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Limpastan K, Norasetthada T, Watcharasaksilp W, Vaniyapong T, Jetjumnong C, Srihagulang C, Praphanuwat T, Vongsfak J. Intracranial pressure monitoring for severe traumatic brain injury: A retrospective study of 273 consecutive patients. Surg Neurol Int 2024; 15:208. [PMID: 38974553 PMCID: PMC11225394 DOI: 10.25259/sni_221_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/25/2024] [Indexed: 07/09/2024] Open
Abstract
Background Intracranial pressure (ICP) monitoring is essential in severe traumatic brain injury (sTBI) cases; yet, the frequency of high ICP occurrences remains debated. This study presents a 9-year analysis of ICP monitoring using intraventricular catheters among sTBI patients. Methods A retrospective review of 1760 sTBI patients (Glasgow Coma Score <9) admitted between January 2011 and December 2019 was conducted. Of these, 280 patients meeting monitoring criteria were included based on Brain Trauma Foundation (BTF) Guidelines. ICP was monitored using intraventricular catheters through right frontal burr holes. Initial ICP readings were recorded intraoperatively, followed by continuous monitoring. Patients with ICP >20 mmHg for 10-15 min during 72 h were categorized with high ICP. Data collected included demographics, computed tomography (CT) findings, intra- and post-operative ICP, and complications. Results Of 273 patients, 228 were male and 45 females, aged 18-80 (71.30% aged 18-45). Traffic accidents were the primary cause (90.48%). Fifty-two-point seventy-five percent experienced high ICP, correlating significantly with subdural hematoma (P < 0.001), intraventricular hemorrhage (P < 0.013), and compressed basal cisterns (P = 0.046) on initial CT. Twenty patients (7.3%) developed meningitis. Lower mortality rates and improved outcomes were observed in the low ICP group across discharge 3-and 6-month follow-ups. Conclusion Adherence to BTF guidelines yielded a 52.75% high ICP rate. Significant correlations were found between high ICP and specific CT abnormalities. This study underscores the benefits of ICP monitoring in selected sTBI cases, suggesting a need to review criteria for initiating monitoring protocols.
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Fujiwara G, Okada Y, Shiomi N, Sakakibara T, Yamaki T, Hashimoto N. Derivation of Coagulation Phenotypes and the Association with Prognosis in Traumatic Brain Injury: A Cluster Analysis of Nationwide Multicenter Study. Neurocrit Care 2024; 40:292-302. [PMID: 36977962 DOI: 10.1007/s12028-023-01712-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The pathogenesis and pathophysiology of traumatic coagulopathy during traumatic brain injury is not well understood, and the appropriate treatment strategy for this condition has not been established. This study aimed to evaluate the coagulation phenotypes and their effect on prognosis in patients with isolated traumatic brain injury. METHODS In this multicenter cohort study, we retrospectively analyzed data from the Japan Neurotrauma Data Bank. Adults with isolated traumatic brain injury (head abbreviated injury scale > 2; abbreviated injury scale of any other trauma < 3) who were registered in the Japan Neurotrauma Data Bank were included in this study. The primary outcome was the association of coagulation phenotypes with in-hospital mortality. Coagulation phenotypes were derived using k-means clustering with coagulation markers, including prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (FBG), and D-dimer (DD) on arrival at the hospital. Multivariable logistic regression analyses were conducted to calculate the adjusted odds ratios of coagulation phenotypes with their 95% confidence intervals (CIs) for in-hospital mortality. RESULTS In total, 556 patients were enrolled and five coagulation phenotypes were identified. The median (interquartile range) score for the Glasgow Coma Scale was 6 (4-9). Cluster A (n = 129) had the closest to normal coagulation values; cluster B (n = 323) had a mild high DD phenotype; cluster C (n = 30) had a prolonged PT-INR phenotype with a higher frequency of antithrombotic medication in elderly patients than in younger patients; cluster D (n = 45) had a low amount of FBG, high DD, and prolonged APTT phenotype with a high incidence of skull fracture; and cluster E (n = 29) had a low amount of FBG and extremely high DD phenotype with high energy trauma and a high incidence of skull fracture. In the multivariable logistic regression analysis, the association of clusters B, C, D, and E with in-hospital mortality yielded the corresponding adjusted odds ratios of 2.17 (95% CI 1.22-3.86), 2.61 (95% CI 1.01-6.72), 10.0 (95% CI 4.00-25.2), and 24.1 (95% CI 7.12-81.3), respectively, relative to cluster A. CONCLUSIONS This multicenter, observational study identified five different coagulation phenotypes of traumatic brain injury and showed associations of these phenotypes with in-hospital mortality.
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Affiliation(s)
- Gaku Fujiwara
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc, 2-4-1, Ohashi, Ritto, Shiga, Japan.
| | - Yohei Okada
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan
| | - Naoto Shiomi
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Ritto, Shiga, Japan
| | | | - Tarumi Yamaki
- Department of Neurosurgery, Kyoto Kujo Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Suehiro E, Tanaka T, Kawashima M, Matsuno A. Challenges in the Treatment of Severe Traumatic Brain Injury Based on Data in the Japan Neurotrauma Data Bank. Neurol Med Chir (Tokyo) 2023; 63:43-47. [PMID: 36436980 PMCID: PMC9995150 DOI: 10.2176/jns-nmc.2022-0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Japan Neurotrauma Data Bank is a source of epidemiological data for patients with severe traumatic brain injury (TBI) and is sponsored by the Japan Society of Neurotraumatology. In this report, we examined the changes in the treatment of severe TBI in Japan based on data of the Japan Neurotrauma Data Bank. Controlling and decreasing intracranial pressure (ICP) are the primary objective of severe TBI treatment. Brain-oriented whole-body control or neurocritical care, including control of cerebral perfusion pressure, respiration, and infusion, are also increasingly considered important because cerebral tissues require oxygenation to improve the outcomes of patients with severe TBI. The introduction of neurocritical care in Japan was delayed compared with that in Western countries. However, the rate of ICP monitoring increased from 28.0% in 2009 to 36.7% in 2015 and is currently likely to be higher. Neurocritical care has also become more common, but the functional prognosis of patients has not significantly improved in Japan. Changes in the background of patients with severe TBI suggest the need for improvement of acute-phase treatment for elderly patients. Appropriate social rehabilitation from the subacute to chronic phases and introduction of cellular therapeutics are also needed for patients with TBI.
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Affiliation(s)
- Eiichi Suehiro
- Department of Neurosurgery, School of Medicine, International University of Health and Welfare
| | - Tatsuya Tanaka
- Department of Neurosurgery, School of Medicine, International University of Health and Welfare
| | - Masatou Kawashima
- Department of Neurosurgery, School of Medicine, International University of Health and Welfare
| | - Akira Matsuno
- Department of Neurosurgery, School of Medicine, International University of Health and Welfare
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Suehiro E, Tanaka T, Michiwaki Y, Wakamiya T, Shimoji K, Onoda K, Yamane F, Kawashima M, Matsuno A. Fact-Finding Survey of Treatment of Traumatic Brain Injury in Japan: Standardization of Care and Collaboration Between Neurosurgery and Emergency Departments. World Neurosurg 2023; 169:e279-e284. [PMID: 36336271 DOI: 10.1016/j.wneu.2022.11.004] [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: 07/11/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Standardization of seamless treatment from prehospital injury care to initial injury and specialized care through collaboration among departments have been promoted in Japan since 2000. This survey was conducted to examine the current status of the system for treatment of traumatic brain injury (TBI) in Japan. METHODS In February 2022, questionnaires on the treatment system and TBI care were sent to 869 facilities that participated in a training program held by the Japan Neurosurgical Society. Responses were received from 480 facilities (55.2%). These responses were compared with those in a similar survey performed in 2008. RESULTS Among the responding facilities, 39.4% had neurosurgeons in emergency departments. Initial care for TBI was the responsibility of the neurosurgery department in 42.3% of the facilities, the emergency department in 26.0%, and jointly between these departments in 29.6%; and neurocritical care was managed by the neurosurgery department in 81.9%, the emergency department in 5.2%, and jointly in 12.1%. For patients with acute-phase TBI, intracranial pressure monitoring was performed in 72.1%. Active normothermia was performed in 86.0%, and decompressive craniectomy in 99.4%, as required. There was compliance with guidelines for treatment and management of TBI in 93.3%. CONCLUSIONS Comparison with the 2008 results suggested role-sharing between 2 departments in TBI treatment is increasing. TBI treatment compliance with the guidelines was high. In-hospital mortality of Japanese patients with TBI has decreased since 2000. This may be due to the progress with standardization of TBI treatment and collaboration among departments in compliance with guidelines.
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Affiliation(s)
- Eiichi Suehiro
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan.
| | - Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
| | - Yuhei Michiwaki
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
| | - Tomihiro Wakamiya
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
| | - Keisuke Onoda
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
| | - Fumitake Yamane
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
| | - Masatou Kawashima
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
| | - Akira Matsuno
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
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Iihara K, Saito N, Suzuki M, Date I, Fujii Y, Houkin K, Inoue T, Iwama T, Kawamata T, Kim P, Kinouchi H, Kishima H, Kohmura E, Kurisu K, Maruyama K, Matsumaru Y, Mikuni N, Miyamoto S, Morita A, Nakase H, Narita Y, Nishikawa R, Nozaki K, Ogasawara K, Ohata K, Sakai N, Sakamoto H, Shiokawa Y, Takahashi JC, Ueki K, Wakabayashi T, Yoshimoto K, Arai H, Tominaga T. The Japan Neurosurgical Database: Statistics Update 2018 and 2019. Neurol Med Chir (Tokyo) 2021; 61:675-710. [PMID: 34732592 PMCID: PMC8666296 DOI: 10.2176/nmc.st.2021-0254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Each year, the Japan Neurosurgical Society (JNS) reports up-to-date statistics from the Japan Neurosurgical Database regarding case volume, patient demographics, and in-hospital outcomes of the overall cohort and neurosurgical subgroup according to the major classifications of main diagnosis. We hereby report patient demographics, in-hospital mortality, length of hospital stay, purpose of admission, number of medical management, direct surgery, endovascular treatment, and radiosurgery of the patients based on the major classifications and/or main diagnosis registered in 2018 and 2019 in the overall cohort (523283 and 571143 patients, respectively) and neurosurgical subgroup (177184 and 191595 patients, respectively). The patient demographics, disease severity, proportion of purpose of admission (e.g., operation, 33.9-33.5%) and emergent admission (68.4-67.8%), and in-hospital mortality (e.g., cerebrovascular diseases, 6.3-6.5%; brain tumor, 3.1-3%; and neurotrauma, 4.3%) in the overall cohort were comparable between 2018 and 2019. In total, 207783 and 225217 neurosurgical procedures were performed in the neurosurgical subgroup in 2018 and 2019, respectively, of which endovascular treatment comprised 19.1% and 20.3%, respectively. Neurosurgical management of chronic subdural hematoma (19.4-18.9%) and cerebral aneurysm (15.4-14.8%) was most common. Notably, the proportion of management of ischemic stroke/transient ischemic attack, including recombinant tissue plasminogen activator infusion and endovascular acute reperfusion therapy, increased from 7.5% in 2018 to 8.8% in 2019. The JNS statistical update represents a critical resource for the lay public, policy makers, media professionals, neurosurgeons, healthcare administrators, researchers, health advocates, and others seeking the best available data on neurosurgical practice.
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Affiliation(s)
- Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | | | - Michiyasu Suzuki
- Department of Advanced ThermoNeuroBiology, Yamaguchi University Graduate School of Medicine
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University School of Medicine
| | - Toru Iwama
- Department of Neurosurgery, Gifu University School of Medicine
| | | | - Phyo Kim
- Department of Neurologic Surgery, Utsunomiya Neurospine Center
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, University of Yamanashi Interdisciplinary Graduate School of Medicine
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Eiji Kohmura
- Kinki Central Hospital of the Mutual Aid Association of Public School Teachers
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University, School of Medicine
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | | | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
| | | | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | | | | | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Hiroaki Sakamoto
- Department of Pediatric Neurosurgery, Osaka City General Hospital
| | | | - Jun C Takahashi
- Department of Neurosurgery, Kindai University Faculty of Medicine
| | - Keisuke Ueki
- Department of Neurologic Surgery, Dokkyo Medical University
| | | | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
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The Association Between D-dimer Levels and Long-Term Neurological Outcomes of Patients with Traumatic Brain Injury: An Analysis of a Nationwide Observational Neurotrauma Database in Japan. Neurocrit Care 2021; 36:483-491. [PMID: 34462882 DOI: 10.1007/s12028-021-01329-7] [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: 03/11/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluated the association between D-dimer (DD) levels and long-term neurological prognoses among patients with isolated traumatic brain injury. METHODS Using data from multiple centers in the Japanese Neurotrauma Data Bank, we conducted an observational retrospective cohort study. Patients with isolated traumatic brain injury (head Abbreviated Injury Scale score > 2; any other Abbreviated Injury Scale score < 3) who were registered in the Japanese Neurotrauma Data Bank from 2015 to 2017 were recruited. We excluded patients younger than age 16 years and those who developed cardiac arrest at hospital admission. We also excluded patients with unknown Glasgow Outcome Scale (GOS) scores at 6 months after injury and those with unknown DD levels. The primary outcome was the association of DD levels with GOS scores at 6 months. We defined GOS scores 1 to 3 as poor and GOS scores 4 and 5 as good. The secondary outcome was the association of DD levels with mortality at 6 months after injury. We conducted multivariate logistic regression analyses to calculate the adjusted odds ratios of DD levels at hospital admission and GOS scores at 6 months as tertiles with 95% confidence intervals (CIs). A total of 293 patients were enrolled (median age 67 years; interquartile range 51-79 years). The median DD level was 27.1 mg/L (interquartile range 9.7-70.8 mg/L), and 58.0% (n = 170) had poor GOS scores at 6 months. RESULTS The multivariable logistic regression analysis indicated that the adjusted odds ratios were 2.52 (95% CI 1.10-5.77) for middle DD levels with poor GOS scores at 6 months and 5.81 (95% CI 2.37-14.2) for high DD levels with poor GOS scores at 6 months. CONCLUSIONS We revealed an association between DD levels and poor long-term neurological outcomes among patients with isolated traumatic brain injury.
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Hospital-level intracranial pressure monitoring utilization and functional outcome in severe traumatic brain injury: a post hoc analysis of prospective multicenter observational study. Scand J Trauma Resusc Emerg Med 2021; 29:5. [PMID: 33407751 PMCID: PMC7789401 DOI: 10.1186/s13049-020-00825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Several observational studies have shown that hospital-level intracranial pressure (ICP) monitoring utilization varies considerably in patients with severe traumatic brain injury (TBI). However, the relationship between hospital-level ICP monitoring utilization and clinical functional outcomes is unknown. This study examined whether patients with severe TBI treated at hospitals with high ICP monitoring utilization have better functional outcomes. Methods A post hoc analysis of the data from a prospective multicenter cohort study in Japan was undertaken, and included severe TBI patients (Glasgow Come Scale score ≤ 8). The primary exposure was hospital-level ICP monitoring utilization. Patients treated at hospitals with more than 80% ICP monitoring utilization were assigned to a high group and the others to a low group. The primary endpoint was a favorable functional outcome at 6 months after injury, defined as a Glasgow Outcome Scale score of good recovery or moderate disability. We conducted multiple logistic regression analyses adjusted for potential confounders. Results Of the 427 included patients, 60 were assigned to the high group and 367 to the low group. Multiple logistic regression analysis revealed that patients in the high group had significantly better functional outcome (adjusted odds ratio [OR]: 2.36; 95% confidence interval [CI]: 1.17–4.76; p = 0.016). Multiple logistic regression analysis adjusted for additional confounders supported this result (adjusted OR: 2.30; 95% CI: 1.07–4.92; p = 0.033). Conclusion Treatment at hospitals with high ICP monitoring utilization for severe TBI patients could be associated with better functional outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-020-00825-7.
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Mouchtouris N, Turpin J, Chalouhi N, Al Saiegh F, Theofanis T, Das S, Shah SO, Jallo J. Statewide Trends in Intracranial Pressure Monitor Use in 36,915 Patients with Severe Traumatic Brain Injury in a Mature Trauma System over the Past 18 Years. World Neurosurg 2019; 130:e166-e171. [PMID: 31203067 DOI: 10.1016/j.wneu.2019.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Intracranial pressure (ICP)-guided therapy has been the mainstay of treatment of patients with severe traumatic brain injury (TBI), but recent data have questioned its efficacy. The aim of this study was to demonstrate trends in compliance to TBI guidelines and use of ICP-guided care in a mature trauma system. METHODS A retrospective analysis was conducted of 36,915 patients with severe TBI collected by the Pennsylvania Trauma Systems Foundation. The registry includes all patients >18 years old with a diagnosis of TBI with a Glasgow Coma Scale score ≤8 who were admitted from January 2000 to December 2017. RESULTS Of 36,915 patients, 73.6% were men with a median age of 43.0 ± 21.3 years. An ICP monitor was placed in 16.3% of all patients. The rate of ICP monitoring ranged from 17.8% of patients in 2000-2004 to 16.7% in 2005-2009, 16.4% in 2010-2014, and 12.8% in 2015-2017 (P < 0.001). The most statistically significant decrease was noted from 2014 (16.4%) to 2015 (14.1%, P = 0.042). The percent decrease in ICP monitoring from 2000-2014 to 2015-2017 was equivalent for patients with Glasgow Coma Scale scores of 3-5 (-4.0%) and 6-8 (-4.5%). CONCLUSIONS As studies emerged that demonstrated unclear benefit of ICP monitoring in improving care in patients with severe TBI, there was a significant statewide decline in the use of ICP monitoring after 2014 among all TBI subpopulations despite noteworthy limitations in the aforementioned studies and clear recommendations from the Brain Trauma Foundation guidelines.
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Affiliation(s)
- Nikolaos Mouchtouris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Justin Turpin
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Fadi Al Saiegh
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Thana Theofanis
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Somnath Das
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Syed Omar Shah
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
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Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) remains an unfortunately common disease with potentially devastating consequences for patients and their families. However, it is important to remember that it is a spectrum of disease and thus, a one 'treatment fits all' approach is not appropriate to achieve optimal outcomes. This review aims to inform readers about recent updates in prehospital and neurocritical care management of patients with TBI. RECENT FINDINGS Prehospital care teams which include a physician may reduce mortality. The commonly held value of SBP more than 90 in TBI is now being challenged. There is increasing evidence that patients do better if managed in specialized neurocritical care or trauma ICU. Repeating computed tomography brain 12 h after initial scan may be of benefit. Elderly patients with TBI appear not to want an operation if it might leave them cognitively impaired. SUMMARY Prehospital and neuro ICU management of TBI patients can significantly improve patient outcome. However, it is important to also consider whether these patients would actually want to be treated particularly in the elderly population.
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Garg K, Singh P, Singla R, Aggarwal A, Borle A, Singh M, Chandra PS, Kale S, Mahapatra A. Role of Decompressive Craniectomy in Traumatic Brain Injury – A Meta-analysis of Randomized Controlled Trials. Neurol India 2019; 67:1225-1232. [PMID: 31744947 DOI: 10.4103/0028-3886.271260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lele A, Kannan N, Vavilala MS, Sharma D, Mossa-Basha M, Agyem K, Mock C, Pandey RM, Dash HH, Mahapatra A, Gupta D. Patients Who Benefit from Intracranial Pressure Monitoring without Cerebrospinal Fluid Drainage After Severe Traumatic Brain Injury. Neurosurgery 2018; 85:231-239. [DOI: 10.1093/neuros/nyy247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 07/11/2018] [Indexed: 12/11/2022] Open
Abstract
AbstractBACKGROUNDIndia has a high traumatic brain injury (TBI) burden and intracranial pressure monitoring (ICP) remains controversial but some patients may benefit.OBJECTIVETo examine the association between ICP monitor placement and outcomes, and identify Indian patients with severe TBI who benefit from ICP monitoringMETHODSWe conducted a secondary analysis of a prospective cohort study at a level 1 Indian trauma center. Patients over 18 yr with severe TBI (admission Glasgow coma scale score < 8) who received tracheal intubation for at-least 48 h were examined. Propensity-based analysis using inverse probability weighting approach was used to examine ICP monitor placement within 72 h of admission and outcomes. Outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) score at discharge, 3, 6, and 12 mo. Death, vegetative, or major impairment defined unfavorable outcome.RESULTSThe 200 patients averaged 36 [18 to 85] yr of age and average injury severity score of 31.4 [2 to 73]. ICP monitors were placed in 126 (63%) patients. Patients with ICP monitor placement experienced lower in-hospital mortality (adjusted relative risk [aRR]; 0.50 [0.29, 0.87]) than patients without ICP monitoring. However, there was no benefit at 3, 6, and 12 mo. With ICP monitor placement, absence of cerebral edema (aRR 0.54, 95% confidence interval 0.35-0.84), and absence of intraventricular hemorrhage (aRR 0.52, 95% confidence interval 0.33-0.82) were associated with reduced unfavorable outcomes.CONCLUSIONICP monitor placement without cerebrospinal fluid drainage within 72 h of admission was associated with reduced in-patient mortality. Patients with severe TBI but without cerebral edema and without intraventricular hemorrhage may benefit from ICP monitoring.
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Affiliation(s)
- Abhijit Lele
- Departments of Anesthesiology & Pain Medicine, University of Washington, Sea-ttle, Washington
- Harborview Injury Prevention and Research Center, Seatt-le, Washington
| | - Nithya Kannan
- Harborview Injury Prevention and Research Center, Seatt-le, Washington
| | - Monica S Vavilala
- Departments of Anesthesiology & Pain Medicine, University of Washington, Sea-ttle, Washington
- Harborview Injury Prevention and Research Center, Seatt-le, Washington
| | - Deepak Sharma
- Departments of Anesthesiology & Pain Medicine, University of Washington, Sea-ttle, Washington
| | | | - Kwesi Agyem
- Department of Radio-logy, University of Washington, Seattle, Washington
| | - Charles Mock
- Departments of Surgery and Epidemiology, University of Washing-ton, Seattle, Washington
| | - R M Pandey
- Department of Epidemiology, All India Institute of Medical Sciences, New Delhi, India
| | - H H Dash
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Center, New Delhi, India
| | - Ashok Mahapatra
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Center, New Delhi, India
| | - Deepak Gupta
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Center, New Delhi, India
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Wu X, He L, Shi F, Dong F, Zeng Q. Number of Fractured Calvarial Bones Predicts Outcome in Traumatic Brain Injury Patients After Early Craniotomy. World Neurosurg 2018; 115:e688-e694. [PMID: 29709739 DOI: 10.1016/j.wneu.2018.04.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prognostic markers are important for neurosurgeons to evaluate the indications for aggressive surgical management. The purpose of this study was to investigate whether the number of fractured calvarial bones could predict the outcome in patients with traumatic brain injury (TBI) after early craniotomy. METHODS TBI patients who underwent early craniotomy were reviewed. The number of fractured calvarial bones was recorded by referring to preoperative computed tomographic (CT) images. Accordingly, patients were assigned to no calvarial fracture group, single calvarial fracture group, and multiple calvarial fractures group. Good outcome was defined as Glasgow Outcome Scale scores of 4 and 5 at discharge. Logistic regression analyses were used to assess the effect of calvarial fracture on outcome. A receiver operating characteristic curve was generated for the final model. RESULTS In all, a total of 141 patients were enrolled. Patients with no calvarial fracture had a significantly lower rate of good outcome (12.5%) than did those with a single calvarial fracture (62.2%, P < 0.001) and those with multiple calvarial fractures (48.6%, P = 0.005). Binary logistic regression showed that the number of fractured calvarial bones was an independent imaging marker for predicting outcome (P = 0.003) after adjustment for age, Glasgow Coma Scale score on admission, and decompressive craniectomy. The area under the curve of the final model was 0.863. CONCLUSIONS The number of fractured calvarial bones is an independent predictor of outcome in TBI patients after early craniotomy. No calvarial facture is associated with poor outcome in these patients.
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Affiliation(s)
- Xiaohua Wu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingzhe He
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feina Shi
- Department of Neurology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fei Dong
- Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qiang Zeng
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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