Articles: traumatic-brain-injuries.
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Background Most deaths following severe traumatic brain injury follow decisions to withdraw life-sustaining therapies. However, the incidence of the withdrawal of life-sustaining therapies and its potential impact on research data interpretation have been poorly characterized. The aim of this systematic review was to assess the reporting and the impact of withdrawal of life-sustaining therapies in randomized clinical trials of patients with severe traumatic brain injury. ⋯ An analysis carried out by imputing a 4% differential rate in instances of withdrawal of life-sustaining therapies between study groups yielded different results and conclusions in one third of the trials. Conclusion Data on the withdrawal of life-sustaining therapies are incompletely reported in randomized controlled trials of patients with severe traumatic brain injury. Given the high proportion of deaths due to the withdrawal of life-sustaining therapies in severe traumatic brain injury patients, and the potential of this medical decision to influence the results of clinical trials, instances of withdrawal of life-sustaining therapies should be systematically reported in clinical trials in this group of patients.
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Traumatic brain injury refers to a broad range of neurological, cognitive, and emotional factors that result from the application of an external force to the head. Individuals recovering from traumatic brain injury will frequently experience acute and chronic pain. ⋯ This review presents evidence that pain is common after traumatic brain injury. However, while there are many potential mechanisms explaining this problem such as neuroinflammation, excitotoxicity, and axonal degeneration, we have no clear understanding of which of them contribute in individual patients. The authors highlight the priorities for research that will expand our knowledge and that may lead to the rational design of therapies that both reduce pain and provide optimal overall outcomes after traumatic brain injury.
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Traumatic brain injury (TBI) and spinal cord injury (SCI) are pathological events that lead to neuropathological conditions which have in consequence the initiation of pro-inflammatory cytokine production. Neuroinflammation plays a key role in the secondary phase of both TBI and SCI after initial cell death. ⋯ The focus of this article is to discuss the time-course and regulation of inflammasome assembly and activation during TBI and SCI and their targeting in designing therapeutic approaches. We particularly focus on the inflammasomes NLRP1 and NLRP3 which play a pivotal function during TBI and SCI in the central nervous system (CNS).
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Journal of neurotrauma · Jul 2018
Adherence to Brain Trauma Foundation Guidelines for Management of Traumatic Brain Injury Patients and Its Effect on Outcomes: Systematic Review.
Traumatic brain injury (TBI) management based on Brain Trauma Foundation (BTF) guidelines is widely accepted and thought to improve outcome. The objectives of this study are to provide an overview of adherence to BTF guidelines and to explore which factors influence adherence. We conducted a search of relevant electronic bibliographic databases. ⋯ Treating patients with higher severity of injury as well as treatment in a Level I trauma center positively influenced adherence. Overall, adherence to BTF guidelines varies. Further research is required to strengthen the current evidence and to identify factors related to adherence to guidelines from a professional prospective.
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Traumatic brain injury (TBI) in children and adolescents is a community-based medical and educational challenge world-over due to increasing urbanization and motorization. In India, children between 1 to 15 years constitute significant proportion of the total population, who are vulnerable for TBI. In developed countries, pediatric trauma mortality still represents more than half of all childhood fatalities, which is 18 times more common than brain tumors. In this study, we attempted to analyze epidemiological factors, management, and outcome of TBI in children at a tertiary care center in Pune, Maharashtra. ⋯ Most of these injuries are preventable in infancy and childhood by ensuring proper vigilance, tender care by the parents and the caretakers. Safe driving techniques have to be followed by parents while traveling with children in their motor vehicles. Need to focus on grading the severity of TBI rather than on factors like age, mode of injury, and presence or absence of external injuries.