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coma scale FOUR

Byoung-Joon Oh, Yong-Gyun Im, Eunjung Park, Young-Gi Min, Sang-Cheon Choi
OBJECTIVE: The effect of induced hypothermia on severe acute carbon monoxide (CO) poisoning remains to be addressed further. We investigated the effect of induced hypothermia on severe acute CO poisoning. METHODS: Retrospective chart review was conducted for patients who diagnosed as severe acute CO poisoning in emergency department and underwent induced hypothermia from May 2013 to May 2014. Hospital courses with critical medication and major laboratory results were investigated through the chart review...
June 2016: Clin Exp Emerg Med
Andrew A Udy, Chelsey Vladic, Edward Robert Saxby, Jeremy Cohen, Anthony Delaney, Oliver Flower, Matthew Anstey, Rinaldo Bellomo, David James Cooper, David V Pilcher
OBJECTIVE: The primary aim of this study was to describe in-hospital mortality in subarachnoid hemorrhage patients requiring ICU admission. Secondary aims were to identify clinical characteristics associated with inferior outcomes, to compare subarachnoid hemorrhage mortality with other neurological diagnoses, and to explore the variability in subarachnoid hemorrhage standardized mortality ratios. DESIGN: Multicenter, binational, retrospective cohort study. SETTING: Data were extracted from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database...
October 3, 2016: Critical Care Medicine
Thomas Godet, Russell Chabanne, Julien Marin, Sophie Kauffmann, Emmanuel Futier, Bruno Pereira, Jean-Michel Constantin
BACKGROUND: The decision to extubate brain-injured patients with residual impaired consciousness holds a high degree of uncertainty of success. The authors developed a pragmatic clinical score predictive of extubation failure in brain-injured patients. METHODS: One hundred and forty brain-injured patients were prospectively included after the first spontaneous breathing trial success. Assessment of multiparametric hemodynamic, respiratory, and neurologic functions was performed just before extubation...
October 3, 2016: Anesthesiology
Katherine Remick, Christopher Redgate, Daniel Ostermayer, Amy H Kaji, Marianne Gausche-Hill
OBJECTIVE: Many Emergency Medicine Services (EMS) protocols require point-of-care blood glucose testing (BGT) for any pediatric patient who presents with seizure or altered level of conscious. Few data describe the diagnostic yield of BGT when performed on all pediatric seizures regardless of presenting mental status. We analyzed a large single center dataset of pediatric patients presenting with prehospital seizures to determine the prevalence of hypoglycemic seizures and the utility of repeat BGT in the emergency department (ED)...
September 16, 2016: Prehospital Emergency Care
Kishor Khanal, Sanjeeb Sudarshan Bhandari, Ninadini Shrestha, Subhash Prasad Acharya, Moda Nath Marhatta
Assessment of level of consciousness is very important in predicting patient's outcome from neurological illness. Glasgow coma scale (GCS) is the most commonly used scale, and Full Outline of UnResponsiveness (FOUR) score is also recently validated as an alternative to GCS in the evaluation of the level of consciousness. We carried out a prospective study in 97 patients aged above 16 years. We measured GCS and FOUR score within 24 h of Intensive Care Unit admission. The mean GCS and the FOUR scores were lower among nonsurvivors than among the survivors and were statistically significant (P < 0...
August 2016: Indian Journal of Critical Care Medicine
Joel Norton, Christine Hymers, Penelope Stein, Joanne May Jenkins, Duncan Bew
BACKGROUND: Acute porphyria is historically known as "the little imitator" in reference to its reputation as a notoriously difficult diagnosis. Variegate porphyria is one of the four acute porphyrias, and can present with both blistering cutaneous lesions and acute neurovisceral attacks involving abdominal pain, neuropsychiatric features, neuropathy, hyponatremia, and a vast array of other nonspecific clinical features. CASE REPORT: A 40-year-old man presented to the Emergency Department (ED) as a major trauma call, having been found in an "acutely confused state" surrounded by broken glass...
September 10, 2016: Journal of Emergency Medicine
Gregoire Boulouis, Andrea Morotti, H Bart Brouwers, Andreas Charidimou, Michael J Jessel, Eitan Auriel, Octavio Pontes-Neto, Alison Ayres, Anastasia Vashkevich, Kristin M Schwab, Jonathan Rosand, Anand Viswanathan, Mahmut E Gurol, Steven M Greenberg, Joshua N Goldstein
BACKGROUND AND PURPOSE: Noncontrast computed tomographic (CT) hypodensities have been shown to be associated with hematoma expansion in intracerebral hemorrhage (ICH), but their impact on functional outcome is yet to be determined. We evaluated whether baseline noncontrast CT hypodensities are associated with poor clinical outcome. METHODS: We performed a retrospective review of a prospectively collected cohort of consecutive patients with primary ICH presenting to a single academic medical center between 1994 and 2016...
October 2016: Stroke; a Journal of Cerebral Circulation
Ahmet Küçük, Abdulfettah Tümtürk
AIM: Television tip overs and head traumas in children showed an increase in the recent years in Turkey and throughout the World. In this study, the injury types, the surgical interventions and the children exposed to head trauma due to an accident caused by a falling television were investigated retrospectively. Some cautions were suggested in order to prevent these injuries. MATERIAL AND METHODS: In the study, the gender, age, Pediatric Glasgow Coma Scale, radiologic findings, the need for intensive care unit, the period spent in the hospital, the applied surgical treatments, the accompanied treatment and pathology of 36 children's case treated in the neurosurgery department of the Erciyes University School of Medicine were evaluated...
April 26, 2016: Turkish Neurosurgery
Taraneh Naghibi, Sara Madani, Saideh Mazloomzadeh, Faramarz Dobakhti
BACKGROUND/AIM: Mortality and morbidity still remain high in patients with traumatic brain injuries. Understanding the role of new treatments in these patients is critical. The aim of this study was to determine the effect of simvastatin on survival and outcome in traumatic brain injury patients. MATERIALS AND METHODS: Forty-four patients were assigned to receive either simvastatin or a placebo. The serum interleukin-6 and C-reactive protein levels were measured at the first 24 h and 48 h after trauma...
2016: Turkish Journal of Medical Sciences
Luis Fernández-Vega Cueto, Carlos Lisa, Aranzazu Poo-López, David Madrid-Costa, Jesús Merayo-Lloves, Jose F Alfonso
PURPOSE: To assess the efficacy outcomes of implanting intrastromal corneal ring segments (ICRS) to correct paracentral keratoconus. METHODS: Four hundred nine eyes with paracentral keratoconus, in which the differences between the axes of refractive cylinder and the corneal flattest meridian and the comatic aberration map were less than 30 degrees, were evaluated before and after the implantation of Ferrara-type ICRS. Snellen uncorrected and best-corrected distance visual acuity, residual refractive errors analyzed with vector analysis, and the root mean square for corneal coma-like aberration for a pupil size of 4...
November 2016: Cornea
Kevin H Chu, Tegwen E Howell, Gerben Keijzers, Jeremy S Furyk, Robert M Eley, Frances B Kinnear, Ogilvie Thom, Ibrahim Mahmoud, Anthony Ft Brown
OBJECTIVES: The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage (SAH), use of diagnostic tests, emergency department (ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache to EDs state-wide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic work up between principal referral and city-regional hospitals were examined...
July 30, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kadhaya David Muballe, Timothy Hardcastle, Erastus Kiratu
OBJECTIVES Penetrating traumatic brain injuries (TBIs) can be divided into gunshot wounds or stab wounds based on the mechanisms of injury. Pediatric penetrating TBIs are of major concern as many parental and social factors may be involved in the causation. The authors describe the penetrating cranial injuries in pediatric patient subgroups at risk and presenting to the Department of Neurosurgery at the University of KwaZulu-Natal, by assessment of the Glasgow Coma Scale (GCS) score and review of the common neurological manifestations including cranial nerve abnormalities...
July 29, 2016: Journal of Neurosurgery. Pediatrics
Hormuzdiyar H Dasenbrock, Robert F Rudy, William B Gormley, Timothy R Smith, Kai U Frerichs, Mohammad Ali Aziz-Sultan, Rose Du
INTRODUCTION: While obliteration of unruptured aneurysms reduces the risk of subarachnoid hemorrhage, perioperative complications impact the risk-benefit ratio of aneurysm repair, and additional data are needed to optimally risk-stratify patients preoperatively. METHODS: Patients who underwent craniotomy for microsurgical clipping of an unruptured aneurysm were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry (2007-2014)...
August 2016: Neurosurgery
Ghada N El-Sarnagawy, Amal Saf Hafez
The decision of intubation and mechanical ventilation in poisoned patients with impaired consciousness can be a difficult task. The present study aimed to evaluate the power of Glasgow Coma Scale (GCS), acute physiology and chronic health evaluation (APACHE II), rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS) at admission in predicting the need of intubation and mechanical ventilation in drug overdose patients with disturbed consciousness level (DCL). This prospective observational study was conducted on 104 poisoned patients who were admitted to Tanta Toxicological Unit with a DCL...
June 23, 2016: Human & Experimental Toxicology
Gregory Hansen, Patrick J McDonald, Doug Martin, Jeff K Vallance
OBJECTIVES: Pre-trauma center care is a critical component in severe pediatric traumatic brain injury (TBI). For geographically large trauma catchment areas, optimizing increased intracranial pressure (ICP) management may potentially improve outcomes. This retrospective study examined ICP management in nontrauma centers and during interfacility transport to the trauma center. METHODS: Charts from a pediatric level I trauma center were reviewed for admissions between 2008 and 2013...
June 2, 2016: Pediatric Emergency Care
Kevin R Carr, Michelle Rodriguez, Alex Ottesen, Joel Michalek, Colin Son, Vaibhav Patel, David Jimenez, Ali Seifi
BACKGROUND: Severe traumatic brain injury is associated with a multi-systemic response and changes in metabolic demand. Patients requiring intracranial pressure monitoring or cerebrospinal fluid diversion, often signifies a greater severity of injury. For this group, the association between RBC transfusion, transfusion thresholds, and clinical recovery is unknown. In this study, we studied the association between transfusion and clinical recovery for severe traumatic brain injury patients requiring external ventricular drain or intracranial pressure monitor placement...
October 2016: Neurocritical Care
Molly M McNett, Shelly Amato, Sue Ann Philippbar
PURPOSE: The aim of this study was to compare predictive ability of hospital Glasgow Coma Scale (GCS) scores and scores obtained using a novel coma scoring tool (the Full Outline of Unresponsiveness [FOUR] scale) on long-term outcomes among patients with traumatic brain injury. Preliminary research of the FOUR scale suggests that it is comparable with GCS for predicting mortality and functional outcome at hospital discharge. No research has investigated relationships between coma scores and outcome 12 months postinjury...
July 2016: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Annika Hickisch, Marie Holmefur
BACKGROUND: It is important for patient safety that the patient's level of consciousness is assessed and documented in a structured and reliable manner. The Full Outline of Unresponsiveness (FOUR) score measures the level of consciousness more comprehensively than the coma scales that are commonly used in Sweden. Therefore, there was a need to translate the FOUR score into Swedish and to evaluate its use in a Swedish healthcare context. OBJECTIVES: The aim of this study was to translate the FOUR score into Swedish and to evaluate the reliability of the Swedish version compared with the reliability of the Glasgow Coma Scale (GCS)...
July 2016: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
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
Daniel M Fountain, Angelos G Kolias, Fiona E Lecky, Omar Bouamra, Thomas Lawrence, Hadie Adams, Simon J Bond, Peter J Hutchinson
OBJECTIVE: We sought to determine 30-day survival trends and prognostic factors following surgery for acute subdural hematomas (ASDHs) in England and Wales over a 20-year period. SUMMARY OF BACKGROUND DATA: ASDHs are still considered the most lethal type of traumatic brain injury. It remains unclear whether the adjusted odds of survival have improved significantly over time. METHODS: Using the Trauma Audit and Research Network (TARN) database, we analyzed ASDH cases in the adult population (>16 yrs) treated surgically between 1994 and 2013...
April 4, 2016: Annals of Surgery
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