1
|
Li D, He X, Li Y, Wu S, Liu J. The effects of hyperbaric oxygen therapy on neuroprotection and recovery after brain resuscitation. Int J Neurosci 2024:1-7. [PMID: 38646692 DOI: 10.1080/00207454.2024.2346172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE Analyze the impact of hyperbaric oxygen therapy on neuroprotection and recovery post severe traumatic brain injury (sTBI) resuscitation. METHODS Retrospective analysis of clinical data from 83 sTBI patients admitted between January 2022 to January 2024. Patients were divided into control (n = 41) and observation (n = 42) groups based on treatment received. Control received standard therapy, while the observation group received hyperbaric oxygen therapy. Effects on clinical outcomes, neuroinjury markers (S100β, GFAP, UCH-L1, NSE), neurotrophic factors (NGF, BDNF), neurological function indicators (NIHSS, CSS), and adverse reactions were compared. RESULTS The observation group showed a higher total effective rate (80.95%) compared to control (60.98%) (p < 0.05). Neuroinjury markers decreased post-treatment in both groups, with the observation group lower (p < 0.05). NGF and BDNF levels increased post-treatment in both groups, with the observation group higher (p < 0.05). NIHSS and CSS scores decreased post-treatment in both groups, with the observation group lower (p < 0.05). No significant difference in adverse reactions between groups (p > 0.05). CONCLUSION Hyperbaric oxygen therapy effectively treats sTBI by improving brain resuscitation success, reducing neuroinjury factors, enhancing neurotrophic factors, and promoting neurological function recovery, without increasing adverse reaction risk.
Collapse
Affiliation(s)
- Di Li
- Emergency Department, Affiliated Hospital of Hebei Engineering University, Handan, China
| | - Xiaoqin He
- Department of Laboratory, Weihai Municipal Hospital, Weihai, China
| | - Yan Li
- Emergency Department, Affiliated Hospital of Hebei Engineering University, Handan, China
| | - Shubiao Wu
- Department of Orthopaedics, Affiliated Hospital of Hebei Engineering University, Handan, China
| | - Jianhui Liu
- Emergency Department, Affiliated Hospital of Hebei Engineering University, Handan, China
| |
Collapse
|
2
|
Sorrentino G, Bayen E, Câmara-Costa H, Francillette L, Toure H, Laurent-Vannier A, Meyer P, Dellatolas G, Chevignard M. Long-term burden of informal caregiver 7-years after severe childhood traumatic brain injury in the traumatisme grave de l'Enfant (TGE) study. Brain Inj 2024; 38:467-478. [PMID: 38379310 DOI: 10.1080/02699052.2024.2318588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To investigate reported burden by the Primary Family Caregiver (PFC) 7-years after severe pediatric traumatic brain injury in the TGE (Traumatisme Grave de l'Enfant) longitudinal study. METHODS Subjective burden was estimated with the Zarit Burden Inventory (ZBI) in 36 PFC (parents), who rated their own health status (Medical Outcome Study Short Form-12), family functioning and their child's level of care and needs (Pediatric/Adult Care And Needs Scale [PCANS/CANS]). Data collection included: child and PFC sociodemographic characteristics, injury-related factors, 'objective' (e.g. overall level of disability: Glasgow Outcome Scale - Extended, GOS-E/GOS-E-Peds) and 'subjective' outcomes (e.g. participation, behavior, executive functions, quality of life and fatigue). RESULTS 25% of PFC reported mild-moderate burden, and 19% moderate-severe burden. Higher burden correlated with worse outcomes in all 'subjective' PFC-rated outcomes, and with self-reported participation. The ZBI correlated strongly with CANS/PCANS and GOS-E/GOS-E-Peds. Overall level of disability and PFC-reported executive functioning explained 62% of the ZBI variance. For equal levels of disability, burden was higher when PFC reported a 'negative' picture of their child. CONCLUSION Significant PFC-reported burden 7-years post-injury was associated with overall disability and 'subjective' PFC-rated outcomes. Factors influencing parental burden in the long term should be identified and psychological support implemented over time.
Collapse
Affiliation(s)
- Gregorio Sorrentino
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
| | - Eléonore Bayen
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Hugo Câmara-Costa
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Leila Francillette
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Hanna Toure
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Anne Laurent-Vannier
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - Philippe Meyer
- Pediatric Anesthesiology Department, Hôpital Necker Enfants Malades, Paris, France
- Faculty of Medicine, Paris Descartes University, Paris, France
| | - Georges Dellatolas
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
| | - Mathilde Chevignard
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Rehabilitation Department for Children with Acquired Neurological Injury, Saint Maurice Hospitals, Saint Maurice, France
| |
Collapse
|
3
|
Wang Y, Guo S, Ji P, Han R, Wang N, Liu J, Chen F, Zhai Y, Wang Y, Jiao Y, Zhao W, Fan C, Xue Y, Qu L, Gao G, Qu Y, Wang L. Is There an Optimal Time Window of Placement of Intracranial Pressure (ICP) Monitor for Elderly Patients With Severe Traumatic Brain Injury? An 11-Year Institutional Cohort Study With Restricted Cubic Spline Analysis. J Neurotrauma 2024. [PMID: 38425191 DOI: 10.1089/neu.2023.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Severe traumatic brain injury (sTBI) is a prominent contributor to both morbidity and mortality in the elderly population. The monitoring of intracranial pressure (ICP) is crucial in the management of sTBI patients. Nevertheless, the appropriate timing for the placement of ICP monitor in elderly sTBI patients remains uncertain. To determine the optimal timing for the placement of ICP monitor in elderly sTBI patients, in this retrospective cohort study, we collected data from elderly patients (> 65 years) who suffered sTBI and received ICP monitors at Tangdu Hospital, The Fourth Military Medical University, between January 2011 and December 2021. To examine the relationship between the time of ICP monitor placement and in-hospital mortality, we conducted a multi-variate-adjusted restricted cubic spline (RCS) analysis. Additionally, logistic regression analysis was applied to further analyze the influencing factors contributing to early or late ICP monitor placements. A total of 283 eligible elderly TBI patients were included in the current analysis. The in-hospital mortality rate was 73 out of 283 (26%). The RCS analysis demonstrated an inverted U-shaped curve in the relationship between the timing of ICP monitor placement and in-hospital mortality. For the elderly sTBI patient cohort, 6 h was identified as the crucial moment for the treatment strategy. In addition, the protective time window for ICP placement was less than 4.92 h for the GCS 3-5 group, and less than 8.26 h for the GCS 6-8 group. However, the clinical benefit of ICP placement decreased gradually over time. The relationship between ICP placement and in-hospital mortality was non-linear, exhibiting an inverted U-shaped curve in elderly patients with sTBI. For elderly patients with sTBI, early (≤ 6 h) ICP placement was associated with reduced in-hospital mortality. The clinical benefit of ICP placement decreased beyond the optimal time window.
Collapse
Affiliation(s)
- Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shaochun Guo
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
- Department of Neurosurgery, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xi'an, China
| | - Peigang Ji
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ruili Han
- Department of Anesthesiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Na Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jinghui Liu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Fan Chen
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yulong Zhai
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yue Wang
- Department of Health Statistics, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yang Jiao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wenjian Zhao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chao Fan
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yanrong Xue
- Time and Frequency Measurement Department, National Time Service Center, Chinese Academy of Sciences, Xi'an, Shaanxi, China
| | - Liang Qu
- Department of Neurosurgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - GuoDong Gao
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Liang Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| |
Collapse
|
4
|
Huang X, Lin W, Wang J, Liu C, Wei G, Wang J, Wang C. Comparison of the efficacy and safety of sodium valproate versus levetiracetam in the treatment of severe traumatic brain injury. Int J Neurosci 2024:1-10. [PMID: 38497924 DOI: 10.1080/00207454.2024.2332959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To observe the efficacy and safety of sodium valproate (VPA) compared to levetiracetam (LEV) in the treatment of severe traumatic brain injury (sTBI). METHODS In this blind, prospective study, eighty-four sTBI patients who had craniotomy from August 2021 to August 2023 were randomly split into two groups through random number table method: LEV and VPA, each with 42 patients. Both received comprehensive treatment post-craniotomy. LEV group: LEV injection on surgery day, transitioning to LEV tablets from day two. VPA group: VPA injection on surgery day, switching to VPA extended-release tablets from day two. The study compared hospital stay, neurological function, clinical outcomes, seizures, and drug reactions between groups. RESULTS The length of hospital stay showed no significant difference between the LEV and VPA groups. Both groups demonstrated improved neurological function post-treatment (NIHSS and BI scores), with no significant between-group differences. Clinical outcomes at 3 months post-treatment were similar in both groups. Seizure occurrence within 3 months after treatment showed no significant difference between the LEV (19.05%) and VPA (23.81%) groups. However, the VPA group experienced a significantly higher rate of drug-related adverse reactions (40.48%) compared to the LEV group (21.43%). CONCLUSION Both VPA and LEV are effective in treating sTBI, showing no significant difference in improving neurological function, daily life abilities, treatment outcomes, and seizure occurrence. However, VPA treatment exhibited a significantly higher incidence of drug-related adverse reactions compared to LEV, indicating that LEV might be a safer option for sTBI treatment.
Collapse
Affiliation(s)
- Xiaolei Huang
- Department of Emergency, The Second Attached Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Wenjia Lin
- Department of Emergency, The Second Attached Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jiayin Wang
- Department of Neurosurgery, The Second Attached Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Chubin Liu
- Department of Neurosurgery, The Second Attached Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Guan Wei
- Department of Emergency, The Second Attached Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Jiawei Wang
- Department of Emergency, The Second Attached Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Chaoyang Wang
- Department of Emergency, The Second Attached Hospital of Fujian Medical University, Quanzhou, Fujian, China
| |
Collapse
|
5
|
Brensing P, Greve S, Hojeij R, Dammann P, Felderhoff-Müser U, Dohna-Schwake C, Bruns N. Current practice of intracranial pressure monitoring in children with severe traumatic brain injury-a nationwide prospective surveillance study in Germany. Front Pediatr 2024; 12:1355771. [PMID: 38405592 PMCID: PMC10884239 DOI: 10.3389/fped.2024.1355771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/31/2024] [Indexed: 02/27/2024] Open
Abstract
Background For management of severe traumatic brain injuries (sTBI) in children, the overall level of evidence to guide diagnostic and therapeutic procedures is low. Since 2016, international guidelines have subsequently suggested invasive intracranial pressure (ICP) monitoring in patients with initial Glasgow Coma Scale (GCS) ≤8. In Germany, ICP monitoring was an individual case decision from 2011 until the 2022 update of the German pediatric TBI guideline. The aim of this study was to evaluate current clinical practice of invasive ICP monitoring in Germany in children <10 years with respect to guideline recommendations. Methods Anonymized clinical data on sTBI cases <10 years of age were collected in a nationwide prospective surveillance study via the German Pediatric Surveillance Unit ESPED from July 2019 until June 2022. Inclusion criteria for the surveillance study were sTBI (initial GCS ≤8) or neurosurgery following TBI. For this analysis, only cases with GCS ≤8 were subject to the present analysis. Descriptive analyses were performed to assess the proportion of ICP monitored patients and describe the cohort. Results Out of 217 reported cases, 102 cases met the inclusion criteria and thus qualified for ICP monitoring. Of these, 37 (36%) received ICP monitoring. Monitored patients were older, had lower median GCS values at presentation (4 vs. 5), higher mortality (32% vs. 22%), and were more frequently diagnosed with cerebral edema (68% vs. 37%). Conclusion In children <10 years with sTBI, the present clinical management regarding ICP monitoring deviates from the current German national and international guidelines. The reasons remain unclear, with the low level of evidence in the field of ICP monitoring and the recency of changes in guideline recommendations as potential contributors. Prospective interventional studies should elucidate the benefit of ICP monitoring and ICP directed therapies to provide evidence-based recommendations on ICP monitoring.
Collapse
Affiliation(s)
- Pia Brensing
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sandra Greve
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rayan Hojeij
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Philipp Dammann
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- C-TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
6
|
Campana S, Cecchetti L, Venturi M, Buemi F, Foti C, Cerasa A, Vicario CM, Carboncini MC, Tomaiuolo F. Evolution of Severe Closed Head Injury: Assessing Ventricular Volume and Behavioral Measures at 30 and 90 Days Post-Injury. J Clin Med 2024; 13:874. [PMID: 38337568 PMCID: PMC10856794 DOI: 10.3390/jcm13030874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Assessing functional outcomes in Severe Closed Head Injury (SCHI) is complex due to brain parenchymal changes. This study examines the Ventricles to Intracranial Volume Ratio (VBR) as a metric for these changes and its correlation with behavioral scales. Methods: Thirty-one SCHI patients were included. VBR was derived from CT scans at 3, 30, and 90 days post-injury and compared with Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), and Early Rehabilitation Barthel Index (ERBI) assessments at 30 and 90 days. Results: Ten patients were excluded post-decompressive craniectomy or ventriculoperitoneal shunt. Findings indicated a VBR decrease at 3 days, suggesting acute phase compression, followed by an increase from 30 to 90 days, indicative of post-acute brain atrophy. VBR correlated positively with the Marshall score in the initial 72 h, positioning it as an early indicator of subsequent brain atrophy. Nevertheless, in contrast to the Marshall score, VBR had stronger associations with DRS and ERBI at 90 days. Conclusions: VBR, alongside behavioral assessments, presents a robust framework for evaluating SCHI progression. It supports early functional outcome correlations informing therapeutic approaches. VBR's reliability underscores its utility in neurorehabilitation for ongoing SCHI assessment and aiding clinical decisions.
Collapse
Affiliation(s)
- Serena Campana
- Neurorehabilitation Unit, Auxilium Vitae Volterra, Via Borgo San Lazzero 5, 56048 Volterra, Italy;
| | - Luca Cecchetti
- Social and Affective Neuroscience (SANe) Group, MoMiLab, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy
| | - Martina Venturi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Francesco Buemi
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera Papardo, 98158 Messina, Italy;
| | - Cristina Foti
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy;
- S. Anna Institute, 88900 Crotone, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
| | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, 98125 Messina, Italy;
| | - Maria Chiara Carboncini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Francesco Tomaiuolo
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| |
Collapse
|
7
|
Gao S, Treble-Barna A, Fabio A, Beers SR, Kelly MK, Rosario BL, Bell MJ, Wisniewski SR. Effects of inpatient rehabilitation after acute care on motor, neuropsychological and behavioral outcomes in children with severe traumatic brain injury. Disabil Rehabil 2024:1-10. [PMID: 38166467 DOI: 10.1080/09638288.2023.2297920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/16/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE An observational study of children with severe traumatic brain injury (TBI) (Approaches and Decisions in Acute Pediatric TBI [ADAPT] Trial) demonstrated the benefits of inpatient rehabilitation on functional outcomes for those with more severely impaired consciousness when medically stable. We conducted a secondary analysis to assess whether using an inpatient rehabilitation or skilled nursing facility after acute hospitalization was associated with better motor, neuropsychological, and behavioral outcomes compared to receiving only non-inpatient rehabilitation among children with severe TBI. MATERIALS AND METHODS We included 180 children who used an inpatient rehabilitation or skilled nursing facility and 74 children who only received non-inpatient rehabilitation from the ADAPT trial. At 12 months post-injury, children underwent tests of motor skills, intellectual functioning, verbal learning, memory, processing speed, and cognitive flexibility. Parents/guardians rated children's executive function and behaviors. We performed inverse probability weighting to adjust for potential confounders. RESULTS No significant differences were found in any motor, neuropsychological, or behavioral measures between children receiving inpatient rehabilitation and children receiving only non-inpatient rehabilitation. CONCLUSIONS Analyses of comprehensive outcomes did not show differences between children receiving inpatient rehabilitation and children receiving only non-inpatient rehabilitation, suggesting a need for more research on specific components of the rehabilitation process.
Collapse
Affiliation(s)
- Shiyao Gao
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony Fabio
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sue R Beers
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Kathleen Kelly
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bedda L Rosario
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael J Bell
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, WA, DC, USA
| | - Stephen R Wisniewski
- Department of Epidemiology, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
8
|
Akhmadullina EM, Bodrova RA. [The use of transcranial micropolarization in the acute period of severe traumatic brain injury in children]. Vopr Kurortol Fizioter Lech Fiz Kult 2024; 101:13-21. [PMID: 38372733 DOI: 10.17116/kurort202410101113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Traumatic brain injury, which is often considered as a silent epidemic, is a public health problem. The duration of acute recovery period remains a commonly used criterion for injury severity and clinical management. In this connection, the first stage of medical rehabilitation is carried out in the conditions of resuscitation and neurosurgery department in the hospital providing specialized care. Rehabilitation techniques such as postural training, phase verticalization, individual kinesiotherapy, transcranial micropolarization and etc. are used. OBJECTIVE To assess the effectiveness of using transcranial micropolarization in acute period of severe traumatic brain injury in children. MATERIAL AND METHODS The study on the effectiveness of using transcranial micropolarization in acute period of severe traumatic brain injury in 85 children, divided into 2 groups, was carried out. The study group (42 patients) received the transcranial micropolarization on the 2nd day after severe traumatic brain injury. The control group (43 patients) received only rehabilitation in neurosurgery department. The neurological status in the patients of both groups was assessed on the 2nd day after severe traumatic brain injury in resuscitation department, and after 1, 3 and 6 months. RESULTS AND CONCLUSION The inclusion of transcranial micropolarization in the early medical rehabilitation of children with severe traumatic brain injury increases consciousness level in a shorter period of time, that predicts early patient's socialization.
Collapse
Affiliation(s)
- E M Akhmadullina
- Children's Republican Clinical Hospital of the Republic of Tatarstan, Kazan, Russia
- Kazan State Medical Academy - branch of the Russian Medical Academy of Continuing Professional Education, Kazan, Russia
| | - R A Bodrova
- Kazan State Medical Academy - branch of the Russian Medical Academy of Continuing Professional Education, Kazan, Russia
| |
Collapse
|
9
|
Li B, Li WG, Guo Y, Wang Y, Xu LY, Yang Y, Xu SG, Tan ZL, Mei YR, Wang KY. Integrating fractional amplitude of low-frequency fluctuation and functional connectivity to investigate the mechanism and prognosis of severe traumatic brain injury. Front Neurol 2023; 14:1266167. [PMID: 38145123 PMCID: PMC10748505 DOI: 10.3389/fneur.2023.1266167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/08/2023] [Indexed: 12/26/2023] Open
Abstract
Objective Functional magnetic resonance imaging (fMRI) has been used for evaluating residual brain function and predicting the prognosis of patients with severe traumatic brain injury (sTBI). This study aimed to integrate the fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity (FC) to investigate the mechanism and prognosis of patients with sTBI. Methods Sixty-five patients with sTBI were included and underwent fMRI scanning within 14 days after brain injury. The patient's outcome was assessed using the Glasgow Outcome Scale-Extended (GOSE) at 6 months post-injury. Of the 63 patients who met fMRI data analysis standards, the prognosis of 18 patients was good (GOSE scores ≥ 5), and the prognosis of 45 patients was poor (GOSE scores ≤ 4). First, we apply fALFF to identify residual brain functional differences in patients who present different prognoses and conjoined it in regions of interest (ROI)-based FC analysis to investigate the residual brain function of sTBI at the acute phase of sTBI. Then, the area under the curve (AUC) was used to evaluate the predictive ability of the brain regions with the difference of fALFF and FC values. Results Patients who present good outcomes at 6 months post-injury have increased fALFF values in the Brodmann area (7, 18, 31, 13, 39 40, 42, 19, 23) and decreased FC values in the Brodmann area (28, 34, 35, 36, 20, 28, 34, 35, 36, 38, 1, 2, 3, 4, 6, 13, 40, 41, 43, 44, 20, 28 35, 36, 38) at the acute phase of sTBI. The parameters of these alterations can be used for predicting the long-term outcomes of patients with sTBI, of which the fALFF increase in the temporal lobe, occipital lobe, precuneus, and middle temporal gyrus showed the highest predictive ability (AUC = 0.883). Conclusion We provide a compensatory mechanism that several regions of the brain can be spontaneously activated at the acute phase of sTBI in those who present with a good prognosis in the 6-month follow-up, that is, a destructive mode that increases its fALFF in the local regions and weakens its FC to the whole brain. These findings provide a theoretical basis for developing early intervention targets for sTBI patients.
Collapse
Affiliation(s)
- Biao Li
- Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Emergency, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Wu-gen Li
- Department of Imaging, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yao Guo
- Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yang Wang
- Department of Neurosurgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu-yang Xu
- Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuan Yang
- Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Shi-guo Xu
- Department of Imaging, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zi-long Tan
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yu-ran Mei
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Kai-yang Wang
- Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|
10
|
Oujamaa L, Delon-Martin C, Jaroszynski C, Termenon M, Silva S, Payen JF, Achard S. Functional hub disruption emphasizes consciousness recovery in severe traumatic brain injury. Brain Commun 2023; 5:fcad319. [PMID: 38757093 PMCID: PMC11098044 DOI: 10.1093/braincomms/fcad319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 08/20/2023] [Accepted: 11/21/2023] [Indexed: 05/18/2024] Open
Abstract
Severe traumatic brain injury can lead to transient or even chronic disorder of consciousness. To increase diagnosis and prognosis accuracy of disorder of consciousness, functional neuroimaging is recommended 1 month post-injury. Here, we investigated brain networks remodelling on longitudinal data between 1 and 3 months post severe traumatic brain injury related to change of consciousness. Thirty-four severe traumatic brain-injured patients were included in a cross-sectional and longitudinal clinical study, and their MRI data were compared to those of 20 healthy subjects. Long duration resting-state functional MRI were acquired in minimally conscious and conscious patients at two time points after their brain injury. The first time corresponds to the exit from intensive care unit and the second one to the discharge from post-intensive care rehabilitation ward. Brain networks data were extracted using graph analysis and metrics at each node quantifying local (clustering) and global (degree) connectivity characteristics. Comparison with brain networks of healthy subjects revealed patterns of hyper- and hypo-connectivity that characterize brain networks reorganization through the hub disruption index, a value quantifying the functional disruption in each individual severe traumatic brain injury graph. At discharge from intensive care unit, 24 patients' graphs (9 minimally conscious and 15 conscious) were fully analysed and demonstrated significant network disruption. Clustering and degree nodal metrics, respectively, related to segregation and integration properties of the network, were relevant to distinguish minimally conscious and conscious groups. At discharge from post-intensive care rehabilitation unit, 15 patients' graphs (2 minimally conscious, 13 conscious) were fully analysed. The conscious group still presented a significant difference with healthy subjects. Using mixed effects models, we showed that consciousness state, rather than time, explained the hub disruption index differences between minimally conscious and conscious groups. While severe traumatic brain-injured patients recovered full consciousness, regional functional connectivity evolved towards a healthy pattern. More specifically, the restoration of a healthy brain functional segregation could be necessary for consciousness recovery after severe traumatic brain injury. For the first time, extracting the hub disruption index directly from each patient's graph, we were able to track the clinical alteration and subsequent recovery of consciousness during the first 3 months following a severe traumatic brain injury.
Collapse
Affiliation(s)
- Lydia Oujamaa
- University Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Chantal Delon-Martin
- University Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Chloé Jaroszynski
- University Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Maite Termenon
- Faculty of Engineering, Biomedical Engineering Department, Mondragon Unibertsitatea (MU-ENG), 20500 Mondragon, Spain
| | - Stein Silva
- Toulouse NeuroImaging Center, Toulouse III Paul Sabatier University, Inserm, 31062 Toulouse, France
- Critical Care Unit, University Teaching Hospital of Purpan, 31059 Toulouse, France
| | - Jean-François Payen
- University Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Sophie Achard
- University Grenoble Alpes, CNRS, Inria, Grenoble INP, LJK, 38000 Grenoble, France
| |
Collapse
|
11
|
Wang XC, Gao SJ, Zhuo SL, Weng CL, Feng HW, Lin J, Lin XS, Huang L. Predictive factors for cerebrocardiac syndrome in patients with severe traumatic brain injury: a retrospective cohort study. Front Neurol 2023; 14:1192756. [PMID: 37538256 PMCID: PMC10394875 DOI: 10.3389/fneur.2023.1192756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Background and objective Cerebrocardiac syndrome (CCS) is a severe complication of severe traumatic brain injury (sTBI) that carries high mortality and disability rates. Early identification of CCS poses a significant clinical challenge. The main objective of this study was to investigate potential risk factors associated with the development of secondary CCS in patients with sTBI. It was hypothesized that elevated right heart Tei index (TI), lower Glasgow Coma Scale (GCS) scores, and elevated cardiac troponin-I (cTnI) levels would independently contribute to the occurrence of CCS in sTBI patients. Methods A retrospective cohort study was conducted to identify risk factors for CCS secondary to sTBI. One hundred and fifty-five patients were enrolled with sTBI admitted to the hospital between January 2016 and December 2020 and divided them into a CCS group (n = 75) and a non-CCS group (n = 80) based on the presence of CCS. This study involved the analysis and comparison of clinical data from two patient groups, encompassing demographic characteristics, peripheral oxygen saturation (SPO2), neuron-specific enolase (NSE), cardiac troponin-I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), optic nerve sheath diameter (ONSD), cardiac ultrasound, acute physiology and chronic health evaluation (APACHE II) scores, and GCS scores and so on. Multivariate logistic regression was employed to identify independent risk factors for CCS, and receiver operating characteristic (ROC) curves were used to assess their predictive value for CCS secondary to sTBI. Results The study revealed that 48.4% of sTBI patients developed secondary CCS. In the multivariate analysis model 1 that does not include NT-proBNP and cTnI, ONSD (OR = 2.582, 95% CI: 1.054-6.327, P = 0.038), right heart Tei index (OR = 2.81, 95% CI: 1.288-6.129, P = 0.009), and GCS (OR = 0.212, 95% CI: 0.086-0.521, P = 0.001) were independent risk factors for secondary CCS in sTBI patients. In multivariate analysis model 2 that includes NT-proBNP and cTnI, cTnI (OR = 27.711, 95%CI: 3.086-248.795, P = 0.003), right heart Tei index (OR = 2.736, 95% CI: 1.056-7.091, P = 0.038), and GCS (OR = 0.147, 95% CI: 0.045-0.481, P = 0.002) were independent risk factors for secondary CCS in sTBI patients. The area under the ROC curve for ONSD, Tei index, GCS, and cTnI were 0.596, 0.613, 0.635, and 0.881, respectively. ONSD exhibited a positive predictive value (PPV) of 0.704 and a negative predictive value (NPV) of 0.634. The Tei index demonstrated a PPV of 0.624 and an NPV of 0.726, while GCS had a PPV of 0.644 and an NPV of 0.815. On the other hand, cTnI exhibited a significantly higher PPV of 0.936 and an NPV of 0.817. These findings indicate that the Tei index, GCS score, and cTnI possess certain predictive value for secondary CCS in patients with sTBI. Conclusions The study provides valuable insights into the identification of independent risk factors for CCS secondary to sTBI. The findings highlight the significance of right heart Tei index, GCS score, and cTnI as potential predictive factors for CCS in sTBI patients. Further larger-scale studies are warranted to corroborate these findings and to provide robust evidence for the development of early intervention strategies aimed at reducing the incidence of CCS in this patient population.
Collapse
Affiliation(s)
- Xin-Cai Wang
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Shang-Jun Gao
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Department of Orthopedics, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Shi-Long Zhuo
- Department of School of Electronic, Electrical Engineering and Physics, Fujian University of Technology, Fuzhou, China
| | - Cui-Lian Weng
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Hang-Wei Feng
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Jian Lin
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Xing-Sheng Lin
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| | - Long Huang
- Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital South Branch, Fuzhou, China
- Fujian Provincial Key Laboratory of Critical Care Medicine, Fuzhou, China
| |
Collapse
|
12
|
Hayes K, Harding S, Buckley K, Blackwood B, Latour JM. Exploring the Experiences of Family Members When a Patient Is Admitted to the ICU with a Severe Traumatic Brain Injury: A Scoping Review. J Clin Med 2023; 12:4197. [PMID: 37445232 DOI: 10.3390/jcm12134197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The needs of family members of patients in the intensive care unit (ICU) with a severe traumatic brain injury (TBI) remain unmet. To date, no review has been performed to explore the experiences of relatives of adults who have been admitted to the ICU for treatment of a TBI. The aim of this scoping review is to explore and map the evidence of the experiences of family members when an adult relative is admitted to an ICU with a severe TBI. This review follows a combination of guidelines from Arksey and O'Malley and the Joanna Briggs Institute. Five electronic databases, Medline, Emcare, Embase, CINAHL, and PsycInfo were searched in February 2023, as were a number of grey literature sources. The population, concepts, and context framework were used to define the inclusion and exclusion criteria. From 4077 records, nine studies were retained, which represented seven discrete studies. The experiences of family members were thematically analyzed. The narrative synthesis of findings revealed three themes: communication with the clinical team, uncertainty, and involvement in care. These results offer richness and depth of understanding to clinicians regarding the experiences of families during this traumatic time. This review provides direction for targeted interventions aimed at supporting family members while in the ICU.
Collapse
Affiliation(s)
- Kati Hayes
- Research and Development Department, North Bristol NHS Trust, Westbury on Trym, Bristol BS10 5NB, UK
| | - Sam Harding
- Research and Development Department, North Bristol NHS Trust, Westbury on Trym, Bristol BS10 5NB, UK
| | - Kirsten Buckley
- Learning and Research Centre, North Bristol NHS Trust, Westbury on Trym, Bristol BS10 5NB, UK
| | - Bronagh Blackwood
- The Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast BT7 1NN, UK
| | - Jos M Latour
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth 6845, Australia
| |
Collapse
|
13
|
Chandankhede AR, Thombre SD, Shukla D. Correlating Intracranial Pressure Following Decompressive Craniectomy With Neurological Outcomes in Severe Traumatic Brain Injury Patients: A Prospective Observational Study. Cureus 2023; 15:e40119. [PMID: 37425601 PMCID: PMC10329403 DOI: 10.7759/cureus.40119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Decompressive craniectomies have been performed in settings with raised intracranial pressure (ICP) after severe traumatic brain injury (TBI). A decompressive craniectomy (DC) is an important salvage procedure for intracranial hypertension. The changes in the intracranial microenvironment after a primary DC are significant in terms of the neurological outcome in the postoperative period. Materials and methods The study comprised 68 patients with severe TBIs who were undergoing primary DC; of these, 59% were male. Recorded data include demographic profiles, clinical features, and cranial computed tomography (CT) scans. All patients underwent a primary unilateral DC with augmentation duraplasty. Intracranial pressure was recorded in the first 24 hours at regular intervals, and the outcome was recorded using the Extended Glasgow Outcome Scale (GOS-E) at two-week and two-month intervals. Results Road traffic accidents (RTAs) are the most common cause of severe TBIs. Imaging studies and intraoperative findings suggest that acute subdural hematomas (SDHs) are the most common pathology leading to high ICP in the postoperative period. Mortality was strongly statistically associated with high ICP values postoperatively at all intervals. The average ICP for the patients who died was 11.871 mmHg higher than the patients who survived (p=0.0009). The Glasgow Coma Scale (GCS) at the time of admission is positively correlated with the neurological outcome at two weeks and two months, with a Pearson correlation coefficient of 0.4190 and 0.4235, respectively. There is a strong negative correlation between ICP in the postoperative period and the neurological outcome at two weeks and two months (Pearson correlation coefficients are -0.828 and -0.841, respectively). Conclusion The results indicate that RTAs are the most common cause of severe TBIs, and acute SDHs are the most common pathology leading to high ICP after the surgery. ICP values in the postoperative period have a strong negative correlation with survival and neurological outcome. Preoperative GCS and postoperative ICP monitoring are important methods of prognostication and planning further management.
Collapse
Affiliation(s)
| | - Snehal D Thombre
- Anesthesiology, Shree Siddheshwar Multispeciality Hospital, Dhule, IND
| | | |
Collapse
|
14
|
Arefan D, Pease M, Eagle SR, Okonkwo DO, Wu S. Comparison of machine learning models to predict long-term outcomes after severe traumatic brain injury. Neurosurg Focus 2023; 54:E14. [PMID: 37552699 DOI: 10.3171/2023.3.focus2376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/21/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE An estimated 1.5 million people die every year worldwide from traumatic brain injury (TBI). Physicians are relatively poor at predicting long-term outcomes early in patients with severe TBI. Machine learning (ML) has shown promise at improving prediction models across a variety of neurological diseases. The authors sought to explore the following: 1) how various ML models performed compared to standard logistic regression techniques, and 2) if properly calibrated ML models could accurately predict outcomes up to 2 years posttrauma. METHODS A secondary analysis of a prospectively collected database of patients with severe TBI treated at a single level 1 trauma center between November 2002 and December 2018 was performed. Neurological outcomes were assessed at 3, 6, 12, and 24 months postinjury with the Glasgow Outcome Scale. The authors used ML models including support vector machine, neural network, decision tree, and naïve Bayes models to predict outcome across all 4 time points by using clinical information available on admission, and they compared performance to a logistic regression model. The authors attempted to predict unfavorable versus favorable outcomes (Glasgow Outcome Scale scores of 1-3 vs 4-5), as well as mortality. Models' performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) with 95% confidence interval and balanced accuracy. RESULTS Of the 599 patients in the database, the authors included 501, 537, 469, and 395 at 3, 6, 12, and 24 months posttrauma. Across all time points, the AUCs ranged from 0.71 to 0.85 for mortality and from 0.62 to 0.82 for unfavorable outcomes with various modeling strategies. Decision tree models performed worse than all other modeling approaches for multiple time points regarding both unfavorable outcomes and mortality. There were no statistically significant differences between any other models. After proper calibration, the models had little variation (0.02-0.05) across various time points. CONCLUSIONS The ML models tested herein performed with equivalent success compared with logistic regression techniques for prognostication in TBI. The TBI prognostication models could predict outcomes beyond 6 months, out to 2 years postinjury.
Collapse
Affiliation(s)
| | - Matthew Pease
- 2Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh; and
| | - Shawn R Eagle
- 2Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh; and
| | - David O Okonkwo
- 2Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh; and
| | - Shandong Wu
- 1Department of Radiology
- 3Department of Biomedical Informatics, and
- 4Department of Bioengineering, University of Pittsburgh
- 5Intelligent Systems Program, University of Pittsburgh, Pennsylvania
| |
Collapse
|
15
|
Torregrossa W, Raciti L, Rifici C, Rizzo G, Raciti G, Casella C, Naro A, Calabrò RS. Behavioral and Psychiatric Symptoms in Patients with Severe Traumatic Brain Injury: A Comprehensive Overview. Biomedicines 2023; 11:biomedicines11051449. [PMID: 37239120 DOI: 10.3390/biomedicines11051449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Traumatic brain injury (TBI) is defined as an altered brain structure or function produced by an external force. Adults surviving moderate and severe TBI often experience long-lasting neuropsychological and neuropsychiatric disorders (NPS). NPS can occur as primary psychiatric complications or could be an exacerbation of pre-existing compensated conditions. It has been shown that changes in behavior following moderate to severe TBI have a prevalence rate of 25-88%, depending on the methodology used by the different studies. Most of current literature has found that cognitive behavioral and emotional deficit following TBI occurs within the first six months whereas after 1-2 years the condition becomes stable. Identifying the risk factors for poor outcome is the first step to reduce the sequelae. Patients with TBI have an adjusted relative risk of developing any NPS several-fold higher than in the general population after six months of moderate-severe TBI. All NPS features of an individual's life, including social, working, and familiar relationships, may be affected by the injury, with negative consequences on quality of life. This overview aims to investigate the most frequent psychiatric, behavioral, and emotional symptoms in patients suffering from TBI as to improve the clinical practice and tailor a more specific rehabilitation training.
Collapse
Affiliation(s)
- William Torregrossa
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Loredana Raciti
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Carmela Rifici
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Giuseppina Rizzo
- Azienda Ospedaliera Universitaria (AOU) Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Gianfranco Raciti
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| | - Carmela Casella
- Azienda Ospedaliera Universitaria (AOU) Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Antonino Naro
- Azienda Ospedaliera Universitaria (AOU) Policlinico G. Martino, Via Consolare Valeria, 1, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Via Palermo S.S. 113 C.da Casazza, 98124 Messina, Italy
| |
Collapse
|
16
|
Chesnut RM, Temkin N, Videtta W, Lujan S, Petroni G, Pridgeon J, Dikmen S, Chaddock K, Hendrix T, Barber J, Machamer J, Guadagnoli N, Hendrickson P, Alanis V, La Fuente G, Lavadenz A, Merida R, Lora FS, Romero R, Pinillos O, Urbina Z, Figueroa J, Ochoa M, Davila R, Mora J, Bustamante L, Perez C, Leiva J, Carricondo C, Mazzola AM, Guerra J. Testing the Impact of Protocolized Care of Patients With Severe Traumatic Brain Injury Without Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol. Neurosurgery 2023; 92:472-480. [PMID: 36790211 PMCID: PMC10158870 DOI: 10.1227/neu.0000000000002251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/30/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Most patients with severe traumatic brain injury (sTBI) in low- or-middle-income countries and surprisingly many in high-income countries are managed without intracranial pressure (ICP) monitoring. The impact of the first published protocol (Imaging and Clinical Examination [ICE] protocol) is untested against nonprotocol management. OBJECTIVE To determine whether patients treated in intensive care units (ICUs) using the ICE protocol have lower mortality and better neurobehavioral functioning than those treated in ICUs using no protocol. METHODS This study involved nineteen mostly public South American hospitals. This is a prospective cohort study, enrolling patients older than 13 years with sTBI presenting within 24 h of injury (January 2014-July 2015) with 6-mo postinjury follow-up. Five hospitals treated all sTBI cases using the ICE protocol; 14 used no protocol. Primary outcome was prespecified composite of mortality, orientation, functional outcome, and neuropsychological measures. RESULTS A total of 414 patients (89% male, mean age 34.8 years) enrolled; 81% had 6 months of follow-up. All participants included in composite outcome analysis: average percentile (SD) = 46.8 (24.0) nonprotocol, 56.9 (24.5) protocol. Generalized estimating equation (GEE) used to account for center effects (confounder-adjusted difference [95% CI] = 12.2 [4.6, 19.8], P = .002). Kaplan-Meier 6-month mortality (95% CI) = 36% (30%, 43%) nonprotocol, 25% (19%, 31%) protocol (GEE and confounder-adjusted hazard ratio [95% CI] = .69 [.43, 1.10], P = .118). Six-month Extended Glasgow Outcome Scale for 332 participants: average Extended Glasgow Outcome Scale score (SD) = 3.6 (2.6) nonprotocol, 4.7 (2.8) protocol (GEE and confounder-adjusted and lost to follow-up-adjusted difference [95% CI] = 1.36 [.55, 2.17], P = .001). CONCLUSION ICUs managing patients with sTBI using the ICE protocol had better functional outcome than those not using a protocol. ICUs treating patients with sTBI without ICP monitoring should consider protocolization. The ICE protocol, tested here and previously, is 1 option.
Collapse
Affiliation(s)
- Randall M. Chesnut
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Nancy Temkin
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Walter Videtta
- Medicina Intensiva, Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina;
| | - Silvia Lujan
- Hospital Emergencia, Dr Clemente Alvarez, Rosario, Argentina;
| | - Gustavo Petroni
- Hospital Emergencia, Dr Clemente Alvarez, Rosario, Argentina;
| | - Jim Pridgeon
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Sureyya Dikmen
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Kelley Chaddock
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | | | - Jason Barber
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Joan Machamer
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | | | - Peter Hendrickson
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Victor Alanis
- Medicina Intensiva, Hospital San Juan de Dios, Santa Cruz de la Sierra, Bolivia;
| | - Gustavo La Fuente
- Medicina Intensiva, Hospital Japones, Santa Cruz de la Sierra, Bolivia;
| | | | - Roberto Merida
- Medicina Intensiva, Hospital San Juan de Dios, Tarija, Bolivia;
| | | | - Ricardo Romero
- Medicina Intensiva, Fundacion Clinica Campbell, Barranquilla, Colombia;
| | - Oscar Pinillos
- Medicina Intensiva, Clinica Universitaria Rafael Uribe, Cali, Colombia;
| | - Zulma Urbina
- Medicina Intensiva, Hospital Erasmo Meoz ICU No 1, Cucuta, Colombia;
| | - Jairo Figueroa
- Medicina Intensiva, Hospital Erasmo Meoz ICU No 2, Cucuta, Colombia;
| | - Marcelo Ochoa
- Medicina Intensiva, Hospital José Carrasco Artega, Cuenca, Ecuador;
| | - Rafael Davila
- Medicina Intensiva, Hospital Luis Razetti, Barinas, Venezuela;
| | - Jacobo Mora
- Medicina Intensiva, Hospital Luis Razetti, Barcelona, Venezuela;
| | - Luis Bustamante
- Medicina Intensiva, Delicia Conception Hospital Masvernat, Concordia, Entre Ríos, Argentina;
| | - Carlos Perez
- Medicina Intensiva, Hospital Justo José de Urquiza, Concepción del Uruguay, Entre Ríos, Argentina;
| | - Jorge Leiva
- Medicina Intensiva, Hospital Córdoba, Córdoba, Argentina;
| | | | - Ana Maria Mazzola
- Medicina Intensiva, Hospital San Felipe, San Nicolás, Buenos Aires, Argentina;
| | - Juan Guerra
- Medicina Intensiva, Hospital COSSMIL Militar, La Paz, Bolivia
| |
Collapse
|
17
|
Maniakhina LE, Muir SM, Tackett N, Johnson D, Mentzer CJ, Mount MG. Significant Hypophosphatemia Is Predictive of Brain Death in Severe Traumatic Brain Injury. Am Surg 2023:31348231160844. [PMID: 36853882 DOI: 10.1177/00031348231160844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Traumatic brain injury (TBI) is one of the most common causes of morbidity and mortality worldwide. Severe TBI carries the greatest risk of brain death progression. There are currently no laboratory markers that predict patient's outcome. We hypothesize that the degree of hypophosphatemia (HP) in TBI is an indicator for progression to brain death. A total of 336 patients, ages 15-89, with a GCS of 8 or less at admission were identified and retrospectively analyzed. Demographics, laboratory studies, and brain death (BD) were collected. Univariate analysis demonstrated HP was correlated with BD (P < .0002). Multivariate analysis showed that phosphate was the only measured electrolyte correlated to BD with a P value < .0001. Mechanism of hypophosphatemia may be related to BD progression and provide future areas for study.
Collapse
Affiliation(s)
- Lana E Maniakhina
- Department of Medical Education, 447877Edward Via College of Osteopathic Medicine-Carolinas Campus, Spartanburg, SC, USA
| | - Sean M Muir
- Department of Medical Education, 447877Edward Via College of Osteopathic Medicine-Carolinas Campus, Spartanburg, SC, USA
| | - Nichole Tackett
- Department of Medical Education, 447877Edward Via College of Osteopathic Medicine-Carolinas Campus, Spartanburg, SC, USA
| | - Daniel Johnson
- Department of Surgery, 7442Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Caleb J Mentzer
- Department of Surgery, 7442Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Michael G Mount
- Department of Surgery, 7442Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| |
Collapse
|
18
|
Hetz M, Juratli T, Tiebel O, Giesecke MT, Tsitsilonis S, Held HC, Beyer F, Kleber C. Acquired Factor XIII Deficiency in Patients with Multiple Trauma. Injury 2022; 54:1257-1264. [PMID: 36577625 DOI: 10.1016/j.injury.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Fibrin stabilizing factor (FXIII) plays a crucial role in blood clotting, tissue repair, and immune defense. FXIII deficiency after trauma can lead to prolonged wound healing due to persistent infections or coagulation disorders. The aim of this study was to describe the prevalence of acquired FXIII deficiency after trauma and to provide a description of the time-course changes of important coagulation parameters in relation to FXIII activity. In this context, patient characteristics, laboratory data, and treatment modalities were examined with respect to their influence on FXIII activity. Furthermore, the effects of in vitro administration of FXIII on clot firmness and outcomes in patients with severe traumatic brain injury were investigated. PATIENTS AND METHODS Two trauma cohorts (A and B) were examined prospectively in a two-center study, and another (cohort C) was examined retrospectively. In cohort A (trauma patients, n=880) routine laboratory tests were conducted, and FXIII activity was measured. In cohort B (polytrauma patients, n=26), additional clinical parameters were collected, and in-vitro FXIII administration and rotational thromboelastometry (ROTEM) analyses were performed. In cohort C (polytrauma patients with severe traumatic brain injury [sTBI], n=84), the impact of initially measured FXIII activity on clinical outcomes after sTBI was investigated using the modified Rankin Scale (mRS) at least 6 months after trauma. RESULTS The prevalence of FXIII activity <70% in cohort A was 12.4%, with significant differences in age, Hb, fibrinogen, and Hct levels, platelet count, aPTT, and INR (vs. prevalence of FXIII activity >70%). Cohort B showed a decrease in FXIII activity from 85% to 58% after 7 days. FXIII deficiency correlated with time after trauma, aPTT, and fibrinogen level, lactate, and Hb levels. In-vitro administration of FXIII showed a positive influence on clot firmness due to improved maximum clot firmness (MCF in FIBTEM) and reduced maximum lysis (ML in EXTEM). Finally, a significant difference in FXIII activity between patients after sTBI with good and poor clinical outcomes was observed 6 months after trauma. CONCLUSION We demonstrated that trauma-associated FXIII deficiency is a common coagulation disorder, with FXIII deficiency increasing further in the first 7 days after trauma, the period of early surgical care. In vitro administration of FXIII was able to demonstrate significant clot stabilizing effects. For trauma patients with sTBI, FXIII activity could serve as a prognostic parameter, as it differed significantly between patients with good and poor clinical outcomes.
Collapse
Affiliation(s)
- Michael Hetz
- Department of Operative Medicine (DOPM), Clinic and Polyclinic for Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Tareq Juratli
- Clinic and Polyclinic for Neurosurgery, University Hospital Carl Gustav Carus of the Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Oliver Tiebel
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus of the Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Moritz Tobias Giesecke
- Department of Operative Orthopedics and Trauma Surgery, Vivantes Klinikum Spandau, Ringstraße 101B, 12203 Berlin, Germany.
| | - Serafeim Tsitsilonis
- Center for Musculoskeletal Surgery (CMSC), Charité - University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Hanns-Christoph Held
- Clinic and Polyclinic for Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus of the Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Franziska Beyer
- UniversityCenter for Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus of the Technical University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Christian Kleber
- Head of Trauma Surgery, Department of Operative Medicine (DOPM), Clinic and Polyclinic for Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig AöR, Germany.
| |
Collapse
|
19
|
Anderson J, Ebeid A, Stallwood-Hall C. Pre-hospital tracheal intubation in severe traumatic brain injury: a systematic review and meta-analysis. Br J Anaesth 2022; 129:977-984. [PMID: 36088135 DOI: 10.1016/j.bja.2022.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Severe traumatic brain injury (TBI) continues to be a leading cause of death, particularly in young adults. Severe TBI contributes to significant socioeconomic burden secondary to the long-term disability, impacting the individual and their family, and wider society. The aim of this study was to determine whether establishing a pre-hospital definitive airway was beneficial to mortality and morbidity when compared with no pre-hospital airway. METHODS A literature search for all relevant studies was performed in Medline, Embase, Cochrane, EBSCO, and Emcare databases, with studies comparing effects of pre-hospital tracheal intubation vs noninvasive airway management on mortality in non-paediatric patients with severe TBI. There were 1025 studies that had abstracts screened from this search. This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS We identified 19 studies that met inclusion criteria. The included studies identified no significant difference in mortality between pre-hospital and no pre-hospital tracheal intubation, with an odds ratio of 1.07 (95% CI, 0.72-1.57; P<0.001). The meta-analysis identified a trend favouring pre-hospital tracheal intubation with respect to long-term morbidity, with an odds ratio of 0.92 (95% CI, 0.51-1.67; P<0.001). CONCLUSIONS Management of traumatic brain injuries is a constantly evolving field, with ever-changing target parameters regarding management. There is growing evidence, based on the RCTs and recent studies, that pre-hospital tracheal intubation in patients with severe TBI is beneficial if performed by well-trained, experienced practitioners in accordance with current TBI guidelines. PROSPERO REGISTRATION CRD42021234439.
Collapse
Affiliation(s)
- Jordan Anderson
- University of London/Queen Mary, London, UK; Flinders Medical Centre, Adelaide, Australia.
| | - Annalize Ebeid
- University of London/Queen Mary, London, UK; Royal Adelaide Hospital, Adelaide, Australia
| | - Catrin Stallwood-Hall
- University of London/Queen Mary, London, UK; Flinders Medical Centre, Adelaide, Australia
| |
Collapse
|
20
|
Cavazzoni E, Boakye T. A 12-Year Audit of Neurological Outcomes Associated with Core Body Temperature >37.5°C in Children with Severe Traumatic Brain Injury. Ther Hypothermia Temp Manag 2022. [PMID: 36355047 DOI: 10.1089/ther.2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hyperthermia exposure is associated with poor neurological outcomes in patients with severe traumatic brain injury (TBI). Our aim was to describe fever in children with severe TBI admitted to a pediatric intensive care unit (PICU) for at least 72 hours and to evaluate associations between fever using a novel approach to describe thermal exposure and neurobehavioral outcomes. The cohort included children from birth to 17 years of age admitted to the PICU between 2000 and 2012 for at least 72 hours who had severe TBI with intracranial pressure monitoring. Patients with non-accidental TBI or pre-existing developmental delays were excluded. Hyperthermia was defined as a core temperature >37.5°C. Hourly temperature measurements were used to calculate the area under the curve (AUC) using the linear trapezoidal rule. Each participant was followed up at the Brain Injury Clinic 6 and 18 months postinjury. Neurobehavioral outcome scores were analyzed against AUC using standard statistical methods. Ninety-eight patients admitted with severe TBI met the study inclusion criteria. Hyperthermia/fever was common (89.7%), and patients remained hyperthermic for a median of 9.4 hours. However, no statistically significant association was found between AUC and abnormal neurological outcomes. The follow-up rates were good at 6 (86.7%) and 18 months (83.7%). The neurological deficit improved with time, with "favorable outcomes" increasing from 72% to 94% at the respective follow-up months. Our study used a novel method to describe patients' fever, providing a different indicator of thermal exposure than that previously reported. In addition, the AUC was well correlated with the maximum temperature recorded and the proportion of time >37.5°C, indicating that it is a good surrogate for thermal exposure. Interestingly, the neurological disabilities of the patients improved over time.
Collapse
Affiliation(s)
- Elena Cavazzoni
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Thomas Boakye
- Children's Critical Care Unit, Gold Coast University Hospital, Gold Coast, Australia
| |
Collapse
|
21
|
de Oliveira DV, Vieira RDCA, Pipek LZ, de Sousa RMC, de Souza CPE, Santana-Santos E, Paiva WS. Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study. J Clin Med 2022; 11:6466. [PMID: 36362693 PMCID: PMC9655294 DOI: 10.3390/jcm11216466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 04/03/2024] Open
Abstract
OBJECTIVE The presence of focal lesion (FL) after a severe traumatic brain injury is an important factor in determining morbidity and mortality. Despite this relevance, few studies show the pattern of recovery of patients with severe traumatic brain injury (TBI) with FL within one year. The objective of this study was to identify the pattern of recovery, independence to perform activities of daily living (ADL), and factors associated with mortality and unfavorable outcome at six and twelve months after severe TBI with FL. METHODOLOGY This is a prospective cohort, with data collected at admission, hospital discharge, three, six, and twelve months after TBI. RESULTS The study included 131 adults with a mean age of 34.08 years. At twelve months, 39% of the participants died, 80% were functionally independent by the Glasgow Outcome Scale Extended, 79% by the Disability Rating Scale, 79% were independent for performing ADLs by the Katz Index, and 53.9% by the Lawton Scale. Report of alcohol intake, sedation time, length of stay in intensive care (ICU LOS), Glasgow Coma Scale, trauma severity indices, hyperglycemia, blood glucose, and infection were associated with death. At six and twelve months, tachypnea, age, ICU LOS, trauma severity indices, respiratory rate, multiple radiographic injuries, and cardiac rate were associated with dependence. CONCLUSIONS Patients have satisfactory functional recovery up to twelve months after trauma, with an accentuated improvement in the first three months. Clinical and sociodemographic variables were associated with post-trauma outcomes. Almost all victims of severe TBI with focal lesions evolved to death or independence.
Collapse
Affiliation(s)
- Daniel Vieira de Oliveira
- Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil
| | | | - Leonardo Zumerkorn Pipek
- Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil
| | | | | | | | - Wellingson Silva Paiva
- Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil
| |
Collapse
|
22
|
Gao S, Treble-Barna A, Fabio A, Kelly MK, Beers SR, Rosario BL, Bell MJ, Wisniewski SR. Effects of inpatient rehabilitation after acute care on functional and quality-of-life outcomes in children with severe traumatic brain injury. Brain Inj 2022; 36:1280-1287. [PMID: 36101488 PMCID: PMC9890641 DOI: 10.1080/02699052.2022.2120211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 04/02/2022] [Accepted: 08/28/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Few studies have assessed the effectiveness of the rehabilitation process in children surviving severe traumatic brain injury (TBI). We evaluated whether receiving inpatient rehabilitation after acute hospitalization was associated with better functional outcomes compared to receiving only non-inpatient rehabilitation in children with severe TBI and explored an effect modification for Glasgow Coma Scale (GCS) score at hospital discharge. METHODS We included 254 children who received rehabilitation following severe TBI from a multinational observational study. The Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds), parent/guardian-reported and child-reported Pediatric Quality of Life Inventory (PedsQL) at 12 months post-injury were assessed and described using summary statistics. Unadjusted and propensity score-weighted linear/ordinal logistic regression modeling were also performed. RESULTS 180 children received inpatient rehabilitation and 74 children received only non-inpatient rehabilitation after acute hospitalization. Among children with a GCS<13 at discharge, those receiving inpatient rehabilitation had a more favorable GOS-E Peds score (OR = 0.12, p = 0.045). However, no such association was observed in children with a higher GCS. We found no differences in PedsQL scores between rehabilitation groups. CONCLUSIONS Future studies are warranted to confirm the benefits of inpatient rehabilitation for children with more severely impaired consciousness when medically stable.
Collapse
Affiliation(s)
- Shiyao Gao
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, USA
| | - Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, USA
| | - Anthony Fabio
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, USA
| | - M. Kathleen Kelly
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, USA
| | - Sue R. Beers
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Bedda L. Rosario
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, USA
| | - Michael J. Bell
- Department of Pediatrics, Division of Critical Care Medicine, Children’s National Hospital, Washington, D.C., USA
| | | |
Collapse
|
23
|
Pinggera D, Rhomberg P, Beer R, Thomé C, Petr O. Brain Tissue Damage Induced by Multimodal Neuromonitoring In Situ during MRI after Severe Traumatic Brain Injury: Incidence and Clinical Relevance. J Clin Med 2022; 11:jcm11113169. [PMID: 35683575 PMCID: PMC9181231 DOI: 10.3390/jcm11113169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022] Open
Abstract
Both neuromonitoring and early magnetic resonance imaging (MRI) provide crucial information for treatment management and prognosis in patients with severe traumatic brain injury (sTBI). So far, neuromonitoring in situ impedes the routine implementation of MRI due to safety concerns. We aimed to evaluate the brain tissue damage induced by inserted neuromonitoring devices and its clinical relevance. Nineteen patients with sTBI and being exposed to at least one MRI with neuromonitoring in situ and one follow-up MRI after neuromonitoring removal were analyzed. All MRIs were reviewed for specific tissue damage. Three females and sixteen males (aged 20–74 years, mean 42.8 years) with an initial median GCS of 5 (range 3–8) were analyzed. No lesion was observed in six patients (31.6%), whereas another six patients (31.6%) demonstrated a detectable probe trajectory. Probe-related tissue damage was visible in seven patients (36.8%) with the size of the lesion prone to further enlarge with increasing cumulative duration of MRI examinations. Upon interdisciplinary evaluation, the lesions were not considered clinically relevant. Neuromonitoring probes in situ during MRI examinations may cause local brain tissue damage, yet without any clinical implications if placed correctly. Therefore, indications must be strictly based on joint decision from all involved disciplines.
Collapse
Affiliation(s)
- Daniel Pinggera
- Department of Neurosurgery, Medical University Innsbruck, 6020 Innsbruck, Austria; (C.T.); (O.P.)
- Correspondence: ; Tel.: +43-512-504-27452
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Ronny Beer
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, 6020 Innsbruck, Austria; (C.T.); (O.P.)
| | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, 6020 Innsbruck, Austria; (C.T.); (O.P.)
| |
Collapse
|
24
|
Yang T, Yu J, Shen H, Yang C, Zhang P, Li Y, Wu H. Risk factors and risk nomogram model of reoperation for hemorrhages after severe traumatic brain injury craniotomy. Ibrain 2022; 8:141-147. [PMID: 37786884 PMCID: PMC10529335 DOI: 10.1002/ibra.12032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/04/2023]
Abstract
Objective This study aimed to explore the risk factors associated with reoperation for postoperative hemorrhages after severe traumatic brain injury (sTBI) craniotomy and establish a risk nomogram model. Methods A retrospective case-control study was performed. Overall, 367 patients who were diagnosed with sTBI and fulfilled the inclusion criteria were enrolled from the Department of Neurosurgery of the Affiliated Hospital of Zunyi Medical University between January 2015 and December 2020. They were divided into a reoperation group and a non-reoperation group according to whether they underwent reoperation for hemorrhages. Using univariate binary logistic regression analysis, the possible risk factors were screened. Subsequently, the independent risk factors of reoperation for postoperative hemorrhages were screened using the forward step method of multivariate binary logistic regression analysis, and a corresponding nomogram model was constructed. The receiver operative characteristic (ROC) curve was used to evaluate the reliability of the model. Finally, 30% of the data were randomly selected for internal verification of the model. Results The reoperation rate for hemorrhage after sTBI emergency craniotomy was 14.71% (54/367); multivariate logistic regression analysis showed that multiple hemorrhages (odds ratio [OR] = 4.38, 95% confidence interval [CI]: 1.815-10.587, p = 0.001), day or night surgery (OR = 0.26, 95% CI: 0.119-0.547, p < 0.001), operation duration (OR = 0.74, 95% CI: 0.119-0.547, p < 0.025), and abnormal intraoperative blood pressure fluctuation (OR = 4.15, 95% CI: 2.090-8.245, p < 0.001) were statistically significant. The sensitivity and specificity of the nomogram model were 0.815 and 0.661, respectively, and the area under ROC curve was 0.76 (95% CI: 0.705-0.833). Internal verification showed that the area under the ROC curve was 0.783 (95% CI: 0.683-0.883). Conclusions Taken together, the results of our study reveal that multiple preoperative intracranial hemorrhages, day and night operation, operation duration, and abnormal fluctuation of intraoperative blood pressure were independent risk factors for postoperative bleeding and reoperation for sTBI. Through the analysis of the influencing factors, a prediction model for the risk of bleeding and reoperation after craniocerebral trauma was developed. Compared with other relevant studies, this prediction model has good prediction efficiency and can be used to predict the occurrence of bleeding and reoperation after sTBI in patients.
Collapse
Affiliation(s)
- Tao Yang
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Jie Yu
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hao Shen
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Chao‐Zhi Yang
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Ping Zhang
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Yi Li
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Hai‐Tao Wu
- Department of NeurosurgeryAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| |
Collapse
|
25
|
Strogulski NR, Stefani MA, Böhmer AE, Hansel G, Rodolphi MS, Kopczynski A, de Oliveira VG, Stefani ET, Portela JV, Schmidt AP, Oses JP, Smith DH, Portela LV. Cerebrospinal fluid purinomics as a biomarker approach to predict outcome after severe traumatic brain injury. J Neurochem 2022; 161:173-186. [PMID: 35157328 PMCID: PMC9035090 DOI: 10.1111/jnc.15590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 11/27/2022]
Abstract
Severe traumatic brain injury (TBI) is associated with high rates of mortality and long-term disability linked to neurochemical abnormalities. Although purine-derivatives play important roles in TBI pathogenesis in preclinical models, little is known about potential changes in purine levels and their implications in human TBI. We assessed cerebrospinal fluid (CSF) levels of purines in severe TBI patients as potential biomarkers that predict mortality and long-term dysfunction. This was a cross-sectional study performed in 17 severe TBI patients (Glasgow Coma Scale < 8) and 51 controls. Two to four hours after admission to ICU, patients were submitted to ventricular drainage and CSF collection for quantification of adenine and guanine purine-derivatives by HPLC. TBI patients survival was followed up to 3 days from admission. A neurofunctional assessment was performed through the modified Rankin Scale (mRS) two years after ICU admission. Purine levels were compared between control and TBI patients, and between surviving and non-surviving patients. Relative to controls, TBI patients presented increased CSF levels of GDP, guanosine, adenosine, inosine, hypoxanthine, and xanthine. Further, GTP, GDP, IMP, and xanthine levels were different between surviving and non-surviving patients. Among the purines, guanosine was associated with improved mRS (p=0.042; r= -0.506). Remarkably, GTP displayed predictive value (AUC=0.841, p=0.024) for discriminating survival vs. non-survival patients up to three days from admission. These results support TBI-specific purine signatures, suggesting GTP as a promising biomarker of mortality, and guanosine as an indicator of long-term functional disability.
Collapse
Affiliation(s)
- Nathan R Strogulski
- Laboratory of Neurotrauma e Biomarkers, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marco Antonio Stefani
- Laboratory of Neuroanatomy, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Ana Elisa Böhmer
- Laboratory of Neurotrauma e Biomarkers, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Gisele Hansel
- Neuroinflammation and Neuroimmunology Laboratory, Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Marcelo S Rodolphi
- Laboratory of Neurotrauma e Biomarkers, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Afonso Kopczynski
- Laboratory of Neurotrauma e Biomarkers, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Vitória G de Oliveira
- Laboratory of Neurotrauma e Biomarkers, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Eduarda T Stefani
- Laboratory of Neuroanatomy, Departamento de Ciências Morfológicas, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Juliana V Portela
- Laboratory of Neurotrauma e Biomarkers, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - André P Schmidt
- Laboratory of Neurotrauma e Biomarkers, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Department of Anesthesia and Perioperative Medicine, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil. Department of Anesthesia, Santa Casa de Porto Alegre, Universidade Federal de Ciências Médicas de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil. Department of Anesthesia, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil
| | - Jean Pierre Oses
- Programa de Pós-Graduação em Ciências Fisiológicas, Instituto de Ciências Biológicas, Universidade Federal do Rio Grande, Rio Grande, RS, Brazil
| | - Douglas H Smith
- Penn Center for Brain Injury and Repair and Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Luis V Portela
- Laboratory of Neurotrauma e Biomarkers, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| |
Collapse
|
26
|
Ahmed N, Kuo Y, Shin S. OCTOGENARIAN' SURVIVAL AFTER NEUROSURGICAL PROCEDURES FOLLOWING SEVERE HEAD TRAUMA. World Neurosurg 2021; 159:e425-e430. [PMID: 34954056 DOI: 10.1016/j.wneu.2021.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fall is a common phenomenon in advanced age and can result in severe traumatic brain injury (TBI). The purpose of the study is to find the survival benefit from aggressive operative intervention. METHOD Trauma quality improvement program (TQIP) database of 2013-2016 was accessed for the study. All patients 80 -89 years old and who sustained severe TBI with Glasgow Coma Scale (GCS) ≤8 and brain Abbreviated Injury Scale (AIS) score ≥3 and underwent operative intervention, craniotomy or craniectomy, were included in the study. Patients were divided into two groups, survivors and deceased, were compared on characteristics, injury severity score (ISS), types of intracranial hemorrhage and comorbidities. Multivariable logistic regression analysis was performed to find the factors associated with survival. A receiving operative characteristic (ROC) curve was created to test the model and area under the curve (AUC) was calculated. RESULTS Out of 1266 patients who qualified for the study, only 477 (37.68%) patients survived. Lower ISS, higher GCS and no history of coagulopathy had higher chances of survival. Operative intervention in epidural hematoma (EDH), brain contusion and Subdural hematoma (SDH) were associated with 3.5, 2.25 and 1.86 odds of survival respectively. Procedure type, craniectomy or craniotomy did not impact the outcome. The AUC was 0.723 [95% CI: 0.694-0.752] CONCLUSION: The octogenarians who underwent craniotomy or craniectomy for severe TBI following a fall had very high mortality. Lower ISS, higher GCS and no history of coagulopathy, and evacuation of SDH, EDH, brain contusion found to have higher probability of survival.
Collapse
Affiliation(s)
- Nasim Ahmed
- Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune NJ USA; Professor of Surgery, Hackensack Meridian School of Medicine, Nutley, NJ. USA.
| | - YenHong Kuo
- Office of Research Administration, Jersey Shore University Medical Center, Neptune NJ USA
| | - SeungHoon Shin
- Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune NJ USA
| |
Collapse
|
27
|
Duan L, Wang C, Wang X, Wang A, Xu T, Peng X, Gao Z. Evaluation of the hyperbaric oxygen therapy on the flash visual evoked potential P2 in patients with severe traumatic brain injury. NeuroRehabilitation 2021; 50:101-104. [PMID: 34776420 DOI: 10.3233/nre-210165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies have shown that hyperbaric oxygen therapy (HBOT) can improve the extraction rate and latency of cortical evoked potential N20 in patients with severe traumatic brain injury, but there are only a few studies on the effect of flash visual evoked potential. OBJECTIVE This study investigated the effect of hyperbaric oxygen therapy on the P2 wave of flash visual evoked potentials in patients with severe traumatic brain injury. METHODS In total, we examined 40 TBI patients who received HBOT, in combination with medication, and 38 TBI patients who received medication alone. The FVEPs apparatus was used to detect the P2 wave extraction rate and the latency of the elicited waveform before and after treatment in both the medicated-only controls and HBOT-treated cohorts. RESULTS Compared with the control group, the HBOT treatment group showed a higher P2 wave elicitation rate, and the P2 wave latency of the HBOT treatment group was significantly shortened (p < 0.05, all). CONCLUSIONS HBOT, in combination with drug therapy, can significantly increase the P2 wave extraction rate and shorten P2 latency in patients with TBI.
Collapse
Affiliation(s)
- Lei Duan
- Nanjing Zijin Hospital, Nanjing, Jiangsu, China
| | | | - Xia Wang
- Nanjing Zijin Hospital, Nanjing, Jiangsu, China
| | - Aiping Wang
- Nanjing Zijin Hospital, Nanjing, Jiangsu, China
| | - Tingting Xu
- Nanjing Zijin Hospital, Nanjing, Jiangsu, China
| | | | | |
Collapse
|
28
|
Gao S, Fabio A, Rosario BL, Kelly MK, Beers SR, Bell MJ, Wisniewski SR. Characteristics Associated with the Use of an Inpatient Rehabilitation or Skilled Nursing Facility after Acute Care in Children with Severe Traumatic Brain Injury. Dev Neurorehabil 2021; 24:466-477. [PMID: 33872126 PMCID: PMC8429094 DOI: 10.1080/17518423.2021.1908441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To characterize inpatient rehabilitation services for children with severe traumatic brain injury (TBI), we included 254 children, whose parents/guardians reported receipt of rehabilitation within a 12-month follow-up period, from a multinational observational study. Children discharged to an inpatient rehabilitation or skilled nursing facility after acute care were classified into the "inpatient rehabilitation" group, and children discharged home after acute care were classified into the "non-inpatient rehabilitation" group. Multivariable regression analyses determined the associations of sociodemographic and clinical characteristics with rehabilitation groups. Children receiving inpatient rehabilitation had a shorter length of acute hospitalization. Children from the UK were less likely to receive inpatient rehabilitation compared to children from the US. Future studies are warranted to extend current findings by identifying the reasons behind differential access to inpatient rehabilitation among children with severe TBI.
Collapse
Affiliation(s)
- Shiyao Gao
- Epidemiology Data Center, University of Pittsburgh
| | | | | | | | - Sue R. Beers
- Department of Psychiatry, University of Pittsburgh
| | - Michael J. Bell
- Department of Pediatrics, Division of Critical Care Medicine, Children’s National Hospital
| | | |
Collapse
|
29
|
Ismail MI, Idris Z, Abdullah JM, Rahman NAA, Nordin M. Comparing the Outcomes of Early and Late Tracheostomy in Severe Traumatic Brain Injury Patient. Malays J Med Sci 2021; 28:63-70. [PMID: 34512131 PMCID: PMC8407789 DOI: 10.21315/mjms2021.28.4.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/01/2021] [Indexed: 11/04/2022] Open
Abstract
Background Patients with severe traumatic brain injury (TBI) were expected to have poor Glasgow Coma Scale (GCS) recovery and prolonged intubation. Therefore, an early tracheostomy procedure was indicated for all severe TBI. In view of growing concern regarding the safety and outcome of early tracheostomy on these patients, it was deemed valid and needed to be addressed. Methods This study was conducted to compare the outcomes of early and late tracheostomies in severe TBI. Only severe TBI patients who were admitted to the Neurosurgery High Dependency Unit (NHDU), Hospital Sultanah Aminah (HSA), Johor Bahru, Johor, Malaysia and who had underwent a tracheostomy were recruited. Three main outcomes noted: duration on ventilation, length of NHDU stay and rate of ventilator associated pneumonia (VAP). Results Out of 155 patients, 72 (46.5%) were in early tracheostomy group (ETG) and 83 (53.5%) were in late tracheostomy group (LTG). The majority of the participants, 95 (61.3%) were ethnic Malays. The mean duration on ventilator use was 2.65 days (1.57) for ETG and 5.63 days (2.35) for LTG. While, mean NHDU stay was 4.75 days (1.98) for ETG and 9.77 days (2.70) for LTG. Upon independent t-test, early duration of tracheostomies had shown significant outcome in reducing length of NHDU stay, (P < 0.001) and had shortening participants’ time on mechanical ventilator (P < 0.001). Then, based on forward multiple logistic regression test, there were significant association between comorbid (P = 0.003) and tracheostomy (P = 0.020) towards presence of VAP when adjusted for other variables. Conclusion In this study it was found that early tracheostomy was significant in shortening the duration on ventilator, reducing the length of NHDU stay and reducing the rate of VAP.
Collapse
Affiliation(s)
- Muhammad Ihfaz Ismail
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Neurosurgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Brain Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Noor Azman A Rahman
- Department of Neurosurgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - Mazin Nordin
- Department of Radiology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| |
Collapse
|
30
|
Mishra T, Kishore K, Jayan M, Thaploo D, Shanbhag NC, Bhat DI, Shukla DP, Konar SK, Devi BI, Hutchinson PJ. When the Bone Flap Expands Like Bellows of Accordion: Feasibility Study Using Novel Technique of Expansile (Hinge) Craniotomy for Severe Traumatic Brain Injury. Neurol India 2021; 69:973-978. [PMID: 34507424 DOI: 10.4103/0028-3886.325310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Decompressive craniectomy (DC) is a rescue operation performed for reduction of intracranial pressure due to progressive brain swelling, mandating the need for cranioplasty. Objective To describe expansile craniotomy (EC) as a noninferior technique that may be effectively utilized in situations requiring standard DC. Materials and Methods A decision to perform DC or EC was taken by consecutively allocation to either of the procedures. The bone flap was divided into three pieces, which were tied loosely to each other and to the skull using silk threads. The primary outcome included functional assessment using Glasgow outcome scale (GOS) score at 1 year. Results and Conclusions Total 67 patients were included in the analyses, of which, 31 underwent EC and 36 underwent DC. Both the cohorts were matched in terms of baseline determinants for age, Glasgow coma scale, and Rotterdam score at admission. There was no significant difference in GOS scores and the extent of volume expansion obtained by EC as compared to DC. Complication rates though less in EC group did not differ significantly between the groups. EC appears to be the safe and effective alternative to DC in the management of brain swelling due to TBI with a potential to obviate the need of cranioplasty.
Collapse
Affiliation(s)
- Tejesh Mishra
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Kislay Kishore
- Department of Neurosurgery; Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Mini Jayan
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Divesh Thaploo
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India; Department of Otorhinolaryngology, Smell and Taste Clinic, TU Dresden, Germany
| | - Nagesh C Shanbhag
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India; Department of Experimental Medical Science, Biomedical Centre, Lund University, Lund, Sweden
| | - Dhananjaya I Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom; RV Aster Hospital, Bangalore, Karnataka, India
| | - Dhaval P Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Subhas K Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Bhagavatula I Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Peter J Hutchinson
- NIHR Global Health Research Group on Neurotrauma; Department of Clinical Neurosciences, University of Cambridge; Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| |
Collapse
|
31
|
Daia C, Scheau C, Spinu A, Andone I, Popescu C, Toader C, Bumbea AM, Verenca MC, Onose G. Modulated Neuroprotection in Unresponsive Wakefulness Syndrome after Severe Traumatic Brain Injury. Brain Sci 2021; 11:1044. [PMID: 34439663 DOI: 10.3390/brainsci11081044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background: We aimed to assess the effects of modulated neuroprotection with intermittent administration in patients with unresponsive wakefulness syndrome (UWS) after severe traumatic brain injury (TBI). Methods: Retrospective analysis of 60 patients divided into two groups, with and without neuroprotective treatment with Actovegin, Cerebrolysin, pyritinol, L-phosphothreonine, L-glutamine, hydroxocobalamin, alpha-lipoic acid, carotene, DL-α-tocopherol, ascorbic acid, thiamine, pyridoxine, cyanocobalamin, Q 10 coenzyme, and L-carnitine alongside standard treatment. Main outcome measures: Glasgow Coma Scale (GCS) after TBI, Extended Glasgow Coma Scale (GOS E), Disability Rankin Scale (DRS), Functional Independence Measurement (FIM), and Montreal Cognitive Assessment (MOCA), all assessed at 1, 3, 6, 12, and 24 months after TBI. Results: Patients receiving neuroprotective treatment recovered more rapidly from UWS than controls (p = 0.007) passing through a state of minimal consciousness and gradually progressing until the final evaluation (p = 0.000), towards a high cognitive level MOCA = 22 ± 6 points, upper moderate disability GOS-E = 6 ± 1, DRS = 6 ± 4, and an assisted gait, FIM =101 ± 25. The improvement in cognitive and physical functioning was strongly correlated with lower UWS duration (−0.8532) and higher GCS score (0.9803). Conclusion: Modulated long-term neuroprotection may be the therapeutic key for patients to overcome UWS after severe TBI.
Collapse
|
32
|
Kajiwara S, Hasegawa Y, Negoto T, Orito K, Kawano T, Yoshitomi M, Sakata K, Takeshige N, Yamakawa Y, Jono H, Saito H, Hirayu N, Takasu O, Hirohata M, Morioka M. Efficacy of a Novel Prophylactic Barbiturate Therapy for Severe Traumatic Brain Injuries: Step-down Infusion of a Barbiturate with Normothermia. Neurol Med Chir (Tokyo) 2021; 61:528-535. [PMID: 34078830 PMCID: PMC8443969 DOI: 10.2176/nmc.oa.2021-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study aimed to examine the beneficial effects of a novel prophylactic barbiturate therapy, step-down infusion of barbiturates, using thiamylal with normothermia (NOR+sdB), on the poor outcome in the patients with severe traumatic brain injuries (sTBI), in comparison with mild hypothermia (MD-HYPO). From January 2000 to March 2019, 4133 patients with TBI were admitted to our hospital. The inclusion criteria were: a Glasgow coma scale (GCS) score of ≤8 on admission, age between 20 and 80 years, intracranial hematoma requiring surgical evacuation of the hematoma with craniotomy and/or external decompression, and patients who underwent management of body temperature and assessed their outcome at 6-12 months. Finally, 43 patients were included in the MD-HYPO (n = 29) and NOR+sdB (n = 14) groups. sdB was initiated intraoperatively or immediately after the surgical treatment. There were no significant differences in patient characteristics, including age, sex, past medical history, GCS on admission, type of intracranial hematoma, and length of hospitalization between the two groups. Although NOR+sdB could not improve the patient's poor outcome either at discharge from the intensive care unit (ICU) or at 6-12 months after admission, the treatment inhibited composite death at discharge from the ICU. The mean value of the maximum intracranial pressure (ICP) in the NOR+sdB group was <20 mmHg throughout the first 120 h. NOR+sdB prevented composite death in the ICU in patients with sTBI, and we may obtain novel insights into the beneficial role of prophylactic barbiturate therapy from suppression of the elevated ICP during the first 120 h.
Collapse
Affiliation(s)
- Sosho Kajiwara
- Department of Neurosurgery, Kurume University School of Medicine
| | - Yu Hasegawa
- Department of Neurosurgery, Kurume University School of Medicine.,Department of Pharmaceutical Sciences, International University of Health and Welfare
| | - Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine
| | - Kimihiko Orito
- Department of Neurosurgery, Kurume University School of Medicine
| | - Takayuki Kawano
- Department of Neurosurgery, Kurume University School of Medicine
| | | | - Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine
| | | | | | - Hirofumi Jono
- Department of Pharmacy, Kumamoto University Hospital
| | | | - Nobuhisa Hirayu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine
| | - Osamu Takasu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine
| | - Masaru Hirohata
- Department of Neurosurgery, Kurume University School of Medicine
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine
| |
Collapse
|
33
|
Hoffman H, Abi-Aad K, Bunch KM, Beutler T, Otite FO, Chin LS. Outcomes associated with brain tissue oxygen monitoring in patients with severe traumatic brain injury undergoing intracranial pressure monitoring. J Neurosurg 2021; 135:1799-1806. [PMID: 34852324 DOI: 10.3171/2020.11.jns203739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Brain tissue oxygen monitoring combined with intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (sTBI) may confer better outcomes than ICP monitoring alone. The authors sought to investigate this using a national database. METHODS The National Trauma Data Bank from 2013 to 2017 was queried to identify patients with sTBI who had an external ventricular drain or intraparenchymal ICP monitor placed. Patients were stratified according to the placement of an intraparenchymal brain tissue oxygen tension (PbtO2) monitor, and a 2:1 propensity score matching pair was used to compare outcomes in patients with and those without PbtO2 monitoring. Sensitivity analyses were performed using the entire cohort, and each model was adjusted for age, sex, Glasgow Coma Scale score, Injury Severity Score, presence of hypotension, insurance, race, and hospital teaching status. The primary outcome of interest was in-hospital mortality, and secondary outcomes included ICU length of stay (LOS) and overall LOS. RESULTS A total of 3421 patients with sTBI who underwent ICP monitoring were identified. Of these, 155 (4.5%) patients had a PbtO2 monitor placed. Among the propensity score-matched patients, mortality occurred in 35.4% of patients without oxygen monitoring and 23.4% of patients with oxygen monitoring (OR 0.53, 95% CI 0.33-0.85; p = 0.007). The unfavorable discharge rates were 56.3% and 47.4%, respectively, in patients with and those without oxygen monitoring (OR 1.41, 95% CI 0.87-2.30; p = 0.168). There was no difference in overall LOS, but patients with PbtO2 monitoring had a significantly longer ICU LOS and duration of mechanical ventilation. In the sensitivity analysis, PbtO2 monitoring was associated with decreased odds of mortality (OR 0.56, 95% CI 0.37-0.84) but higher odds of unfavorable discharge (OR 1.59, 95% CI 1.06-2.40). CONCLUSIONS When combined with ICP monitoring, PbtO2 monitoring was associated with lower inpatient mortality for patients with sTBI. This supports the findings of the recent Brain Oxygen Optimization in Severe Traumatic Brain Injury phase 2 (BOOST 2) trial and highlights the importance of the ongoing BOOST3 trial.
Collapse
Affiliation(s)
| | | | | | - Timothy Beutler
- Departments of1Neurosurgery.,3Neurology, State University of New York Upstate Medical University, Syracuse, New York
| | - Fadar O Otite
- 3Neurology, State University of New York Upstate Medical University, Syracuse, New York
| | | |
Collapse
|
34
|
Wang Z, Winans NJ, Zhao Z, Cosgrove ME, Gammel T, Saadon JR, Mani R, Ravi B, Fiore SM, Mikell CB, Mofakham S. Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness. Front Surg 2021; 8:627008. [PMID: 33968974 PMCID: PMC8097005 DOI: 10.3389/fsurg.2021.627008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: Severe traumatic brain injury (sTBI) often results in disorders of consciousness. Patients emerging from coma frequently exhibit aberrant behaviors such as agitation. These non-purposeful combative behaviors can interfere with medical care. Interestingly, agitation is associated with arousal and is often among the first signs of neurological recovery. A better understanding of these behaviors may shed light on the mechanisms driving the return of consciousness in sTBI patients. This study aims to investigate the association between posttraumatic agitation and the recovery of consciousness. Methods: A retrospective chart review was conducted in 530 adult patients (29.1% female) admitted to Stony Brook University Hospital between January 2011 and December 2019 with a diagnosis of sTBI and Glasgow Coma Scale (GCS) ≤8. Agitation was defined as a Richmond Agitation Sedation Scale (RASS) > +1, or any documentation of equivalently combative and violent behaviors in daily clinical notes. The ability to follow verbal commands was used to define the recovery of consciousness and was assessed daily. Results: Of 530 total sTBI patients, 308 (58.1%) survived. Agitation was present in 169 of all patients and 162 (52.6%) of surviving patients. A total of 273 patients followed commands, and 159 of them developed agitation. Forty patients developed agitation on hospital arrival whereas 119 developed agitation later during their hospital course. Presence of in-hospital agitation positively correlated with command-following (r = 0.315, p < 0.001). The time to develop agitation and time to follow commands showed positive correlation (r = 0.485, p < 0.001). These two events occurred within 3 days in 54 (44.6%) patients, within 7 days in 81 (67.8%) patients, and within 14 days in 96 (80.2%) patients. In 71 (59.7%) patients, agitation developed before command-following; in 36 (30.2%) patients, agitation developed after command-following; in 12 (10.1%) patients, agitation developed on the same day as command-following. Conclusion: Posttraumatic agitation in comatose patients following sTBI is temporally associated with the recovery of consciousness. This behavior indicates the potential for recovery of higher neurological functioning. Further studies are required to identify neural correlates of posttraumatic agitation and recovery of consciousness after sTBI.
Collapse
Affiliation(s)
- Zhe Wang
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Nathan J Winans
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States.,Department of Neurological Surgery, Columbia University Medical Center, New York, NY, United States
| | - Zirun Zhao
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Megan E Cosgrove
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Theresa Gammel
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Jordan R Saadon
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Racheed Mani
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Bharadwaj Ravi
- Department of Neurobiology and Behavior, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Susan M Fiore
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Charles B Mikell
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Sima Mofakham
- Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| |
Collapse
|
35
|
Câmara-Costa H, Viot S, Francillette L, Opatowski M, Toure H, Brugel D, Laurent-Vannier A, Meyer P, Watier L, Dellatolas G, Chevignard M. Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l'Enfant study. J Neuropsychol 2021; 16:183-210. [PMID: 33856121 DOI: 10.1111/jnp.12247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore memory functioning 7 years after severe paediatric traumatic brain injury (TBI), associated factors, and relationships with other outcomes. METHOD Children aged 0-15 years (n = 65), consecutively admitted over a 3-year period in a single trauma centre, who survived after severe non-inflicted TBI, were included in a prospective longitudinal study. Memory assessments were performed 7 years post-injury using the Children's Memory Scale or the Wechsler Memory Scale (WMS IV), according to age. The General Memory Score (GMS-7) was the primary outcome. RESULTS Thirty-seven patients were available for assessment at 7 years post-injury. Mean GMS-7 was in the low average range (M = 84.9, SD = 12.1). Lower GMS-7 was significantly associated with markers of higher injury severity, such as length of coma. One year post-injury functional and disability outcomes explained 74% of the variance of GMS-7. Concurrent intellectual ability and type of ongoing education correlated strongly with GMS-7. Age at injury and parental education were not associated with memory outcome. CONCLUSIONS Memory functioning is variable but often strongly impaired several years after severe paediatric TBI, and is mostly related to injury severity, functional outcomes measured 1 year post-injury, and concomitant cognitive and educational outcomes. GMS-7 was lower at 7 years than one year post-injury, supporting the importance of long term follow-up.
Collapse
Affiliation(s)
- Hugo Câmara-Costa
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCre), Paris, France
| | - Solène Viot
- Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France.,Physical and Rehabilitation Medicine Unit, Bordeaux University Hospital, Bordeaux, France
| | - Leila Francillette
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France
| | - Marion Opatowski
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM. UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Hanna Toure
- Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Dominique Brugel
- Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Anne Laurent-Vannier
- Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| | - Philippe Meyer
- Pediatric Anesthesiology Department, Hôpital Necker Enfants Malades, Paris, France.,Faculté de Médecine René Descartes, Université Paris 5, Paris, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM. UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Georges Dellatolas
- Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCre), Paris, France
| | - Mathilde Chevignard
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCre), Paris, France.,Rehabilitation Department for Children with Acquired Brain Injury, and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France
| |
Collapse
|
36
|
Luo J, Xia Z, Che Y, Zhou K. Characteristics, treatments, and prognosis of a critical illness polyneuromyopathy patient with positive anti-GM1 after severe traumatic brain injury: A case report. Clin Exp Pharmacol Physiol 2021; 48:831-836. [PMID: 33715175 DOI: 10.1111/1440-1681.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/01/2020] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Abstract
To investigate the clinical features, treatment and prognosis of critical illness polyneuromyopathy (CIPNM) in patients with severe traumatic brain injury (sTBI) who had positive anti-ganglioside GM1 (anti-GM1) antibody IgG. A case of CIPNM with positive anti-GM1 antibody IgG was retrospectively analysed and followed-up for 30 months. After 1 week of treatment with large dose of short-term glucocorticoid and human immunoglobulin, the muscle strength of both lower extremities was restored to grade 1. Three months later, the muscle strength and muscle tension of the patient's limbs returned to normal except for grade 3 of bilateral dorsal extensor muscle strength. In addition, the patient can walk alone with a waddling gait. After 30 months, there was no recurrence. The application of large dose of short-term glucocorticoid and human immunoglobulin to CIPNM that are positive for anti-GM1 antibodies may be an effective treatment.
Collapse
Affiliation(s)
- Jiemin Luo
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, China
| | - Zhiyuan Xia
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, China
| | - Yanjun Che
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, China.,Department of NSICU, Jingjiang People's Hospital, Jingjiang, China
| | - Ke Zhou
- Department of Neurosurgery, Jingjiang People's Hospital, Jingjiang, China
| |
Collapse
|
37
|
Godoy DA, Badenes R, Robba C, Murillo Cabezas F. Hyperventilation in Severe Traumatic Brain Injury Has Something Changed in the Last Decade or Uncertainty Continues? A Brief Review. Front Neurol 2021; 12:573237. [PMID: 33776876 PMCID: PMC7991081 DOI: 10.3389/fneur.2021.573237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Daniel Agustín Godoy
- Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina.,Intensive Care Unit, Hospital San Juan Bautista, Catamarca, Argentina
| | - Rafael Badenes
- Department Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari de Valencia, Valencia, Spain.,Department of Surgery, University of Valencia, Valencia, Spain.,INCLIVA Research Medical Institute, Valencia, Spain
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for Oncology and Neuroscience, Genoa, Italy.,School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | | |
Collapse
|
38
|
Wang YR, Zheng QB, Wei GF, Meng LJ, Feng QL, Yuan WJ, Ou JL, Liu WL, Li Y. Elevated PCT at ICU discharge predicts poor prognosis in patients with severe traumatic brain injury: a retrospective cohort study. J Int Med Res 2021; 48:300060520922456. [PMID: 32368956 PMCID: PMC7218983 DOI: 10.1177/0300060520922456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose Disease severity and inflammatory response status are closely related to a
poor prognosis and must be assessed in patients with severe traumatic brain
injury (STBI) before intensive care unit (ICU) discharge. Whether elevated
serum procalcitonin (PCT) levels can predict a poor prognosis in STBI
patients before ICU discharge is unclear. Methods This retrospective observational cohort study enrolled 199 STBI patients who
were in the ICU for at least 48 hours and survived after discharge. Based on
serum PCT levels at discharge, patients were divided into the high-PCT group
(PCT ≥ 0.25 ng/mL) and the low-PCT group (PCT < 0.25 ng/mL). We assessed
the relationship between serum PCT levels and a poor prognosis. Results The high-PCT group had a higher rate of adverse outcomes compared with the
low-PCT group. Multivariate logistic regression analysis showed that the
Acute Physiology and Chronic Health Evaluation II (APACHE II) score,
Sequential Organ Failure Assessment (SOFA) score, white blood cell (WBC)
count, C-reactive protein (CRP) level, and PCT level at discharge were
significantly associated with adverse outcomes. Conclusions Elevated PCT levels at ICU discharge were associated with a poor prognosis in
STBI patients. The serum PCT level as a single indicator has limited value
for clinical decision-making.
Collapse
Affiliation(s)
- Yu-Rong Wang
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qing-Bin Zheng
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Guang-Fa Wei
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Li-Jun Meng
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qing-Ling Feng
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wen-Jie Yuan
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jin-Lei Ou
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wei-Li Liu
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yong Li
- Department of Critical Care Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| |
Collapse
|
39
|
Zhao S, Xu D, Li R, Zou Q, Chen Z, Wang H, He X. [Clinical efficacy of restrictive fluid management in patients with severe traumatic brain injury]. Nan Fang Yi Ke Da Xue Xue Bao 2021; 41:111-115. [PMID: 33509762 DOI: 10.12122/j.issn.1673-4254.2021.01.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the effects of restrictive fluid management in patients with severe traumatic brain injury (sTBI). METHODS Between January, 2019 and June, 2020, we randomly assigned 51 postoperative patients (stay in the ICU of no less than 7 days) with sTBI into treatment group (n=25) with restrictive fluid management and the control group (n=26) with conventional fluid management. The data of optic nerve sheath diameter (ONSD), middle cerebral artery pulsatility index (MAC- PI), neuron-specific enolase (NSE) level, inferior vena cava (IVC) diameter, Glascow Coma Scale (GCS) score, mean arterial blood pressure, heart rate, and fluid balance of the patients were collected at ICU admission and at 1, 3 and 7 days after ICU admission, and the duration of mechanical ventilation, ICU stay, and 28-day mortality were recorded. RESULTS The cumulative fluid balance of the two groups were positive on day 1 and negative on days 3 and 7 after ICU admission; at the same time points, the patients in the treatment group had significantly greater negative fluid balance than those in the control group (P < 0.05). In both of the groups, the ONSD and MCA-PI values were significantly higher on day 1 than the baseline (P < 0.05), reached the peak levels on day 3, and decreased on day 7; at the same time point, these values were significantly lower in the treatment group than in the control group (P < 0.05). No significant difference was found in NSE level on day 1 between the two groups (P>0.05); on day 3, NSE level reached the peak level and was significantly higher in the control group (P < 0.05); on day 7, NSE level was lowered the level of day 1 in the treatment group but remained higher than day 1 level in the control group. The 28-day mortality rate did not differ significantly between the two groups (16.00% vs 23.08%, P>0.05); the duration of mechanical ventilation, length of ICU stay, and the number of tracheotomy were all significantly shorter or lower in the treatment group than in the control group (P < 0.05). CONCLUSIONS Restrictive fluid management can reduce cerebral edema and improve the prognosis but does not affect the 28-day mortality of patients with sTBI.
Collapse
Affiliation(s)
- Shibing Zhao
- Department of Critical Medicine, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - Decai Xu
- Department of Neurosurgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - Rui Li
- Department of Critical Medicine, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - Qi Zou
- Department of Critical Medicine, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - Zhenzhen Chen
- Department of Critical Medicine, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - Huaxue Wang
- Department of Critical Medicine, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - Xiandi He
- Department of Critical Medicine, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| |
Collapse
|
40
|
Lenstra JJ, Kuznecova-Keppel Hesselink L, la Bastide-van Gemert S, Jacobs B, Nijsten MWN, van der Horst ICC, van der Naalt J. The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury. Front Neurol 2021; 11:597737. [PMID: 33488498 PMCID: PMC7819976 DOI: 10.3389/fneur.2020.597737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to evaluate the frequency of electrocardiographic (ECG) abnormalities in the acute phase of severe traumatic brain injury (TBI) and the association with brain injury severity and outcome. In contrast to neurovascular diseases, sparse information is available on this issue. Data of adult patients with severe TBI admitted to the Intensive Care Unit (ICU) for intracranial pressure monitoring of a level-1 trauma center from 2002 till 2018 were analyzed. Patients with a cardiac history were excluded. An ECG recording was obtained within 24 h after ICU admission. Admission brain computerized tomography (CT)-scans were categorized by Marshall-criteria (diffuse vs. mass lesions) and for location of traumatic lesions. CT-characteristics and maximum Therapy Intensity Level (TILmax) were used as indicators for brain injury severity. We analyzed data of 198 patients, mean (SD) age of 40 ± 19 years, median GCS score 3 [interquartile range (IQR) 3–6], and 105 patients (53%) had thoracic injury. In-hospital mortality was 30%, with sudden death by cardiac arrest in four patients. The incidence of ECG abnormalities was 88% comprising ventricular repolarization disorders (57%) mostly with ST-segment abnormalities, conduction disorders (45%) mostly with QTc-prolongation, and arrhythmias (38%) mostly of supraventricular origin. More cardiac arrhythmias were observed with increased grading of diffuse brain injury (p = 0.042) or in patients treated with hyperosmolar therapy (TILmax) (65%, p = 0.022). No association was found between ECG abnormalities and location of brain lesions nor with thoracic injury. Multivariate analysis with baseline outcome predictors showed that cardiac arrhythmias were not independently associated with in-hospital mortality (p = 0.097). Only hypotension (p = 0.029) and diffuse brain injury (p = 0.017) were associated with in-hospital mortality. In conclusion, a high incidence of ECG abnormalities was observed in patients with severe TBI in the acute phase after injury. No association between ECG abnormalities and location of brain lesions or presence of thoracic injury was present. Cardiac arrhythmias were indicative for brain injury severity but not independently associated with in-hospital mortality. Therefore, our findings likely suggest that ECG abnormalities should be considered as cardiac mimicry representing the secondary effect of traumatic brain injury allowing for a more rationale use of neuroprotective measures.
Collapse
Affiliation(s)
- Jelmer-Joost Lenstra
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Sacha la Bastide-van Gemert
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bram Jacobs
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
41
|
Xiong W, Qian K. Low-Protein, Hypocaloric Nutrition with Glutamine versus Full-Feeding in the Acute Phase in ICU Patients with Severe Traumatic Brain Injury. Neuropsychiatr Dis Treat 2021; 17:703-710. [PMID: 33688193 PMCID: PMC7936715 DOI: 10.2147/ndt.s296296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the 28-day mortality, the length of ICU stay, days in the hospital, days of ventilator use, adverse events, and nosocomial infection events of low-protein, hypocaloric nutrition with glutamine in the first 7 days of the intensive care unit (ICU) patients with severe traumatic brain injury (STBI). PATIENTS AND METHODS A total of 53 patients diagnosed with STBI enrolled from the third affiliated hospital of Nanchang University (Nanchang, China), from January 2019 to July 2020, were divided into two groups. We performed a randomized prospective controlled trial. The intervention group (n=27) was nutritional supported (intestinal or parenteral) with a caloric capacity of 20-40% of European Conference on Clinical Nutrition and Metabolism (ESPEN) recommendations; specifically, low-protein intake was 0.5-0.7g/kg per day (containing the amount of alanyl-glutamine), glutamine was 0.3 g/kg per day, and the intervention treatment lasted for 7 days. The control group (n=26) was nutritionally supported with a caloric capacity of 70-100% of ESPEN recommendations, and the protein intake was 1.2-1.7 g/kg per day. The primary endpoint was 28-day mortality. Secondary endpoints were the length of ICU stay, days in the hospital, days of ventilator use, adverse events and nosocomial infection events. RESULTS There were no differences in baseline characteristics between groups. Survival curve analysis using the Kaplan-Meier method revealed no significant difference in 28-day mortality between the two groups (P=0.31) while adverse events (χ 2= 5.853, P=0.016), nosocomial infection rate (χ 2 = 4.316, P=0.038), the length of ICU stay (t=-2.617, P=0.012), hospitalization time (t=-2.169, P=0.036), and days of ventilator use (t=-2.144,P=0.037) of patients in the intervention group were significantly lower than those in the control group. CONCLUSION Low-protein, hypocaloric nutrition with glutamine did not show different outcomes in 28-day mortality compared to full-feeding nutritional support in the ICU patients with STBI. However, low-protein, hypocaloric nutrition with glutamine could provide a lower need for ICU time, hospitalization time, and ventilator time in the ICU patients with STBI.
Collapse
Affiliation(s)
- Weichuan Xiong
- Department of Critical Care Medicine, The Third Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China.,Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - KeJian Qian
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| |
Collapse
|
42
|
Lazzarino G, Amorini AM, Barnes NM, Bruce L, Mordente A, Lazzarino G, Pietro VD, Tavazzi B, Belli A, Logan A. Low Molecular Weight Dextran Sulfate (ILB ®) Administration Restores Brain Energy Metabolism Following Severe Traumatic Brain Injury in the Rat. Antioxidants (Basel) 2020; 9:E850. [PMID: 32927770 DOI: 10.3390/antiox9090850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in people less than 40 years of age in Western countries. Currently, there are no satisfying pharmacological treatments for TBI patients. In this study, we subjected rats to severe TBI (sTBI), testing the effects of a single subcutaneous administration, 30 min post-impact, of a new low molecular weight dextran sulfate, named ILB®, at three different dose levels (1, 5, and 15 mg/kg body weight). A group of control sham-operated animals and one of untreated sTBI rats were used for comparison (each group n = 12). On day 2 or 7 post-sTBI animals were sacrificed and the simultaneous HPLC analysis of energy metabolites, N-acetylaspartate (NAA), oxidized and reduced nicotinic coenzymes, water-soluble antioxidants, and biomarkers of oxidative/nitrosative stress was carried out on deproteinized cerebral homogenates. Compared to untreated sTBI rats, ILB® improved energy metabolism by increasing ATP, ATP/ adenosine diphosphate ratio (ATP/ADP ratio), and triphosphate nucleosides, dose-dependently increased NAA concentrations, protected nicotinic coenzyme levels and their oxidized over reduced ratios, prevented depletion of ascorbate and reduced glutathione (GSH), and decreased oxidative (malondialdehyde formation) and nitrosative stress (nitrite + nitrate production). Although needing further experiments, these data provide the first evidence that a single post-injury injection of a new low molecular weight dextran sulfate (ILB®) has beneficial effects on sTBI metabolic damages. Due to the absence of adverse effects in humans, ILB® represents a promising therapeutic agent for the treatment of sTBI patients.
Collapse
|
43
|
Pan JJ, Hou XZ, Wang P, Li W, Zhang Q, Dong T. Effect of acupuncture method of removing-stasisand resuscitating on the consciousness of patients with severe traumatic brain injury: A randomized clinical trial. Medicine (Baltimore) 2020; 99:e22056. [PMID: 32899069 PMCID: PMC7478541 DOI: 10.1097/md.0000000000022056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION With the development of social economy, transportation and various infrastructures have also developed, but it has objectively increased the number of patients with head injury. Although the current craniocerebral medicine technology continues to advance, long-term bed rest and other complications have led to an insignificant decrease in the mortality rate of coma patients. It is not uncommon for patients with disturbance of consciousness caused by head injury in major hospitals. METHODS/DESIGN This will be a retrospective, single-blind clinical observational study. We will select 50 cases that meet the subject's selection criteria. According to whether they received acupuncture treatment or not, they will be randomly divided into 2 groups, namely treatment group and control group. The control group will be given conventional Western medicine treatment, and the treatment group will be given acupuncture method of removing-stasis and resuscitating treatment on the basis of the control group. DISCUSSION Our purpose is to observe the role of acupuncture method of removing-stasis and resuscitating in promoting the recovery of patients with severe head injury. We aim to provide more evidence-based medical evidence for acupuncture treatment of this disease. TRIAL REGISTRATION ClinicalTrials.gov, ChiCTR2000034732, Registered on 19 July 2020.
Collapse
|
44
|
Li Y, Liu C, Luo X, He Q, Cheng Y, Shen W, Xie Z. Controlling nutritional status score and prognostic nutrition index predict the outcome after severe traumatic brain injury. Nutr Neurosci 2020; 25:690-697. [PMID: 32778001 DOI: 10.1080/1028415x.2020.1804097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Immune-nutritional status is correlated with a clinical outcome in critical illness. Recently, controlling nutritional status (CONUT) score and prognostic nutrition index (PNI) has been reported to predict prognosis following cancer and other diseases. The aim of this study was to explore the relationship between the CONUT score and PNI and 6-month outcome in patients with severe traumatic brain injury (STBI). METHODS We retrospectively analyzed the clinical data of 78 patients with STBI, including the CONUT score and PNI. Patients were divided into high CONUT group and low CONUT group. Patients were also divided into high PNI and low PNI group respectively. The 6-month outcome was evaluated by the modified Rankin scale (mRS). The unfavorable outcome was defined as mRS score ≥3. RESULTS The unfavorable outcome group had lower Glasgow coma scale (GCS) scores, serum albumin, total cholesterol, PNI, and higher CONUT scores (P < 0.05). Both CONUT scores and PNI were strongly correlated with mRS (r = 0.429, P < 0.05; r = -0.590, P < 0.05, respectively). After adjustment for confounding factors, the odds ratios of CONUT scores and PNI for predicting unfavorable outcome were 10.478 (95% CI: 2.793-39.301) and -0.039 (95% CI: 0.008-0.204), respectively. The area under the curve (AUC) of CONUT scores for predicting unfavorable outcome was 0.777 (95% CI: 0.674-0.880, P < 0.01), which was similar to PNI (0.764, 95% CI: 0.657-0.87, P < 0.01). CONCLUSION Both CONUT scores and PNI might be novel independent predictors of the poor outcome in STBI.
Collapse
Affiliation(s)
- Yuanyou Li
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Chang Liu
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Xu Luo
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qiuguang He
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuan Cheng
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Weiwei Shen
- Department of Endocrinology, The First Affiliated Hospital, Chongqing Medical and Pharmaceutical College, Chongqing, People's Republic of China
| | - Zongyi Xie
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| |
Collapse
|
45
|
Pan Y, Xue Y, Zhao P, Ding J, Ren Z, Xu J. Significance of ICP-related parameters for the treatment and outcome of severe traumatic brain injury. J Int Med Res 2020; 48:300060520941291. [PMID: 32854551 PMCID: PMC7459188 DOI: 10.1177/0300060520941291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective To analyze the significance of intracranial pressure (ICP)-related parameters
on outcome in patients with severe traumatic brain injury. The ICP-related
parameters included ICP, ICP dose (DICP), regression of the correlation
coefficient between amplitude and pressure (RAP), pressure reactivity index
(PRx), and cerebral perfusion pressure (CPP). Methods A retrospective analysis was performed using clinical information from 29
patients with severe traumatic brain injury who were admitted to the
Department of Neurosurgery from January 2018 to January 2019. All patients
underwent ICP probe implantation after admission. Patients were followed up
for 6 months after discharge, and were categorized into either the favorable
or unfavorable outcome group based on their Glasgow Outcome Scale score. The
differences in ICP, DICP, RAP, PRx, and CPP between the two groups were
analyzed for their effects on outcome. Results The average ICP, DICP, PRx, and RAP values in patients with favorable
outcomes were significantly lower than in patients with unfavorable
outcomes, while CPP values were significantly higher in the favorable
outcome group. Conclusion Average ICP, DICP, PRx, RAP, and CPP values may indicate disease status and
relate to patient outcomes. It is important to use multiple parameters to
predict patients’ disease severity and prognosis.
Collapse
Affiliation(s)
- Yuchun Pan
- Department of Neurosurgery, Lishui People's Hospital, Lishui Region of Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Yuanfeng Xue
- Department of Neurosurgery, Lishui People's Hospital, Lishui Region of Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Penglai Zhao
- Department of Neurosurgery, Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Junhong Ding
- Department of Neurosurgery, Lishui People's Hospital, Lishui Region of Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Zhiwen Ren
- Department of Neurosurgery, Lishui People's Hospital, Lishui Region of Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Jian Xu
- Department of Neurosurgery, Lishui People's Hospital, Lishui Region of Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| |
Collapse
|
46
|
Pinggera D, Luger M, Bürgler I, Bauer M, Thomé C, Petr O. Safety of Early MRI Examinations in Severe TBI: A Test Battery for Proper Patient Selection. Front Neurol 2020; 11:219. [PMID: 32373042 PMCID: PMC7179696 DOI: 10.3389/fneur.2020.00219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: Early magnetic resonance imaging (MRI) provides important information for management and prognosis in patients with severe traumatic brain injury (sTBI). Yet, optimal timing of MRI remains unknown. The aim of our study was to evaluate the safety of early MRI and to identify a method for appropriate patient selection to minimize adverse events related to the intrahospital transport (IHT) and the MRI examination. Methods: Twenty-six patients with sTBI [mean Glasgow Coma Scale (GCS) 6, range 3–8] admitted to our neurosurgical ICU from 03/2015 to 12/2017 and receiving at least one MRI within the first 14 days after initial traumatic event were prospectively included in the study. The following requirements were fulfilled for at least 4 h prior to anticipated MRI: MAP > 70 mmHg, aPCO2 30–40 mmHg, stable ICP < 25 mmHg. All relevant cardiopulmonary and cerebral parameters and medication were recorded. The following MRI sequences were performed: DWI, FLAIR, 3D T2-space, 3D T1 MPRAGE, 3D SWI, 3D TOF, pASL, and 1H/31P-MRS. Results: Four females and 22 males (aged 23–78 years, mean 46.4 years) with a median GCS on admission of 5 (range 3–8) were analyzed. In total, 40 IHTs were performed within the first 14 days (mean 6 days, range 1–14 days). Mean pre-MRI ICP was 14.1 mmHg (range 3–32 mmHg). The mean post-MRI ICP was 14.3 mmHg (range 3–29 mmHg), decreasing to a mean ICP of 13.2 mmHg after 1 h (range 3–29 mmHg). There were no significant differences in ICP measurements before and after MRI (p = 0.30). MAP remained stable with no significant changes during the entire IHT and MRI. No other adverse events were observed as well. Conclusion: Early MRI in acute severe TBI is feasible and safe. Yet, careful patient selection with prior adequate testing of cardiopulmonary and cerebral parameters is crucial to minimize transport- or examination-related morbidity.
Collapse
Affiliation(s)
- Daniel Pinggera
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Luger
- Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Iris Bürgler
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Marlies Bauer
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
47
|
Zakrepina AV, Sidneva YG, Bratkova MV, Valiullina SA. [Mental activity of the children during the early stage of rehabilitation after acute severe brain damage]. Vopr Kurortol Fizioter Lech Fiz Kult 2020; 97:51-59. [PMID: 32207708 DOI: 10.17116/kurort20209701151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Children who have suffered brain damage form a large group of patients in need of rehabilitation. For rehabilitation, patients require not only surgical, neurosurgical, traumatological, pharmacological and other medical support, but also the creation of special conditions for psychiatric care, psychological and pedagogical correction of their psychophysical potential. Neurological, motor and mental consequences of severe injuries of the nervous system in children lead to a high degree of disability with a subsequent restriction of their life, where social maladaptation and a violation of the quality of life are the primary problems. An integrated approach with differentiated qualified help will increase the effectiveness of rehabilitation programs and help the children adapt when they return to their normal environment. AIM To identify the characteristics of mental activity during the recovery of the level of consciousness in children after acute severe brain damage at an early stage of rehabilitation. MATERIAL AND METHODS We examined 210 children under the age of 18 years with severe brain damage (traumatic brain injury, hypoxia, hydrocephalus) who were admitted for treatment and rehabilitation. Clinical-psychopathological, pedagogical methods were used for examination as well as diagnostic scales, questionnaires. RESULTS The main differentiating signs were divided into three groups, depending on the mental activity of the child, the level of consciousness: Group 1 - 37 (18%) patients with mental activity with physical, cognitive and social abilities with the minimal '+' consciousness (a-/hyperkinetic mutism with emotional reactions, understanding of speech); 2-nd group - 67 (32%) patients with dominant manifestations of physical and cognitive abilities with the minimal '-' consciousness (a-/hyperkinetic mutism without emotional manifestations and understanding of speech); 3rd group - 106 (50%) children with a weak manifestation of mental activity (physical abilities) in a vegetative status/exit from a vegetative status. CONCLUSION Three variants of mental activity in children after acute severe brain injuries were distinguished - from minimal involuntary reactions or their absence during the vegetative status/exit from the vegetative status to arbitrary actions according to the instructions of an adult with a minimum '+' consciousness. Understanding the dynamics of the recovery of children's mental activity after neurotrauma may make it possible to have a differentiated approach to psychiatric, psychological and pedagogical rehabilitation in order to correct the recovery of mental functions in pediatric patients, and to prevent the developmental disorders as the child grows.
Collapse
Affiliation(s)
- A V Zakrepina
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma of the Department of Healthcare of Moscow, Moscow, Russia; Institute of Correctional Pedagogics of the Russian Academy of Education of the Russian Academy of Education, Moscow, Russia
| | - Yu G Sidneva
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma of the Department of Healthcare of Moscow, Moscow, Russia; N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of Russia, Moscow, Russia
| | - M V Bratkova
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma of the Department of Healthcare of Moscow, Moscow, Russia; Moscow City University, Institute of special education and complex rehabilitation, Moscow, Russia
| | - S A Valiullina
- Clinical and Research Institute of Emergency Pediatric Surgery and Trauma of the Department of Healthcare of Moscow, Moscow, Russia
| |
Collapse
|
48
|
Zhao J, Wang T, Lv Q, Zhou N. Expression of heat shock protein 70 and Annexin A1 in serum of patients with acutely severe traumatic brain injury. Exp Ther Med 2019; 19:1896-1902. [PMID: 32104246 PMCID: PMC7026958 DOI: 10.3892/etm.2019.8357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/24/2019] [Indexed: 12/21/2022] Open
Abstract
Trends of early expression levels of heat shock protein 70 (Hsp70) and Annexin A1 (ANXA1) in serum of patients with acutely severe traumatic brain injury and the effects on clinical prognosis were investigated. Eighty-four patients with severe traumatic brain injury admitted to Binzhou Center Hospital from June 2014 to July 2017 were selected as the experimental group. Glasgow coma scale and acute physiology and chronic health evaluation II (APACHE II) score were obtained after admission. A further 75 healthy subjects were selected as the control group. Serum expression of Hsp70 and ANXA1 in the two groups was detected by enzyme-linked immunosorbent assay on the 1st, 2nd, 3rd and 4th day after admission. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of Hsp70 and ANXA1 for the death of patients with acutely severe traumatic brain injury. Compared with the control group, expression of Hsp70 in the experimental group was significantly increased on the 1st, 2nd, 3rd and 4th day after admission (P<0.05), while expression of ANXA1 was significantly decreased (P<0.05). Expression levels of serum Hsp70 in the experimental group reached the peak on the 3rd day after admission, and the difference was statistically significant compared with the 1st, 2nd and 4th day (P<0.05). Expression of ANXA1 was the lowest on the 3rd day, and the difference was statistically significant compared with the 1st, 2nd and 4th day (P<0.05). The ROC curve analysis showed that the area under the curve of serum Hsp70 and ANXA1 was, respectively, 0.721 (95% CI: 0.611–0.829) and 0.684 (95% CI: 0.569–0.799). In conclusion, Hsp70 and ANXA1 may be involved in the occurrence and progression of acutely severe traumatic brain injury. The detection of serum Hsp70 and ANXA1 has certain diagnostic value for the death of patients with acutely severe traumatic brain injury.
Collapse
Affiliation(s)
- Junjing Zhao
- Department of Neurosurgery, Binzhou Center Hospital, Binzhou, Shandong 251700, P.R. China
| | - Tao Wang
- Department of Neurosurgery, Liaocheng Third People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Qiming Lv
- Department of Neurosurgery, Liaocheng Third People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Nan Zhou
- Department of Health Care, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| |
Collapse
|
49
|
Shackelford SA, Del Junco DJ, Reade MC, Bell R, Becker T, Gurney J, McCafferty R, Marion DW. Association of time to craniectomy with survival in patients with severe combat-related brain injury. Neurosurg Focus 2019; 45:E2. [PMID: 30544314 DOI: 10.3171/2018.9.focus18404] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIn combat and austere environments, evacuation to a location with neurosurgery capability is challenging. A planning target in terms of time to neurosurgery is paramount to inform prepositioning of neurosurgical and transport resources to support a population at risk. This study sought to examine the association of wait time to craniectomy with mortality in patients with severe combat-related brain injury who received decompressive craniectomy.METHODSPatients with combat-related brain injury sustained between 2005 and 2015 who underwent craniectomy at deployed surgical facilities were identified from the Department of Defense Trauma Registry and Joint Trauma System Role 2 Registry. Eligible patients survived transport to a hospital capable of diagnosing the need for craniectomy and performing surgery. Statistical analyses included unadjusted comparisons of postoperative mortality by elapsed time from injury to start of craniectomy, and Cox proportional hazards modeling adjusting for potential confounders. Time from injury to craniectomy was divided into quintiles, and explored in Cox models as a binary variable comparing early versus delayed craniectomy with cutoffs determined by the maximum value of each quintile (quintile 1 vs 2-5, quintiles 1-2 vs 3-5, etc.). Covariates included location of the facility at which the craniectomy was performed (limited-resource role 2 facility vs neurosurgically capable role 3 facility), use of head CT scan, US military status, age, head Abbreviated Injury Scale score, Injury Severity Score, and injury year. To reduce immortal time bias, time from injury to hospital arrival was included as a covariate, entry into the survival analysis cohort was defined as hospital arrival time, and early versus delayed craniectomy was modeled as a time-dependent covariate. Follow-up for survival ended at death, hospital discharge, or hospital day 16, whichever occurred first.RESULTSOf 486 patients identified as having undergone craniectomy, 213 (44%) had complete date/time values. Unadjusted postoperative mortality was 23% for quintile 1 (n = 43, time from injury to start of craniectomy 30-152 minutes); 7% for quintile 2 (n = 42, 154-210 minutes); 7% for quintile 3 (n = 43, 212-320 minutes); 19% for quintile 4 (n = 42, 325-639 minutes); and 14% for quintile 5 (n = 43, 665-3885 minutes). In Cox models adjusted for potential confounders and immortal time bias, postoperative mortality was significantly lower when time to craniectomy was within 5.33 hours of injury (quintiles 1-3) relative to longer delays (quintiles 4-5), with an adjusted hazard ratio of 0.28, 95% CI 0.10-0.76 (p = 0.012).CONCLUSIONSPostoperative mortality was significantly lower when craniectomy was initiated within 5.33 hours of injury. Further research to optimize craniectomy timing and mitigate delays is needed. Functional outcomes should also be evaluated.
Collapse
Affiliation(s)
| | - Deborah J Del Junco
- 1Joint Trauma System, Defense Center of Excellence, San Antonio.,2Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, Texas
| | - Michael C Reade
- 3Joint Health Command, Australian Defence Force, Brisbane, Queensland, Australia
| | - Randy Bell
- 4Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Jennifer Gurney
- 1Joint Trauma System, Defense Center of Excellence, San Antonio
| | - Randall McCafferty
- 6Neurosurgery, San Antonio Military Medical Center, San Antonio, Texas; and
| | - Donald W Marion
- 7Defense and Veterans Brain Injury Center, Silver Spring, Maryland
| |
Collapse
|
50
|
Wan G, Wang L, Zhang G, Zhang J, Lu Y, Li J, Yi X. Effects of probiotics combined with early enteral nutrition on endothelin-1 and C-reactive protein levels and prognosis in patients with severe traumatic brain injury. J Int Med Res 2019; 48:300060519888112. [PMID: 31802692 PMCID: PMC7604984 DOI: 10.1177/0300060519888112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To investigate the effects of probiotics combined with early enteral nutrition on levels of endothelin-1 (ET-1), C-reactive protein (CRP), and inflammatory factors, and on the prognosis of patients with severe traumatic brain injury (TBI). METHODS We enrolled 76 adults with severe TBI. The patients were divided randomly into two equal groups administered enteral nutrition with and without probiotics, respectively. Demographic and clinical data including age, sex, Glasgow Coma Scale score, Sequential Organ Failure Score, Acute Physiology, Chronic Health Score, hospitalization, mortality, and infections were recorded. RESULTS Serum levels of inflammatory factors gradually decreased with increasing treatment time in both groups. However, ET-1 at 15 days, and interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α, and CRP at 7 and 15 days decreased significantly more in the combined treatment group. Hospitalization duration and pulmonary infection rates were also significantly reduced in the combined compared with the enteral nutrition alone group. GCS scores at 15 days were significantly lower in the combined compared with the enteral nutrition group. CONCLUSION Probiotics combined with early enteral nutrition could reduce serum levels of ET-1, CRP, and IL-6, IL-10, and TNF-α, and could thus improve the recovery of patients with severe TBI.
Collapse
Affiliation(s)
- Guohua Wan
- Department of Nutrition, Shengli Oilfield Central Hospital, Dongying, China
| | - Linlin Wang
- Department of Nutrition, Shengli Oilfield Central Hospital, Dongying, China
| | - Guanhong Zhang
- Joint Surgery, Shengli Oilfield Central Hospital, Dongying, China
| | - Jian Zhang
- Hepatobiliary Surgery, Shengli Oilfield Central Hospital, Dongying, China
| | - Yanli Lu
- Department of Nutrition, Shengli Oilfield Central Hospital, Dongying, China
| | - Jun Li
- Department of Surgery, Sinopec Group Shengli Petroleum Administration Shengcai Hospital, Dongying, China
| | - Xinhao Yi
- Scientific Education Section, Shengli Oilfield Central Hospital, Dongying, China
| |
Collapse
|