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Muehlschlegel S, Rajajee V, Wartenberg KE, Alexander SA, Busl KM, Creutzfeldt CJ, Fontaine GV, Hocker SE, Hwang DY, Kim KS, Madzar D, Mahanes D, Mainali S, Meixensberger J, Sakowitz OW, Varelas PN, Weimar C, Westermaier T. Guidelines for Neuroprognostication in Critically Ill Adults with Moderate-Severe Traumatic Brain Injury. Neurocrit Care 2024; 40:448-476. [PMID: 38366277 PMCID: PMC10959796 DOI: 10.1007/s12028-023-01902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Moderate-severe traumatic brain injury (msTBI) carries high morbidity and mortality worldwide. Accurate neuroprognostication is essential in guiding clinical decisions, including patient triage and transition to comfort measures. Here we provide recommendations regarding the reliability of major clinical predictors and prediction models commonly used in msTBI neuroprognostication, guiding clinicians in counseling surrogate decision-makers. METHODS Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, we conducted a systematic narrative review of the most clinically relevant predictors and prediction models cited in the literature. The review involved framing specific population/intervention/comparator/outcome/timing/setting (PICOTS) questions and employing stringent full-text screening criteria to examine the literature, focusing on four GRADE criteria: quality of evidence, desirability of outcomes, values and preferences, and resource use. Moreover, good practice recommendations addressing the key principles of neuroprognostication were drafted. RESULTS After screening 8125 articles, 41 met our eligibility criteria. Ten clinical variables and nine grading scales were selected. Many articles varied in defining "poor" functional outcomes. For consistency, we treated "poor" as "unfavorable". Although many clinical variables are associated with poor outcome in msTBI, only the presence of bilateral pupillary nonreactivity on admission, conditional on accurate assessment without confounding from medications or injuries, was deemed moderately reliable for counseling surrogates regarding 6-month functional outcomes or in-hospital mortality. In terms of prediction models, the Corticosteroid Randomization After Significant Head Injury (CRASH)-basic, CRASH-CT (CRASH-basic extended by computed tomography features), International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT)-core, IMPACT-extended, and IMPACT-lab models were recommended as moderately reliable in predicting 14-day to 6-month mortality and functional outcomes at 6 months and beyond. When using "moderately reliable" predictors or prediction models, the clinician must acknowledge "substantial" uncertainty in the prognosis. CONCLUSIONS These guidelines provide recommendations to clinicians on the formal reliability of individual predictors and prediction models of poor outcome when counseling surrogates of patients with msTBI and suggest broad principles of neuroprognostication.
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Affiliation(s)
- Susanne Muehlschlegel
- Departments of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Katharina M Busl
- Departments of Neurology and Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Gabriel V Fontaine
- Departments of Pharmacy and Neurosciences, Intermountain Health, Salt Lake City, UT, USA
| | - Sara E Hocker
- Department of Neurology, Saint Luke's Health System, Kansas City, MO, USA
| | - David Y Hwang
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keri S Kim
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Dominik Madzar
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Dea Mahanes
- Departments of Neurology and Neurosurgery, University of Virginia Health, Charlottesville, VA, USA
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Oliver W Sakowitz
- Department of Neurosurgery, Neurosurgery Center Ludwigsburg-Heilbronn, Ludwigsburg, Germany
| | | | - Christian Weimar
- Institute of Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany
- BDH-Klinik Elzach, Elzach, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, Helios Amper Klinikum Dachau, Dachau, Germany.
- Faculty of Medicine, University of Würzburg, Würzburg, Germany.
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Wu H, Li X, Zhao L, Yuan J, Xing Y, Bai M, Sun S. Risk factors for mortality in brain injury patients who have severe hypernatremia and received continuous venovenous hemofiltration. Heliyon 2023; 9:e21792. [PMID: 38027977 PMCID: PMC10663868 DOI: 10.1016/j.heliyon.2023.e21792] [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: 05/02/2023] [Revised: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background and objectives The mortality rate for people with brain injuries is increased when hypernatremia is present. Patients with severe hypernatremia, who have a significant short-term mortality rate, were shown to benefit from continuous venovenous hemofiltration (CVVH), which has been indicated to be successful. Exploring the risk factors for short-term mortality in brain injury patients who underwent CVVH and had severe hypernatremia was the aim of the current study. Materials and methods Retrospective screening was performed on patients with brain injuries who underwent CVVH at Xijing Hospital between 1 December 2010 and 31 December 2021 and who have a diagnosis of severe hypernatremia. The outcomes included 28-day patient mortality and hospital stay duration. The patient survival rate was examined using the Kaplan-Meier survival curve. To determine the risk factors for short-term death for patients, univariate and multivariate Cox regression analysis models were used. Results Our current study included a total of 83 individuals. The included patients had a median age of 49 (IQR 35-59) years. Of the included patients, 58 patients (69.9 %) died within 28 days. The median length of hospital stay for the patient was 13 (IQR 7-21) days. The APACHE II score, SOFA score, GCS, PLT count, INR, stroke, mechanical ventilation, and vasopressor reliance were related to 28-day mortality according to the univariate Cox analysis. INR (HR = 1.004, 95 % Cl: 1.001-1.006, P = 0.008), stroke (HR = 1.971, 95 % Cl: 1.031-3.768, P = 0.04), mechanical ventilation (HR = 3.948, 95 % Cl: 1.090-14.294, P = 0.036), and vasopressor dependency (HR = 2.262, 95 % Cl: 1.099-4.655, P = 0.027) were independently associated with the risk of 28-day death rates, according to multivariate Cox regression analysis. Conclusions Brain injuries who have severe hypernatremia requires CVVH, which has high short-term patient mortality. Mechanical ventilation, INR increase, stroke, and vasopressor dependence are independently associated with increased patient mortality risk.
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Affiliation(s)
- Hao Wu
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
- Xi'an Medical University, Xi 'an, Shanxi, China
| | - Xiayin Li
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
- Xi'an Medical University, Xi 'an, Shanxi, China
| | - Lijuan Zhao
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
| | - Jinguo Yuan
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
| | - Yan Xing
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
| | - Ming Bai
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West, Road, Xi'an, Shanxi, 710032, China
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Maleki MS, Mazaheri SA, Hosseini SH, Majdabadi HA, Poursadeqiyan M, Faghihi A, Naderi Z, Bardsiri TI, Khedri B, Amanat N, Khajehnasiri F, Ivanbagha R. Epidemiology of Traumatic Brain Injury in Iran: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1818-1831. [PMID: 38033848 PMCID: PMC10682591 DOI: 10.18502/ijph.v52i9.13565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/15/2023] [Indexed: 12/02/2023]
Abstract
Background Traumatic brain injury (TBI) is one of leading cause of death and disability in Iran that has serious consequences on people's health. Understanding of epidemiology of TBI can be helpful for policy making in health care management. Therefore, this study aimed to examine the epidemiology of TBI in Iran. Methods PubMed, Web of Science, Scopus, Google scholar, and internal databases including, SID, Magiran, and IranMedex were searched to identify the relevant published studies up to Feb 2022. Moreover, the references list of key studies was scanned to find more records. The Joanna Briggs Institute (JBI) tool was used to assess the quality of included studies. The Excel and Comprehensive Meta-Analysis software were to analyze the data. Results Overall, 23,446 patients from 15 studies were included in the study. The overall mean age of the patients was 31.36 ± 0.13 yr (95%CI: 31.10 to 31.61). The majority of the patients were male (74.37%), with a male to female ratio of 3:1. The incidence rate of TBI was 15.3 to 144 per 100,000 population. The mortality rate of TBI was estimated to be 10.4% (95%CI: 5% to 19%). The most common causes of injury were road traffic accidents (RTAs) (60%; 95%CI: 49% to 70%), and falling (20%; 95%CI: 16% to 26%), respectively. The most frequent type of head injury was subdural hematoma. Conclusion Our findings highlight that appropriate control and prevention strategies should be focused on male, road traffic accidents, and the group under 40 yr.
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Affiliation(s)
- Mohsen Saheban Maleki
- Department of Anesthesia, Clinical Research Developmental Unit Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
| | | | - Seyed Hossein Hosseini
- Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mohsen Poursadeqiyan
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Aboalfazl Faghihi
- Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zeinab Naderi
- Department of Nursing, Sirjan School of Medical Sciences, Sirjan, Iran
| | | | - Behzad Khedri
- Department of Social Work, Social Studies Faculty, Hanze University of Applied Science, Groningen, Netherlands
| | - Nasir Amanat
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Farahnaz Khajehnasiri
- Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Ivanbagha
- Department of Midwifery, School of Nursing, Tabriz University of Medical Sciences, Tabriz, Iran
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Aregago G, Gishu T, Getaneh E, Tirore LL, Abame DE, Meskele S. Incidence of mortality and its predictors among patients with head injury admitted to adult intensive care unit at AaBET and ALERT hospitals, Addis Ababa, Ethiopia. J Family Med Prim Care 2022; 11:5277-5284. [PMID: 36505640 PMCID: PMC9730995 DOI: 10.4103/jfmpc.jfmpc_2129_21] [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: 10/25/2021] [Revised: 01/06/2022] [Accepted: 03/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background Traumatic head injury, referred to as the "silent epidemic", remains a growing public health concern and the leading cause of mortality in young adults, with a disproportionate burden of disability and death occurring in low-income and middle-income countries, including Ethiopia. However, estimates of the traumatic brain injury burden from low and middle-income countries are scarce. The aim of this study was to assess outcome and its associated factors among patients with head injury admitted to the Adult Intensive care unit at AaBET and ALERT hospitals, Addis Ababa, Ethiopia. Methods Institution-based retrospective cohort study was conducted at AaBET and ALERT hospitals from February 01, 2019 to January 30, 2020. All head injury patients' records were reviewed. A structured checklist was used to collect data. Binary logistic regression analysis was used to identify factors associated with death among head injury patients. Result Out of 205 patients, 178 (86.8%) improved, while 27 (13.2%) died. Road traffic accident was the most common cause of head injury (Adjusted odds ratio (AOR) = 46.3%). Patients with pulse rate admission (AOR = 1.49), NA + level (3.48), type of head injury (AOR = 3.67), mechanical ventilation (AOR = 4.70) were significant predictors of death among patients with head injuries. Conclusion The incidence of death among head injury patients was 13.2% (27). Road traffic accident was the leading cause of head injury. Pulse rate, plasma sodium level, penetrating head injury, being on a mechanical ventilator were predictors of death among traumatic head injury (THI) patients treated for head injuries. Prevention of road traffic accidents and continuous awareness creation about the consequences of a road traffic accident is recommended.
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Affiliation(s)
- Gezehagn Aregago
- Intensive Care Unit, Nigist Elleni Mohammed Memorial Comprehensive Specialized Hospital, Wachemo University, Hossana, Ethiopia
| | - Teshome Gishu
- Department of Nursing, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ermias Getaneh
- Department of Nursing, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lire Lemma Tirore
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia,Address for correspondence: Mr. Lire Lemma Tirore, Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia. E-mail:
| | - Desta Erkalo Abame
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Simeon Meskele
- Department of Anatomy, College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
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Silva CDLN, Lopes MCBT, Thomaz RR, Whitaker IY. Mortalidade de motociclistas com lesões traumáticas resultantes de acidentes de trânsito na cidade de São José dos Campos, em 2015: estudo de coorte. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2020. [DOI: 10.1590/s1679-49742020000500003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Analisar fatores associados à mortalidade por lesões traumáticas entre motociclistas. Métodos: Coorte prospectiva, conduzida no Hospital Municipal de São José dos Campos, Brasil, 2015. Foram incluídos motociclistas com lesões traumáticas, ≥14 anos de idade, hospitalizados. Analisaram-se as variáveis sociodemográficas do acidente e da hospitalização, por modelo de regressão de Poisson, apresentando-se risco relativo (RR) e intervalos de confiança de 95% (IC95%). Resultados: Entre 190 motociclistas, 161 (84,7%), jovens do sexo masculino, revelaram 422 (41,8%) lesões em extremidades inferiores e superiores. A incidência de óbito foi maior na medida do aumento da gravidade do trauma, fisiológica (RR=9,67 [IC95% 1,46;64,26]; e RR=4,71 [IC95% 1,36;16,26]) e anatômica (RR=31,49 [IC95% 3,72;266,38]); e mostrou-se menor em até uma semana de internação (RR=0,39 [IC95% 0,15;0,98]). Conclusão: A gravidade do trauma e o tempo de internação associaram-se ao óbito de motociclistas, mas novos estudos devem ser conduzidos para confirmar esses achados e analisar essas relações mais detalhadamente.
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Rubiano AM, Maldonado M, Montenegro J, Restrepo CM, Khan AA, Monteiro R, Faleiro RM, Carreño JN, Amorim R, Paiva W, Muñoz E, Paranhos J, Soto A, Armonda R, Rosenfeld JV. The Evolving Concept of Damage Control in Neurotrauma: Application of Military Protocols in Civilian Settings with Limited Resources. World Neurosurg 2019; 125:e82-e93. [PMID: 30659971 DOI: 10.1016/j.wneu.2019.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/02/2019] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of the present review was to describe the evolution of the damage control concept in neurotrauma, including the surgical technique and medical postoperative care, from the lessons learned from civilian and military neurosurgeons who have applied the concept regularly in practice at military hospitals and civilian institutions in areas with limited resources. METHODS The present narrative review was based on the experience of a group of neurosurgeons who participated in the development of the concept from their practice working in military theaters and low-resources settings with an important burden of blunt and penetrating cranial neurotrauma. RESULTS Damage control surgery in neurotrauma has been described as a sequential therapeutic strategy that supports physiological restoration before anatomical repair in patients with critical injuries. The application of the concept has evolved since the early definitions in 1998. Current strategies have been supported by military neurosurgery experience, and the concept has been applied in civilian settings with limited resources. CONCLUSION Damage control in neurotrauma is a therapeutic option for severe traumatic brain injury management in austere environments. To apply the concept while using an appropriate approach, lessons must be learned from experienced neurosurgeons who use this technique regularly.
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Affiliation(s)
- Andres M Rubiano
- Institute of Neurosciences and Neurosurgery, El Bosque University, Bogotá, Colombia; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; INUB MEDITECH Research Group, MEDITECH Foundation, Cali, Colombia; MEDITECH Foundation, Cali Valle, Colombia.
| | - Miguel Maldonado
- School of Medicine, Central Military Hospital, Nueva Granada Military University, Bogota, Colombia
| | - Jorge Montenegro
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; Department of Research, INUB-MEDITECH Research Group, MEDITECH Foundation, Cali, Colombia; Puerto Asís Hospital, Puerto Asís, Colombia
| | - Claudia M Restrepo
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; Department of Research, INUB-MEDITECH Research Group, MEDITECH Foundation, Cali, Colombia; Central Military Hospital, Nueva Granada Military University, Bogota, Colombia
| | - Ahsan Ali Khan
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; Department of Research, INUB-MEDITECH Research Group, MEDITECH Foundation, Cali, Colombia; Department of Neurosurgery, Neurotrauma, and Global Surgery, MEDITECH Foundation, Barrow Neurological Institute, University of Cambridge, Cambridge, United Kingdom
| | - Ruy Monteiro
- Neurological Surgery Service, Hospital Municipal Miguel Couto, Río de Janeiro, Brazil
| | - Rodrigo M Faleiro
- Department of Neurosurgery, Hospital Sao Joao XXIII, Belo Horizonte, Minas Gerais, Brazil
| | - José N Carreño
- Neurointensive Care Unit, Santa Fe Foundation University Hospital, Bogotá, Colombia; Central Military Hospital, Nueva Granada Military University, Bogotá, Colombia
| | - Robson Amorim
- Emergency Neurosurgery Service, Hospital das Clínicas, University of São Paulo Medical School, Manaus, Brazil
| | - Wellingson Paiva
- Neurosurgical Intensive Care Unit, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Erick Muñoz
- Neurological Surgery Service, Central Military Hospital, Nueva Granada Military University, Bogotá, Colombia
| | - Jorge Paranhos
- Intensive Care Unite and Neuroemergency Service, Santa Casa de Misericordia Hospital, São João del Rei-Minas Gerais, Brazil
| | - Alvaro Soto
- Neurosurgery Service, San Antonio Hospital, Pitalito, Huila, Colombia
| | - Rocco Armonda
- Department of Neuroendovascular Surgery, Med-Star Washington Hospital Center, Med-Star Georgetown University Hospital, Washington, DC, USA
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia; Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
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