Articles: traumatic-brain-injuries.
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Long bone fracture is one of the most common concomitant injuries in pediatric traumatic brain injury (TBI) patients, requiring surgical intervention in the form of intramedullary nailing (IMN), open reduction and internal fixation (ORIF), or temporary external fixation, otherwise known as damage control orthopedics (DCO), for transient stabilization before definitive repair. There are no definitive guidelines for femur fracture management in polytrauma TBI pediatric patients. This study investigates the outcomes of patients with TBI and femur fractures who underwent DCO versus early total care (ETC), hypothesizing that delayed fracture fixation is associated with worse outcomes. ⋯ III.
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Eur J Trauma Emerg Surg · Feb 2025
Impact of interhospital transport on outcome in traumatic epidural hematoma: experiences of a level-1 trauma center.
Epidural hematomas (EDH) are associated with a high rate of mortality and morbidity. Good clinical outcome depends on initial Glasgow Coma Scale (GCS), pupillary abnormalities, hematoma volume, age and time to surgery. The latter is mostly influenced by distance to the next level-1-trauma center. ⋯ Interhospital transport did not cause a significant delay of surgical treatment and outcome was comparable between direct and indirect transport to specialized neurosurgical care. Direct transport was more common on severe TBI and in patients with pupillary abnormalities, but secondary transport also allowed for adequate care.
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Scand J Trauma Resus · Feb 2025
ASA score is an independent predictor of 1-year outcome after moderate-to-severe traumatic brain injury.
This study aimed to investigate whether incorporating pre-injury health status, measured by the American Society of Anesthesiologists (ASA) score, improves outcome prediction models for moderate-to-severe traumatic brain injury (msTBI) patients. ⋯ In this retrospective single-center cohort study, we found that ASA score improves existing prognostic models for msTBI. Incorporating this simple comorbidity measure could enhance outcome prediction and support more personalized acute management. Future prospective studies are needed to validate these results.
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Multicenter Study Observational Study
Tranexamic Acid in Pediatric Traumatic Brain Injury: A Multicenter Retrospective Observational Study.
Tranexamic acid (TXA) can be used after trauma to prevent bleeding. Our goal was to examine the influence of TXA on morbidity and mortality for children with severe traumatic brain injury (TBI). ⋯ TXA administration was not associated with either death or poor neurologic outcome. Prospective clinical trials of TXA usage in children with severe TBI are needed.
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Review
Unique considerations in the assessment and management of traumatic brain injury in older adults.
The age-specific incidence of traumatic brain injury in older adults is rising in high-income countries, mainly due to an increase in the incidence of falls. The severity of traumatic brain injury in older adults can be underestimated because of a delay in the development of mass effect and symptoms of intracranial haemorrhage. Management and rehabilitation in older adults must consider comorbidities and frailty, the treatment of pre-existing disorders, the reduced potential for recovery, the likelihood of cognitive decline, and the avoidance of future falls. ⋯ Although prognostication is uncertain, unsubstantiated nihilism (eg, early withdrawal decisions from the assumption that old age necessarily leads to poor outcomes) should be avoided. The absence of management recommendations for older adults highlights the need for stronger evidence to enhance prognostication. In the meantime, decision making should be multidisciplinary, transparent, personalised, and inclusive of patients and relatives.