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Ahmed N, Russo L, Kuo YH. Outcomes of Repeat Surgery in Pediatric Severe Traumatic Brain Injury: An Analysis from Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial. World Neurosurg 2024; 184:e195-e202. [PMID: 38266987 DOI: 10.1016/j.wneu.2024.01.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Early operative intervention, craniotomy, and/or craniectomy are occasionally warranted in severe traumatic brain injury (TBI). Persistent increased intracranial pressure or accumulation of intracranial hematoma postsurgery can result in higher mortality and morbidity. There is a gap in information regarding the outcome of repeat surgery (RS) in pediatric patients with severe TBI. METHODS An observational cohort study titled Approaches and Decisions in Acute Pediatric TBI Trial data was obtained from the Federal Interagency Traumatic Brain Injury Research Informatics System. All pediatric patients who underwent craniotomy or decompressive craniectomy, survived more than 44 hours and were found to have persistent elevated intracranial pressure >20 mmHg for 2 consecutive hours were included in the study. The purpose of the study was to find the outcomes of RS in pediatric severe TBI. Propensity based matching was used to find the outcomes. The primary outcome was 60-day mortality. RESULTS Out of 1000 total patients enrolled in the Approaches and Decisions in Acute Pediatric Trial, 160 patients qualified for this study. Propensity score matching created 13 pairs of patients. There were no significant differences found between the groups who had RS versus those who did not have repeat surgery on baseline characteristics. There were no significant differences found between the groups regarding 60-day mortality, median hospital days, median intensive care unit days, and 6-month favorable outcome on Glasgow Outcome Scale Extended score. CONCLUSIONS There was no difference in mortality between patients who underwent a second surgery and patients who did not have to undergo a second surgery.
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Affiliation(s)
- Nasim Ahmed
- Department of Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA; Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Neptune, New Jersey, USA.
| | - Larissa Russo
- Division of Trauma, Jersey Shore University Medical Center, Neptune, New Jersey, USA
| | - Yen-Hong Kuo
- Office of Research Administration, Jersey Shore University Medical Center, Neptune, New Jersey, USA
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Eghbal K, Farrokhi MR, Mousavi SR, Shahpari Motlagh MA, Kazeminezhad A, Ghaffarpasand F. Acute supratentorial subdural hematoma after craniocervical junction arachnolysis in a patient with posttraumatic syringomyelia; case report and literature review. Clin Case Rep 2023; 11:e7170. [PMID: 37006844 PMCID: PMC10064022 DOI: 10.1002/ccr3.7170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
In patients with SAA rapid CSF drainage while performing durotomy must be avoided by utilizing cotton pads and lowering the head level to avoid catastrophic complications.
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Affiliation(s)
- Keyvan Eghbal
- Department of NeurosurgeryShiraz University of Medical SciencesShirazIran
| | - Majid Reza Farrokhi
- Shiraz Neurosciences Research Center, Department of NeurosurgeryShiraz University of Medical SciencesShirazIran
| | - Seyed Reza Mousavi
- Department of NeurosurgeryShiraz University of Medical SciencesShirazIran
| | | | - Ali Kazeminezhad
- Department of Neurosurgery, Peymanieh Hospital, Trauma Research CenterJahrom University of Medical SciencesJahromIran
| | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and PainShiraz University of Medical SciencesShirazIran
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Fokin AA, Wycech Knight J, Davis B, Stalder R, Mendes MAP, Darya M, Puente I. The timing and value of early postoperative computed tomography after head surgery in traumatic brain injury patients. Clin Neurol Neurosurg 2023; 226:107606. [PMID: 36706679 DOI: 10.1016/j.clineuro.2023.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To analyze the timing of the early postoperative computed tomography (CT) in traumatic brain injury (TBI) patients, and compare CT and neurological examination (NE) findings. METHODS Retrospective analysis included 353 TBI patients admitted to two level 1 trauma centers (2016-2020) who underwent head surgery and postoperative CT within 24 h. Analyzed variables: age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), Abbreviated Injury Scale head (AISh), comorbidities, CT and NE findings and timing, head surgery type, and mortality. RESULTS Patients mean age was 61.9 years, ISS 25.1, GCS 11.0, AISh 4.7. Postoperatively, mean time to first positive CT was 6.1 h and to first positive NE was 13.2 h. Positive CT alone was more accurate in identifying need for 2nd head surgery than positive NE alone (21.8 % vs 6.0 %, p = 0.04). There was no difference between patients with CT done earlier than 6 h compared to patients with CT done after 6 h in mortality (26.1 % vs 22.0 %, p = 0.4) or 2nd surgery rate (12.2 % vs 12.2 %, p = 1.0). Reversal of postoperative CT findings occurred in 1/6 of patients and was more common when CT was done earlier than 6 h compared to CT done later (25.7 % vs 0.8 %, p < 0.001). Early CT within 1 h rarely leads to the change of management but often is followed by another CT within 12 h. CONCLUSION In TBI patients postoperative CT was more effective than NE in predicting a need for 2nd head surgery. Postoperative head CT at 6 h is recommended to allow timely detection of intracranial deterioration, reduce the number of CTs and reversal findings as it does not increase 2nd surgery rates and mortality.
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Affiliation(s)
- Alexander A Fokin
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, 777 Glades Rd, Boca Raton, FL 33431, USA.
| | - Joanna Wycech Knight
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Broward Health Medical Center, Division of Trauma and Critical Care Services,1600 S Andrews Ave, Fort Lauderdale, FL 33316, USA
| | - Brooke Davis
- Broward Health Medical Center, Division of Trauma and Critical Care Services,1600 S Andrews Ave, Fort Lauderdale, FL 33316, USA
| | - Ryan Stalder
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, 777 Glades Rd, Boca Raton, FL 33431, USA
| | - Mary Anne P Mendes
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; St.George's University, School of Medicine, University Centre Grenada, West Indies, Grenada
| | - Maral Darya
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, 777 Glades Rd, Boca Raton, FL 33431, USA
| | - Ivan Puente
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, 777 Glades Rd, Boca Raton, FL 33431, USA; Broward Health Medical Center, Division of Trauma and Critical Care Services,1600 S Andrews Ave, Fort Lauderdale, FL 33316, USA; Florida International University, Herbert Wertheim College of Medicine, Department of Surgery, 11200 SW 8th St, Miami, FL 33199, USA
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Weykamp MB, Stern KE, Brakenridge SC, Robinson BR, Wade CE, Fox EE, Holcomb JB, O’Keefe GE. PREHOSPITAL CRYSTALLOID RESUSCITATION: PRACTICE VARIATION AND ASSOCIATIONS WITH CLINICAL OUTCOMES. Shock 2023; 59:28-33. [PMID: 36703275 PMCID: PMC9886338 DOI: 10.1097/shk.0000000000002039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
ABSTRACT Introduction: Although resuscitation guidelines for injured patients favor blood products, crystalloid resuscitation remains a mainstay in prehospital care. Our understanding of contemporary prehospital crystalloid (PHC) practices and their relationship with clinical outcomes is limited. Methods: The Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial data set was used for this investigation. We sought to identify factors associated with PHC volume variation and hypothesized that higher PHC volume is associated with worse coagulopathy and a higher risk of acute respiratory distress syndrome (ARDS) but a lower risk of acute kidney injury (AKI). Subjects were divided into groups that received <1,000 mL PHC (PHC<1,000) and ≥1,000 mL PHC (PHC≥1,000); initial laboratory values and outcomes (ARDS and AKI risk) were summarized with medians and interquartile ranges or percentages and compared using Wilcoxon rank-sum tests and chi-square tests. The primary outcome was ARDS risk. Multivariable regression was used to characterize the association of each 500 mL aliquot of PHC with initial laboratory values and clinical outcomes. Results: PHC volume among study subjects (n = 680) varied (median, 0.3 L; interquartile range, 0-0.9 L) with weak associations demonstrated among prehospital hemodynamics, intubation, Glasgow Coma Score, and Injury Severity Score (0.008 ≤ R2 ≤ 0.09); prehospital time and enrollment site explained more variation in PHC volume with R2 values of 0.2 and 0.54, respectively. Compared with PHC<1,000, PHC≥1,000 had higher INR, PT, PTT, and base deficit and lower hematocrit and platelets. The proportion of ARDS in the PHC≥1,000 group was higher than PHC<1,000 (21% vs. 12%, P < 0.01), whereas the rate of AKI was similar between groups (23% vs. 23%, P = 0.9). In regression analyses, each 500 mL of PHC was associated with increased INR and PTT, and decreased hematocrit and platelet count (P < 0.05). Each 500 mL of PHC was associated with increased ARDS risk and decreased AKI risk (P < 0.05). Conclusion: PHC administration correlates poorly with prehospital hemodynamics and injury characteristics. Increased PHC volume is associated with greater anemia, coagulopathy, and increased risk of ARDS, although it may be protective against AKI.
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Affiliation(s)
- Michael B. Weykamp
- Department of Surgery, Harborview Medical Center, The University of Washington, Washington
| | - Katherine E. Stern
- Department of Surgery, Harborview Medical Center, The University of Washington, Washington
- Department of Surgery, The University of San Francisco – East Bay, California
| | - Scott C. Brakenridge
- Department of Surgery, Harborview Medical Center, The University of Washington, Washington
| | - Bryce R.H. Robinson
- Department of Surgery, Harborview Medical Center, The University of Washington, Washington
| | - Charles E. Wade
- Department of Surgery and Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Texas
| | - Erin E. Fox
- Department of Surgery and Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Texas
| | - John B. Holcomb
- Department of Surgery, University of Alabama at Birmingham, Alabama
| | - Grant E. O’Keefe
- Department of Surgery, Harborview Medical Center, The University of Washington, Washington
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Yang T, Yu J, Shen H, Yang C, Zhang P, Li Y, Wu H. Risk factors and risk nomogram model of reoperation for hemorrhages after severe traumatic brain injury craniotomy. IBRAIN 2022; 8:141-147. [PMID: 37786884 PMCID: PMC10529335 DOI: 10.1002/ibra.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/04/2023]
Abstract
Objective This study aimed to explore the risk factors associated with reoperation for postoperative hemorrhages after severe traumatic brain injury (sTBI) craniotomy and establish a risk nomogram model. Methods A retrospective case-control study was performed. Overall, 367 patients who were diagnosed with sTBI and fulfilled the inclusion criteria were enrolled from the Department of Neurosurgery of the Affiliated Hospital of Zunyi Medical University between January 2015 and December 2020. They were divided into a reoperation group and a non-reoperation group according to whether they underwent reoperation for hemorrhages. Using univariate binary logistic regression analysis, the possible risk factors were screened. Subsequently, the independent risk factors of reoperation for postoperative hemorrhages were screened using the forward step method of multivariate binary logistic regression analysis, and a corresponding nomogram model was constructed. The receiver operative characteristic (ROC) curve was used to evaluate the reliability of the model. Finally, 30% of the data were randomly selected for internal verification of the model. Results The reoperation rate for hemorrhage after sTBI emergency craniotomy was 14.71% (54/367); multivariate logistic regression analysis showed that multiple hemorrhages (odds ratio [OR] = 4.38, 95% confidence interval [CI]: 1.815-10.587, p = 0.001), day or night surgery (OR = 0.26, 95% CI: 0.119-0.547, p < 0.001), operation duration (OR = 0.74, 95% CI: 0.119-0.547, p < 0.025), and abnormal intraoperative blood pressure fluctuation (OR = 4.15, 95% CI: 2.090-8.245, p < 0.001) were statistically significant. The sensitivity and specificity of the nomogram model were 0.815 and 0.661, respectively, and the area under ROC curve was 0.76 (95% CI: 0.705-0.833). Internal verification showed that the area under the ROC curve was 0.783 (95% CI: 0.683-0.883). Conclusions Taken together, the results of our study reveal that multiple preoperative intracranial hemorrhages, day and night operation, operation duration, and abnormal fluctuation of intraoperative blood pressure were independent risk factors for postoperative bleeding and reoperation for sTBI. Through the analysis of the influencing factors, a prediction model for the risk of bleeding and reoperation after craniocerebral trauma was developed. Compared with other relevant studies, this prediction model has good prediction efficiency and can be used to predict the occurrence of bleeding and reoperation after sTBI in patients.
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Affiliation(s)
- Tao Yang
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Jie Yu
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hao Shen
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Chao‐Zhi Yang
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Ping Zhang
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yi Li
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hai‐Tao Wu
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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