Severe traumatic brain injury: outcome in patients with diffuse axonal injury managed conservatively in Hospital Sultanah Aminah, Johor Bahru--an observational study (original) (raw)
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Patients with isolated severe head injury with diffuse axonal injury and without any surgical lesion may be treated safely without cerebral resuscitation and intracranial pressure (ICP) monitoring. Seventy two patients were divided into three groups of patients receiving treatment based on ICP-CPPtargeted, or conservative methods either with or without ventilation support. The characteristics of these three groups were compared based on age, gender, Glasgow Coma Scale (GCS), pupillary reaction to light, computerized tomography scanning according to the Marshall classification, duration of intensive care unit (ICU) stays, Glasgow Outcome Score (GOS) and possible complications. There were higher risk of mortality (p < 0.001), worse GCS improvement upon discharge (p < 0.001) and longer ICU stays (p = 0.016) in ICP group compared to Intubation group. There were no significant statistical differences of GOS at 3rd and 6th months between all three groups.
Journal of Clinical Neuroscience, 2009
The aim of the study was to report management and outcome of traumatic brain injury (TBI) in a Jakarta University hospital, and to determine prognostic factors. All consecutive patients with an Abbreviated Injury Score (AIS) head of P 4 or an AIS head score of P 3 combined with an AIS score of P 2 in any other body region were analyzed on patient characteristics and outcome. Prognostic factors evaluated were Glasgow Coma Scale (GCS) score, pupil reactions and probability of survival based on the Trauma and Injury Severity Score (TRISS) method. A total of 49 patients were included; overall mortality was 37%. The GCS and abnormal pupil reactions were associated with mortality with an odds ratio of 0.78 and 6.90, respectively. Thus, TBI has a poor prognosis in the population under study. The TRISS has limitations in evaluating trauma care for this selected group of patients. GCS and pupil reactions are valuable and simple for usage as prognostic factors.
Outcome of severe traumatic brain injury at a critical care unit: a review of 87 patients
Annals of African Surgery, 2009
OBJECTIVE: To determine the outcome of severe traumatic brain injury and to document the factors influencing mortality. DESIGN: A six months prospective study. SETTINGS: The intensive care unit (ICU) of Kenyatta National Hospital (KNH), a tertiary referral centre in Kenya. SUBJECTS: Eighty Seven adult patients with severe traumatic brain injury admitted between April and September 2005. METHODS: Basic demographic, clinical, radiological and mechanism of injury data were recorded at admission and during ICU stay. The main outcome measure was survival or death. The outcome groups were compared for the injury severity, mean arterial pressure, serum glucose level, grade of diffuse axonal injury and the presence of mydriasis and anisocoria using the X 2 test and the Fischers Exact test as appropriate. RESULTS: Severe traumatic brain injury accounted for 14.3% of all ICU admissions. This study included 73 men (83.9%) and 14 women (16.1%) with a mean patient age of 34 ± 17 years. Motor vehicle accidents were the main cause (58.6%). Forty six patients (54.0%) died. Twenty nine percent of patients had persistent vegetative state or severe disability. Factors that were associated with poor outcome on univariate analysis were Glasgow coma scale of less than 5, diffuse axonal injury and intracerebral mass lesions and blood sugar greater than 10mmol / L. CONCLUSION: Severe TBI is a frequent cause of hospital admission to critical care units among young men with a high mortality (54%) rate.
Journal of the Dow University of Health Sciences, 2021
Objective: To determine the characteristics, management and outcome of patients with traumatic brain injury (TBI) and associated risk factors. Methods: This cross-sectional study was conducted at Shaheed Mohtarma Benazir Bhutto Institute of Trauma from January 2018 to April 2019. TBI patients ≥16 years of age that were admitted to the intensive care unit (ICU) or high dependency unit (HDU) and managed conservatively or surgically, were included. Central nervous system (CNS) infection, mortality and associated risk factors were noted. Results: The mean age was 30.9 ± 13.6 years with 116 (91.3%) males. CNS infection developed in 72 (56.7%) patients. Of 72, 29 (40%) had positive CSF culture and in 28 (38.8 %) multidrug resistant Acinetobacter spp. susceptibile to only colistin was reported. Antimicrobial therapy with intravenous colistin with meropenem was used in 63 (87.5%) patients. A significant association of CNS infection was found with age (p-value 0.047), cerebrospinal fluid (CSF) leak at presentation (p-value 0.045), type of surgery (p-value 0.001), and duration of ER stay (p-value 0.047). Mortality occurred in 83 (65.4%) patients. A significant association of mortality was found with low Glasgow coma scale (GCS) at presentation (p-value 0.031), CSF leak at presentation (p-value <0.001), intraventricular hemorrhage, TBI type (p-value <0.001), polytrauma (p-value 0.003), CNS infection (p-value <0.001), and duration of emergency room stay (p-value 0.009). Conclusion High mortality was observed in patients with traumatic brain injury. Intracranial infection is strongly correlated with mortality underscoring the need for strict infection control and prevention measures.
Outcome Of Traumatic Brain Injury: A Retrospective Audit
The Internet Journal of Anesthesiology, 2013
OBJECTIVE: To assess the outcome of traumatic brain injury patients admitted at our centre. STUDY DESIGN: A retrospective audit PLACE AND DURATION OF STUDY: All patients admitted with traumatic brain injury at the Aga Khan University Karachi between January 2009 to June 2009 were included in this audit. METHODOLOGY: Data was collected from the files of a total of 51 patients admitted with traumatic brain injury on a predesigned form. The form included the details for GCS at admission, pattern of referral and outcome of admitted patients like GCS at the time of discharge, focal deficit or disability and in hospital death. RESULTS: 41.1% (n=21) of the cases admitted had moderate or severe TBI and 58.8 % (n=30) had minor brain injuries. The mortality rate of severe TBI in our audit was 46.2 %(n=6) which is similar to that reported from underdeveloped countries but is significantly higher compared to countries following standardized protocols of prehospital and in hospital management (3...
Intensive Care Treatment in Traumatic Brain Injury
Turkish Journal of Anesthesia and Reanimation, 2015
Head injury remains a serious public problem, especially in the young population. The understanding of the mechanism of secondary injury and the development of appropriate monitoring and critical care treatment strategies reduced the mortality of head injury. The pathophysiology, monitoring and treatment principles of head injury are summarised in this article.
Diagnosis and Management Process in Traumatic Brain Injury
IntechOpen, 2024
Every year, over 10 million people worldwide suffer from traumatic brain injury. A shock, blow, or bump to the head, as well as a penetrating head injury, can all result in traumatic brain damage (TBI), which is a disturbance of normal brain function. It also comes with potential side effects, like oxygen deprivation-induced damage, increased intracranial pressure, and cerebral edema. Traumatic brain damage comes in two primary forms: closed and open. Both primary and secondary effects might result from an injury that is localized (focal injury) or diffuse (widespread). In order to prevent the secondary injuries brought on by conditions like hypoxia and hypotension, management of severe TBI entails receiving acute care with close attention to the airway, oxygenation, and appropriate hemodynamic support. Treating people with traumatic brain injuries remains difficult. Research has made a substantial contribution to our understanding of how injuries occur and how general hospital care is provided. Further research is required to help build evidence-based therapy techniques that can be used to improve functional results and lessen patient management variability.
Journal of Trauma: Injury, Infection & Critical Care, 2011
Background: Diffuse axonal injury (DAI) is usually associated to severe trauma. Recent imaging advances made its diagnosis easier. Its prognosis impact is not yet well established. The aim of this article is to describe the epidemiologic, clinical, and radiologic features of posttraumatic DAI and to study its prognosis impact on mortality and outcome according to Glasgow Outcome Scale. Methods: This is a retrospective study over a 4-year period (2004-2007) of 124 patients admitted for head trauma. Demographic, clinical, biological, and radiologic findings were recorded at admission and during intensive care unit stay. Results: Mean age (Ϯstandard deviation) was 28 years Ϯ 15.8 years. Cranial computed tomography scan was sufficient enough to diagnose DAI in 31 patients. Magnetic resonance imaging was performed in 105 patients with a delay of 7.7 days Ϯ 8.6 days. Most patients were classified as stage II (49.5%) or stage III (44.8%) according to Gentry's classification. In a multivariate analysis, factors associated with higher mortality were dysautonomia (p ϭ 0.018; odds ratio [OR] ϭ 4.17), hyperglycemia Ն8 mmol/L (p ϭ 0.001; OR ϭ 3.84) on intensive care unit admission, and subdural hematoma (p ϭ 0.031; OR ϭ 3.99), whereas factors associated to poor outcome according to Glasgow Outcome Scale score were Glasgow Coma Scale score Ͻ8 (p ϭ 0.032, OR ϭ 3.55), secondary systemic injuries score Ն3 (p ϭ 0.034, OR ϭ 2.83), hyperglycemia Ն8 mmol/L (p ϭ 0.002, OR ϭ 5.55), and DAI count Ն6 (p ϭ 0.035, OR ϭ 3.33). In patients with pure DAI, the absence of consciousness recovery was the unique independent factor of mortality (p Ͻ 0.001, OR ϭ 116.4), whereas only transfusion need was an independent factor of poor outcome (p ϭ 0.017, OR ϭ 4.44). Conclusion: Dysautonomia, hyperglycemia, and subdural hematoma are the main factors associated to higher mortality when DAIs are diagnosed, whereas a DAI count Ն6 is associated to poor outcome. Magnetic resonance imaging classification did not have a prognosis value even in patients with pure DAI.
Factors Related To Outcome of Traumatic Brain Injury Patients at M Djamil Padang Hospital
Bioscientia Medicina : Journal of Biomedicine and Translational Research, 2021
Background: Traumatic brain injury is still a major threat because it can cause global morbidity and mortality. Many factors can affect the outcome of a traumatic brain injury. Some conditions that can exacerbate traumatic brain injury include GCS conditions, blood pressure variability, and pupillary reflexes.Methods: The research was conducted in M. Djamil Padang Hospital from October 2020 to March 2021. The study design was a cross-sectional study in traumatic brain injury patients with ≤ 48 hours of onset and the aged between 18-60 years. The subjects in this study consisted of 66 subjects. At 6 weeks after onset, a GOS assessment was performed to assess patient outcomes. Statistical analysis was performed computerized with SPSS 22.0. P-value <0.05 was considered statistically significant. Results: Most of the patients were male (71.2%) with an average age of 36.41 ± 14,275 years, and the most common injury mechanism was traffic accidents (95.5%). There was a significant relat...