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https://www.readbyqxmd.com/read/29329548/the-cost-of-a-pediatric-neurocritical-care-program-for-traumatic-brain-injury-a-retrospective-cohort-study
#1
Steven W Howard, Zidong Zhang, Paula Buchanan, Stephanie L Bernell, Christine Williams, Lindsey Pearson, Michael Huetsch, Jeff Gill, Jose A Pineda
BACKGROUND: Inpatient care for children with severe traumatic brain injury (sTBI) is expensive, with inpatient charges averaging over $70,000 per case (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet.ahrq.gov/#setup ]). This ranks sTBI in the top quartile of pediatric conditions with the greatest inpatient costs (Hospital Inpatient, Children Only, National Statistics...
January 12, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29325878/can-we-identify-futility-in-kids-an-evaluation-of-admission-parameters-predicting-100-mortality-in-1292-severely-injured-children
#2
Kyle J Kalkwarf, Shane D Jensen, Myron Allukian, Matthew T Harting, Charles S Cox, Erin E Fox, Charles E Wade, Bryan A Cotton
BACKGROUND: Objective parameters predicting futility of care in severely injured pediatric patients are lacking. While futility of care has been investigated in a limited number of studies in trauma patients, none of these studies achieves a 100% success rate in a large cohort of pediatric patients. The purpose of the current study was to identify extreme laboratory values that could be used to predict 100% mortality in severely injured children. STUDY DESIGN: Registry-based, historical cohort of all severely injured children (level 1 trauma, <16 years old), who were not dead on arrival, between January 2010 and December 2016 from a single level 1 trauma center...
January 8, 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29325790/how-do-oral-and-maxillofacial-surgeons-manage-concussion
#3
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/29321395/-hmgb1-as-a-representative-damp-and-anti-hmgb1-antibody-therapy
#4
Masahiro Nishibori
High mobility group box-1 (HMGB1), a representative damage-associated molecular patterns (DAMPs), has been reported to be involved in many inflammatory diseases. To validate HMGB1 as a target molecule of inflammatory diseases and to examine the effects of inhibition of HMGB1 on the diseases, we raised anti-HMGB1 monoclonal antibody (mAb) neutralizing extracellular HMGB1 and characterized it. We report the effects of anti-HMGB1 mAb on brain infarction, brain hemorrhage, brain trauma, epilepsy and neuropathic pain using animal models...
2018: Nihon Yakurigaku Zasshi. Folia Pharmacologica Japonica
https://www.readbyqxmd.com/read/29310574/traumatic-brain-injury-tbi-outcomes-in-an-lmic-tertiary-care-centre-and-performance-of-trauma-scores
#5
Samitha Samanamalee, Ponsuge Chathurani Sigera, Ambepitiyawaduge Pubudu De Silva, Kaushila Thilakasiri, Aasiyah Rashan, Saman Wadanambi, Kosala Saroj Amarasiri Jayasinghe, Arjen M Dondorp, Rashan Haniffa
BACKGROUND: This study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting. METHODS: Adult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited...
January 8, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29306988/acute-phase-response-after-fatal-traumatic-brain-injury
#6
Benjamin Ondruschka, Sandra Schuch, Dirk Pohlers, Heike Franke, Jan Dreßler
An inflammatory response occurring after fatal traumatic brain injury (TBI) initiates time-dependent cascades of acute phase response. This may offer the potential to monitor postmortem biomarker levels of several pro-inflammatory cytokines to gain information about the cause of death and the trauma survival time. Cerebrospinal fluid (CSF) and serum samples were collected from forensic autopsies of 95 adult cadavers after postmortem intervals up to 6 days. The cases were divided according to their cause of death into fatal TBI (n = 46) with different survival times and age- and gender-matching non-TBI fatalities as controls (n = 49)...
January 6, 2018: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/29306936/remote-healing-of-bipolar-disorder-eating-disorder-not-otherwise-specified-posttraumatic-stress-disorder-fibromyalgia-and-irritable-bowel-syndrome-through-lifestyle-change
#7
Kelly Brogan
This case report illustrates the relationship between gut, hormonal, and brain function in that dietary change, mindfulness interventions, and detoxification led to resolution of disabling psychiatric symptoms. In this case, a single Caucasian female resolved her symptoms of bipolar disorder (BD) including psychotic features and suicidality, posttraumatic stress disorder symptoms from childhood torture, disordered eating, fibromyalgia, and irritable bowel syndrome through lifestyle interventions. This patient survived a severe trauma history only to develop alcohol dependence, disordered eating, and depressive symptoms, which were treated with a polypharmaceutical psychiatric approach...
October 2017: Advances in Mind-body Medicine
https://www.readbyqxmd.com/read/29306704/neuroprotective-effect-of-acute-ethanol-intoxication-in-tbi-is-associated-to-the-hierarchical-modulation-of-early-transcriptional-responses
#8
Akila Chandrasekar, Bahar Aksan, Florian Olde Heuvel, Philip Förstner, Daniela Sinske, Rida Rehman, Annette Palmer, Albert Ludolph, Markus Huber-Lang, Tobias Böckers, Daniela Mauceri, Bernd Knöll, Francesco Roselli
Ethanol intoxication is a risk factor for traumatic brain injury (TBI) but clinical evidence suggests that it may actually improve the prognosis of intoxicated TBI patients. We have employed a closed, weight-drop TBI model of different severity (2cm or 3cm falling height), preceded (-30min) or followed (+20min) by ethanol administration (5g/Kg). This protocol allows us to study the interaction of binge ethanol intoxication in TBI, monitoring behavioral changes, histological responses and the transcriptional regulation of a series of activity-regulated genes (immediate early genes, IEGs)...
January 4, 2018: Experimental Neurology
https://www.readbyqxmd.com/read/29305711/early-management-of-retained-hemothorax-in-blunt-head-and-chest-trauma
#9
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/29304719/neuroimmunology-of-traumatic-brain-injury-a-longitudinal-study-of-interdependency-of-inflammatory-markers-and-heart-rate-variability-in-severe-traumatic-brain-injury
#10
Akhil Deepika, Bhagavatula Indira Devi, Dhaval P Shukla, Talakad N Sathyaprabla, Rita Christopher, Shruthi S Ramesh
The purpose of the present study is to evaluate the inter-dependency between the electrophysiological (Heart rate variability) and inflammatory markers in traumatic brain injury (TBI) patients and the outcome in patients with severe TBI. A prospective exploratory study was done with a sample size of 89 severe traumatic brain injury patients. The Heart rate variability of these patients was recorded using a telemetric device BioHarness® (Zephyr technologies). The recordings were made on day 1 of the patients' admission into the ICU followed by serial recordings on Day 3 and day 10...
January 5, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29303451/traumatic-midline-subarachnoid-hemorrhage-on-initial-computed-tomography-as-a-marker-of-severe-diffuse-axonal-injury
#11
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
#12
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
https://www.readbyqxmd.com/read/29303440/predictive-value-of-positive-high-sensitivity-troponin-t-in-intubated-traumatic-brain-injury-patients
#13
Ayman El-Menyar, Mohammad Asim, Rifat Latifi, Shrikant I Bangdiwala, Hassan Al-Thani
OBJECTIVE The clinical relevance of high-sensitivity troponin T (HsTnT) in trauma patients is not well explored. In this study, the authors aimed to study the predictive value of serum HsTnT in intubated patients who had sustained traumatic brain injury (TBI). METHODS A retrospective analysis was conducted for all intubated TBI patients between 2010 and 2014 at a national level 1 trauma center. Data were analyzed and compared based on the HsTnT status on admission (group 1, negative results; and group 2, positive results)...
January 5, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29291174/clinical-study-to-assess-the-outcome-in-surgically-managed-patients-of-spontaneous-intracerebral-hemorrhage
#14
Yashwanth S Sandeep, M Raja Guru, Ranjan Kumar Jena, Veldurti Ananta Kiran Kumar, Amit Agrawal
Introduction: Spontaneous intracerebral hemorrhage (SICH) subtype of stroke is characterized by bleeding into brain parenchyma which is not accompanied by trauma. Emergency surgical evacuation of large size SICH increases the chances of survival but does not help in functional recovery of the patients. The present study was conducted to assess the outcome of surgical management in patients with SICH. Materials and Methods: All patients who were diagnosed with SICH and underwent surgical evacuation of the hematoma included in the study...
October 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/29288841/management-of-severe-traumatic-brain-injury-first-24-hours
#15
Thomas Geeraerts, Lionel Velly, Lamine Abdennour, Karim Asehnoune, Gérard Audibert, Pierre Bouzat, Nicolas Bruder, Romain Carrillon, Vincent Cottenceau, François Cotton, Sonia Courtil-Teyssedre, Claire Dahyot-Fizelier, Frédéric Dailler, Jean-Stéphane David, Nicolas Engrand, Dominique Fletcher, Gilles Francony, Laurent Gergelé, Carole Ichai, Etienne Javouhey, Pierre-Etienne Leblanc, Thomas Lieutaud, Philippe Meyer, Sébastien Mirek, Gilles Orliaguet, François Proust, Hervé Quintard, Catherine Ract, Mohamed Srairi, Karim Tazarourte, Bernard Vigué, Jean-François Payen
The latest French Guidelines for the management in the first 24hours of patients with severe traumatic brain injury (TBI) were published in 1998. Due to recent changes (intracerebral monitoring, cerebral perfusion pressure management, treatment of raised intracranial pressure), an update was required. Our objective has been to specify the significant developments since 1998. These guidelines were conducted by a group of experts for the French Society of Anesthesia and Intensive Care Medicine (Société Francaise d'Anesthésie Réanimation (SFAR)) in partnership with the Association de Neuro-Anesthésie-Réanimation de Langue Française (ANARLF), the Société Française de Neurochirurgie (SFN), the Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP) and the Association des Anesthésistes-Réanimateurs Pédiatriques d'Expression Française (ADARPEF)...
December 27, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29285982/effects-of-veliparib-on-microglial-activation-and-functional-outcomes-following-traumatic-brain-injury-in-the-rat-and-pig
#16
Karen Irvine, Robin Bishop, Seok Joon Won, Jianguo Xu, Katherine Hamel, Valerie Coppes, Pardeep Singh, Andrew Sondag, Eric Rome, Jayinee Basu, Giordano Santos, S Scott Panter, Raymond Swanson
The inflammation response induced by brain trauma can impair recovery. This response requires several hours to fully develop, and thus provides a clinically relevant therapeutic window of opportunity. Poly(ADP-ribose) polymerase inhibitors suppress inflammatory responses, including brain microglial activation. Here we evaluated delayed treatment with veliparib, a poly(ADP-ribose) polymerase inhibitor currently in clinical trials as a cancer therapeutic, in rats and pigs subjected to controlled cortical impact (CCI)...
December 29, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29283612/moving-effective-treatment-for-posttraumatic-stress-disorder-to-primary-care-a-randomized-controlled-trial-with-active-duty-military
#17
Jeffrey A Cigrang, Sheila A Rauch, Jim Mintz, Antoinette R Brundige, Jennifer A Mitchell, Elizabeth Najera, Brett T Litz, Stacey Young-McCaughan, John D Roache, Elizabeth A Hembree, Jeffrey L Goodie, Scott M Sonnek, Alan L Peterson
INTRODUCTION: Many military service members with PTSD do not receive evidence-based specialty behavioral health treatment because of perceived barriers and stigma. Behavioral health providers in primary care can deliver brief, effective treatments expanding access and reducing barriers and stigma. The purpose of this randomized clinical trial was to determine if a brief cognitive-behavior therapy delivered in primary care using the Primary Care Behavioral Health model would be effective at reducing PTSD and co-occurring symptoms...
December 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/29283434/elevation-of-the-head-during-intensive-care-management-in-people-with-severe-traumatic-brain-injury
#18
REVIEW
Jose D Alarcon, Andres M Rubiano, David O Okonkwo, Jairo Alarcón, Maria José Martinez-Zapata, Gerard Urrútia, Xavier Bonfill Cosp
BACKGROUND: Traumatic brain injury (TBI) is a major public health problem and a fundamental cause of morbidity and mortality worldwide. The burden of TBI disproportionately affects low- and middle-income countries. Intracranial hypertension is the most frequent cause of death and disability in brain-injured people. Special interventions in the intensive care unit are required to minimise factors contributing to secondary brain injury after trauma. Therapeutic positioning of the head (different degrees of head-of-bed elevation (HBE)) has been proposed as a low cost and simple way of preventing secondary brain injury in these people...
December 28, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29283022/cns-injury-posttranslational-modification-of-the-tau-protein-as-a-biomarker
#19
Mitchell T Caprelli, Andrea J Mothe, Charles H Tator
The ideal biomarker for central nervous system (CNS) trauma in patients would be a molecular marker specific for injured nervous tissue that would provide a consistent and reliable assessment of the presence and severity of injury and the prognosis for recovery. One candidate biomarker is the protein tau, a microtubule-associated protein abundant in the axonal compartment of CNS neurons. Following axonal injury, tau becomes modified primarily by hyperphosphorylation of its various amino acid residues and cleavage into smaller fragments...
November 1, 2017: Neuroscientist: a Review Journal Bringing Neurobiology, Neurology and Psychiatry
https://www.readbyqxmd.com/read/29282438/management-of-unruptured-traumatic-middle-meningeal-artery-pseudoaneurysms-through-onyx-embolization
#20
Nicolas K Khattar, Andrew C White, Enzo M Fortuny, Rob T Hruska, Robert F James
Traumatic pseudoaneurysms of the middle meningeal artery (MMA) represent less than 1% of all intracranial aneurysms, and occur mostly in association with temporal bone fractures following head trauma. Given the unknown natural history, it is unclear whether they should be treated. We present two cases of MMA pseudoaneurysms discovered during trauma workups. The first patient is a 44-year-old male with severe traumatic brain injury (TBI) following a motor vehicle accident. The patient was found to have two right-sided middle meningeal artery pseudoaneurysms that were treated successfully with Onyx® (Medtronic, Minneapolis, MN) embolization...
October 23, 2017: Curēus
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