1
|
Ahmed N, Kuo YH, Shin SH. Surgical Outcomes of Epidural Hematoma in Trauma Patients with Absent Pupillary Reactions: A National Trauma Data Analysis. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38821065 DOI: 10.1055/s-0044-1786535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Absent pupillary reaction occasionally heralds a poor prognosis following severe head injury. The purpose of the study was to evaluate the outcome of all patients who underwent acute evacuation of epidural hematoma (EDH) despite absent bilateral pupillary reaction. METHODS The Trauma Quality Improvement Program (TQIP) database for the calendar years 2017 and 2018 was accessed for the study. Adult patients ≥18 years of age who sustained severe traumatic brain injury (TBI) with the diagnosis of EDH and underwent evacuation of the hematoma were included in the study. The patients' characteristics, injury severity score (ISS), Glasgow Coma Scale (GCS) score, midline shift, and comorbidities were compared between patients who had absence of both pupillary reaction (ABPR) and those who presented with presence of both pupillary reaction (PBPR). The primary outcome of the study was in-hospital mortality. Propensity score matching analyses were performed for the study. RESULTS No significant differences were found between the ABPR and PBPR groups regarding the median age (37 years [interquartile range (IQR): 26-53] vs. 40 years [IQR: 28-55]), gender (males; 81.9 vs. 79.5%), median ISS (29 [25.5-34] vs. 27 [25-33]), GCS score (3 [3-4] vs. 3 [3-3], presence of significant midline shift (75.9 vs. 79.5%), and comorbidities. The patients who presented with ABPR had a significantly higher mortality (34.9 vs. 10.8%; p = 0.002). A higher number of patients were discharged to skilled nursing and rehabilitation facilities (16.7 vs. 10.8% and 46.3 vs. 41.9%, respectively; p = 0.045). CONCLUSION Approximately 65% of severe TBI patients survived after the evacuation of the EDH despite the absence of pupillary reaction.
Collapse
Affiliation(s)
- Nasim Ahmed
- Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, New Jersey, United States
- Hackensack Meridian School of Medicine, Nutley, New Jersey, United States
| | - Yen-Hong Kuo
- Office of Research Administration, Hackensack Meridian Health Research Institute, Nutley, New Jersey, United States
- Hackensack Meridian School of Medicine, Nutley, New Jersey, United States
| | - Seung Hoon Shin
- Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, New Jersey, United States
| |
Collapse
|
2
|
Pisică D, Volovici V, Yue JK, van Essen TA, den Boogert HF, Vande Vyvere T, Haitsma I, Nieboer D, Markowitz AJ, Yuh EL, Steyerberg EW, Peul WC, Dirven CMF, Menon DK, Manley GT, Maas AIR, Lingsma HF. Clinical and Imaging Characteristics, Care Pathways, and Outcomes of Traumatic Epidural Hematomas: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study. Neurosurgery 2024:00006123-990000000-01172. [PMID: 38771081 DOI: 10.1227/neu.0000000000002982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/05/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Guideline recommendations for surgical management of traumatic epidural hematomas (EDHs) do not directly address EDHs that co-occur with other intracranial hematomas; the relative rates of isolated vs nonisolated EDHs and guideline adherence are unknown. We describe characteristics of a contemporary cohort of patients with EDHs and identify factors influencing acute surgery. METHODS This research was conducted within the longitudinal, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury cohort study which prospectively enrolled patients with traumatic brain injury from 65 hospitals in 18 European countries from 2014 to 2017. All patients with EDH on the first scan were included. We describe clinical, imaging, management, and outcome characteristics and assess associations between site and baseline characteristics and acute EDH surgery, using regression modeling. RESULTS In 461 patients with EDH, median age was 41 years (IQR 24-56), 76% were male, and median EDH volume was 5 cm3 (IQR 2-20). Concomitant acute subdural hematomas (ASDHs) and/or intraparenchymal hemorrhages were present in 328/461 patients (71%). Acute surgery was performed in 99/461 patients (21%), including 70/86 with EDH volume ≥30 cm3 (81%). Larger EDH volumes (odds ratio [OR] 1.19 [95% CI 1.14-1.24] per cm3 below 30 cm3), smaller ASDH volumes (OR 0.93 [95% CI 0.88-0.97] per cm3), and midline shift (OR 6.63 [95% CI 1.99-22.15]) were associated with acute surgery; between-site variation was observed (median OR 2.08 [95% CI 1.01-3.48]). Six-month Glasgow Outcome Scale-Extended scores ≥5 occurred in 289/389 patients (74%); 41/389 (11%) died. CONCLUSION Isolated EDHs are relatively infrequent, and two-thirds of patients harbor concomitant ASDHs and/or intraparenchymal hemorrhages. EDHs ≥30 cm3 are generally evacuated early, adhering to Brain Trauma Foundation guidelines. For heterogeneous intracranial pathology, surgical decision-making is related to clinical status and overall lesion burden. Further research should examine the optimal surgical management of EDH with concomitant lesions in traumatic brain injury, to inform updated guidelines.
Collapse
Affiliation(s)
- Dana Pisică
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Victor Volovici
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - John K Yue
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Thomas A van Essen
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Division of Neurosurgery, Department of Surgery, QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hugo F den Boogert
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thijs Vande Vyvere
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Iain Haitsma
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Daan Nieboer
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Amy J Markowitz
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Esther L Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Ewout W Steyerberg
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center and Haaglanden Medical Center, Leiden and The Hague, the Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - David K Menon
- Division of Anaesthesia, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Hester F Lingsma
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Lee SW, Werner B, Anireddy S, Ayutyanont N. Characteristics, Outcomes, and Its Associated Factors Among Patients Hospitalized With Mild Traumatic Brain Injuries. Am J Phys Med Rehabil 2024; 103:47-52. [PMID: 37549368 DOI: 10.1097/phm.0000000000002298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
OBJECTIVE The aim of the study is to investigate the characteristics and hospital outcomes of patients with mild traumatic brain injuries. DESIGN A total of 1940 patients with mild traumatic brain injuries from seven community hospitals between 2017 and 2019 were identified using International Classification of Disease codes and an documented initial Glasgow Coma Scale score of 13-15. A stepwise logistic regression was used to identify demographics and clinical characteristics associated with in-hospital mortality and home discharge. RESULTS The median age was 69 yrs old with 66.6% associated with falls at admission. Subdural hemorrhage was the most common brain lesion and more common in the group with falls. Increased age, male sex, epidural hemorrhage, presence of hemiplegia, paraplegia, renal disease, cancer, hospital-acquired sepsis, anemia, and use of direct vasodilator were associated with increased odds of in-hospital mortality. Increased age, medical coverage by Medicare, cerebral edema, lower initial Glasgow Coma Scale, length of stay, comorbidity of acute myocardiac infarction, and use of thiamine and opioids were associated with decreased likelihood of discharge to home. CONCLUSIONS Recognizing characteristics of hospitalized patients with mild traumatic brain injuries and their association with increased in-hospital mortality and nonhome discharge can be useful for improving care of this vulnerable population.
Collapse
Affiliation(s)
- Se Won Lee
- From the Sunrise Health GME Consortium, MountainView Hospital, HCA Healthcare, Las Vegas, Nevada
| | | | | | | |
Collapse
|
4
|
Srinivasaiah B, Venkataramaiah S, Sadashiva N, Kamath S, Shukla D. Impact of perioperative factors on short-term outcomes after emergency surgery for acute traumatic extradural hematoma - A retrospective cohort study. Clin Neurol Neurosurg 2023; 232:107874. [PMID: 37478640 DOI: 10.1016/j.clineuro.2023.107874] [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: 04/17/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Preoperative clinical and imaging findings predict neurological outcomes in patients with traumatic brain injury (TBI). Similarly, intraoperative factors such as blood loss and hypotension can also affect outcomes. However, there is not much data regarding the influence of perioperative variables on clinical outcomes in patients with extradural hematoma (EDH). This study aimed to understand the effect of perioperative factors on short-term neurological outcomes in patients operated for acute traumatic EDH. METHODS After obtaining institutional ethical approval, we collected data retrospectively from records of patients who underwent emergency surgery for acute traumatic EDH over a two-year period. Data regarding age, gender, preoperative Glasgow coma scale (GCS) score, clinical and imaging findings, surgical and anesthetic details, blood loss and transfusion, duration of hospital stay, and GCS score at discharge were collected. Patients with discharge GCS score of 14-15 were considered to have favorable outcome and <14 as unfavorable outcome. Regression analysis was performed to examine the association between predictors and outcomes. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated. RESULTS Data of 501 patients were analyzed. Outcome was favorable in 343 (68.5 %) and unfavorable in 158 (31.5 %) patients. On multivariate logistic regression analysis (OR, 95 % CI, p value), age (1.03, 1.01-1.05, 0.01), preoperative GCS score (0.68, 0.61-0.76, <0.001), signs of basal skull fracture (1.9, 1.02-3.61, 0.043) and intraoperative blood loss (2.23, 1.2-4.16, 0.01) were independently associated with unfavorable outcome. Pneumonia, neurological deficits, inotrope use and duration of hospital stay was more in this group. CONCLUSIONS Older age, poor pre-operative GCS score, signs of basal skull fracture, and intraoperative blood loss were associated with lower discharge GCS score, increased neurological deficits and longer hospital stay in patients operated for acute traumatic EDH.
Collapse
Affiliation(s)
- Bharath Srinivasaiah
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sudhir Venkataramaiah
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sriganesh Kamath
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| |
Collapse
|
5
|
Abe N, Gardiner M, Dory C, Gonda D, Harvey H, Hilfiker M, Hollenbach K, Kanegaye JT. Predictive Factors for Delayed Surgical Intervention in Children With Epidural Hematomas. Pediatr Emerg Care 2023; 39:402-407. [PMID: 36730955 DOI: 10.1097/pec.0000000000002825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Optimal treatment of children with traumatic intracranial epidural hematomas (EDHs) is unknown. We sought to identify clinical and radiographic predictors of delayed surgical intervention among children with EDH admitted for observation. METHODS We retrospectively identified patients younger than 15 years with acute traumatic EDHs evaluated at our level 1 pediatric trauma center. We excluded patients with penetrating head injuries, recent surgical evacuation of EDH, or depressed skull fracture requiring surgical repair and assigned the remaining subjects to the immediate surgery group if they underwent immediate surgical evacuation, to the supportive-therapy-only group if they underwent observation only, and to the delayed surgery group if they underwent surgery after observation. We abstracted clinical and laboratory findings, surgical interventions, and neurological outcome and measured EDH dimensions and volumes, adjusting for cranial size. We compared clinical and radiographic characteristics among groups and performed receiver-operator characteristic analyses of predictors of delayed surgery. RESULTS Of 172 patients with EDH, 103 patients met the inclusion criteria, with 6 (6%) in the immediate surgery group, 87 (84%) in the supportive-therapy-only group, and 10 (10%) in the delayed surgery group. Headache, prothrombin time of >14 seconds, EDH maximal thickness of ≥1.1 cm, volume of ≥14 mL, EDH thickness/cranial width index of ≥0.08 and EDH volume/cranial volume index of ≥0.18, and mass effect were associated with delayed surgical intervention. There was no difference in length of stay or functional impairment between the immediate and delayed surgery groups. However, patients in delayed surgery group were more likely to have subjective symptoms at discharge than those in immediate surgery group. CONCLUSIONS Among patients with EDH admitted for observation, larger EDH, mass effect, headaches, and prothrombin time of >14 seconds were associated with delayed surgical intervention. A larger-scale study is warranted to identify independent predictors of delayed surgery in children under observation for EDH.
Collapse
|
6
|
Choi DH, Jeong TS, Kim WK. Clinical Outcome of Patients Diagnosed Traumatic Intracranial Epidural Hematoma With Severe Brain Injury (Glasgow Coma Scale ≤8) Who Undergo Surgery: A Report From the Korean Neuro-Trauma Data Bank System. Korean J Neurotrauma 2022; 18:153-160. [PMID: 36381437 PMCID: PMC9634314 DOI: 10.13004/kjnt.2022.18.e62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE To evaluate the clinical outcomes and prognostic factors in surgically treated patients with severe brain injury (Glasgow Coma Scale [GCS] score ≤8) diagnosed with traumatic epidural hematoma (EDH). METHODS From January 2018 to June 2021, 1,122 patients with an initial GCS score ≤8 were retrospectively enrolled in the Korean Neuro-Trauma Data Bank System. Clinical data of 79 surgically treated patients with EDH were compared between the unfavorable (scores of 1-4 on the Glasgow Outcome Scale-Extended [GOSE]) and favorable (score of 5-8 on the GOSE) outcome groups. RESULTS The overall mortality rate was 13.9%, and 60.8% of the patients had good outcomes at six months post-trauma. In the univariate analysis, increasing age (p=0.010), lower initial GCS score (p=0.001), higher Rotterdam computed tomography (CT) score (p=0.012), craniotomy rather than craniectomy (p=0.032), larger EDH volume (p=0.007), and loss of pupillary reactivity (unilateral unreactive pupil, p=0.026; bilateral unreactive pupils, p<0.001), were significantly correlated with unfavorable outcomes. Of these factors, increasing age (p=0.011) and bilateral unreactive pupils (p=0.002) were the most significant risk factors in the multivariate logistic regression analysis. The interval from admission to the brain CT scan was not correlated with the outcome; however, it was significantly longer in the unfavorable outcome group. CONCLUSION Despite severe brain injury, more than half of the patients with EDH had favorable outcomes after surgical treatment. Our findings suggest that prompt diagnosis and surgical treatment should be considered for such cases.
Collapse
Affiliation(s)
- Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Tae Seok Jeong
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Korea Neuro-Trauma Data Bank Committee, Korean Neurotraumatology Society, Seoul, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - KNTDB Investigators
- Korea Neuro-Trauma Data Bank Committee, Korean Neurotraumatology Society, Seoul, Korea
| |
Collapse
|
7
|
Hu J, Sokh V, Nguon S, Heng YV, Husum H, Kloster R, Odland JØ, Xu S. Emergency Craniotomy and Burr-Hole Trephination in a Low-Resource Setting: Capacity Building at a Regional Hospital in Cambodia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116471. [PMID: 35682054 PMCID: PMC9179964 DOI: 10.3390/ijerph19116471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022]
Abstract
To evaluate the teaching effect of a trauma training program in emergency cranial neurosurgery in Cambodia on surgical outcomes for patients with traumatic brain injury (TBI). We analyzed the data of TBI patients who received emergency burr-hole trephination or craniotomy from a prospective, descriptive cohort study at the Military Region 5 Hospital between January 2015 and December 2016. TBI patients who underwent emergency cranial neurosurgery were primarily young men, with acute epidural hematoma (EDH) and acute subdural hematoma (SDH) as the most common diagnoses and with long transfer delay. The incidence of favorable outcomes three months after chronic intracranial hematoma, acute SDH, acute EDH, and acute intracerebral hematoma were 96.28%, 89.2%, 93%, and 97.1%, respectively. Severe traumatic brain injury was associated with long-term unfavorable outcomes (Glasgow Outcome Scale of 1–3) (OR = 23.9, 95% CI: 3.1–184.4). Surgical outcomes at 3 months appeared acceptable. This program in emergency cranial neurosurgery was successful in the study hospital, as evidenced by the fact that the relevant surgical capacity of the regional hospital increased from zero to an acceptable level.
Collapse
Affiliation(s)
- Jingjing Hu
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
| | - Vannara Sokh
- Military Region 5 Hospital, Battambang, Cambodia; (V.S.); (S.N.)
| | - Sophy Nguon
- Military Region 5 Hospital, Battambang, Cambodia; (V.S.); (S.N.)
| | - Yang Van Heng
- Trauma Care Foundation Cambodia, Battambang, Cambodia;
| | - Hans Husum
- Tromsø Mine Victim Resource Center, University Hospital North Norway, 9038 Tromsø, Norway; (H.H.); (R.K.)
- Department of Community Medicine, UiT the Arctic University of Norway, 9019 Tromsø, Norway
| | - Roar Kloster
- Tromsø Mine Victim Resource Center, University Hospital North Norway, 9038 Tromsø, Norway; (H.H.); (R.K.)
- Department of Neurosurgery, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Jon Øyvind Odland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Correspondence: (J.Ø.O.); (S.X.)
| | - Shanshan Xu
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5009 Bergen, Norway
- Correspondence: (J.Ø.O.); (S.X.)
| |
Collapse
|
8
|
Subdural and epidural hematoma occurrence in relation to the head impact site: An autopsy study. J Forensic Leg Med 2021; 85:102283. [PMID: 34794084 DOI: 10.1016/j.jflm.2021.102283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022]
Abstract
Blunt head injury is a major public health and socioeconomic problem causing death and disability particularly among the young population throughout the world. The purpose of the present study was to evaluate if the impact site is correlated with the subdural and epidural hematoma occurrence. A retrospective analysis of consecutive autopsy cases submitted to our Department during a 5-year period was performed. The basic criterion for inclusion in the study was death due to blunt head injury. The recorded variables included the circumstances of death, the existence, and location of head injuries, the primary impact site, age, gender, and toxicological results. A total number of 683 fatal head injury cases was recorded, with most of them being male (74.1%). In 424 cases (62.1%) fatal head injuries were due to road traffic accidents. Fall (from height or on the ground) was the cause of death in 220 (32.2%) cases followed by inflicted impact-assault in 26 (3.8%) cases. A subdural hematoma was found more frequently (26.9%) than epidural (5.0%). Epidural hematomas were found only under the primary impact site, whereas subdural hematomas were coup, contrecoup, or bilateral. An epidural hematoma was found to be almost 5 times more frequent in cases in which a subdural hematoma was present. A higher proportion of subdural, as well as epidural hematoma, was found when the site of impact was the temporal region, followed by the parietal one. Sex did not exert any influence on the probability of subdural and epidural hematoma, whereas for age, a 10% increase in the probability of subdural hematoma occurrence was observed with 10-year age increase.
Collapse
|
9
|
Zanello M, Roux A, Gavaret M, Bartolomei F, Huberfeld G, Charlier P, Georges-Zimmermann P, Carron R, Pallud J. King Charles VIII of France's Death: From an Unsubstantiated Traumatic Brain Injury to More Realistic Hypotheses. World Neurosurg 2021; 156:60-67. [PMID: 34537407 DOI: 10.1016/j.wneu.2021.09.056] [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: 07/14/2021] [Revised: 09/09/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
On April 7, 1498, Charles VIII, King of France, attended a game of palm in the ditches of the Château d'Amboise. The 27-year-old King suddenly collapsed and became comatose. He laid down, almost on his own, on a straw mat that was hastily arranged, and he died 9 hours later. His contemporaries perceived his death as a perfect reminder of fatality: a king could die alone in a miserable gallery. All who looked into this curious death had dwelled on the frontal blow to head that the king had sustained right before his demise and had not considered alternative scenarios. The present study, still with limited available evidence, aimed to reexamine the historical account of his death in light of modern medical knowledge. It is virtually impossible that a minor bump with low kinetic energy could kill a 27-year-old man. Many historical accounts of Charles VIII's life and death, including Italian ambassadors' letters, led us to reconsider the commonly held version and to propose an alternative hypothesis. We have concluded that Charles VIII had experienced an acute consciousness disorder with language impairment that could have been related to an epileptic condition secondary to neurosyphilis. We have discussed whether a more accurate diagnosis for the cause of death could be obtained by a pathological analysis of the King's remains.
Collapse
Affiliation(s)
- Marc Zanello
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France; Université de Paris, Paris, France; INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France.
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France; Université de Paris, Paris, France; INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Martine Gavaret
- Université de Paris, Paris, France; Neurophysiology Department, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Fabrice Bartolomei
- Epileptology and Cerebral Rythmology, APHM-Timone University Hospital, Marseille, France; Aix Marseille Université, INSERM, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Gilles Huberfeld
- Clinical Neurophysiology Department, Pitie-Salpetriere Hospital, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Paris, France; Neuroglial Interactions in Cerebral Physiopathology, Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, Paris, France
| | - Philippe Charlier
- Department of Research and Higher Education, Musée du quai Branly-Jacques Chirac, Paris, France; Laboratory Anthropology, Archaeology, Biology, Paris-Saclay University, UFR of Health Sciences, Montigny-Le-Bretonneux, France
| | | | - Romain Carron
- Aix Marseille Université, INSERM, INS, Institut de Neurosciences des Systèmes, Marseille, France; Department of Functional and Stereotactic Neurosurgery, APHM-Timone University Hospital, Marseille, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France; Université de Paris, Paris, France; INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| |
Collapse
|
10
|
Luo Y, He X, Yang M, Du C, Jin X. A prognostic scoring system for operated acute epidural hematoma based on gray-white matter ratio. Medicine (Baltimore) 2021; 100:e26888. [PMID: 34414943 PMCID: PMC8376358 DOI: 10.1097/md.0000000000026888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To determine the prognostic risk factors of patients with acute epidural hematoma (AEDH), a scoring system was established based on gray-white matter ratio (GWR) and internal verification was performed.All patients with AEDH who underwent surgical treatment in Qinghai Provincial People's Hospital from January 2013 to June 2019 were continuously collected. The clinical and imaging data of the patients were collected. According to Glasgow Outcome Scale at 3 months after operation, the patients were divided into poor and good prognosis groups, respectively. The GWR value of the nonhematoma side was measured at the inner capsule area. Univariate and multivariate analyses were used. Independent predictors significantly related to the prognosis of AEDH were screened out and a nomogram was established based on these factors.A total of 170 cases were included in this study, the Glasgow Coma Score (severe and moderate), cerebral hernia, midline shift, preoperative GWR, postoperative GWR, hematoma thickness/midline shift, time from coma to surgery, and decompression of bone flap were the independent risk factors for predicting the poor prognosis of AEDH. Moreover, the prediction ability of nomogram was higher than any other independent predictive factors.The nomogram model established represents the most effective factor to predict the prognosis of operated AEDH. The scoring system is characterized by high accuracy, simplicity and feasibility, with a wide range of clinical application prospects.
Collapse
Affiliation(s)
- Yunxing Luo
- Graduate School, Qinghai University, Xining, Qinghai 810016, PR China
| | - Xiwu He
- Department of Neurosurgery, the Fifth People's Hospital of Qinghai Province, Xining, Qinghai 810007, PR China
| | - Mingfei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai 810007, PR China
| | - Chaonan Du
- Graduate School, Qinghai University, Xining, Qinghai 810016, PR China
| | - Xiaoqing Jin
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai 810007, PR China
| |
Collapse
|
11
|
Charcos IB, Wong TW, Larsen BR, Azurdia AR, Gridley DG, Vail SJ, Hollingworth AK, Lettieri SC, Feiz-Erfan I. Location of Traumatic Cranial Epidural Hematoma Correlates with the Source of Hemorrhage: A 12-Year Surgical Review. World Neurosurg 2021; 152:e138-e143. [PMID: 34033954 DOI: 10.1016/j.wneu.2021.05.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Epidural hematoma (EDH) can result in a catastrophic outcome of traumatic brain injury. Current management guidelines do not consider the source of hemorrhage in decision making. The purpose of this study was to examine the relationship between EDH location and the source of hemorrhage. METHODS We report retrospectively reviewed, prospectively obtained surgical data of patients with acute traumatic cranial EDH treated between 2007 and 2018. Computed tomography (CT) scans were used to categorize EDH location as lateral or medial. The source of hemorrhage was identified intraoperatively by a single surgeon. RESULTS Overall, of 92 evacuated EDHs (in 87 patients), 71 (77.2%) were in the lateral location. Arterial bleeding was the cause of EDH in 63.4% of the lateral EDHs and 9.2% of the medial EDHs (P < 0.0001). In the cases where surgery was done primarily to treat EDH, 65.3% had an arterial bleed source (P < 0.0001). In those treated for primary reasons other than EDH evacuation, 75% had a venous bleed source (P = 0.002). CONCLUSIONS The location of EDH correlates with the source of hemorrhage. The decision to operate on EDH may be influenced by this factor.
Collapse
Affiliation(s)
- Iris B Charcos
- Department of Surgery, Division of Neurosurgery, Creighton University, School of Medicine Phoenix, Phoenix, Arizona, USA; Valleywise Health Medical Center, Phoenix, Arizona, USA
| | - Tina W Wong
- Department of Surgery, Division of Neurosurgery, Creighton University, School of Medicine Phoenix, Phoenix, Arizona, USA; Valleywise Health Medical Center, Phoenix, Arizona, USA
| | - Brett R Larsen
- Department of Radiology, Creighton University, School of Medicine Phoenix, Phoenix, Arizona, USA; Valleywise Health Medical Center, Phoenix, Arizona, USA; The University of Arizona, College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Adrienne R Azurdia
- Emergency Medicine, Creighton University, School of Medicine Phoenix, Phoenix, Arizona, USA; Department of Emergency Medicine, HonorHealth Scottsdale, Scottsdale, Arizona, USA; Valleywise Health Medical Center, Phoenix, Arizona, USA; The University of Arizona, College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Daniel G Gridley
- Department of Radiology, Creighton University, School of Medicine Phoenix, Phoenix, Arizona, USA; Valleywise Health Medical Center, Phoenix, Arizona, USA; The University of Arizona, College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Sydney J Vail
- Division of Trauma, Creighton University, School of Medicine Phoenix, Phoenix, Arizona, USA; Valleywise Health Medical Center, Phoenix, Arizona, USA; The University of Arizona, College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Alexzandra K Hollingworth
- Division of Trauma, Creighton University, School of Medicine Phoenix, Phoenix, Arizona, USA; Department of Surgery and Anesthesia, Midwestern University, Glendale, Arizona, USA; Valleywise Health Medical Center, Phoenix, Arizona, USA; The University of Arizona, College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Salvatore C Lettieri
- Division of Plastic Surgery, Creighton University, School of Medicine Phoenix, Phoenix, Arizona, USA; Division of Plastic Surgery, Mayo Clinic, Phoenix, Arizona, USA; Valleywise Health Medical Center, Phoenix, Arizona, USA; The University of Arizona, College of Medicine Phoenix, Phoenix, Arizona, USA
| | - Iman Feiz-Erfan
- Department of Surgery, Division of Neurosurgery, Creighton University, School of Medicine Phoenix, Phoenix, Arizona, USA; Valleywise Health Medical Center, Phoenix, Arizona, USA; The University of Arizona, College of Medicine Phoenix, Phoenix, Arizona, USA.
| |
Collapse
|
12
|
Wang Y, Li Z, Zhang X, Chen Z, Li D, Chen W, Gu J, Sun D, Rong T, Kwan P. Development and validation of a clinical score to predict late seizures after intracerebral hemorrhage in Chinese. Epilepsy Res 2021; 172:106600. [PMID: 33721707 DOI: 10.1016/j.eplepsyres.2021.106600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/17/2021] [Accepted: 03/03/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Seizures are a frequent complication after intracerebral hemorrhage (ICH). The CAVE score was developed in Europeans to predict late seizures after ICH. Given the higher incidence of ICH in Asians, we aimed to develop and validate a clinical scoring tool for predicting post-ICH late seizures in Chinese. METHODS We retrospectively included patients admitted with ICH to a major stroke center in Shandong province, China, in the derivation cohort, who were followed up for occurrence of late seizures (more than seven days after ICH). We applied Cox regression model to identify significant clinical factors which were used to derive a predictive scoring model. The performance of this model was compared with CAVE, and validated in a separate cohort of patients with ICH admitted to another stroke center. RESULTS In the derivation cohort (n = 602; median age 65 years; 57 % male;median follow up 24 months), 47 (7.8 %) patients had late seizures during follow up. Four significant risk factors were identified and selected to derive the LANE score (Lobar hemorrhage, Age <65 years, NIHSS score ≥15, Early seizures). The total possible points ranged from 0 to 6, corresponding to positive predictive values of 10.1%-100%, and negative predictive values of 96.8%-92.2%, respectively. The c-statistics of the LANE score in the derivation cohort and validation cohort (n = 521) were 0.83 and 0.78, respectively, while those of the CAVE score were 0.81 and 0.74, respectively. CONCLUSION We have developed and validated a clinical scoring tool for predicting late seizures after ICH in Chinese. This tool may be used to identify high risk patients for closer monitoring and clinical trials of therapies to prevent post-ICH epilepsy in the future.
Collapse
Affiliation(s)
- Yan Wang
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Zhen Li
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Xiaosai Zhang
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China; Fuzhou Children's Hospital of Fujian Province, Department of Pediatrics, Fuzhou, China.
| | - Zhibin Chen
- Monash University, Central Clinical School, Department of Neuroscience, Melbourne, Australia; Monash University, School of Public Health and Preventive Medicine, Clinical Epidemiology, Melbourne, Australia; University of Melbourne. Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia.
| | - Dongmei Li
- Qingdao Municipal Hospital, Department of Neurology, Qingdao, China.
| | - Wenxian Chen
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Jiamei Gu
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Dongyun Sun
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Ting Rong
- The Affiliated Hospital of Qingdao University, Department of Neurology, 16 Jiangsu Road, Qingdao, China.
| | - Patrick Kwan
- Monash University, Central Clinical School, Alfred Hospital, Department of Neuroscience, Melbourne, Australia; University of Melbourne, Royal Melbourne Hospital, Department of Neurology, Melbourne, Australia.
| |
Collapse
|
13
|
Tyngkan L, Mahfouz N, Bilal S, Fatima B, Malik N. Duret Hemorrhage after Extradural Hematoma Evacuation–A Rare Entity. INDIAN JOURNAL OF NEUROTRAUMA 2021. [DOI: 10.1055/s-0041-1725213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractTraumatic brainstem injury can be classified as primary or secondary. Secondary brainstem hemorrhage that evolves from raised intracranial pressure (ICP) and transtentorial herniation is referred to as Duret hemorrhage. We report a 25-year-old male who underwent emergency craniotomy, with evacuation of acute epidural hematoma, and postoperatively developed fatal Duret hemorrhage. Duret hemorrhage after acute epidural hematoma (EDH) evacuation is a very rare complication and the outcome is grave in most of the cases.
Collapse
Affiliation(s)
- Lamkordor Tyngkan
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| | - Nazia Mahfouz
- Department of Pulmonary Medicine, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| | - Sobia Bilal
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| | - Bazla Fatima
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| | - Nayil Malik
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| |
Collapse
|
14
|
Aromatario M, Torsello A, D’Errico S, Bertozzi G, Sessa F, Cipolloni L, Baldari B. Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57020125. [PMID: 33535407 PMCID: PMC7912597 DOI: 10.3390/medicina57020125] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 04/09/2023]
Abstract
Epidural hematomas (EDHs) and subdural hematomas (SDHs), or so-called extra-axial bleedings, are common clinical entities after a traumatic brain injury (TBI). A forensic pathologist often analyzes cases of traumatic EDHs or SDHs due to road accidents, suicides, homicides, assaults, domestic or on-the-job accidents, and even in a medical responsibility scenario. The aim of this review is to give an overview of the published data in the medical literature, useful to forensic pathologists. We mainly focused on the data from the last 15 years, and considered the most updated protocols and diagnostic-therapeutic tools. This study reviews the epidemiology, outcome, and dating of extra-axial hematomas in the adult population; studies on the controversial interdural hematoma are also included.
Collapse
Affiliation(s)
| | - Alessandra Torsello
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
| | - Stefano D’Errico
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Giuseppe Bertozzi
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
- Correspondence:
| | - Francesco Sessa
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
| | - Luigi Cipolloni
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00186 Rome, Italy;
| |
Collapse
|
15
|
Ayogu O, Onobun D, Igbokwe K, Ugwuanyi C, Mordi C, Ibeneme S. Factors affecting the outcome of traumatic brain injured patients with acute epidural haematoma in National Hospital, Abuja. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2021; 11:1-4. [PMID: 35873877 PMCID: PMC9302390 DOI: 10.4103/jwas.jwas_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Objective: The objective is to determine the prognostic factors affecting the surgical outcome of patients surgically treated for acute epidural haematoma. Materials and Methods: A retrospective review of 71 consecutive patients who underwent neurosurgery for acute epidural haematomas over a 5-year period (from January 2015 to December 2019) was conducted. Clinical characteristics and the time intervals were investigated to determine the interactions between all these factors and the outcome. The outcome was graded according to the Glasgow Outcome Scale (GOS) at subsequent follow-up clinic visits. Results: The severity of traumatic brain injury using the Glasgow Coma Scale score (chi-square test, P = 0.033) had a statistically significant relationship with the outcome. The patients’ age, gender, and total length of time until surgical intervention (P > 0.05) were of no statistical significance in relation to the outcome. The mortality rate of patients presenting at our centre is 16.9%. Overall, after surgery, 47 of 71 with epidural haematoma had good recovery (GOS 5). Twelve of 71 patients had GOS of 2–4. Twelve patients died. The median duration from injury to presentation was 15 hours with an interquartile range of 15 hours. Conclusion: Our results indicate that the severity of brain injury is an independent risk factor in determining the outcome of epidural haematoma in traumatic brain injury.
Collapse
|
16
|
Anwer M, Rehman AU, Ahmed F, Kumar S, Uddin MM. Delayed Extradural Hematoma after Evacuation of Contralateral Acute Extradural Hematoma. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1713722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Introduction Traumatic head injury with extradural hematoma (EDH) is seen in 2% of patients. Development of EDH on the contralateral side is an uncommon complication that has been reported in various case reports.
Methods We report here a case of an 18-year-old male who had a road traffic injury. He was diagnosed as a case of left-sided large frontotemporoparietal acute extradural bleed with a mass effect toward the right side. He was managed with urgent craniotomy and evacuation of hematoma. A noncontrast computed tomography (NCCT) scan performed 8 hours after postoperative period showed a large frontotemporoparietal bleed on the right side with a mass effect toward the left side. He was again taken to the operating room and right-sided craniotomy and evacuation of hematoma were performed. A postoperative NCCT scan revealed a resolved hematoma. The patient made a complete recovery in the postoperative period and is doing well.
Conclusion Delayed onset epidural hematoma is diagnosed when the initial computed tomography (CT) scan is negative or is performed early and when late CT scan performed to assess clinical or ICP deterioration shows an EDH. The diagnosis of such a condition requires a high index of suspicion based on the mechanism of injury along with fracture patterns. Additionally, change in pupillary size, raised intracranial pressure, and bulging of the brain intraoperatively are additional clues for contralateral bleeding. Neurologic deterioration may or may not be associated with delayed EDH presentation. An early postoperative NCCT scan within 24 hours is recommended to detect this complication with or without any neurologic deterioration.
Collapse
Affiliation(s)
- Majid Anwer
- Department of Trauma Surgery and Critical Care, Medaz Hospital, Patna, India
| | - Atique Ur Rehman
- Department of Trauma Surgery and Critical Care, Medaz Hospital, Patna, India
| | - Farheen Ahmed
- Department of Anesthesiology & Critical Care, Indira Gandhi Institute Of Medical Sciences, Sheikhpura, Patna, India
| | - Satyendra Kumar
- Department of Trauma Surgery and Critical Care, Medaz Hospital, Patna, India
| | - Md Masleh Uddin
- Department of Trauma Surgery and Critical Care, Medaz Hospital, Patna, India
| |
Collapse
|
17
|
Binder H, Tiefenboeck TM, Majdan M, Komjati M, Schuster R, Hajdu S, Leitgeb J. Management and outcome of traumatic subdural hematoma in 47 infants and children from a single center. Wien Klin Wochenschr 2020; 132:499-505. [PMID: 32333270 PMCID: PMC7518988 DOI: 10.1007/s00508-020-01648-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
Background Traumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children. It is hypothesized, that with the adequate treatment of SDH in children and adolescence, excellent clinical and functional outcomes can be achieved. The aim of this study was to present the severity and outcome of traumatic SDH in children and adolescence as well as to analyze differences between patients treated surgically and conservatively. Methods In this study 47 infants and children with a subdural hematoma (SDH) were treated between 1992 and 2010 at a single level-one trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. To classify the outcomes the Glasgow outcome scale (GOS) scores at hospital discharge and at follow-up visits were used. Severity of SDH was classified according to the Rotterdam score. Results In total, 47 cases were treated (21 surgically, 26 conservatively), with 10 patients needing delayed surgery. Overall, 89% of the patients were able to leave hospital, 5 patients died, 2 patients (5%) within 24 h, another 2 (5%) after 48 h and 1 (2%) within 7 days. In 25 patients (53%) a good recovery was recorded at the last follow-up visit. Outcome was mainly influenced by the following factors: age, severity of TBI, and neurological status. Overall, in 70% good clinical and neurological outcomes could be achieved. Conclusion The results of this study confirmed that pediatric SDH is a rare, but serious condition. Despite a poor prognosis, most patients could be treated with good outcomes, given that the choice of treatment is correct. Trial registration Research registry 2686 Electronic supplementary material The online version of this article (10.1007/s00508-020-01648-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Harald Binder
- Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas M Tiefenboeck
- Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Marek Majdan
- International Neurotrauma Research Organization, Vienna, Austria
| | - Micha Komjati
- Department of Orthopaedics, Sacred Heart Hospital of Jesus, Vienna, Austria
| | - Rupert Schuster
- Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes Leitgeb
- Department of Orthopaedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| |
Collapse
|
18
|
Rosyidi RM, Priyanto B, Al Fauzi A, Sutiono AB. Toward zero mortality in acute epidural hematoma: A review in 268 cases problems and challenges in the developing country. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2019. [DOI: 10.1016/j.inat.2019.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
19
|
Liu X, Qiu Y, Zhang J, Zhang Q, Chen L, Chen L, Sun X. Emergent Single Burr Hole Evacuation for Traumatic Acute Subdural Hematoma with Cerebral Herniation: A Retrospective Cohort Comparison Analysis. World Neurosurg 2018; 120:e1024-e1030. [PMID: 30201582 DOI: 10.1016/j.wneu.2018.08.219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the clinical benefits of emergent single burr hole evacuation technology in traumatic acute subdural hematoma (ASDH) with cerebral herniation cases. METHODS We conducted a review comparing patients with ASDH with cerebral herniation who underwent single burr hole evacuation followed by decompressive craniectomy and intracranial hematoma removal surgery (n = 45, group A) and those who underwent decompressive craniectomy and intracranial hematoma removal surgery after rapid infusion of mannitol 250 mL (n = 53, group B) in our institution. Pre- and postoperative assessments included Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), activities of daily living (ADLs), and common complication incidences. RESULTS At 1 and 6 months after operation, the median GCS score of group A was significantly higher than group B (P = 0.04 and P = 0.03, respectively). After 6 months, the GOS score and ADLs between the 2 groups had significant differences (P < 0.05). There were no differences between the 2 groups in the common complication incidences. CONCLUSIONS Emergent single burr hole evacuation in combination with decompressive craniectomy surgery is a useful treatment for ASDH with cerebral herniation, which can achieve reduction of intracranial pressure as soon as possible and improve the prognosis.
Collapse
Affiliation(s)
- Xuemeng Liu
- Department of Neurosurgery, FeiXian People Hospital, FeiXian, China
| | - Yongyi Qiu
- Department of Neurosurgery, ZhongNan Hospital, WuHan University, WuHan, China
| | - Jibo Zhang
- Department of Neurosurgery, ZhongNan Hospital, WuHan University, WuHan, China
| | - Qingwen Zhang
- Department of Neurosurgery, FeiXian People Hospital, FeiXian, China
| | - Lin Chen
- Department of Neurosurgery, FeiXian People Hospital, FeiXian, China
| | - Lizhu Chen
- Department of Neurosurgery, FeiXian People Hospital, FeiXian, China
| | - Xiangyu Sun
- Department of Neurosurgery, FeiXian People Hospital, FeiXian, China.
| |
Collapse
|
20
|
Clinical Outcome of Epidural Hematoma Treated Surgically in the Era of Modern Resuscitation and Trauma Care. World Neurosurg 2018; 118:e166-e174. [PMID: 29959068 DOI: 10.1016/j.wneu.2018.06.147] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/17/2018] [Accepted: 06/18/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Patients from contemporary populations with traumatic brain injury (TBI) resulting from epidural hematoma (EDH) may differ regarding age, comorbidities, and coagulation status. We therefore analyzed predictors for the clinical outcome of patients with EDH treated surgically regarding modern approaches to resuscitation and trauma care. METHODS A retrospective observational analysis was carried out. All patients included underwent surgery. The indication for surgery followed international guidelines. Retrospective data evaluation considered data reflecting the effectiveness of trauma care, baseline characteristics, and radiologic findings. In this analysis, we divided patients into 2 groups (isolated EDH vs. EDH plus other intracranial traumatic injuries). The neurologic outcome was assessed at discharge using the Glasgow Outcome Scale. RESULTS Two hundred and sixty-eight patients with epidural hematoma, of whom 131 underwent surgery, were treated between January 1997 and December 2012 in our level-1 trauma center. The overall mortality was 6.8% (mortality for patients with Glasgow Outcome Scale score <9, 15%). As expected, factors with a highly significant (P < 0.01) impact on outcome were concomitant with other intracranial injuries, brain midline shift, and higher Injury Severity Score. Alcohol intoxication was a significant (P < 0.05) predictor of an unfavorable outcome. Anticoagulants and Glasgow Coma Scale score at admission had no significant impact on the outcome. CONCLUSIONS The outcome for EDH is more favorable than decades ago, most probably reflecting a well-established chain of trauma care. Therefore, EDH is a treatable disease with a high probability of a favorable outcome.
Collapse
|
21
|
Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma. ROMANIAN NEUROSURGERY 2018. [DOI: 10.2478/romneu-2018-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH) were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses.
Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS) at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU), length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis.
Results: Distribution of GCS were, between 13-15 in 18 (36%) patients, 9-13 in 23 (46%) patients and 3-8 in 9 (18%) patients. The reasons for emergency department admissions were fall from high in 29 (58%) patients, assault in 11 (22%) patients and motor vehicle accident in 10 (20%) patients. The average cost per ICU stay was 2838 $ (range=343-20571 $). The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients).
Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.
Collapse
|
22
|
Atci IB, Yilmaz H, Yaman M, Baran O, Türk O, Solmaz B, Kocaman Ü, Ozdemir NG, Demirel N, Kocak A. Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma. ROMANIAN NEUROSURGERY 2017. [DOI: 10.1515/romneu-2017-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH) were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS) at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU), length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36%) patients, 9-13 in 23 (46%) patients and 3-8 in 9 (18%) patients. The reasons for emergency department admissions were fall from high in 29 (58%) patients, assault in 11 (22%) patients and motor vehicle accident in 10 (20%) patients. The average cost per ICU stay was 2838 $ (range=343-20571 $). The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients). Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.
Collapse
|
23
|
Guo C, Liu L, Wang B, Wang Z. Swirl sign in traumatic acute epidural hematoma: prognostic value and surgical management. Neurol Sci 2017; 38:2111-2116. [DOI: 10.1007/s10072-017-3121-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022]
|
24
|
Kiessling JW, Hertzler DA, Drucker DE, Spader HS. Traumatic Frontal Epidural Hematoma Caused by Multiple Arterial Injuries in the Anterior Fossa. World Neurosurg 2017; 97:757.e19-757.e23. [DOI: 10.1016/j.wneu.2016.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
|
25
|
Zangbar B, Serack B, Rhee P, Joseph B, Pandit V, Friese RS, Haider AA, Tang AL. Outcomes in Trauma Patients with Isolated Epidural Hemorrhage: A Single-Institution Retrospective Cohort Study. Am Surg 2016. [DOI: 10.1177/000313481608201228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The type, location, and size of intracranial hemorrhage are known to be associated with variable outcomes in patients with traumatic brain injury (TBI). The aim of our study was to assess the outcomes in patients with isolated epidural hemorrhage (EDH) based on the location of EDH. We performed a 3-year (2010–2012) retrospective chart review of the patients with TBI in our level 1 trauma center. Patients with an isolated EDH on initial head CT scan were included. Patients were divided into four groups based on the location of EDH: frontal, parietal, temporal, and occipital. Differences in demographics and outcomes between the four groups were assessed. Outcome measures were progression on repeat head CT and neurosurgical intervention (NI). A total of 76 patients were included in this study. The mean age was 20.6 ± 15.2 years, 68.4 per cent were male, median Glasgow Coma Scale (GCS) score 15 (13–15), and median head Abbreviated Injury Scale score was 3 (2–4). About 32.9 per cent patients (n = 25) had frontal EDH, 26.3 per cent (n = 20) had temporal EDH, 10.5 per cent (n = 8) had occipital EDH, while the remaining 30.3 per cent (n = 23) had parietal EDH. The overall progression rate was 21.1 per cent (n = 12) and NI rate was 29 per cent (n = 22). There was no difference in the outcome of patients based on location of EDH. Patients with NI had a longer hospital length of stay ( P = 0.02) and longer intensive care unit length of stay ( P = 0.05). The incidence of isolated EDH is low in patients with blunt TBI. Patients with isolated EDH undergoing NI have longer hospital stays compared to patients without NI. Further investigation is warranted to identify factors associated with need for NI and adverse outcomes in the cohort of patients with isolated EDH.
Collapse
Affiliation(s)
- Bardiya Zangbar
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Bradley Serack
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Peter Rhee
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Viraj Pandit
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Randall S. Friese
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Ansab A. Haider
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Andrew L. Tang
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| |
Collapse
|
26
|
Binder H, Majdan M, Tiefenboeck TM, Fochtmann A, Michel M, Hajdu S, Mauritz W, Leitgeb J. Management and outcome of traumatic epidural hematoma in 41 infants and children from a single center. Orthop Traumatol Surg Res 2016; 102:769-74. [PMID: 27622712 DOI: 10.1016/j.otsr.2016.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 05/13/2016] [Accepted: 06/08/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children. HYPOTHESIS We hypothese that due to adequate treatment of EDH in children and adolescence excellent clinical and functional outcome can be reached. PURPOSE To evaluate retrospectively our treatment process of EDH and to elucidate the relationship between trauma mechanism, injury pattern, radiological presentation, subsequent therapy and functional outcome. PATIENTS AND METHODS Hundred and twenty infants and children with traumatic brain injuries (TBI) were treated between 1992 and 2009 at a single level-one trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. To classify the outcomes the Glasgow Outcome Scale (GOS) scores at hospital discharge and at follow-up visits were used. EDH was classified according to the Rotterdam score. RESULTS Finally, 41 cases were diagnosed with an EDH and therefore included in our study. Twenty-one cases were treated surgically; however of these in 11 patients delayed surgery was necessary. Twenty patients were treated conservatively. Two patients (5%) died within 24hours, 39 patients (95%) survived. One of the operatively treated patients (2%) presented in a vegetative state, another one had severe disability, and however, 32 patients (78%) showed good recovery at latest follow-up. DISCUSSION Age, severity of TBI, and neurological status were the main factors influencing outcome after TBI due to acute EDH. We found that immediate as well as delayed surgical evacuation of EDH resulted in excellent outcomes in most cases. Conservative treatment was started in 76% of our cases - however needing in 35% delayed surgical intervention. Overall in all groups excellent final clinical and neurological outcomes could be reached.
Collapse
Affiliation(s)
- H Binder
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - M Majdan
- International Neurotrauma Research Organization, Vienna, Austria
| | - T M Tiefenboeck
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - A Fochtmann
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - M Michel
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - S Hajdu
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - W Mauritz
- Department of Anesthesiology and Intensive Care Medicine, Lorenz Böhler Hospital, Vienna, Austria
| | - J Leitgeb
- Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
27
|
Adeleye AO, Jite IE, Smith OA. A tale of two acute extradural hematomas. Surg Neurol Int 2016; 7:54. [PMID: 27213108 PMCID: PMC4866064 DOI: 10.4103/2152-7806.181905] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/03/2016] [Indexed: 11/17/2022] Open
Abstract
Background: In much of the Western hemisphere, mortality from traumatic acute extradural hematomas (AEDH) has been drastically brought down toward 0%. This is still not the case however in most developing countries. Case Description: This report represents a tragi-comic tale of two cases of traumatic AEDH managed by an academic neurosurgeon in a neurosurgically ill-resourced private health facility during a nationwide industrial strike action preventing clinical-surgical care in the principal author's University Teaching Hospital. A young man presented with altered consciousness, Glasgow Coma Score (GCS) 14/15, following a road accident. The cranial computed tomography (CT) scan was obtained only 9 h after its request, long after the man had actually deteriorated to GCS 7/15 with pupillary changes. The neurosurgeon, summoned from the nearby University Teaching Hospital for the operative care of this man, arrived on-site and was about moving the patient into the operative room when he took the final breaths and died, all within 2 h of the belated neuroimaging. This scenario repeated itself in the same health facility just 24 h later with another young man who presented GCS 7/15 and another identical CT evidence of traumatic AEDH. With more financially able relations, the diagnostic/surgical care of this second patient was much more prompt. He made a very brisk recovery from neurosurgical operative intervention. He is alive and well, 5-month postoperative. Conclusions: In most low-resourced health systems of the developing countries, a significant proportion of potentially salvageable cases of AEDH still perish from this disease condition.
Collapse
Affiliation(s)
- Amos Olufemi Adeleye
- Department of Surgery, Division of Neurological Surgery, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Ikechi E Jite
- Department of Family Medicine, Molly Specialist Hospital, Ibadan, Nigeria
| | - Omolara A Smith
- Department of Family Medicine, Molly Specialist Hospital, Ibadan, Nigeria
| |
Collapse
|
28
|
Godoy DA, Rubiano A, Rabinstein AA, Bullock R, Sahuquillo J. Moderate Traumatic Brain Injury: The Grey Zone of Neurotrauma. Neurocrit Care 2016; 25:306-19. [DOI: 10.1007/s12028-016-0253-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
29
|
Al-Qazzaz MA, Jabor MAM. Medico-legal study of intracranial causes of death. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2014. [DOI: 10.1016/j.ejfs.2014.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
30
|
Scotter J, Hendrickson S, Marcus HJ, Wilson MH. Prognosis of patients with bilateral fixed dilated pupils secondary to traumatic extradural or subdural haematoma who undergo surgery: a systematic review and meta-analysis. Emerg Med J 2014; 32:654-9. [DOI: 10.1136/emermed-2014-204260] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/06/2014] [Indexed: 01/23/2023]
|
31
|
Holmes MW, Goodacre S, Stevenson MD, Pandor A, Pickering A. The cost-effectiveness of diagnostic management strategies for children with minor head injury. Arch Dis Child 2013; 98:939-44. [PMID: 23968775 DOI: 10.1136/archdischild-2012-302820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To estimate the cost-effectiveness of diagnostic management strategies for children with minor head injury and identify an optimal strategy. METHODS A probabilistic decision analysis model was developed to estimate the costs and quality-adjusted life years (QALYs) accrued by each of six potential management strategies for minor head injury, including a theoretical 'zero option' strategy of discharging all patients home without investigation. The model took a lifetime horizon and the perspective of the National Health Service. RESULTS The optimal strategy was based on the Children's Head injury Algorithm for the prediction of Important Clinical Events (CHALICE) rule, although the costs and outcomes associated with each strategy were broadly similar. CONCLUSIONS Liberal use of CT scanning based on a high sensitivity decision rule is not only effective but also cost saving, with the CHALICE rule being the optimal strategy, although there is some uncertainty in the results. Incremental changes in the costs and QALYs are very small when all selective CT strategies are compared. The estimated cost of caring for patients with brain injury worsened by delayed treatment is very high compared with the cost of CT scanning. This analysis suggests that all hospitals receiving children with minor head injury should have unrestricted access to CT scanning for use in conjunction with evidence-based guidelines.
Collapse
Affiliation(s)
- M W Holmes
- School of Health and Related Research, The University of Sheffield, , Sheffield, England
| | | | | | | | | |
Collapse
|
32
|
Khan MB, Riaz M, Javed G, Hashmi FA, Sanaullah M, Ahmed SI. Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country. Surg Neurol Int 2013; 4:103. [PMID: 24032078 PMCID: PMC3766325 DOI: 10.4103/2152-7806.116425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 07/01/2013] [Indexed: 11/21/2022] Open
Abstract
Background: Children with epidural hematoma (EDH) present differently than adults. The outcome of treatment is also different. We aim to report our experiences with EDH in pediatric age group in terms of mode of injury, presenting features, management, and outcomes. We also aim to identify different prognostic indicators in pediatric patients with EDH. Methods: We prospectively collected data from 24 consecutively surgically treated pediatric patients. The data collected included presenting features, radiological imaging, details of management, and outcomes. Descriptive analysis was performed and different variables were tested for any statistical significance with Glasgow Outcome Score (GOS). Results: There were 19 male and 5 female patients. The mean Glasgow Coma Scale (GCS) score at presentation was 9.3 ± 4.4. Falls were the most common cause of EDH. Outcome assessment was done at 3 month follow up. A total of 15 patients had a GOS score of 5, 4 patients had a GOS score of 4, 2 patients had a GOS score of 3, while 3 patients had a GOS score of 1. On univariate analysis, admitting GCS score, patient's age, the time from injury to admission and injury to surgery, anisocoric pupils at presentation and effacement of basal cisterns were significantly associated with the outcome of GOS score. Conclusion: Falls are the most common mode of injury leading to EDH in children. Lower GCS at presentation, younger age at trauma, increased time since trauma to surgery and admission, anisocoria and effacement of basal cisterns are statistically significant variables in surgically treated pediatric patients of EDH that confer a poorer prognosis. A timely surgical intervention can result in excellent outcomes.
Collapse
Affiliation(s)
- Muhammad Babar Khan
- Department of Surgery, Section of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | | | | |
Collapse
|
33
|
Extradural haematoma—To evacuate or not? Revisiting treatment guidelines. Clin Neurol Neurosurg 2013; 115:1201-5. [DOI: 10.1016/j.clineuro.2013.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 04/23/2013] [Accepted: 05/05/2013] [Indexed: 11/22/2022]
|
34
|
Araujo JLV, Aguiar UDP, Todeschini AB, Saade N, Veiga JCE. Epidemiological analysis of 210 cases of surgically treated traumatic extradural hematoma. Rev Col Bras Cir 2013; 39:268-71. [PMID: 22936224 DOI: 10.1590/s0100-69912012000400005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 02/05/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the epidemiology, clinical and radiological presentation of patients with traumatic extradural hematoma (EDH) undergoing neurosurgical procedures. METHODS We performed a chart review of 210 patients admitted to the emergency department with EDH diagnosed by CT scan and surgically treated between August 1998 and January 2008. Variables analyzed were: age, gender, clinical and radiological presentation, mechanism of injury and neurological status at discharge from hospital. RESULTS In 49.2% trauma mechanism was fall; 89.2% of patients were male, 49.7% of cases had a Glasgow Coma Scale (GCS) between 13 and 15; 61% of patients had age between 20 and 49 years; the location of EDH was the temporo-parietal and temporal in 26.5% and 19.6% of the cases, respectively; 32.8% had associated intracranial lesions, with skull fractures seen in around 45% of cases; 76.2% of surgically treated patients were discharged with minimal or no neurologic deficit. CONCLUSION We observed that, in the study population, EDH appears more often in males, in the fourth decade of life, and is more related to falls. On admission, GCS was observed between 13 and 15 and it is appropriate to mention the involvement of the temporo-parietal region in most cases. We believe that knowledge of the epidemiology of traumatic epidural hematoma can assist in developing public health measures aimed at prevention and early identification of this disease in the population.
Collapse
|
35
|
Pan A, Li M, Gao JY, Xue ZQ, Li Z, Yuan XY, Luo DW, Luo XG, Yan XX. Experimental epidural hematoma causes cerebral infarction and activates neocortical glial and neuronal genesis in adult guinea pigs. J Neurosci Res 2012; 91:249-61. [DOI: 10.1002/jnr.23148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 08/26/2012] [Accepted: 09/02/2012] [Indexed: 12/16/2022]
|
36
|
Mezue WC, Ndubuisi CA, Chikani MC, Achebe DS, Ohaegbulam SC. Traumatic extradural hematoma in enugu, Nigeria. Niger J Surg 2012; 18:80-4. [PMID: 24027399 PMCID: PMC3762009 DOI: 10.4103/1117-6806.103111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Acute traumatic extradural hematoma (EDH) is life threatening and requires prompt intervention. This is a study of incidence and outcome of consecutive patients with EDH managed in Enugu, Nigeria against a background of delayed referral. Materials and Methods: We retrospectively examined all consecutive trauma cases managed between 2003 and 2009 and analyzed patients with acute traumatic extradural hematoma in isolation or in combination with other intra cranial lesions. Age, sex, cause of injury, time of presentation, Glasgow Coma Score (GCS), pupil reactivity, treatment and clinical outcomes were determined. Results: Of 817 head injuries, 69 (8.4%) had EDH, a mean of 9.9 patients per year. Males were 57 (83%) and females 12 (17%). Peak age incidences were the second and third decades of life, with a mean age of 30.2 years. Causes were road traffic accidents (57%), assault (22%) and falls (9%). Twenty-six (38%) patients presented within 24 h of injury and only one patient presented within 4 h. The average time lag before presentation was 94.2 h. At presentation 39% had GCS of 13-15, 27% had 9-12 and 34% had 3-8. The most common location of hematoma was temporal (27.5%). Forty (59%) patients had surgery while 14 (20%) were managed conservatively. Ten patients (14.5%) died and of these 70% had GCS <8 and 60% had a seizure. Conclusion: We conclude that early appropriate treatment of EDH results in good high quality survival (Glasgow Outcome Score 4 or 5). Low GCS should not be an absolute contraindication for surgery. Seizure prophylaxis should be considered in patients with GCS <8.
Collapse
Affiliation(s)
- Wilfred C Mezue
- Department of Surgery, Neurosurgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | | | | | | |
Collapse
|
37
|
Traumatic Epidural Hematoma of the Posterior Cranial Fossa. Korean J Neurotrauma 2012. [DOI: 10.13004/kjnt.2012.8.2.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
38
|
Nelson JA. Local skull trephination before transfer is associated with favorable outcomes in cerebral herniation from epidural hematoma. Acad Emerg Med 2011; 18:78-85. [PMID: 21414061 DOI: 10.1111/j.1553-2712.2010.00949.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The patient with epidural hematoma and cerebral herniation has a good prognosis with immediate drainage, but a poor prognosis with delay to decompression. Such patients who present to nonneurosurgical hospitals are commonly transferred without drainage to the nearest neurosurgical center. This practice has never been demonstrated to be the safest approach to treating these patients. A significant minority of emergency physicians (EPs) have advised and taught bedside burr hole drainage or skull trephination before transfer for herniating patients. The objective of this study was to assess the effect of nonneurosurgeon drainage on neurologic outcome in patients with cerebral herniation from epidural hematoma. METHODS A structured literature review was performed using EMBASE, the Cochrane Library, and the Emergency Medicine Abstracts database. RESULTS No evidence meeting methodologic criteria was found describing outcomes in patients transferred without decompressive procedures. For patients receiving local drainage before transfer, 100% had favorable outcomes. CONCLUSIONS Although the total number of patients is small and the population highly selected, the natural history of cerebral herniation from epidural hematoma and the best available evidence suggests that herniating patients have improved outcomes with drainage procedures before transport.
Collapse
Affiliation(s)
- James A Nelson
- Emergency Department, Pioneers Memorial Hospital, Brawley, CA, USA.
| |
Collapse
|
39
|
Hassan NA, Kelany RSE, Emara AM, Amer M. Pattern of craniofacial injuries in patients admitted to Tanta University Hospital--Egypt. J Forensic Leg Med 2009; 17:26-32. [PMID: 20083047 DOI: 10.1016/j.jflm.2009.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Revised: 04/08/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
Abstract
The goal of this work was to determine the craniofacial injury patterns in hospitalized patients to facilitate the awareness, by identifying, describing and quantifying trauma for use in planning and evaluation of preventive programs. Two-hundred and fifty five patients with craniofacial injuries were registered at the department of neurosurgery in Tanta University Hospital. Data were collected including age, gender, medical history, cause of injury and type of injury, location and frequency of soft tissue injuries, skull fractures, facial bone fractures, brain injuries and concomitant injuries, patient symptoms, clinical signs and the radiological findings. The most common causes of craniofacial injuries were road traffic accidents, followed by activity of daily life and assaults. Gender distribution showed that, males were at higher risk than females with a ratio of 5.5/1. In total of skull fractures, 47.84% were fissure fracture and 24.31% were depressed fractures. In total of brain injuries, 7.06% for concussion, 4.71% for contusion, 10.98% for brain laceration, 14.12% for pneumocephalus and 36.47% for brain edema. Regression analysis revealed increased risk for skull fractures and brain injuries in traffic accidents were 84.78%, 94.20%, respectively, and 59.14%, 50.54% in activity of daily life, but the probability of soft tissue injuries increase in traffic accident and violence.
Collapse
Affiliation(s)
- Neven Ahmed Hassan
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Egypt
| | | | | | | |
Collapse
|
40
|
Chaudhuri K, Malham GM, Rosenfeld JV. Survival of trauma patients with coma and bilateral fixed dilated pupils. Injury 2009; 40:28-32. [PMID: 19070839 DOI: 10.1016/j.injury.2008.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 09/04/2008] [Accepted: 09/05/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND Survival of patients with severe trauma presenting with Glasgow Coma Score (GCS) 3 and bilateral fixed dilated pupils is uncertain. Pre-hospital management of these patients affects the true measurement of the GCS and other factors may affect pupillary status. PATIENTS AND METHODS A retrospective review was undertaken of all patients who were classified GCS 3 and had bilateral fixed dilated pupils on admission to a Level 1 Adult Trauma Centre between July 2001 and March 2005. Pre-hospital assessment, hospital interventions and outcomes were determined. RESULTS Ninety-three patients fulfilled the criteria for inclusion into the study. There were 6 survivors who were all less than 28 years of age, had at least one GCS score above 3 in the pre-hospital phase and were more likely to have had an evacuable mass lesion on CT brain scan and undergo craniotomy. Of the 6 surviving patients, none had significant thoracoabdominal injuries. Four of the survivors had Glasgow Outcome Score (GOS) of 4 or 5. Time to hospital, mechanism of injury and pre-hospital haemodynamic parameters had no significant effect on survival. Of the 57 patients who were GCS 3 at the scene of the accident, post-basic resuscitation and on admission, none survived. CONCLUSION Pre-hospital GCS scores, prior to the effects of intubation, sedation and paralysis should be given more attention when assessing prognosis in patients who are GCS 3 on admission. Trauma patients with GCS 3 persisting from the scene with bilaterally fixed dilated pupils have no appreciable chance of survival. Further interventions such as ICU admission and surgery may not be warranted. Physicians may need to consider stopping treatment and discussing organ donation.
Collapse
Affiliation(s)
- Krishanu Chaudhuri
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | | | | |
Collapse
|
41
|
Louzada PR, Vaitsman RP, Souza ABMD, Coutinho PDO, Lengruber RT, Neves FWBD, Missaka H, Lima MAA, Salame JM. Bilateral cortical atrophy after severe brain trauma and extradural homatoma. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 65:1237-40. [PMID: 18345438 DOI: 10.1590/s0004-282x2007000700029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 09/12/2007] [Indexed: 11/22/2022]
Abstract
We report the case of a severe head injured 43-year old male patient with a large extradural hematoma, Glasgow Coma Scale 3 and dilated fixed pupils. Patient was promptly submitted to surgical evacuation of the lesion, but remained in persistent vegetative state in the post-operative time. Head computed tomography scans performed before surgery, and at early and late post-operative periods comparatively revealed extreme bilateral cortical atrophy. Late consequences of severe head trauma drastically affect the prognosis of patients, being its prevention, and neuroprotection against secondary injury still a therapeutical challenge for neurosurgeons.
Collapse
Affiliation(s)
- Paulo Roberto Louzada
- Serviço de Neurocirurgia, Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
|
43
|
Yang YM, Yang XH, Huang MD, Chen WQ, Li WA. Efficacy of subdural saline injection during surgery for acute epidural haematomas. Brain Inj 2007; 21:1303-6. [PMID: 18236204 DOI: 10.1080/02699050701727478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PRIMARY OBJECTIVE The purpose of this study was to investigate the efficacy of subdural space saline injection surgery in the management of large acute epidural haematomas (EDHs). METHODS AND PROCEDURES Over a period of 6 years, the authors employed the technique of subdural space saline injection to facilitate elevation of dura after evacuation of supratentorial epidural haematomas. MAIN OUTCOMES AND RESULTS. Eighty patients with supratentorial epidural haematomas underwent the procedure. Infusion of saline in the subdural space not only helps elevation of the dura, facilitate haemostasis and application of suspension stitches during operation, it also avoids ICP fluctuations during the operations. Post-operative CT scans showed rapid disappearance of saline and reposition of cerebral structure. No patient required re-operation for residual haematoma. CONCLUSIONS Subdural saline injection is an effective operative technique in the management of large epidural haematoma.
Collapse
Affiliation(s)
- Ying-Ming Yang
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, People's Republic of China.
| | | | | | | | | |
Collapse
|