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Rivera D, Greving S, Arango-Lasprilla JC, von Steinbuechel N, Zeldovich M. Comparability of (Post-Concussion) Symptoms across Time in Individuals after Traumatic Brain Injury: Results from the CENTER-TBI Study. J Clin Med 2022; 11:jcm11144090. [PMID: 35887853 PMCID: PMC9322034 DOI: 10.3390/jcm11144090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
Post-concussion symptoms often occur after TBI, persist and cause disabilities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used in this population, but little is known about the comparability of the symptoms over time, i.e., longitudinal measurement invariance (MI). The objectives of this study were to analyze the longitudinal MI of RPQ symptoms from three to twelve months after TBI and to find factors related to RPQ symptoms. The study involved 1023 individuals after TBI who took part in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study and completed the RPQ at three, six and twelve months post-injury. Longitudinal confirmatory factor analysis showed that the three-factor structure (somatic, emotional and cognitive) remains stable within one year after TBI. Linear mixed models revealed that sex, injury cause and prior psychiatric problems were related to the RPQ three-factor structure as well as to the RPQ total score. The study strengthens evidence for the RPQ’s factorial structure stability within one year after TBI and identifies sex, injury cause and prior psychiatric problems as important factors that may help clinicians to prevent future complications of symptomatology after TBI.
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Affiliation(s)
- Diego Rivera
- Department of Health Sciences, Public University of Navarre, Arrosadia Campus, 31006 Pamplona, Spain;
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea Street 3, 31008 Pamplona, Spain
| | - Sven Greving
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany; (S.G.); (N.v.S.)
| | | | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany; (S.G.); (N.v.S.)
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany; (S.G.); (N.v.S.)
- Correspondence:
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Borazjani R, Ajdari MR, Niakan A, Yousefi O, Amoozandeh A, Sayadi M, Khalili H. Current Status and Outcomes of Critical Traumatic Brain Injury (GCS = 3-5) in a Developing Country: A Retrospective, Registry-Based Study. World J Surg 2022; 46:2335-2343. [PMID: 35789431 DOI: 10.1007/s00268-022-06645-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients sustaining critical TBI [initial Glasgow Coma Scale (GCS) ≤ 5] generally have poor outcomes. Little is known about the frequency, mortality rate, and functional outcomes of such patients in Iran. METHODS In this retrospective, registry-based cohort study, the demographic and clinicoradiological findings of TBI patients were queried from March 21, 2017, to March 21, 2020. We included TBI patients with initial GCS of 3-5. The functional outcome was assessed using the Glasgow Outcome Score-extended 6 (GOSE-6) months after the hospital discharge. Patients were classified as having unfavorable (GOSE-6 ≤ 4) and favorable (GOSE-6 > 4) outcomes. Gathered data were compared between groups. Multivariable logistic regression analysis was done to find factors affecting the outcome. RESULTS Four hundred ninety-seven patients (mean age = 37.59 ± 17.89) were enrolled, and 69.2% had unfavorable outcomes. Elderly patients (age ≥ 65 years) were highly overrepresented among the unfavorable group. 48.9% had bilateral fixed dilated pupils (BDFP), who mostly attained unfavorable outcomes. The overall in-hospital mortality rate was 50.3%. The in-hospital mortality rate was appalling among elderly patients with BFDP and GCS 3( 90%) and GCS 4(100%). Age ≥ 65 years [odds ratio (OR) 3.45, 95% confidence interval (CI) 1.19-10.04], and BFDP (OR 4.48, 95% CI 2.60-7.73) increase the odds of unfavorable outcomes according to the regression analysis. CONCLUSION The survival rate and favorable outcomes of critical TBI patients are generally poor. However, we believe that the neurotrauma surgeons should discuss with patients' proxies and explain the clinical conditions and possible outcomes.
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Affiliation(s)
- Roham Borazjani
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Ajdari
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Niakan
- Department of Neurosurgery, Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Chamran Blvd, Shiraz, 7194815711, Iran
| | - Omid Yousefi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arsham Amoozandeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Department of Biostatistics, Cardiovascular Research Center,, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hosseinali Khalili
- Department of Neurosurgery, Trauma Research Center, Shahid Rajaee Trauma Hospital, Shiraz University of Medical Sciences, Chamran Blvd, Shiraz, 7194815711, Iran.
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Lopez-de-Andres A, Jimenez-Garcia R, Hernández-Barrera V, Jiménez-Trujillo I, de Miguel-Yanes JM, Carabantes-Alarcon D, de Miguel-Diez J, Lopez-Herranz M. Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016-18. Cardiovasc Diabetol 2021; 20:138. [PMID: 34243780 PMCID: PMC8272346 DOI: 10.1186/s12933-021-01334-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background To analyze incidence, use of therapeutic procedures, use of oral anticoagulants (OACs) and antiplatelet agents prior to hospitalization, and in-hospital outcomes among patients who were hospitalized with hemorrhagic stroke (HS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the role of sex differences among those with T2DM. Methods Using the Spanish National Hospital Discharge Database we estimated the incidence of HS hospitalizations in men and women aged ≥ 35 years with and without T2DM. Propensity score matching (PSM) was used to compare population subgroups according to sex and the presence of T2DM. Results HS was coded in 31,425 men and 24,975 women, of whom 11,915 (21.12%) had T2DM. The adjusted incidence of HS was significantly higher in patients with T2DM (both sexes) than in non-T2DM individuals (IRR 1.15; 95% CI 1.12–1.17). The incidence of HS was higher in men with T2DM than in T2DM women (adjusted IRR 1.60; 95% CI 1.57–1.63). After PSM, men and women with T2DM have significantly less frequently received decompressive craniectomy than those without T2DM. In-hospital mortality (IHM) was higher among T2DM women than matched non-T2DM women (32.89% vs 30.83%; p = 0.037), with no differences among men. Decompressive craniectomy was significantly more common in men than in matched women with T2DM (5.81% vs. 3.33%; p < 0.001). IHM was higher among T2DM women than T2DM men (32.89% vs. 28.28%; p < 0.001). After adjusting for confounders with multivariable logistic regression, women with T2DM had a 18% higher mortality risk than T2DM men (OR 1.18; 95% CI 1.07–1.29). Use of OACs and antiplatelet agents prior to hospitalization were associated to higher IHM in men and women with and without T2DM. Conclusions T2DM is associated with a higher incidence of HS and with less frequent use of decompressive craniectomy in both sexes, but with higher IHM only among women. Sex differences were detected in T2DM patients who had experienced HS, with higher incidence rates, more frequent decompressive craniectomy, and lower IHM in men than in women. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01334-2.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department. Hospital General, Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Marta Lopez-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
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Shah DB, Paudel P, Joshi S, Karki P, Sharma GR. Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal. Asian J Neurosurg 2021; 16:288-293. [PMID: 34268153 PMCID: PMC8244698 DOI: 10.4103/ajns.ajns_392_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/25/2020] [Accepted: 03/16/2021] [Indexed: 11/11/2022] Open
Abstract
Objective: Decompressive craniectomy (DC) is one of the commonly used treatment modalities for refractory intracranial hypertension after traumatic brain injury. The objective of this study is to assess the functional outcome following DC in closed traumatic brain injury based on Glasgow Outcome Scale (GOS). Materials and Methods: This is a retrospective study conducted at Nepal Mediciti Hospital, Nepal, from September 2017 to October 2019. Data of the patients who had undergone DC for closed traumatic brain injury were reviewed from medical record files. Patients who had DC for nontraumatic causes were excluded from the study. Functional outcome was assessed using GOS at 3 months of follow-up. Results: Of the 52 decompressive craniectomies, 46 were included in the study. The majority was male (71.7%). The mean age and the mean Glasgow Coma Scale (GCS) score at presentation were 41.87 (standard deviation [SD] ± 15.29) and 7.59 (SD ± 2.97), respectively. The most common mode of injury was road traffic accident (76.1%). 60.9% had GCS score ≤8 while 39.1% had >8 GCS on admission. 34.8% had both the pupils reactive while 58.7% were anisocoric. Majority had Marshall IV and above grade of injury (67.4%). Sixteen (34.8%) had inhospital mortality. Favorable outcome was seen in 39.1%. GCS score >8 at presentation (72.2%, P < 0.001), bilaterally intact pupillary reflexes (75%, P < 0.001), Marshall grade injury ≤3 on computed tomography scan (90%, P < 0.001), and age <50 years (50%, P = 0.039) were significantly associated with favorable outcome. Procedure-related complications were seen in 36.9%. Conclusion: Favorable outcome was seen in 39.1%. Age <50 years, higher GCS score at presentation (>8), intact pupillary reflexes, and lower Marshall grade injuries were associated with favorable outcome. We recommend a larger prospective study to assess the long-term functional outcome after DC using extended GOS.
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Affiliation(s)
| | - Prakash Paudel
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Sumit Joshi
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Prasanna Karki
- Department of Neurosciences, Nepal Mediciti Hospital, Lalitpur, Nepal
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Cui W, Ge S, Shi Y, Wu X, Luo J, Lui H, Zhu G, Guo H, Feng D, Qu Y. Death after discharge: prognostic model of 1-year mortality in traumatic brain injury patients undergoing decompressive craniectomy. Chin Neurosurg J 2021; 7:24. [PMID: 33879254 PMCID: PMC8058982 DOI: 10.1186/s41016-021-00242-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/31/2021] [Indexed: 11/21/2022] Open
Abstract
Background Despite advances in decompressive craniectomy (DC) for the treatment of traumatic brain injury (TBI), these patients are at risk of having a poor long-term prognosis. The aim of this study was to predict 1-year mortality in TBI patients undergoing DC using logistic regression and random tree models. Methods This was a retrospective analysis of TBI patients undergoing DC from January 1, 2015, to April 25, 2019. Patient demographic characteristics, biochemical tests, and intraoperative factors were collected. One-year mortality prognostic models were developed using multivariate logistic regression and random tree algorithms. The overall accuracy, sensitivity, specificity, and area under the receiver operating characteristic curves (AUCs) were used to evaluate model performance. Results Of the 230 patients, 70 (30.4%) died within 1 year. Older age (OR, 1.066; 95% CI, 1.045–1.087; P < 0.001), higher Glasgow Coma Score (GCS) (OR, 0.737; 95% CI, 0.660–0.824; P < 0.001), higher d-dimer (OR, 1.005; 95% CI, 1.001–1.009; P = 0.015), coagulopathy (OR, 2.965; 95% CI, 1.808–4.864; P < 0.001), hypotension (OR, 3.862; 95% CI, 2.176–6.855; P < 0.001), and completely effaced basal cisterns (OR, 3.766; 95% CI, 2.255–6.290; P < 0.001) were independent predictors of 1-year mortality. Random forest demonstrated better performance for 1-year mortality prediction, which achieved an overall accuracy of 0.810, sensitivity of 0.833, specificity of 0.800, and AUC of 0.830 on the testing data compared to the logistic regression model. Conclusions The random forest model showed relatively good predictive performance for 1-year mortality in TBI patients undergoing DC. Further external tests are required to verify our prognostic model.
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Affiliation(s)
- Wenxing Cui
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China
| | - Shunnan Ge
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China
| | - Yingwu Shi
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China
| | - Xun Wu
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China
| | - Jianing Luo
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China
| | - Haixiao Lui
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China
| | - Gang Zhu
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China
| | - Hao Guo
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China
| | - Dayun Feng
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, No. 569 Xin Si Road, Xi'an, 710038, Shaanxi Province, China.
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Yin X, Wu J, Zhou L, Ni C, Xiao M, Meng X, Zhu X, Cao Q, Li H. The pattern of hospital-community-home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: Is it feasible? Int J Clin Pract 2021; 75:e13881. [PMID: 33283421 DOI: 10.1111/ijcp.13881] [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] [Received: 10/23/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tracheostomy is very common in patients with severe traumatic brain injury (TBI), long-term nursing care are needed for those patients. We aimed to evaluate the effects of hospital-community-home (HCH) nursing in those patients. METHODS This study was a before-after study design. Patients were divided into control groups (traditional nursing care) and HCH group(HCH nursing care). Tracheostomy patients with severe TBI needing long-term care were included. All patients underwent a two-month long follow-up. Glasgow coma score (GCS), Karnofsky, Self-Anxiety Scale (SAS) from caregiver and Barthel assessment at the discharge and two months after discharge were evaluated. The tracheostomy-related complications were recorded and compared. RESULTS A total of 60 patients were included. There were no significant differences between the two groups in the GCS, Karnofsky, SAS from caregiver and Barthel index at discharge((all P > .05); the GCS, Karnofsky and Barthel index were all significantly increased after two-month follow-up for the two groups (all P < .05), and the GCS, Karnofsky and Barthel index at two-month follow-up in HCH group were significantly higher than that of the control group(all P < .05), but the SAS from caregiver at two-month follow-up in HCH group was significantly less than that of the control group(P = .009). The incidence of block of artificial tracheal cannula and readmission in HCH group were significant less than that of control group (all P < .05). CONCLUSION HCH nursing care is feasible in tracheostomy patients with severe TBI, future studies are needed to further evaluate the role of HCH nursing care.
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Affiliation(s)
- Xiangyi Yin
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Jie Wu
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Lihui Zhou
- Department of General Surgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Chunyan Ni
- Department of Nursing, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Minyan Xiao
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Xianlan Meng
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Xiaowen Zhu
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Qing Cao
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Huifen Li
- Department of Nursing, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
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Liu C, Xie J, Xiao X, Li T, Li H, Bai X, Li Z, Wang W. Clinical predictors of prognosis in patients with traumatic brain injury combined with extracranial trauma. Int J Med Sci 2021; 18:1639-1647. [PMID: 33746580 PMCID: PMC7976565 DOI: 10.7150/ijms.54913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/04/2021] [Indexed: 12/20/2022] Open
Abstract
Objective: The purpose of this study was to investigate whether routine blood tests on admission and clinical characteristics can predict prognosis in patients with traumatic brain injury (TBI) combined with extracranial trauma. Methods: Clinical data of 182 patients with TBI combined with extracranial trauma from April 2018 to December 2019 were retrospectively collected and analyzed. Based on GOSE score one month after discharge, the patients were divided into a favorable group (GOSE 1-4) and unfavorable group (GOSE 5-8). Routine blood tests on admission and clinical characteristics were recorded. Results: Overall, there were 48 (26.4%) patients with unfavorable outcome and 134 (73.6%) patients with favorable outcome. Based on multivariate analysis, independent risk factors associated with unfavorable outcome were age (odds ratio [OR], 1.070; 95% confidence interval [CI], 1.018-1.124; p<0.01), admission Glasgow Coma Scale (GCS) score (OR, 0.807; 95% CI, 0.675-0.965; p<0.05), heart rate (OR, 1.035; 95% CI, 1.004-1.067; p<0.05), platelets count (OR, 0.982; 95% CI, 0.967-0.997; p<0.05), and tracheotomy (OR, 15.201; 95% CI, 4.121-56.078; p<0.001). Areas under the curve (AUC) of age, admission GCS, heart rate, tracheotomy, and platelets count were 0.678 (95% CI, 0.584-0.771), 0.799 (95% CI, 0.723-0.875), 0.652 (95% CI, 0.553-0.751), 0.776 (95% CI, 0.692-0.859), and 0.688 (95% CI, 0.606-0.770), respectively. Conclusions: Age, admission GCS score, heart rate, tracheotomy, and platelets count can be recognized as independent predictors of clinical prognosis in patients with severe TBI combined with extracranial trauma.
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Affiliation(s)
- Chengli Liu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.R. China
| | - Jie Xie
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.R. China
| | - Xinshuang Xiao
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.R. China
| | - Tianyu Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.R. China
| | - Hui Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.R. China
| | - Xiangjun Bai
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.R. China
| | - Zhanfei Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.R. China
| | - Wei Wang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, P.R. China
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Decompressive Craniectomy Improves QTc Interval in Traumatic Brain Injury Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228653. [PMID: 33233364 PMCID: PMC7700327 DOI: 10.3390/ijerph17228653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022]
Abstract
Background: Traumatic brain injury (TBI) is commonly associated with cardiac dysfunction, which may be reflected by abnormal electrocardiograms (ECG) and/or contractility. TBI-related cardiac disorders depend on the type of cerebral injury, the region of brain damage and the severity of the intracranial hypertension. Decompressive craniectomy (DC) is commonly used to reduce intra-cranial hypertension (ICH). Although DC decreases ICH rapidly, its effect on ECG has not been systematically studied. The aim of this study was to analyze the changes in ECG in patients undergoing DC. Methods: Adult patients without previously known cardiac diseases treated for isolated TBI with DC were studied. ECG variables, such as: spatial QRS-T angle (spQRS-T), corrected QT interval (QTc), QRS and T axes (QRSax and Tax, respectively), STJ segment and the index of cardio-electrophysiological balance (iCEB) were analyzed before DC and at 12–24 h after DC. Changes in ECG were analyzed according to the occurrence of cardiac arrhythmias and 28-day mortality. Results: 48 patients (17 female and 31 male) aged 18–64 were studied. Intra-cranial pressure correlated with QTc before DC (p < 0.01, r = 0.49). DC reduced spQRS-T (p < 0.001) and QTc interval (p < 0.01), increased Tax (p < 0.01) and changed STJ in a majority of leads but did not affect QRSax and iCEB. The iCEB was relatively increased before DC in patients who eventually experienced cardiac arrhythmias after DC (p < 0.05). Higher post-DC iCEB was also noted in non-survivors (p < 0.05), although iCEB values were notably heart rate-dependent. Conclusions: ICP positively correlates with QTc interval in patients with isolated TBI, and DC for relief of ICH reduces QTc and spQRS-T. However, DC might also increase risk for life-threatening cardiac arrhythmias, especially in ICH patients with notably prolonged QTc before and increased iCEB after DC.
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Tau T, Kelly A, lekgwara P. Predicting outcome in patients with traumatic brain injury who undergo a decompressive craniectomy at a single academic center in Pretoria, South Africa. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Goda R, Sharma R, Katiyar V, Singla R, Borkar S, Vora Z. Early Outcome Following Decompressive Craniectomy for Traumatic Brain Injury: A Prediction Model. World Neurosurg 2019; 127:656. [PMID: 31266111 DOI: 10.1016/j.wneu.2019.02.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Revanth Goda
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Varidh Katiyar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Singla
- Department of Neurosurgery, PGIMER Chandigarh, Chandigarh, India.
| | - Sachin Borkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Zainab Vora
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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Tian R, Liu W, Dong J, Zhang J, Xu L, Zhang B, Tao X, Li J, Liu B. In Reply to "Early Outcome Following Decompressive Craniectomy for Traumatic Brain Injury: A Prediction Model". World Neurosurg 2019; 127:657. [PMID: 31266112 DOI: 10.1016/j.wneu.2019.03.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Runfa Tian
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, P. R. China; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, P. R. China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, P. R. China
| | - Jinqian Dong
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, P. R. China
| | - Ji Zhang
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Long Xu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, P. R. China
| | - Bin Zhang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, P. R. China
| | - Xiaogang Tao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, P. R. China
| | - Jingsheng Li
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, P. R. China
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, P. R. China; China National Clinical Research Center for Neurological Diseases, Beijing, P. R. China; Beijing Key Laboratory of Central Nervous System Injury, Beijing, P. R. China; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, P. R. China; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Beijing, P. R. China.
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