Articles: trauma.
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Journal of neurotrauma · May 2014
Prehospital Heart Rate and Blood Pressure Increase the Positive Predictive Value of the Glasgow Coma Scale for High-Mortality Traumatic Brain Injury.
We hypothesized that vital signs could be used to improve the association between a trauma patient's prehospital Glasgow Coma Scale (GCS) score and his or her clinical condition. Previously, abnormally low and high blood pressures have both been associated with higher mortality for patients with traumatic brain injury (TBI). We undertook a retrospective analysis of 1384 adult prehospital trauma patients. ⋯ When the GCS was <15, ROC AUCs were significantly higher for a multi-variate regression model (GCS, SBP, and HR) versus GCS alone. In particular, patients with abnormalities in all parameters (GCS, SBP, and HR) were significantly more likely to have high-mortality TBI versus those with abnormalities in GCS alone. This could be useful for mobilizing resources (e.g., neurosurgeons and operating rooms at the receiving hospital) and might enable new prehospital management protocols where therapies are selected based on TBI mortality risk.
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Journal of neurotrauma · May 2014
Agreement on and predictors of long term psychosocial development 16 years post childhood traumatic brain injury.
Childhood traumatic brain injury (CTBI) is one of the most common causes of childhood mortality and morbidity, with psychosocial impairment being among the most debilitating persisting consequences. Child and adolescent survivors of CTBI have fewer friends and lower self-esteem with a higher risk of developing a psychiatric disorder. In most research to date, findings in the psychosocial domain have been based on parent reports, with the child or adolescent only consulted infrequently. ⋯ On the scales with poor agreement, there was no consistent contribution identified for any injury or preinjury factors. Preinjury adaptive behavior partly predicted withdrawn and overall internalizing symptoms, with a trend to also partly predict anxious/depressed and rule-breaking behavior reported by the significant other. Because young adults and significant others had poor agreement on the less-overt symptoms, these young adults may be at a higher risk of developing more-severe symptoms or disorders if it is not identified in time.
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Journal of neurotrauma · May 2014
Observational StudyEffect of osmotherapy on optic nerve sheath diameter in patients with increased intracranial pressure.
The measurement of ocular nerve sheath diameter (ONSD) via ocular ultrasound scanning is a recent non-invasive method for intracranial pressure (ICP) assessment. Few clinical studies have assessed ONSD variations during osmotherapy for the treatment of sustained increased ICP episodes. The aim of our study was to determine the rate of ONSD variation after mannitol administration for increased ICP episodes. ⋯ The ONSD significantly decreased after mannitol infusion from 6.3 (6.1-6.7) to 5. mm (5.5-6.3) (p=0.0007). Concomitantly, the intracranial pressure decreased from 35 (32-41) to 25 (22-29) mmHg (p=0.001) and the CPP increased from 47 (50-60) to 66 (59-69) mmHg (p=0.003). The variations of ONSD appear to be an interesting parameter to evaluate the efficacy of osmotherapy for elevated ICP episodes in patients with acute brain injury.