Thara Tunthanathip; Suphak Udomwitthayaphiban
Volume 7, Issue 4 , October 2019, , Pages 347-354
Abstract
Objective: To determine the factors associated with mortality in penetrating brain injury (PTBI) and proposed the nomogram predicting the risk of death. Methods: A retrospective cohort study was conducted on all patients who had sustained PTBI between 2009 and 2018. Collected data included clinical characteristics, ...
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Objective: To determine the factors associated with mortality in penetrating brain injury (PTBI) and proposed the nomogram predicting the risk of death. Methods: A retrospective cohort study was conducted on all patients who had sustained PTBI between 2009 and 2018. Collected data included clinical characteristics, neuroimaging findings, treatment, and outcomes. Prognostic factors analysis was conducted using a forest plot. Therefore, the nomogram was developed and validated. For the propose of evaluation, the nomogram’s sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Receiver Operating Characteristic (ROC) curve and the area under the receiver operating characteristic (AUC) were determined for validating the optimal cut-off point of the total scores. Results: During the study period, 62 individuals enrolled. In the univariate analysis, factors associated with the morality were normal pupils’ reactivity to light (OR 0.04, p < 0.001), hypotension (OR 9.91, p <0.001), hypoxia (OR 10.2, p =0.04), bihemispheric injuries (OR 19.0, p =0.001), multilobar injuries (OR 21.5, p < 0.001), subarachnoid hemorrhage (OR 6.9, p = 0.02), intraventricular hemorrhage (OR 26.6, p = 0.006), basal cistern effacement (OR 28.8, , p <0.001), midline shift >5 mm (OR 0.19, p <0.001) were significantly associated with death. In multivariable analysis, hypotension (OR 8.82, p =0.03), normal pupils’ reactivity to light (OR 0.07, p =0.01), midline shift >5 mm (OR 18.23, p <0.007) were significantly associated with death. The nomogram’s sensitivity, specificity, PPV, NPV, and AUC for predicting mortality (total score ≥ 100) were 80%, 92.6%, 72.7%, 95.0%, and, 0.86 respectively. Conclusions: PTBI is the fatal injury depend on both clinical and neuroimaging parameters. The nomogram is the alternative method providing prognostic parameters toward implication for clinical decision making.
Roghieh Molaei-Langroudi; Ahmad Alizadeh; Ehsan Kazemnejad-Leili; Vahid Monsef-Kasmaie; Seyed-Younes Moshirian
Volume 7, Issue 3 , July 2019, , Pages 269-277
Abstract
Objective: To investigate the risk factors that can be proper indications for performing brain computerized tomography (CT)-scan in patients with mild and moderate traumatic brain injury (TBI) in order to avoid unnecessary exposure to radiation, saving on costs as well as time wasted in emergency wards.Methods: ...
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Objective: To investigate the risk factors that can be proper indications for performing brain computerized tomography (CT)-scan in patients with mild and moderate traumatic brain injury (TBI) in order to avoid unnecessary exposure to radiation, saving on costs as well as time wasted in emergency wards.Methods: Data of patients with mild traumatic brain injury (TBI) referring to Emergency Department with age ≥2 years and primary GCS of 13-15 were examined including focal neurological deficit, anisocoria, skull fracture, multiple trauma, superior injury of clavicle, decreased consciousness, and amnesia. Brain CT-scan was performed in all the patients. Kappa Coefficient was used to determine the ratio of agreement of the CT indications (+ and ⎼) and multiple logistic regression to determine the relative odds of positive CTs.Results: Overall we included 610 patients. One-hundred and one patients (16.5%) had positive and 509 (83.5%) had negative CT findings. Of positive CTs, the highest percentage was dedicated to high-energy mechanism of trauma. High-energy trauma mechanism (OR=1.056, 95% CI, OR, 1.03-1.04, P<0.001), superior injury of clavicle (OR=1.07, 95% CI, OR, 1.03-1.1, P<0.001) and moderate to severe headache (OR=1.04, 95% CI, OR, 1.02-1.05, P<0.001) were positive predictors of CT findings. The combined mean of positive symptoms equaled 0.29 ± 0.64 in negative CTs, but 5.13 ± 2.4 in positive CTs, showing a significant difference. (P<0.001)Conclusion: Abnormal positive brain CT in victims with mild TBI is predictable if one or several risk factors are taken into account such as moderate to severe headache, decreased consciousness, skull fracture, high-energy trauma mechanism, superior injury of clavicle and GCS of 13-14. The more the symptoms, the more likely the positive CT results would be.
Daniel Agustin Godoy; Pablo David Guerrero Suarez; Luis Rafael Moscote-Salazar; Mario Di Napoli
Volume 5, Issue 3 , July 2017, , Pages 143-151
Abstract
Intracranial hypertension (IH) is one of the final pathways of acute brain injury. In severe traumatic brain injury (sTBI), it independently predicts poor outcomes. Its control represents a key aspect of the management. Lack of response to conventional therapies signals a state of ‘’refractory ...
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Intracranial hypertension (IH) is one of the final pathways of acute brain injury. In severe traumatic brain injury (sTBI), it independently predicts poor outcomes. Its control represents a key aspect of the management. Lack of response to conventional therapies signals a state of ‘’refractory IH’’, with an associated mortality rate of 80-100%. In such cases, hypothermia, barbiturates at high doses (BBT), decompressive craniectomy (DC), and extreme hyperventilation are utilized. However, none of them has proven efficacy. Indomethacin (INDO), a non-steroidal anti-inflammatory drug, may be an option with an acceptable safety profile and easy to administer. Reported series showed encouraging results. We herein present a case of refractory IH after sTBI in which INDO was utilized. In refractory IH, INDO can help to decrease ICP and improve cerebral perfusion pressure. However, it requires administration under strict protocol since it’s not free of adverse effects after withdrawal.
Hosseinali Khalili; Amin Niakan; Fariborz Ghaffarpasand; Arash Kiani; Reza Behjat
Volume 5, Issue 3 , July 2017, , Pages 190-196
Abstract
Objective: To investigate the determinants of outcome in patients with traumatic brain injury (TBI) undergoing decompressive craniectomy (DC) in a large level I trauma center in southern Iran.Methods: This retrospective cross-sectional study was conducted during an 18-month period from 2013 to 2014 in ...
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Objective: To investigate the determinants of outcome in patients with traumatic brain injury (TBI) undergoing decompressive craniectomy (DC) in a large level I trauma center in southern Iran.Methods: This retrospective cross-sectional study was conducted during an 18-month period from 2013 to 2014 in Shahid Rajaei hospital, a Level I trauma center in Southern Iran. Patients with TBI who had undergone DC were included and the medical charts were reviewed regarding demographics, clinical, radiological and outcome characteristics. The outcome was determined by extended Glasgow outcome scale (GOS-E) after one year of surgery. The variables were compared between those with favorable and unfavorable outcome to investigate the outcome determinants. Results: Overall 142 patients with mean age of 34.8 ± 15.5 (ranging from 15 to 85) years were included. There were 127 (89.4%) men and 15 (10.6%) women among the patients. After 1-year, the mortality rate was 58 (40.8%) and 8 (5.6%) patients were persistent vegetative state. The final outcome was found to be unfavorable in 77 (54.2%) patients. Unfavorable outcome was associated with lower GCS on admission (p<0.001) as well as occurrence of postoperative hydrocephalus (p=0.011). Formation of the postoperative subdural hygroma after the operation was found to be associated with favorable outcome (p=0.019).Conclusion: DC in patients with TBI is associated with favorable outcome in most of them. On admission GCS, postoperative hydrocephalus and presence of postoperative subdural hygroma are among the important predictors of outcome in TBI patients undergoing DC.
Arash Mani; Seyed Ali Dastgheib; Atie Chanoor; Hosseinali Khalili; Laaya Ahmadzadeh; Jamshid Ahmadi
Volume 3, Issue 3 , July 2015, , Pages 93-96
Abstract
Objective: To evaluate and describe the sleep quality in seven subscales among the patients with mild traumatic brain injury (TBI) and compare it with normal patterns.Methods: This cross-sectional study was conducted within a 6-month period from February to August 2014 in Shahid Rajaei trauma center ...
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Objective: To evaluate and describe the sleep quality in seven subscales among the patients with mild traumatic brain injury (TBI) and compare it with normal patterns.Methods: This cross-sectional study was conducted within a 6-month period from February to August 2014 in Shahid Rajaei trauma center of Shiraz. Participants were selected randomly from all adult (18-60 years of age) patients admitted during the study period with impression of mild TBI (GCS of more than 13). The patients’ sleep quality and demographic characteristics were evaluated by Pittsburgh sleep quality index (PSQI) and self-report questionnaire, respectively. Results were compared with normal data, which extracted from the normative data of PSQI manual.Results: Overall we included 60 patients with mild TBI with mean age of 36.2 ± 13.4 years. All the patients had sleep disturbance. Among them there were 46 (76.7%) men and 14 (23.3%) women. The subjective sleep quality (p=0.01), sleep latency (p=0.01), habitual sleep efficiency (p=0.01), sleep disturbance (p=0.01), use of sleep medication (p=0.01) and day time dysfunction (p=0.01) were significantly lower in patients with mild TBI when compared to those with mild TBI when compared to normal values. There were no difference between men and women regarding the sleep quality. The sleep duration was comparable between the subjects and the normal values.Conclusion: Patients with mild TBI have poor sleep quality which should be considered as one of the main factors in interventions after the injury and it might lead to better quality of life.
Hosseinali Khalili; Golnaz Yadollahikhales; Mohammad Isaee
Volume 3, Issue 2 , April 2015, , Pages 53-58
Abstract
Objective: To determine the diagnostic value of serum white blood cell (WBC) count, fever (>38˚C) and WBC rise (>10%) for bacterial meningitis in patients with severe traumatic brain injury (TBI).Method: This cross-sectional study was conducted in Shahid Rajaei hospital affiliated with Shiraz ...
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Objective: To determine the diagnostic value of serum white blood cell (WBC) count, fever (>38˚C) and WBC rise (>10%) for bacterial meningitis in patients with severe traumatic brain injury (TBI).Method: This cross-sectional study was conducted in Shahid Rajaei hospital affiliated with Shiraz University of Medical Sciences during a 1-year period from 2013 to 2014. We included consecutively all the patients with severe TBI admitted to our center during the study period who were febrile (>38˚C orally) and underwent lumbar puncture (LP) and analysis and culture of cerebrospinal fluid (CSF). Laboratory analysis of CSF and blood were performed within 2 hours of LP. CSF culture was considered the gold standard for diagnosis of bacterial meningitis. The sensitivity, specificity, positive and negative predictive value (PPV, NPV) of peripheral blood WBC count, fever (>38˚C) and WBC rise (>10%) was determined according to the CSF culture.Results: Overall we included242 consecutive patients with severe TBI. The mean age of the participants was 32.8 ± 17.4 years. Acinetobacter was the most common organism found in the CSF cultures. The sensitivity and specificity of peripheral WBC count (>10,000)was 48.4% (95% CI: 0.42-0.56) and 47% (95% CI: 0.37-0.58) respectively. The PPV and NPV was 13.1% (95% CI: 0.33-0.52) and 84.8% (95% CI: 0.42-0.61), respectively. The AUC for WBC count was 0.478 (95% CI: 0.37-0.58) indicating low accuracy for the diagnosis of bacterial meningitis. The AUC for WBC rise (>10%) and temperature >38˚C was0.460 (95% CI: 0.351-0.569) and 0.517 (95% CI: 0.410-0.624) respectively, both indicating low accuracy for diagnosis of bacterial meningitis. Conclusion: The results of the current study indicates that peripheral blood leukocyte count, fever (>38˚C) and WBC rise (>10%) is a non-reliable marker for diagnosis of bacterial meningitis in patients with severe TBI.
Somaye Kavusipur; Zahra Rojhani Shirazi; Zahra Ardekani; Soqra Omidi
Volume 1, Issue 2 , April 2013, , Pages 86-89
Abstract
Objective: To determine the prediction value of disorder of consciousness scale (DOCS) for consciousness recovery after traumatic brain injury (TBI) leading to coma.Methods: This is a descriptive-cross-sectional study of the correlation between the level of patients’ consciousness in the first and ...
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Objective: To determine the prediction value of disorder of consciousness scale (DOCS) for consciousness recovery after traumatic brain injury (TBI) leading to coma.Methods: This is a descriptive-cross-sectional study of the correlation between the level of patients’ consciousness in the first and second weeks and the first 2 months after traumatic brain injury, using DOCS scale.Results: The findings of the present study showed that the sensitivity and specificity of DOCS in determining individual’s consciousness after first week and two months after injury are 66% and 41% respectively, and regarding DOCSU2 the corresponding values were 94% and 50% (p=0.001).Conclusion: Passage of time is one of the most significant factors in predicting the resumption of consciousness in patients with brain injury, and more accurate results are expected following the acute phase. However, the application of disorder of consciousness scale could be of a great help to patients’ families and rehabilitation staff in regard to providing a better services to meet the patients” future needs.
