Head trauma

The prognostic value of admission point-of-care testing and modified Glasgow Coma Scale score in dogs and cats with traumatic brain injuries (2007-2010): 212 cases

OBJECTIVE

To investigate the association between admission point-of-care parameters and survival to discharge in dogs and cats with traumatic brain injury (TBI).

DESIGN

Retrospective study 2007-2010.

SETTING

A rural university teaching hospital and an urban private practice teaching hospital.

ANIMALS

One hundred thirty-one dogs and 81 cats admitted to the emergency service with evidence of head injury based on history from the owner or physical exam.

MEASUREMENTS AND MAIN RESULTS

In dogs, nonsurvivors had significantly higher glucose concentrations at admission than survivors (median = 8.49 mmol/L [153 mg/dl] vs 6.83 mmol/L [123 mg/dl], p = 0.039). In cats, there was no significant difference in admission glucose between survivors and nonsurvivors (median = 10.21 mmol/L [184 mg/dl] vs 10.93 mmol/L [197 mg/dl], p = 0.17). Modified Glasgow Coma Scale (MGCS) score was available for 105 of the 131 dogs (80%) and was significantly higher in survivors than in nonsurvivors (median = 16 vs 11, p < 0.0001). MGCS was available for 45 of the 81 cats (56%) and was significantly higher in survivors than in nonsurvivors (median = 17 vs 14, p = 0.0005). The relative prognostic value of the admission point-of-care testing parameters and MGCS were assessed using a stepwise linear regression model, which included admission glucose, pH, base excess, sodium, and MGCS. In dogs, only admission glucose was an independent predictor of survival (odds ratio = 1.027, 95% confidence interval, 1.0042-1.05, p = 0.019).

CONCLUSIONS

These results suggest that, as in people with TBI, increased blood glucose concentrations may have prognostic significance in dogs with TBI but not in cats. In addition, MGCS score may be predictive of survival in both dogs and cats with TBI.

Hypernatremia and Coagulopathy May or May Not Be Useful Clinical Biomarkers in Dogs with Head Trauma: A Retrospective Study

This study was performed to evaluate clinical biomarkers as prognostic values in dogs with traumatic brain injury (TBI) based on findings in human patients. Sodium levels of 158 dogs with TBI and 169 patients with trauma without involvement of the head except head trauma (EHT) were examined. TBI patients with hypernatremia had a slightly higher risk of dying (22.03 %) than dogs with normal sodium levels (19.76%). However, there was no significant correlation between sodium levels and outcome in TBI patients (p = 0.6357). Dogs with sodium levels >160 mmol/L were non-survivors. In dogs with late-onset post-traumatic epilepsy (PTE) more often hyponatremia was measured, and in dogs with immediate PTE mild hypernatremia or normal sodium levels were measured after the trauma. Evaluation of coagulation parameters in a subpopulation of dogs showed a strong correlation between partial thromboplastin time/prothrombin time (PTT/PT) and the Modified Glasgow Coma Scale (MGCS) (p = 0.0006; p = 0.0306). In conclusion, unlike in human patients, sodium levels displayed no significant correlation with survival in dogs with TBI in the current study. However, in cases with severe TBI, dog owners often elect euthanasia before severe hypernatremia can be measured. Late PTE was observed in cases with initial hyponatremia. Because of a significant correlation between PTT/PT and MGCS, coagulopathy might be considered as a prognostic clinical biomarker in canine TBI patients.

Updates in the management of the small animal patient with neurologic trauma

Neurologic trauma, encompassing traumatic brain injury (TBI) and acute spinal cord injury (SCI), is a cause of significant morbidity and mortality in veterinary patients. Acute SCIs occurring secondary to trauma are also common. Essential to the management of TBI and SCI is a thorough understanding of the pathophysiology of the primary and secondary injury that occurs following trauma. This article reviews the pathophysiology of this primary and secondary injury, as well as recommendations regarding clinical assessment, diagnostics, pharmacologic and nonpharmacologic therapy, and prognosis.

Cervical injury following a horse kick to the head in two dogs

Two dogs were presented to North Carolina State University Veterinary Teaching Hospital following blunt trauma to the head delivered by a horse kick. On presentation, both dogs had resolving clinical signs directly related to the head trauma, but both also had compromise to their upper airway as a result of indirect injury to the soft tissues of the neck, visible on plain radiographs. One dog made a full recovery following a period of assisted ventilation. The other dog was euthanized at the request of the owner. These injuries illustrate the importance of evaluating the cervical spine and soft tissues of the neck following blunt trauma to the head.

Emergency management of the head trauma patient. Principles and practice

Management of the severely brain-injured dog or cat can be frustrating, especially considering the lack of proven effective therapies for head trauma patients. A working knowledge of the basic pathophysiology of head trauma and intracranial pressure (ICP) dynamics is essential to the logical treatment of head traumatized patients. Prevention and correction of hypotension and hypoxemia are necessary for preventing progressive increases in ICP. Mannitol is recommended in most cases of severe head trauma, but there is little evidence to support the use of glucocorticoids in acutely brain-injured dogs and cats. The role of surgical intervention for head-traumatized dogs and cats is still uncertain, but may be beneficial in some cases. Aggressive, expedient treatment and attentive patient monitoring are key aspects of successfully managing canine and feline head trauma patients.