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Palabiyik O, Tomak Y, Acar M, Erkorkmaz U, Tuna AT, Suner KO, Ceylan D. Relationship between platelet indices and red cell distribution width and short-term mortality in traumatic brain injury with 30-day mortality. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:18-23. [PMID: 36820710 PMCID: PMC9937619 DOI: 10.1590/1806-9282.00210889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/12/2022] [Indexed: 02/19/2023]
Abstract
OBJECTIVE This study aimed at investigating whether there is a relationship between 7- or 30-day mortality and mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, or red cell distribution width in patients with traumatic brain injury. METHODS We retrospectively analyzed intensive care unit patients with traumatic brain injury. We recorded patients' ages; genders; diagnoses; Glasgow Coma Scale scores; length of intensive care unit stay (in days); mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, and red cell distribution width values upon hospital admission; and health on the 7th and 30th days of their stays. RESULTS We analyzed data from 110 patients. Of these, 84 (76.4%) were male and 26 (23.6%) were female. On the 7- and 30-day mortality evaluations, compared to the living patients, the deceased patients had a significantly higher median age and a significantly lower median Glasgow Coma Scale. Thus, increased age and lower Glasgow Coma Scale scores were associated with increased 7- and 30-day mortality rates. mean platelet volume and platelet distribution width values were similar in living and deceased patients. platelet count-to-total lymphocyte count ratio values were lower in deceased patients, but this difference was not statistically significant. Within 30 days after traumatic brain injury, deceased patients' red cell distribution width values were significantly elevated in deceased patients compared to those of living patients. CONCLUSION Mean platelet volume, platelet distribution width, and platelet count-to-total lymphocyte count ratio values were not associated with 7- and 30-day mortality, whereas only elevated red cell distribution width was associated with 30-day mortality.
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Affiliation(s)
- Onur Palabiyik
- Sakarya University, Faculty of Medicine, Department of Anesthesiology and Reanimation – Sakarya, Turkey.,Corresponding author:
| | - Yakup Tomak
- Dogus University, Hisar Intercontinental Hospital, Department of Anesthesiology and Reanimation – İstanbul, Turkey
| | - Muberra Acar
- Istanbul Umraniye Training and Research Hospital, Department of Anesthesiology and Reanimation – İstanbul, Turkey
| | - Unal Erkorkmaz
- Sakarya University, Faculty of Medicine, Department of Biostatistics – Sakarya, Turkey
| | - Ayca Tas Tuna
- Sakarya University, Faculty of Medicine, Department of Anesthesiology and Reanimation – Sakarya, Turkey
| | - Kezban Ozmen Suner
- Sakarya University Training and Research Hospital, Department of Intensive Care – Sakarya, Turkey
| | - Davut Ceylan
- Sakarya University, Faculty of Medicine, Department of Neurosurgery – Sakarya, Turkey
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Jost JN. Primary Decompressive Craniectomy After Traumatic Brain Injury: A Literature Review. Cureus 2022; 14:e29894. [PMID: 36348855 PMCID: PMC9631546 DOI: 10.7759/cureus.29894] [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] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Traumatic brain injuries (TBIs) still put a high burden on public health worldwide. Medical and surgical treatment strategies are continuously being studied, but the role and indications of primary decompressive craniectomy (DC) remain controversial. In medically refractory intracranial hypertension after severe traumatic brain injury, secondary decompressive craniectomy is a last resort treatment option to control intracranial pressure (ICP). Randomized controlled studies have been extensively performed on secondary decompressive craniectomy and its role in the management of severe traumatic brain injuries. Indications, prognostic factors, and long-term outcomes in primary decompressive craniectomy during the evacuation of an epidural, subdural, or intracerebral hematoma in the acute phase are still a matter of ongoing research and controversy to this day. Prospective trials have been designed, but the results are yet to be published. In isolated epidural hematoma without underlying brain injury, osteoplastic craniotomy is likely to be sufficient. In acute subdural hematoma (ASDH) with relevant brain swelling and preoperative CT signs such as effaced cisterns, overly proportional midline-shift compared to a relatively small acute subdural hematoma, and accompanying brain contusions as well as pupillary abnormalities, intraventricular hemorrhage, and coagulation disorder, primary decompressive craniectomy is more likely to be of benefit for patients with traumatic brain injury. The role of intracranial pressure monitoring after primary decompressive craniectomy is recommended, but prospective trials are pending. More refined guidelines and hopefully class I evidence will be established with the ongoing trials: randomized evaluation of surgery with craniectomy for patients undergoing evacuation of acute subdural hematoma (RESCUE-ASDH), prospective randomized evaluation of decompressive ipsilateral craniectomy for traumatic acute epidural hematoma (PREDICT-AEDH), and pragmatic explanatory continuum indicator summary (PRECIS).
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Tang Z, Yang R, Zhang J, Huang Q, Zhou X, Wei W, Jiang Q. Outcomes of Traumatic Brain-Injured Patients With Glasgow Coma Scale < 5 and Bilateral Dilated Pupils Undergoing Decompressive Craniectomy. Front Neurol 2021; 12:656369. [PMID: 34113309 PMCID: PMC8185205 DOI: 10.3389/fneur.2021.656369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Decompressive craniectomy (DC) plays an important role in the treatment of patients with severe traumatic brain injury (sTBI) with mass lesions and intractably elevated intracranial hypertension (ICP). However, whether DC should be performed in patients with bilateral dilated pupils and a low Glasgow Coma Scale (GCS) score is still controversial. This retrospective study explored the clinical outcomes and risk factors for an unfavorable prognosis in sTBI patients undergoing emergency DC with bilateral dilated pupils and a GCS score <5. Methods: The authors reviewed the data from patients who underwent emergency DC from January 2012 to March 2019 in a medical center in China. All data, such as patient demographics, radiological findings, clinical parameters, and preoperative laboratory variables, were extracted. Multivariate logistic regression analysis was performed to determine the factors associated with 30-day mortality and 6-month negative neurological outcome {defined as death or vegetative state [Glasgow Outcome Scale (GOS) score 1-2]}. Results: A total of 94 sTBI patients with bilateral dilated pupils and a GCS score lower than five who underwent emergency DC were enrolled. In total, 74 patients (78.7%) died within 30 days, and 84 (89.4%) had a poor 6-month outcome (GOS 1-2). In multivariate analysis, advanced age (OR: 7.741, CI: 2.288-26.189), prolonged preoperative activated partial thromboplastin time (aPTT) (OR: 7.263, CI: 1.323-39.890), and low GCS (OR: 6.162, CI: 1.478-25.684) were associated with a higher risk of 30-day mortality, while advanced age (OR: 8.812, CI: 1.817-42.729) was the only independent predictor of a poor 6-month prognosis in patients undergoing DC with preoperative bilateral dilated pupils and a GCS score <5. Conclusions: The mortality and disability rates are extremely high in severe TBI patients undergoing emergency DC with bilateral fixed pupils and a GCS score <5. DC is more valuable for younger patients.
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Affiliation(s)
- Zhiji Tang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Ruijin Yang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Jinshi Zhang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Qianliang Huang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Xiaoping Zhou
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Wenjin Wei
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
| | - Qiuhua Jiang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China
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AL-Shudifat ARM, Kahlon B, Bin Abdulqader S, Almutairi W, Alsumali K, Aldhfyan Y, Al-Abdallat L. Outcome of Severe Traumatic Brain Injury at KSMC: Functional Outcomes of ICP Monitor Insertion-Two Years' Experience. Open Access Emerg Med 2021; 13:155-159. [PMID: 33880070 PMCID: PMC8052127 DOI: 10.2147/oaem.s288262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate functional outcomes of severe traumatic brain injuries after insertion of intracranial pressure (ICP) monitor at King Saud Medical City (KSMC) and their correlation to each other. PATIENTS AND METHODS A retrospective observational study for all adult patients (age >18 years) who were diagnosed with severe head injury and underwent ICP insertion at KSMC. Patients diagnosed between 2017 and 2019 were included. Data for measured outcomes, Glasgow outcome scale (GOS), Karnofsky Performance Score (KPS) and length of stay (LOS) and prognostic factors, data like: age, gender and primary Glasgow coma score (GCS) was obtained from patients' files and direct communication with patients or their caregivers. We also compared patients who underwent ICP monitoring alone with those who underwent ICP with decompressive craniectomy (DC). Follow-up period ranged from 6-24 months. RESULTS Seventy-four patients were included in this cohort study. Outcome measurements for patients with decompression and ICP were lower than those with ICP alone. KPS and GOS showed strong correlation (p<0.01) in whole cohort and in both subgroups (ICP alone and ICP with DC). KPS showed significant correlation with length of stay (p=0.026). CONCLUSION ICP monitoring is valid tool in management of severely head injured patients. Patients who underwent DC had a worse outcome. KPS can be used as alternative tool to measure functional outcome in severe traumatic brain injury.
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Affiliation(s)
- Abdul Raman M AL-Shudifat
- Department of Neurosurgery, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Neurosurgery, King Saud Medical City (KSMC), Riyadh, Saudi Arabia
| | - Babar Kahlon
- Department of Neurosurgery, King Saud Medical City (KSMC), Riyadh, Saudi Arabia
| | | | - Wajab Almutairi
- Department of Neurosurgery, King Saud Medical City (KSMC), Riyadh, Saudi Arabia
| | - Khairiah Alsumali
- Department of Neurosurgery, King Saud Medical City (KSMC), Riyadh, Saudi Arabia
| | - Yazeed Aldhfyan
- Department of Neurosurgery, King Saud Medical City (KSMC), Riyadh, Saudi Arabia
| | - Laith Al-Abdallat
- Department of Neurosurgery, School of Medicine, The University of Jordan, Amman, Jordan
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Clavijo A, Khan AA, Mendoza J, Montenegro JH, Johnson ED, Adeleye AO, Rubiano AM. The Role of Decompressive Craniectomy in Limited Resource Environments. Front Neurol 2019; 10:112. [PMID: 30863354 PMCID: PMC6399379 DOI: 10.3389/fneur.2019.00112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/28/2019] [Indexed: 12/12/2022] Open
Abstract
Decompressive craniectomy (DC) is a neurosurgical procedure useful to prevent and manage the impact of high intracranial pressure (ICP) that leads to brain herniation and brain's tissue ischemia. In well-resourced environment this procedure has been proposed as a last tier therapy when ICP is not controlled by medical therapies in the management of different neurosurgical emergencies like traumatic brain injury (TBI), stroke, infectious diseases, hydrocephalus, tumors, etc. The purpose of this narrative review is to discuss the role of DC in areas of low neurosurgical and neurocritical care resources. We performed a literature review with a specific search strategy in web repositories and some local and regional journals from Low and Middle-Income Countries (LMICs). The most common publications include case reports, case series and observational studies describing the benefits of the procedure on different pathologies but with several types of biases due to the absence of robust studies or clinical registries analysis in these kinds of environments.
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Affiliation(s)
- Angélica Clavijo
- INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia
| | - Ahsan A Khan
- MEDITECH Foundation, Clinical Research, Cali, Colombia.,Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Juliana Mendoza
- INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia
| | - Jorge H Montenegro
- INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia.,MEDITECH Foundation, Clinical Research, Cali, Colombia
| | - Erica D Johnson
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Amos O Adeleye
- Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,College of Medicine, University of Ibadan, and University College Hospital (UCH), Ibadan, Nigeria
| | - Andrés M Rubiano
- INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia.,MEDITECH Foundation, Clinical Research, Cali, Colombia.,Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
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