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Glasgow Coma Scale

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https://www.readbyqxmd.com/read/29341965/osmotic-shifts-cerebral-edema-and-neurologic-deterioration-in-severe-hepatic-encephalopathy
#1
Eric Michael Liotta, Anna L Romanova, Bryan D Lizza, Laura J Rasmussen-Torvik, Minjee Kim, Brandon Francis, Rajbeer Singh Sangha, Timothy J Carroll, Daniel Ganger, Daniela P Ladner, Andrew M Naidech, James J Paparello, Shyam Prabhakaran, Farzaneh A Sorond, Matthew B Maas
OBJECTIVES: We sought to determine the effect of acute electrolyte and osmolar shifts on brain volume and neurologic function in patients with liver failure and severe hepatic encephalopathy. DESIGN: Retrospective analysis of brain CT scans and clinical data. SETTING: Tertiary care hospital ICUs. PATIENTS: Patients with acute or acute-on-chronic liver failure and severe hepatic encephalopathy. INTERVENTIONS: Clinically indicated CT scans and serum laboratory studies...
February 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29337920/acute-traumatic-endotheliopathy-in-isolated-severe-brain-injury-and-its-impact-on-clinical-outcome
#2
Venencia Albert, Arulselvi Subramanian, Deepak Agrawal, Hara Prasad Pati, Siddhartha Datta Gupta, Asok Kumar Mukhopadhyay
STUDY DESIGN: Prospective observational cohort. OBJECTIVE: To investigate the difference in plasma levels of syndecan-1 (due to glycocalyx degradation) and soluble thrombomodulin (due to endothelial damage) in isolated severe traumatic brain injury (TBI) patients with/without early coagulopathy. A secondary objective was to compare the effects of the degree of TBI endotheliopathy on hospital mortality among patients with TBI-associated coagulopathy (TBI-AC). METHODS: Data was prospectively collected on isolated severe TBI (sTBI) patients with Glasgow Coma Scale (GCS) ≤8 less than 12 h after injury admitted to a level I trauma centre...
January 16, 2018: Medical Sciences: Open Access Journal
https://www.readbyqxmd.com/read/29336770/limit-crystalloid-resuscitation-after-traumatic-brain-injury
#3
Ara Ko, Megan Y Harada, Galinos Barmparas, Eric J T Smith, Kurtis Birch, Zachary R Barnard, Dorothy A Yim, Eric J Ley
Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of trauma patients with head abbreviated injury scale score ≥2, who received crystalloids during ED resuscitation between 2004 and 2013. Clinical characteristics and volume of crystalloids received in the ED were collected...
December 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29334825/the-influence-of-traumatic-axonal-injury-in-thalamus-and-brain-stem-on-level-of-consciousness-at-scene-or-admission-a-clinical-mri-study
#4
Hans Kristian Moe, Kent Gøran Moen, Toril Skandsen, Kjell Arne Kvistad, Steven Laureys, Asta Kristine Håberg, Anne Vik
The aim of this study was to investigate how traumatic axonal injury (TAI) lesions in the thalamus, basal ganglia and brain stem on clinical brain MRI are associated with level of consciousness in the acute phase in patients with moderate-severe traumatic brain injury (TBI). 158 patients with moderate-severe TBI (7-70 years) with early 1.5T MRI (median 7 days, range 0-35) without mass lesion were prospectively included. Glasgow Coma Scale (GCS) scores were registered before intubation or at admission. TAI lesions were identified in T2*gradient echo (GRE), fluid attenuated inversion recovery (FLAIR) and diffusion weighted imaging (DWI) scans...
January 15, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29332774/an-analysis-of-intoxicated-patients-transported-by-a-doctor-helicopter
#5
Ikuto Takeuchi, Kazuhiko Omori, Hiroki Nagasawa, Kei Jitsuiki, Takashi Iso, Akihiko Kondo, Kouhei Ishikawa, Hiromichi Ohsaka, Youichi Yanagawa
OBJECTIVE: We retrospectively investigated all of the intoxicated patients who were transported by a doctor helicopter (DH) in eastern Shizuoka between April 2004 and December 2015 to determine when air medical transport was used in cases of toxic exposure. METHODS: Subjects were divided into 2 groups: an outpatient group of subjects who went home after receiving a medical evaluation and treatment and an admission group. RESULTS: The outpatient and admission groups included 17 and 31 subjects, respectively...
January 2018: Air Medical Journal
https://www.readbyqxmd.com/read/29328003/characterizing-the-type-and-location-of-intracranial-abnormalities-in-mild-traumatic-brain-injury
#6
Harri Isokuortti, Grant L Iverson, Noah D Silverberg, Anneli Kataja, Antti Brander, Juha Öhman, Teemu M Luoto
OBJECTIVE The incidence of intracranial abnormalities after mild traumatic brain injury (TBI) varies widely across studies. This study describes the characteristics of intracranial abnormalities (acute/preexisting) in a large representative sample of head-injured patients who underwent CT imaging in an emergency department. METHODS CT scans were systematically analyzed/coded in the TBI Common Data Elements framework. Logistic regression modeling was used to quantify risk factors for traumatic intracranial abnormalities in patients with mild TBIs...
January 12, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29327268/serum-thiol-levels-and-thiol-disulphide-homeostasis-in-gunshot-injuries
#7
Hasan Buyukaslan, Umut Gulacti, Mehmet Tahir Gökdemir, Ramazan Giden, Hakim Celik, Özcan Erel, Erman Mustafa Dörterler
BACKGROUND: Gunshot injuries result in serious traumatic tissue damage due to high velocity of the bullet, deep penetration, and ballistic effect. Trauma is known to be related with oxidative stress. Serum thiol levels and disulphide/thiol homeostasis are novel oxidative stress biomarkers. In this study, we aimed to investigate serum thiol levels and disulphide/thiol homeostasis in injury patterns of patients admitted to the emergency department with a gunshot injury. METHOD: A total of 128 participants were included in the study...
January 11, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29326762/outcome-determinants-of-patients-with-traumatic-pelvic-fractures-a-cohort-study-in-a-level-i-trauma-center-in-southern-iran
#8
S Paydar, M Chaabi, M Akhavan, Z Ghahramani, M Dehghankhalili
Pelvic fracture is a result of devastating injuries and is usually encountered in conjunction with other life-threatening injuries. The aim of the current study was to determine the outcome determinants of patients with pelvic fractures referred to a large trauma center in southern Iran. This retrospective cross-sectional study was conducted in a level I trauma center over a period of three years from 2012 to 2015. We included all patients with pelvic fractures whose medical records had sufficient data. Data were compared between good condition and poor conditions...
November 2017: Malaysian Orthopaedic Journal
https://www.readbyqxmd.com/read/29325790/how-do-oral-and-maxillofacial-surgeons-manage-concussion
#9
D Hammond, R Welbury, G Sammons, E Toman, M Harland, S Rice
Craniofacial trauma results in distracting injuries that are easy to see, and as oral and maxillofacial surgeons (OMFS) we gravitate towards injuries that can be seen and are treatable surgically. However, we do tend not to involve ourselves (and may potentially overlook) injuries that are not obvious either visually or radiographically, and concussion is one such. We reviewed the records of 500 consecutive patients who presented with facial fractures at the Queen Elizabeth Hospital, Birmingham, to identify whether patients had been screened for concussion, and how they had been managed...
January 8, 2018: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29324173/the-risk-of-deterioration-in-gcs13-15-patients-with-traumatic-brain-injury-identified-by-computed-tomography-imaging-a-systematic-review-and-meta-analysis
#10
Carl Marincowitz, Fiona E Lecky, William Townend, Aditya Borakati, Andrea Fabbri, Trevor A Sheldon
The optimal management of mild traumatic brain injury (TBI) patients with injuries identified by computed tomography (CT) brain scan is unclear. Some guidelines recommend hospital admission for an observation period of at least 24 h. Others argue that selected lower-risk patients can be discharged from the Emergency Department (ED). The objective of our review and meta-analysis was to estimate the risk of death, neurosurgical intervention, and clinical deterioration in mild TBI patients with injuries identified by CT brain scan, and assess which patient factors affect the risk of these outcomes...
January 11, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29318180/systemic-inflammatory-response-syndrome-infection-and-outcome-in-intracerebral-hemorrhage
#11
Amelia K Boehme, Mary E Comeau, Carl D Langefeld, Aaron Lord, Charles J Moomaw, Jennifer Osborne, Michael L James, Sharyl Martini, Fernando D Testai, Daniel Woo, Mitchell S V Elkind
Objective: Systemic inflammatory response syndrome (SIRS) may be related to poor outcomes after intracerebral hemorrhage (ICH). Methods: The Ethnic/Racial Variations of Intracerebral Hemorrhage study is an observational study of ICH in whites, blacks, and Hispanics throughout the United Sates. SIRS was defined by standard criteria as 2 or more of the following on admission: (1) body temperature <36°C or >38°C, (2) heart rate >90 beats per minute, (3) respiratory rate >20 breaths per minute, or (4) white blood cell count <4,000/mm3 or >12,000/mm3...
March 2018: Neurology® Neuroimmunology & Neuroinflammation
https://www.readbyqxmd.com/read/29315336/hyperphosphatemia-is-associated-with-high-mortality-in-severe-burns
#12
George Kuo, Cheng-Chia Lee, Shih-Yi Yang, Yen-Chang Hsiao, Shiow-Shuh Chuang, Su-Wei Chang, Kun-Hua Tu, Pei-Chun Fan, Ya-Chung Tian, Yung-Chang Chen, Chih-Hsiang Chang
INTRODUCTION: Phosphate level is often deranged during acute illness, regardless of the presence of kidney injury or not. A few studies described that hypophosphatemia may associated with outcome in patients admitted to the burn unit, but the literatures for hyperphosphatemia is limited. Our study aims to evaluate if hyperphosphatemia, one of the sign of severe tissue damage or kidney injury, will associate with mortality of patients with severe burns. MATERIALS AND METHODS: The study was a post hoc analysis of prospectively collected data from patients admitted to the burn unit between September 2006 and December 2011...
2018: PloS One
https://www.readbyqxmd.com/read/29305758/ventriculostomy-and-risk-of-upward-herniation-in-patients-with-obstructive-hydrocephalus-from-posterior-fossa-mass-lesions
#13
Sherri A Braksick, Benjamin T Himes, Kendall Snyder, Jamie J Van Gompel, Jennifer E Fugate, Alejandro A Rabinstein
BACKGROUND: Patients with posterior fossa lesions causing obstructive hydrocephalus present a unique clinical challenge, as relief of hydrocephalus can improve symptoms, but the perceived risk of upward herniation must also be weighed against the risk of worsening or continued hydrocephalus and its consequences. The aim of our study was to evaluate for clinically relevant upward herniation following external ventricular drainage (EVD) in patients with obstructive hydrocephalus due to posterior fossa lesions...
January 5, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29305711/early-management-of-retained-hemothorax-in-blunt-head-and-chest-trauma
#14
Fong-Dee Huang, Wen-Bin Yeh, Sheng-Shih Chen, Yuan-Yuarn Liu, I-Yin Lu, Yi-Pin Chou, Tzu-Chin Wu
BACKGROUND: Major blunt chest injury usually leads to the development of retained hemothorax and pneumothorax, and needs further intervention. However, since blunt chest injury may be combined with blunt head injury that typically requires patient observation for 3-4 days, other critical surgical interventions may be delayed. The purpose of this study is to analyze the outcomes of head injury patients who received early, versus delayed thoracic surgeries. MATERIALS AND METHODS: From May 2005 to February 2012, 61 patients with major blunt injuries to the chest and head were prospectively enrolled...
January 5, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29305272/effect-of-hyperosmolar-therapy-on-outcome-following-spontaneous-intracerebral-hemorrhage-ethnic-racial-variations-of-intracerebral-hemorrhage-erich-study
#15
Manan Shah, Lee Birnbaum, Jennifer Rasmussen, Padmini Sekar, Charles J Moomaw, Jennifer Osborne, Anastasia Vashkevich, Daniel Woo
PURPOSE: We aimed to identify the effect of hyperosmolar therapy (mannitol and hypertonic saline) on outcomes after intracerebral hemorrhage (ICH) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study. METHODS: Comparison of ICH cases treated with hyperosmolar therapy versus untreated cases was performed using a propensity score based on age, initial Glasgow Coma Scale, location of ICH (lobar, deep, brainstem, and cerebellar), log-transformed initial ICH volume, presence of intraventricular hemorrhage, and surgical interventions...
January 3, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29304855/prognostic-value-of-coagulation-tests-for-in-hospital-mortality-in-patients-with-traumatic-brain-injury
#16
Qiang Yuan, Jian Yu, Xing Wu, Yi-Rui Sun, Zhi-Qi Li, Zhuo-Ying Du, Xue-Hai Wu, Jin Hu
BACKGROUND: Coagulopathy is commonly observed after traumatic brain injury (TBI). However, it is not known whether using the standard independent predictors in conjunction with coagulation tests would improve their prognostic value. We determined the incidence of TBI-associated coagulopathy in patients with isolated TBI (iTBI), evaluated the prognostic value of coagulation tests for in-hospital mortality, and tested their predictive power for in-hospital mortality in patients with iTBI...
January 5, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29304054/injury-mechanisms-patterns-and-outcomes-of-older-polytrauma-patients-an-analysis-of-the-dutch-trauma-registry
#17
Rob de Vries, Inge H F Reininga, Oliver Pieske, Rolf Lefering, Mostafa El Moumni, Klaus Wendt
BACKGROUND: Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. METHODS: Data from polytrauma (ISS≥16) patients between 2009 and 2014 were extracted from the Dutch trauma registry (DTR). Younger (Group A: ages 18-59) and older (Group B: ages ≥60) polytrauma patients were compared...
2018: PloS One
https://www.readbyqxmd.com/read/29303836/integrating-quantitative-pupillometry-into-regular-care-in-a-neurotrauma-intensive-care-unit
#18
Maighdlin Anderson, Jonathan Elmer, Lori Shutter, Ava Puccio, Sheila Alexander
In the setting of acute traumatic brain injury (TBI), an abnormal pupil assessment may suggest a worsening intracranial lesion. Early detection of pupillary changes may expedite emergent care to improve outcomes. Automated, handheld pupillometers have been commercially available for 20 years, and several studies suggest that their use may facilitate early recognition of worsening injury and intracranial hypertension. The use of pupillometry as a bedside tool in the routine care of patients with severe TBI (Glasgow Coma Scale score ≤ 8) has not been described...
February 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/29303451/traumatic-midline-subarachnoid-hemorrhage-on-initial-computed-tomography-as-a-marker-of-severe-diffuse-axonal-injury
#19
Daddy Mata-Mbemba, Shunji Mugikura, Atsuhiro Nakagawa, Takaki Murata, Kiyoshi Ishii, Shigeki Kushimoto, Teiji Tominaga, Shoki Takahashi, Kei Takase
OBJECTIVE The objective of this study was to test the hypothesis that midline (interhemispheric or perimesencephalic) traumatic subarachnoid hemorrhage (tSAH) on initial CT may implicate the same shearing mechanism that underlies severe diffuse axonal injury (DAI). METHODS The authors enrolled 270 consecutive patients (mean age [± SD] 43 ± 23.3 years) with a history of head trauma who had undergone initial CT within 24 hours and brain MRI within 30 days. Six initial CT findings, including intraventricular hemorrhage (IVH) and tSAH, were used as candidate predictors of DAI...
January 5, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29303442/blossoming-contusions-identifying-factors-contributing-to-the-expansion-of-traumatic-intracerebral-hemorrhage
#20
Joseph A Carnevale, David J Segar, Andrew Y Powers, Meghal Shah, Cody Doberstein, Benjamin Drapcho, John F Morrison, John R Williams, Scott Collins, Kristina Monteiro, Wael F Asaad
OBJECTIVE Traumatic brain injury (TBI) remains a significant cause of neurological morbidity and mortality. Each year, more than 1.7 million patients present to the emergency department with TBI. The goal of this study was to evaluate the prognosis of traumatic cerebral intraparenchymal hemorrhage (tIPH), to develop subclassifications of these injuries that relate to prognosis, and to provide a more comprehensive assessment of hemorrhagic progression contusion (HPC) by analyzing the rate at which tIPH "blossom" (i...
January 5, 2018: Journal of Neurosurgery
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