain injury and outcomes. DESIGN: Secondary analysis of a randomized, controlled trial of therapeutic hypothermia (Pediatric Traumatic Brain Injury Consortium: Hypothermia, also known as "the Cool Kids Trial" (NCT 00222742). SETTINGS: Fifteen clinical sites in the United States, Australia, and New Zealand. SUBJECTS: Inclusion criteria included 1) age less than 18 years, 2) postresuscitation Glasgow Coma Scale less than or equal to 8, 3) Glasgow Coma Scale motor score less than 6, and 4) available to be randomized within 6 hours after injury...
January 24, 2018: Pediatric Critical Care Medicine
Christopher J Tignanelli, Wayne E Vander Kolk, Judy N Mikhail, Matthew J Delano, Mark R Hemmila
BACKGROUND: The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT-verified trauma center compliance with these criteria is associated with low undertriage rates and improved overall mortality. METHODS: Data from a state-wide collaborative quality initiative was used...
February 2018: Journal of Trauma and Acute Care Surgery
Yajuan Hu, Changqing Wang, Xiaoxiang Yan, Hong Fu, Kai Wang
BACKGROUND: Ischemic stroke that is sufficiently severe to cause loss of consciousness has a high rate of morbidity and mortality. Many individuals who suffer from these disorders never recover conscious awareness. In this study, we aimed to identify an accurate and simple bedside method to predict awareness recovery after severe acute ischemic stroke. METHODS: Between 2013 and 2017, all consecutive patients with consciousness disorders after acute ischemic stroke were recruited to the study...
December 15, 2017: Journal of the Neurological Sciences
Atte Sivula, Teemu Luoto, Jani Heinilä, Heini Huhtala, Sari Karlsson, Arvi Yli-Hankala, Jaakko Långsjö
BACKGROUND: The goal was to increase the knowledge of Full Outline of UnResponsiveness (FOUR) score in Finland, release its Finnish version and to evaluate its usefulness in Finnish ICU patients. MATERIALS AND METHODS: The highest FOUR and Glasgow Coma Scale (GCS) scores of the adult ICU patients treated in Tampere University Hospital between 1st January and 31st October 2015 were analyzed retrospectively. In-hospital and 1-month mortality were the primary end-points...
2017: Duodecim; Lääketieteellinen Aikakauskirja
John D Yonge, Phillip Kemp Bohan, Justin J Watson, Christopher R Connelly, Lynn Eastes, Martin A Schreiber
BACKGROUND: Under-triaged trauma patients have worse clinical outcomes. We evaluated the capability of four pre-hospital variables to identify this population at the lowest level trauma activation (level 3). METHODS: A retrospective review of adult trauma activations from 2004 to 2014 was completed. Pre-hospital vital signs and Glasgow Coma Scale were converted to categorical variables. Patients were under-triaged based on meeting current level 1 or 2 criteria, or requiring a pre-defined critical intervention...
December 6, 2017: World Journal of Surgery
Parli Raghavan Ravi, M N Vijai, Sachin Shouche
Background: In recent years ultrasound guided percutaneous tracheostomy (USPCT) has become a routine practice in critical care units. Its safety and superiority over conventional percutaneous tracheostomy and bronchoscopic guided PCT is proven to be non-inferior in elective cases. However its role in emergency percutaneous tracheostomy has never been studied, since percutaneous tracheostomy itself remains an enigma in accessing emergency airway. There is no report of use of ultrasound guided percutaneous tracheostomy in emergency setting so far in the literature...
2017: Disaster and Military Medicine
Rebecka Rubenson Wahlin, Veronica Lindström, Sari Ponzer, Veronica Vicente
BACKGROUND: Best evidence guidelines are intended to standardise assessment and treatment of patients with head trauma and improve outcomes for TBI patients. The primary aim was to explore pre-hospital emergency care nurses' (PECNs') documented assessment and care of patients with head trauma and the secondary aim to study gender differences in the documented care and interventions given by the PECNs. METHODS: A retrospective observational study was conducted by evaluating 2750 prehospital medical records...
January 2018: International Emergency Nursing
Abdolkarim Rahmanian, Mohammad Jamali, Kamran Bagheri Lankarani, Sulmaz Ghahramani
OBJECTIVE: Subarachnoid haemorrhage (SAH), caused by the rupture of intracranial aneurysms, is a devastating event with high rates of morbidity and mortality. Aneurysmal subarachnoid haemorrhage (aSAH) plays a critical role in the potential loss of life as its sufferers are usually of a young age. We aimed to investigate the incidence of aSAH along with the patients' characteristics over five consecutive years in Fars, a large province located in Southern Iran. METHODS: In this prospective study, anonymous data of all patients diagnosed with aSAH in Fars province were collected after patient admission and surgery...
2017: PloS One
Stephen Ray, Ajit Rayamajhi, Laura J Bonnett, Tom Solomon, Rachel Kneen, Michael J Griffiths
Background Acute encephalitis syndrome (AES) is a common cause of coma in Nepali children. The Glasgow coma scale (GCS) is used to assess the level of coma in these patients and predict outcome. Alternative coma scales may have better inter-rater reliability and prognostic value in encephalitis in Nepali children, but this has not been studied. The Adelaide coma scale (ACS), Blantyre coma scale (BCS) and the Alert, Verbal, Pain, Unresponsive scale (AVPU) are alternatives to the GCS which can be used. Methods Children aged 1-14 years who presented to Kanti Children's Hospital, Kathmandu with AES between September 2010 and November 2011 were recruited...
November 16, 2017: Paediatrics and International Child Health
Monica M DiFiori, Laura C Lamb, Lori L Calavan, Christopher H Comey, James M Feeney
OBJECTIVE: To determine the effect of direct oral anticoagulants (DOACs) compared with warfarin on the 30-day readmission rates in patients with traumatic intracranial hemorrhage (ICH). METHODS: We conducted a retrospective review of patients from our hospital's trauma database admitted between June 2011 and October 2015 to our level II trauma center after sustaining a traumatic ICH while receiving anticoagulant therapy. Patients were stratified based on the anticoagulation drug (DOAC or warfarin) prescribed on admission...
November 6, 2017: World Neurosurgery
Rie Ichikawa, Yukihiro Maeda, Akiko Shibuya, Yoshimasa Umesato, Yoshiaki Kondo, Takeshi Maeda, Atsuo Yoshino, Shori Takahashi
OBJECTIVES: Head trauma is one of the main causes of death in childhood and often leaves severe disability with serious neurological damage. Appropriate treatment must be provided immediately to improve outcomes. This study was performed to identify factors associated with a poor prognosis at an early stage of severe head injury in children. METHODS: The subjects were registered in the Japan Neurotrauma Data Bank. They were 119 children (mean age, 8 years; male, 67...
October 31, 2017: Pediatric Emergency Care
Claire Vines, Stephanie J Tesseneer, Robert D Cox, Damon A Darsey, Kristin Carbrey, Michael A Puskarich
OBJECTIVES: To evaluate the feasibility, safety, and preliminary efficacy of four-factor prothrombin complex concentrate (4-factor PCC) administration by an air ambulance service prior to or during transfer of patients with warfarin-associated major hemorrhage to a tertiary care center for definitive management (interventional arm) compared to patients receiving 4-factor PCC following transfer by air ambulance or ground without 4-factor PCC treatment (conventional arm). METHODS: Retrospective chart review of patients presenting to a large academic medical center...
October 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Brian L Edlow, Camille Chatelle, Camille A Spencer, Catherine J Chu, Yelena G Bodien, Kathryn L O'Connor, Ronald E Hirschberg, Leigh R Hochberg, Joseph T Giacino, Eric S Rosenthal, Ona Wu
See Schiff (doi:10.1093/awx209) for a scientific commentary on this article. Patients with acute severe traumatic brain injury may recover consciousness before self-expression. Without behavioural evidence of consciousness at the bedside, clinicians may render an inaccurate prognosis, increasing the likelihood of withholding life-sustaining therapies or denying rehabilitative services. Task-based functional magnetic resonance imaging and electroencephalography techniques have revealed covert consciousness in the chronic setting, but these techniques have not been tested in the intensive care unit...
September 1, 2017: Brain: a Journal of Neurology
A Ceja-Espinosa, J A Franco-Jiménez, A Sosa-Nájera, G A Gutiérrez-Aceves, M I Ruiz-Flores
BACKGROUND: Endoscopy has gained a crucial role in high specialty neurosurgery during the last decades. At present, there are well-defined flexible neuroendoscopic procedures to treat ventricular and subarachnoid space pathologies. Neurocysticercosis is recognized as a common cause of neurologic disease in developing countries and the United States. Surgical intervention, especially cerebrospinal fluid diversion, is the key for management of hydrocephalus. In 2002, a consensus suggested that ventricular forms should be treated with endoscopy as the first option...
2017: Surgical Neurology International
Sofia Simões Ferreira, Daniel Meireles, Alexandra Pinto, Francisco Abecasis
INTRODUCTION: The Full Outline of UnResponsiveness - FOUR scale has been previously validated to assess impaired consciousness in the adult population. The aim of this study is the translation into Portuguese and validation of the FOUR scale in the pediatric population. The study also compares the FOUR scale and Glasgow coma scale score ratings and the clinical outcome of patients hospitalized in Pediatric Intensive Care Units. MATERIAL AND METHODS: This study prospectively rated patients admitted to the Pediatric Intensive Care Units with impaired consciousness during one year...
September 29, 2017: Acta Médica Portuguesa
G Mion, J Le Masson, C Granier, C Hoffmann
The objective of this study was to explore whether ketamine prevents or exacerbates acute or post-traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010-2012). The diagnosis of post-traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain...
December 2017: Anaesthesia
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