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Merakis MP, Weaver N, Fischer A, Balogh ZJ. Time to traumatic intracranial hematoma evacuation: contemporary standard and room for improvement. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02573-0. [PMID: 38888792 DOI: 10.1007/s00068-024-02573-0] [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: 09/03/2023] [Accepted: 06/01/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Traumatic intracranial hematoma (TICH) is a neurosurgical emergency with high mortality and morbidity. The time to operative decompression is a modifiable but inconsistently reported risk factor for TICH patients? OUTCOMES We aimed to provide contemporary time to evacuation data and long-term trends in timing of TICH evacuation in a trauma system. METHODS A 13-year retrospective cohort study ending in 2021 at a trauma system with one level-1 trauma center included all patients undergoing urgent craniotomy or craniectomy for evacuation of TICH. Demographics, injury severity and key timeframes of care were collected. Subgroups analyzed were polytrauma versus isolated head injury, direct admissions versus transfers and those who survived versus those who died. Linear regression of times from injury to operating room was performed. RESULTS Seventy-eight TICH patients (Age: 35 (22-56); 58 (74%) males; ISS: 25(25-41); AIS head: 5 (4-5); mortality: 21 (27%) patients) were identified. Initial GCS was 8 (3.25-14) which decreased to 3 (3-7) by arrival in the trauma center. There were 46 (59%) patients intubated prior to arrival. Median time from injury to operation was 4.88 (3.63-6.80) hours. Linear regression of injury to OR showed increasing times to operative intervention for direct admissions to the trauma center over the study period (p=0.04). There was no associated change in mortality or Glasgow outcome score over the same time. CONCLUSION This contemporary data shows timing from injury to evacuation is approaching 5 hours. Over the 13-year study period the time to operative intervention significantly increased for direct admissions. This study will guide our institutions response to TICH presentations in the future. Other trauma systems should critically appraise their results with the same reporting standard.
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Affiliation(s)
- Michael P Merakis
- John Hunter Hospital & University of Newcastle, Newcastle, NSW, Australia
| | - Natasha Weaver
- John Hunter Hospital & University of Newcastle, Newcastle, NSW, Australia
| | - Angela Fischer
- John Hunter Hospital & University of Newcastle, Newcastle, NSW, Australia
| | - Zsolt J Balogh
- John Hunter Hospital & University of Newcastle, Newcastle, NSW, Australia.
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Roldan M, Abay TY, Uff C, Kyriacou PA. A pilot clinical study to estimate intracranial pressure utilising cerebral photoplethysmograms in traumatic brain injury patients. Acta Neurochir (Wien) 2024; 166:109. [PMID: 38409283 PMCID: PMC10896864 DOI: 10.1007/s00701-024-06002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/03/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE In this research, a non-invasive intracranial pressure (nICP) optical sensor was developed and evaluated in a clinical pilot study. The technology relied on infrared light to probe brain tissue, using photodetectors to capture backscattered light modulated by vascular pulsations within the brain's vascular tissue. The underlying hypothesis was that changes in extramural arterial pressure could affect the morphology of recorded optical signals (photoplethysmograms, or PPGs), and analysing these signals with a custom algorithm could enable the non-invasive calculation of intracranial pressure (nICP). METHODS This pilot study was the first to evaluate the nICP probe alongside invasive ICP monitoring as a gold standard. nICP monitoring occurred in 40 patients undergoing invasive ICP monitoring, with data randomly split for machine learning. Quality PPG signals were extracted and analysed for time-based features. The study employed Bland-Altman analysis and ROC curve calculations to assess nICP accuracy compared to invasive ICP data. RESULTS Successful acquisition of cerebral PPG signals from traumatic brain injury (TBI) patients allowed for the development of a bagging tree model to estimate nICP non-invasively. The nICP estimation exhibited 95% limits of agreement of 3.8 mmHg with minimal bias and a correlation of 0.8254 with invasive ICP monitoring. ROC curve analysis showed strong diagnostic capability with 80% sensitivity and 89% specificity. CONCLUSION The clinical evaluation of this innovative optical nICP sensor revealed its ability to estimate ICP non-invasively with acceptable and clinically useful accuracy. This breakthrough opens the door to further technological refinement and larger-scale clinical studies in the future. TRIAL REGISTRATION NCT05632302, 11th November 2022, retrospectively registered.
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Affiliation(s)
- Maria Roldan
- Research Centre for Biomedical Engineering, School of Science & Technology, University of London, London, EC1V 0HB, UK.
| | - Tomas Ysehak Abay
- Research Centre for Biomedical Engineering, School of Science & Technology, University of London, London, EC1V 0HB, UK
| | - Christopher Uff
- Barts Health NHS Trust: Royal London Hospital, E1 1BB, London, UK
| | - Panayiotis A Kyriacou
- Research Centre for Biomedical Engineering, School of Science & Technology, University of London, London, EC1V 0HB, UK
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Courville EN, Owodunni OP, Courville JT, Kazim SF, Kassicieh AJ, Hynes AM, Schmidt MH, Bowers CA. Frailty Is Associated With Decreased Survival in Adult Patients With Nonoperative and Operative Traumatic Subdural Hemorrhage: A Retrospective Cohort Study of 381,754 Patients. ANNALS OF SURGERY OPEN 2023; 4:e348. [PMID: 38144491 PMCID: PMC10735122 DOI: 10.1097/as9.0000000000000348] [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: 03/16/2023] [Accepted: 09/06/2023] [Indexed: 12/26/2023] Open
Abstract
Objective We investigated frailty's impact on traumatic subdural hematoma (tSDH), examining its relationship with major complications, length of hospital stay (LOS), mortality, high level of care discharges, and survival probabilities following nonoperative and operative management. Background Despite its frequency as a neurosurgical emergency, frailty's impact on tSDH remains underexplored. Frailty characterized by multisystem impairments significantly predicts poor outcomes, necessitating further investigation. Methods A retrospective study examining tSDH patients ≥18 years and assigned an abbreviated injury scale score ≥3, and entered into ACS-TQIP between 2007 and 2020. We employed multivariable analyses for risk-adjusted associations of frailty and our outcomes, and Kaplan-Meier plots for survival probability. Results Overall, 381,754 tSDH patients were identified by mFI-5 as robust-39.8%, normal-32.5%, frail-20.5%, and very frail-7.2%. There were 340,096 nonoperative and 41,658 operative patients. The median age was 70.0 (54.0-81.0) nonoperative, and 71.0 (57.0-80.0) operative cohorts. Cohorts were predominately male and White. Multivariable analyses showed a stepwise relationship with all outcomes P < 0.001; 7.1% nonoperative and 14.9% operative patients had an 20% to 46% increased risk of mortality, that is, nonoperative: very frail (HR: 1.20 [95% CI: 1.13-1.26]), and operative: very frail (HR: 1.46 [95% CI: 1.38-1.55]). There were precipitous reductions in survival probability across mFI-5 strata. Conclusion Frailty was associated with major complications, LOS, mortality, and high level care discharges in a nationwide population of 381,754 patients. While timely surgery may be required for patients with tSDH, rapid deployment of point-of-care risk assessment for frailty creates an opportunity to equip physicians in allocating resources more precisely, possibly leading to better outcomes.
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Affiliation(s)
- Evan N. Courville
- From the Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM
| | - Oluwafemi P. Owodunni
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM
- Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM
| | - Jordyn T. Courville
- Louisiana State University Health and Sciences Center School of Medicine, Shreveport, Louisiana, US; University of New Mexico School of Medicine, Albuquerque, NM
| | - Syed F. Kazim
- From the Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM
| | - Alexander J. Kassicieh
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM
- Louisiana State University Health and Sciences Center School of Medicine, Shreveport, Louisiana, US; University of New Mexico School of Medicine, Albuquerque, NM
| | - Allyson M. Hynes
- Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM
- Division of Critical Care, Department of Surgery, University of New Mexico Hospital, Albuquerque, NM
| | - Meic H. Schmidt
- From the Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM
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Duvvi A, Ganji M, Habal Y, Bekele H, Kim C, Yates E, Seligson S, McWhir G, Kalantari H, Singh J, Hassen GW. Emergency department burr hole simulation using 3D-printed model. Am J Emerg Med 2023; 71:104-108. [PMID: 37356338 DOI: 10.1016/j.ajem.2023.06.032] [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: 05/06/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Traumatic epidural hematoma (EDH) with the potential to displace the brain tissue and increase intracranial pressure (ICP), is a life-threatening condition that requires emergent intervention. In rare circumstances, Emergency Physician (EP) may have to do skull trephination to reduce the ICP as a temporary measure. SPECIFIC AIMS To evaluate emergency medicine (EM) residents' comfort in performing emergency department (ED) burr holes and to assess their difficulties and evaluate comfort level before and after simulated EDH cases. MATERIALS AND METHODS A 3D-printed skull and electrical and manual drills were used for the simulation. Subjective comfort level pre and post-procedure, as well as objective procedural skills and time to complete the drill, were recorded. RESULTS Twenty EM residents participated in the simulation study. The median time to perforate through the skull was 4 s for the electric drill and 10 s for the manual drill. A comfort level of 5 and above was reported by 12 participants for the manual drill and by 17 participants for the electric drill. Six participants had mild and 2 participants had moderate observed difficulty in handling the manual and electric drill. Most participants performed both procedures successfully with one attempt only. Three participants have an overall comfort level above 5 before the simulation and 13 participants had a post-simulation. CONCLUSION The 3D-printed model assisted the ED burr hole simulation and the residents could perform the procedure with minimum difficulties.
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Affiliation(s)
- Anisha Duvvi
- Albert Einstein School of Medicine, USA; Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Mohammad Ganji
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Yasmine Habal
- Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Hebron Bekele
- Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Ceilim Kim
- Metropolitan Hospital Center, Department of Emergency Medicine, USA; Columbia University, Postbac Premed Program, USA
| | - Evan Yates
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Shterna Seligson
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Greg McWhir
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Hossein Kalantari
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Jaspreet Singh
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Getaw Worku Hassen
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA.
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Akinkugbe O, Saxena R, Ramnarayan P. Comparison of Specialist and Nonspecialist Transport Teams for Emergency Neurosurgery. Pediatr Emerg Care 2023; 39:173-178. [PMID: 36083193 DOI: 10.1097/pec.0000000000002844] [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: 11/26/2022]
Abstract
OBJECTIVES Current guidance in the United Kingdom recommends that children requiring emergency neurosurgical intervention should be transported by referring hospital (RH) teams. We aimed to compare transports performed by RH teams and by specialized pediatric critical care transport (PCCTs) teams in terms of timings and patient outcomes. METHODS We conducted a retrospective analysis over a 5-year period of children admitted from an external hospital to the pediatric intensive care unit at a pediatric neurosurgical center and receiving emergency neurosurgery within 24 hours of admission. Data were collected on RH characteristics, patient demographics, clinical status, transfer method (RH or PCCT team), timings (arrival at neurosurgical center, neurosurgical procedure), and clinical outcomes (length of stay and mortality). Univariate analysis was used to compare patient characteristics, times, and outcomes between RH and PCCT team transfers. Survival analysis was performed to analyze arrival time by transfer modality. RESULTS During the study period, 75 children with acute neurosurgical emergencies were transferred. Median age was 6.7 years (interquartile range, 1.8-10.7), and 63% had nontraumatic diagnoses. The commonest mode of transfer was by RH teams after initial referral to a PCCT team (53.3%). The median distance was greatest for transfers by RH teams (14 km). Overall median arrival time was 5 hours (interquartile range, 3.6-7.4) with no significant difference between groups ( P = 0.3). Median length of pediatric intensive care unit stay and mortality did not differ between groups. CONCLUSIONS Specialist critical care transport teams are involved in one third of transfers of children with acute neurosurgical emergencies. While the overriding priority is timely transfer, a tailored approach to the use of PCCTs may be appropriate particularly for children presenting to hospitals nearer to neurosurgical centers.
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Affiliation(s)
| | - Romit Saxena
- From the Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Holton P, Zolnourian A, Bulters D. Time to evacuation of acute subdural and extradural haematoma: prospective study before and after implementation of a major trauma centre. Br J Neurosurg 2023:1-8. [PMID: 36750795 DOI: 10.1080/02688697.2023.2173723] [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: 07/20/2022] [Accepted: 09/08/2022] [Indexed: 02/09/2023]
Abstract
Purpose: Patients with Extradural (EDH) and Acute Subdural Haematomas (ASDH) represent a subgroup of head-injured patients that gain the most from timely treatment. While treatment times for head injury overall improved since the introduction of Major Trauma Centres (MTCs), no data exists describing how the time to treatment of EDH and ASDH has changed. We, therefore, compared the evacuation of ASDH and EDH before and after the implementation of a major trauma network.Methods: Data was collected prospectively between 1 May 2006 to 31 May 2007 and 1 March 2014 to 31 March 2016. The study was carried out at University Hospital Southampton, designated MTC in 2012. Patients over 18 with ASDH or EDH requiring emergency surgery were included.Results: The median time (IQR) for decompression was 4.8h (3.9-6.6) in 2006-7 and 4.4h (3.4-5.9) in 2014-16, p = 0.386. The proportion treated within 4 hours was 32% in 2006-7, and 33% in 2014-16 (p = 1.000). Analysis showed a decrease in time for CT scan (p = 0.01) and acceptance by neurosurgery (p < 0.001). There were increases in time for transferring to hospital (p = 0.005), awaiting operating theatre (p = 0.005), and operative time (p = 0.018).Conclusions: Since the introduction of MTCs, there has been no significant reduction in time to treat this select group of patients despite reductions in time to treatment of most other trauma and head-injured patients. This may be because parts of the pathway have improved, but others haven't. It is also possible that while previously head injury was poorly served, resources were prioritised to this group so finding further gains is difficult.
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Affiliation(s)
- Patrick Holton
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ardalan Zolnourian
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Diederik Bulters
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Faried A, Hidajat NN, Harsono AB, Giwangkancana GW, Hartantri Y, Imron A, Arifin MZ. Delayed definitive treatment of life-threatening neurosurgery patient with suspected coronavirus disease 2019 infection in the midst of pandemic: Report of two cases. Surg Neurol Int 2021; 12:18. [PMID: 33500833 PMCID: PMC7827364 DOI: 10.25259/sni_828_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic has affected global health system; in the context of the COVID-19 pandemic, both surgeon and anesthesiologist often dealt with emergency situation, optimal timing of surgery and safety protocol in hospital setting must be implemented with many facets for both patients and health-care providers. CASE DESCRIPTION We reported two cases. Case#1 - A 16-year-old male was referred to our hospital, due to a decreased of consciousness following a motor vehicle accident. Head CT scan revealed an epidural hemorrhage on the left temporoparietal. The patient was suspected for having COVID-19 from the reactivity of his serum against SARS-CoV-2 antigen. Procedures for the confirmation of COVID-19 and surgical preparation caused 12 h delayed from the admission. Nevertheless, the patient was deteriorated clinically before he was transported to the operating room and died after 6 cycles of cardiopulmonary resuscitation. Case#2 - A 25-year-old male was referred to RSHS, due to a decreased of consciousness, diagnosed as bilateral proximal shunt exposed with suspected COVID-19; delay occurred due to unavailability of negative pressure intensive unit for postoperative care. This caused 5760 h (4 days) delayed for bilateral shunt removal and temporary extraventricular drainage. CONCLUSION Optimal timing of surgery, a good safety, and health protocol during pandemic in emergency setting are an obligation to protect health providers and patients. A decision-making plan must be organized precisely to maintain alertness, achieve the highest possible standard of care, and outcome in emergency surgical cases. Lack of monitoring must be abated to avoid fatality for patient, especially in emergency surgery setting.
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Affiliation(s)
- Ahmad Faried
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
- Stem Cell Unit, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Nucki Nursjamsi Hidajat
- Stem Cell Unit, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
- Department of Orthopaedics and Traumatology, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Ali Budi Harsono
- Stem Cell Unit, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Gezy Weita Giwangkancana
- Department of Anesthesiology and Intensive Care Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Yovita Hartantri
- Department of Internal Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Akhmad Imron
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Muhammad Zafrullah Arifin
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
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Barro B, Kobner S, Ansari A. Decompression of Subdural Hematomas Using an Intraosseous Needle in the Emergency Department: A Case Series. Clin Pract Cases Emerg Med 2020; 4:312-315. [PMID: 32926674 PMCID: PMC7434269 DOI: 10.5811/cpcem.2020.6.46069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Traumatic subdural hematomas beget significant morbidity and mortality if not rapidly decompressed. This presents a unique challenge to the emergency physician without immediate neurosurgical support. Case Report We report two cases of patients in Los Angeles County with traumatic subdural hematomas and clinical deterioration in the emergency department (ED) who were treated with decompression using an intraosseous needle drill. Discussion We believe these cases represent the first use of this technique to temporize a subdural hematoma in the ED.
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Affiliation(s)
- Brett Barro
- LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Scott Kobner
- LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Ashkon Ansari
- Keck School of Medicine of USC, Department of Emergency Medicine, Los Angeles, California; Antelope Valley Hospital, Department of Emergency Medicine, Lancaster, California
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Maine RG, Kajombo C, Purcell L, Gallaher JR, Reid TD, Charles AG. Effect of in-hospital delays on surgical mortality for emergency general surgery conditions at a tertiary hospital in Malawi. BJS Open 2019; 3:367-375. [PMID: 31183453 PMCID: PMC6551403 DOI: 10.1002/bjs5.50152] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
Background In sub‐Saharan Africa, surgical access is limited by an inadequate surgical workforce, lack of infrastructure and decreased care‐seeking by patients. Delays in treatment can result from delayed presentation (pre‐hospital), delays in transfer (intrafacility) or after arrival at the treating centre (in‐hospital delay; IHD). This study evaluated the effect of IHD on mortality among patients undergoing emergency general surgery and identified factors associated with IHD. Methods Utilizing Malawi's Kamuzu Central Hospital Emergency General Surgery database, data were collected prospectively from September 2013 to November 2017. Included patients had a diagnosis considered to warrant urgent or emergency intervention for surgery. Bivariable analysis and Poisson regression modelling was done to determine the effect of IHD (more than 24 h) on mortality, and identify factors associated with IHD. Results Of 764 included patients, 281 (36·8 per cent) had IHDs. After adjustment, IHD (relative risk (RR) 1·68, 95 per cent c.i. 1·01 to 2·78; P = 0·045), generalized peritonitis (RR 4·49, 1·69 to 11·95; P = 0·005) and gastrointestinal perforation (RR 3·73, 1·25 to 11·08; P = 0·018) were associated with a higher risk of mortality. Female sex (RR 1·33, 1·08 to 1·64; P = 0·007), obtaining any laboratory results (RR 1·58, 1·29 to 1·94; P < 0·001) and night‐time admission (RR 1·59, 1·32 to 1·90; P < 0·001) were associated with an increased risk of IHD after adjustment. Conclusion IHDs were associated with increased mortality. Increased staffing levels and operating room availability at tertiary hospitals, especially at night, are needed.
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Affiliation(s)
- R. G. Maine
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - C. Kajombo
- Department of SurgeryKamuzu Central HospitalLilongweMalawi
| | - L. Purcell
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - J. R. Gallaher
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - T. D. Reid
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - A. G. Charles
- Department of SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Durnford S, Bulstrode H, Durnford A, Chakraborty A, Tarmey NT. Temporising an extradural haematoma by intraosseous needle craniostomy in the District General Hospital by non-neurosurgical doctors - A case report. J Intensive Care Soc 2018; 19:76-79. [PMID: 29456607 PMCID: PMC5810882 DOI: 10.1177/1751143717734997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 69-year-old man admitted to the emergency department of a UK district general hospital with an extradural haematoma following closed head injury. He deteriorated rapidly before transfer to the regional neurosurgical centre and was treated with decompression of the extradural haematoma through an EZ-IO™ intraosseous needle in our department, with telephone guidance from the neurosurgeon. We believe this to be the first reported use of this technique in a district general hospital.
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Affiliation(s)
- Sahra Durnford
- Department of Critical Care, Queen Alexandra Hospital, Portsmouth, UK
| | - Harry Bulstrode
- Wessex Neurosurgical Centre, University Hospital Southampton, UK
| | - Andrew Durnford
- Wessex Neurosurgical Centre, University Hospital Southampton, UK
| | | | - Nicholas T Tarmey
- Department of Critical Care, Queen Alexandra Hospital, Portsmouth, UK
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Candefjord S, Winges J, Malik AA, Yu Y, Rylander T, McKelvey T, Fhager A, Elam M, Persson M. Microwave technology for detecting traumatic intracranial bleedings: tests on phantom of subdural hematoma and numerical simulations. Med Biol Eng Comput 2017; 55:1177-1188. [PMID: 27738858 PMCID: PMC5544814 DOI: 10.1007/s11517-016-1578-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 09/21/2016] [Indexed: 11/28/2022]
Abstract
Traumatic brain injury is the leading cause of death and severe disability for young people and a major public health problem for elderly. Many patients with intracranial bleeding are treated too late, because they initially show no symptoms of severe injury and are not transported to a trauma center. There is a need for a method to detect intracranial bleedings in the prehospital setting. In this study, we investigate whether broadband microwave technology (MWT) in conjunction with a diagnostic algorithm can detect subdural hematoma (SDH). A human cranium phantom and numerical simulations of SDH are used. Four phantoms with SDH 0, 40, 70 and 110 mL are measured with a MWT instrument. The simulated dataset consists of 1500 observations. Classification accuracy is assessed using fivefold cross-validation, and a validation dataset never used for training. The total accuracy is 100 and 82-96 % for phantom measurements and simulated data, respectively. Sensitivity and specificity for bleeding detection were 100 and 96 %, respectively, for the simulated data. SDH of different sizes is differentiated. The classifier requires training dataset size in order of 150 observations per class to achieve high accuracy. We conclude that the results indicate that MWT can detect and estimate the size of SDH. This is promising for developing MWT to be used for prehospital diagnosis of intracranial bleedings.
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Affiliation(s)
- Stefan Candefjord
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden.
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden.
- SAFER Vehicle and Traffic Safety Centre at Chalmers, Gothenburg, Sweden.
| | - Johan Winges
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
| | - Ahzaz Ahmad Malik
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
| | - Yinan Yu
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
| | - Thomas Rylander
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
| | - Tomas McKelvey
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
| | - Andreas Fhager
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
| | - Mikael Elam
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
- Clinical Neurophysiology, Sahlgrenska University Hospital, Blå Stråket 5, 413 45, Gothenburg, Sweden
| | - Mikael Persson
- Department of Signals and Systems, Chalmers University of Technology, 412 96, Gothenburg, Sweden
- MedTech West, Sahlgrenska University Hospital, Röda Stråket 10 B, 413 45, Gothenburg, Sweden
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Shibahashi K, Sugiyama K, Kashiura M, Okura Y, Hoda H, Hamabe Y. Emergency Trepanation as an Initial Treatment for Acute Subdural Hemorrhage: A Multicenter Retrospective Cohort Study. World Neurosurg 2017; 106:185-192. [PMID: 28669875 DOI: 10.1016/j.wneu.2017.06.134] [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: 04/20/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rapid decompression with trepanation and drainage in an emergency room has been proposed as a potentially effective initial intervention for early-stage acute subdural hemorrhage; however, the actual safety and efficacy of the procedure remain unclear. The aim of this study was to evaluate the feasibility of emergency trepanation as an initial treatment for acute subdural hemorrhage. METHODS We investigated patients with thick subdural hemorrhages who had undergone craniotomy between 2004 and 2015 in Japan using a nationwide trauma registry (the Japan Trauma Data Bank). The endpoint was survival at discharge. We compared patients who underwent trepanation in an emergency room with those who did not undergo trepanation, and adjusted for potential confounders using a multivariate logistic regression model. RESULTS During the study period, 236,698 patients were registered in the Japan Trauma Data Bank. Of the 1391 patients who were eligible for analysis, 305 had undergone trepanation in an emergency room. The survival rate was 37.7% in patients who had undergone emergency trepanation and 59.3% in those who had not. Performing emergency trepanation was significantly associated with decreased survival even after adjusting for possible confounders (adjusted odds ratio, 0.55; 95% confidence interval, 0.40-0.76; P < 0.001). CONCLUSIONS Our results indicate that performing trepanation in an emergency room is associated with a decreased survival rate.
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Affiliation(s)
- Keita Shibahashi
- Department of Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan.
| | - Kazuhiro Sugiyama
- Department of Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Masahiro Kashiura
- Department of Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Yoshihiro Okura
- Department of Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Hidenori Hoda
- Department of Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Yuichi Hamabe
- Department of Emergency and Intensive Care Center, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
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Epidemiologic study in hospitalized patients with head injuries. Eur J Trauma Emerg Surg 2016; 43:467-473. [PMID: 27062402 DOI: 10.1007/s00068-016-0668-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 04/01/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to analyze epidemiologic data of patients with head injuries (HI) who were admitted to the Trauma and Emergency Surgery Department. METHODS The hospital records of 497 patients with HI who were admitted to the Trauma and Emergency Surgery Department from January 1, 2014, through 31 December, 2014, were analyzed retrospectively. RESULTS The male-to-female ratio was 2:1, and the mean age was 16.3 years. The rates of patients with mild, moderate, and severe HI were 93, 3, and 4 %, respectively. The most common cause of trauma was falls. Linear fractures were the most common radiologic diagnoses with 242 cases (49 %). Of the patients admitted to hospital, 22 % presented 4 h after the trauma had occurred. Mortality rate due to HI was 3 % (15 patients). Outcome was associated with admission Glasgow Coma Scale and presence of additional trauma. CONCLUSIONS The number of traffic accidents and assaults were considerably higher in the young adult population compared with the other age groups. Traffic accidents accounted for 46.6 % of the mortality rate. Mortality in HI patients mostly arises from preventable conditions, and the young adult population seems to be the most affected group. HI should be considered as a public health issue, and prevention of HI should be the primary goal.
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Lu T, Guan J, An C. Preoperative trepanation and drainage for acute subdural hematoma: Two case reports. Exp Ther Med 2015; 10:225-230. [PMID: 26170939 DOI: 10.3892/etm.2015.2456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/11/2015] [Indexed: 11/05/2022] Open
Abstract
Craniotomy is frequently used for the treatment of acute subdural hematoma; however, it the procedure exhibits a high mortality rate. Preoperative trepanation and drainage in an emergency ward may reduce intracranial pressure, shorten operation time and lower patient mortality, and is thus applicable to the treatment of acute subdural hematoma. The present study reports the cases of two elderly patients that benefitted from trepanation and drainage of an acute subdural hematoma. In each case, the family members of the patients refused to consent to a craniotomy; thus, burr-hole drainage was selected as an alternative option for relieving intracranial pressure. The risks require careful evaluation when considering whether trepanation with drainage is an option for a patient. Following treatment, the two cases were cured and discharged on days 48 and 18 after admission, respectively. The present case studies indicate that trepanation with drainage may be a promising approach for reducing craniotomy-associated mortality and closely monitoring condition variation in elderly patients. Following trepanation with drainage, certain patients do not undergo a craniotomy.
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Affiliation(s)
- Tianshu Lu
- Department of Pathogen Biology, School of Basic Medicine, China Medical University, Shenyang, Liaoning 110001, P.R. China ; General Hospital of Shenyang Military Region, Shenyang, Liaoning 110001, P.R. China
| | - Jingyu Guan
- General Hospital of Shenyang Military Region, Shenyang, Liaoning 110001, P.R. China
| | - Chunli An
- Department of Pathogen Biology, School of Basic Medicine, China Medical University, Shenyang, Liaoning 110001, P.R. China
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Petrov A, Wynne KE, Parsley MA, Petrov IY, Petrov Y, Ruppert KA, Prough DS, DeWitt DS, Esenaliev RO. Optoacoustic detection of intra- and extracranial hematomas in rats after blast injury. PHOTOACOUSTICS 2014; 2:75-80. [PMID: 25302157 PMCID: PMC4182815 DOI: 10.1016/j.pacs.2014.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/31/2014] [Accepted: 04/02/2014] [Indexed: 05/03/2023]
Abstract
Surgical drainage of intracranial hematomas is often required within the first four hours after traumatic brain injury (TBI) to avoid death or severe disability. Although CT and MRI permit hematoma diagnosis, they can be used only at a major health-care facility. This delays hematoma diagnosis and therapy. We proposed to use an optoacoustic technique for rapid, noninvasive diagnosis of hematomas. In this study we developed a near-infrared OPO-based optoacoustic system for hematoma diagnosis and cerebral venous blood oxygenation monitoring in rats. A specially-designed blast device was used to inflict TBI in anesthetized rats. Optoacoustic signals were recorded from the superior sagittal sinus and hematomas that allowed for measurements of their oxygenations. These results indicate that the optoacoustic technique may be used for early diagnosis of hematomas and may provide important information for improving outcomes in patients with TBI.
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Affiliation(s)
- Andrey Petrov
- Laboratory for Optical Sensing and Monitoring, Center for Biomedical Engineering, The University of Texas Medical Branch, Galveston, TX 77555-1156, USA
| | - Karon E. Wynne
- Department of Neuroscience and Cell Biology, The University of Texas Medical Branch, Galveston, TX 77555-0625, USA
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX 77555-0591, USA
| | - Margaret A. Parsley
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX 77555-0591, USA
| | - Irene Y. Petrov
- Laboratory for Optical Sensing and Monitoring, Center for Biomedical Engineering, The University of Texas Medical Branch, Galveston, TX 77555-1156, USA
| | - Yuriy Petrov
- Laboratory for Optical Sensing and Monitoring, Center for Biomedical Engineering, The University of Texas Medical Branch, Galveston, TX 77555-1156, USA
| | - Katherine A. Ruppert
- Department of Neuroscience and Cell Biology, The University of Texas Medical Branch, Galveston, TX 77555-0625, USA
| | - Donald S. Prough
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX 77555-0591, USA
| | - Douglas S. DeWitt
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX 77555-0591, USA
| | - Rinat O. Esenaliev
- Laboratory for Optical Sensing and Monitoring, Center for Biomedical Engineering, The University of Texas Medical Branch, Galveston, TX 77555-1156, USA
- Department of Neuroscience and Cell Biology, The University of Texas Medical Branch, Galveston, TX 77555-0625, USA
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX 77555-0591, USA
- Corresponding author: Professor, Director of Laboratory for Optical Sensing and Monitoring, Director of High-resolution Ultrasound Imaging Core of UTMB, Center for Biomedical Engineering, UTMB Comprehensive Cancer Center, Department of Neuroscience and Cell Biology, and Department of Anesthesiology, Research Building #21, 301 University Boulevard, University of Texas Medical Branch, Galveston, Texas 77555-1156, Tel.: +409 772 8144; fax: +409 772 8144.
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Dickinson P, Eynon CA. Improving the Timeliness of Time-Critical Transfers: Removing ‘Referral and Acceptance’ from the Transfer Pathway. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Where a ‘time-critical’ condition exists and care cannot be provided at the patient's current hospital, traditional ‘refer and accept’ pathways of care may delay immediate transfer. This paper describes how to identify time-critical patient groups and the sources of delay. This enabled a local clinical network to redesign the transfer process, resulting in the removal of specialist teams from the transfer decision-making process, changing the process from ‘refer and accept’ to ‘send and inform.’ In cases where referral to and acceptance by specialist teams were removed from the decision-making pathway, a median time saving of 1 hour 38 minutes was achieved.
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Affiliation(s)
- Phillip Dickinson
- Speciality Registrar 7 in ICM and Anaesthesia, Quality Improvement Fellow, Wessex Trauma Network 2011–12
| | - C Andy Eynon
- Director of Major Trauma and Consultant in Neurosciences ICU, University Hospital Southampton NHS Foundation Trust
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The Cauldron – Slaying the Sacred Cows of ICM. J Intensive Care Soc 2013. [DOI: 10.1177/17511437130141s104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lin G, Teplitsky A, Hymas G, Bahouth H. Evacuation of wounded with intracranial injury to a hospital without neurosurgical service versus primary evacuation to a level I trauma centre. Injury 2012; 43:2136-40. [PMID: 22831923 DOI: 10.1016/j.injury.2012.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 07/04/2012] [Accepted: 07/05/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several studies have shown that delay in neurosurgical intervention worsens the neurologic outcome. However, rapid evacuation of wounded sustaining intracranial injury (ICI) to the nearest hospital may have some advantages, as the nearest hospital ER may be a better environment to prevent a secondary brain injury than the ambulance. Also, evacuation to a referral centre of all the wounded suspected in the field to have ICI will result in high rates of over triage. In order to create a factual basis for triage and resource utilization of wounded with possible ICI, we measured the delay in neurosurgical intervention of wounded with ICI that were evacuated to a hospital without neurosurgery service, the Western Galilee Hospital (WGH), Naharia, Israel, and its impact on morbidity and mortality. METHODS AND MATERIALS A retrospective case-control study was conducted for a period of 29 months. The study population included wounded over the age of two years, sustaining blunt ICI as diagnosed by CT scan that were evacuated to the WGH and later transferred to a level 1 trauma centre, Rambam Health Care Campus (RHCC), Haifa. Wounded were included only if the abbreviated injury score (AIS) of any other body system did not exceed 2. A control group of 29 wounded (one per month) was matched by random selection of wounded who met the inclusion criteria, primarily evacuated to RHCC and underwent neurosurgical intervention. Demographic data, anatomical characteristics of the injury, physiological parameters of injury severity, treatment at the ER, the schedules of neurosurgical interventions, ICU and hospital stay and discharge destination were recorded. Comparison between the groups was performed by Chi-square test for nominal variables, Fisher's exact test for 2×2 contingency tables, and Student's t test for numeric variables. The statistical significance was set at 5% (p<0.05). RESULTS 162 wounded that were evacuated to WGH and later transferred to RHCC were included in the study. 31(19.1%) of them required invasive neurosurgical intervention. The wounded that needed neurosurgical intervention were transferred earlier: 165.7 (SD 61.1) min on average from arrival to WGH to arrival RHCC, compared to 217.8 (SD 152.9) min for those who did not need any intervention (p<0.005). The demographic variables, injury characteristics, physiological parameters and ER treatment of the wounded that underwent neurosurgical intervention were similar whether the wounded were transferred from WGH or arrived directly to RHCC. The time passed until neurosurgical intervention, was significantly shorter for wounded admitted directly to RHCC: 2h and 13.9 min (133.9 (SD 71.9)min) on average from admission to intervention compared to 4h and 47.6 min (287.6 (SD 107.5)min) on average from WGH admission to neurosurgical intervention (p<0.001). Lengths of ICU stay and hospital stay were similar in both groups. Two patients from each group died. 12 wounded admitted directly to RHCC group and 8 wounded transferred from WGH were discharged to a neurological rehabilitation. CONCLUSIONS Only a minority of wounded with an intracranial bleeding require neurosurgical intervention, but primary evacuation of these wounded to a hospital with no neurosurgery service results in an unacceptable delay in neurosurgical intervention. In this study, we did not find that this delay had an influence on prognosis, but a larger sample and a prolonged follow up are probably needed. A faster neurosurgical intervention can be achieved by a direct evacuation from the field to a level 1 trauma centre, or by expedition of the transfer process.
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Affiliation(s)
- Guy Lin
- The Trauma Unit, Western Galilee Hospital, Naharia, Israel.
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Why mortality is still high with modern care of 613 evacuated mass lesions presented as severe head injuries 1999-2009. ACTA NEUROCHIRURGICA. SUPPLEMENT 2012. [PMID: 22327712 DOI: 10.1007/978-3-7091-0956-4_58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Of 1,949 successive acute severe head injuries (SHI) over a period of 11 years 1999-2009, 613 (31.5%) underwent evacuation of mass lesions. Mortality at 3 months of evacuated mass (EM) lesions was higher over 10 years compared with that of non-EM lesions (it was overall 22%). The reduction of mortality was significantly less in EM compared with that for non-surgical cases (14.4-9.4% recently) and for the cases that were operated but not for mass evacuation (18.1-12.1%). A few explanations are: first, more SDH (60.5% of the EM recently compared with 45.9% in the first few years); second, more severe cases and older patients with co-morbidities were treated surgically; third, advances in prehospital care brought more severe patients to operative care - the rate of referrals decreased from 61.5% to 52.8% recently; fourth, part of the significant shortening of the injury to NT admission time (163-141 min) vanished owing to the parallel elongation of admission to operation time (95-100 min), thus, the threshold recommendation of 4 h to mass evacuation was achieved in only 52%; fifth, introducing decompressive craniectomy was not associated with outcome improvement.
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Tsang KKT, Whitfield PC. Traumatic brain injury: review of current management strategies. Br J Oral Maxillofac Surg 2011; 50:298-308. [PMID: 21530028 DOI: 10.1016/j.bjoms.2011.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 03/17/2011] [Indexed: 11/26/2022]
Abstract
Head injury is a common condition with a high morbidity and mortality. Serious intracranial haematomas require early recognition and evacuation to maximise chances of independent outcomes. Recent organisational changes have promoted the development of trauma units and major trauma centres where patients can go through triage and be managed in an appropriate environment, and the development of management pathways in intensive treatment units has resulted in improvements in the outcome of traumatic brain injuries. Evidence for the treatment of cerebral perfusion pressure, and management of hyperventilation, osmotherapy, tracheostomy, and leakage of cerebrospinal fluid (CSF) has accumulated during the last decade and is important in the management of patients in all clinical settings. Since head injury is commonly associated with maxillofacial injuries, this review will be relevant to all who deal with this aspect of trauma.
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Affiliation(s)
- Kevin King-Tin Tsang
- Derriford Hospital, Department of Neurosurgery, Derriford Road, Plymouth PL6 8DH, United Kingdom.
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Major Traumatic Brain Injury: Time to Tertiary Care and the Impact of a Clinical Guideline. ACTA ACUST UNITED AC 2011; 70:1134-40. [DOI: 10.1097/ta.0b013e3182146c79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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.
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Affiliation(s)
- James A Nelson
- Emergency Department, Pioneers Memorial Hospital, Brawley, CA, USA.
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Booth C, Datta D, Protheroe R. Delays in Transfer Times for Patients with Extradural Haematomas in Greater Manchester. J Intensive Care Soc 2010. [DOI: 10.1177/175114371001100409] [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
Affiliation(s)
- Chris Booth
- Chris Booth ST6 in Intensive Care Medicine and Anaesthesia, North Western Deanery
- Work performed at Salford Royal Foundation Trust
| | - Devjay Datta
- Devjay Datta ST5 in Anaesthesia, North Western Deanery
- Work performed at Salford Royal Foundation Trust
| | - Richard Protheroe
- Richard Protheroe Consultant in Intensive Care Medicine and Anaesthesia, Salford Royal Foundation Trust
- Work performed at Salford Royal Foundation Trust
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