Articles: traumatic-brain-injuries.
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Randomized Controlled Trial
Time to and Possible Risk Factors for Recurrence after Burr-hole Drainage of Chronic Subdural Hematoma - A Subanalysis of the cSDH-Drain Randomized Controlled Trial.
The randomized controlled Chronic Subdural Hematoma (cSDH)-Drain-Trial showed comparable recurrence rates after placing a subperiosteal drain (SPD) or a subdural drain (SDD) for surgically drained cSDH, although SDD was associated with higher rates of infection and iatrogenic brain injury. This subanalysis examines the time to recurrence and possible risk factors for recurrence after burr-hole drainage of cSDH and placement of a SPD compared with a SDD. ⋯ The inserted drain type after burr-hole drainage of cSDH does not seem to influence time to recurrence. SPD may be warranted in routine clinical practice, independent of individual patient, surgical, or hematoma characteristics.
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Journal of neurotrauma · Dec 2019
Randomized Controlled TrialCopenhagen Head Injury Ciclosporin (CHIC) study: A phase IIa safety, pharmacokinetics and biomarker study of ciclosporin in severe head injury patients.
Traumatic brain injury (TBI) contributes to almost one third of all trauma-related deaths, and those that survive often suffer from long-term physical and cognitive deficits. Ciclosporin (cyclosporine, cyclosporin A) has shown promising neuroprotective properties in pre-clinical TBI models. The Copenhagen Head Injury Ciclosporin (CHIC) study was initiated to establish the safety profile and pharmacokinetics of ciclosporin in patients with severe TBI, using a novel parenteral lipid emulsion formulation. ⋯ The four biomarkers, glial fibrillary acidic protein, neurofilament light, tau, and ubiquitin carboxy-terminal hydrolase L1, showed consistent trends to decrease during the 5-day treatment period, whereas the samples taken on the days after the treatment period showed higher values in the majority of patients. In conclusion, ciclosporin, as administered in this study, is safe and well tolerated. The study confirmed that ciclosporin is able to pass the blood-brain barrier in a TBI population and provided an initial biomarker-based signal of efficacy.
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Randomized Controlled Trial
Derivation and validation of an easy-to-compute trauma score that improves prognostication of mortality or the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure (TRIAGES) score.
Multiple trauma scores have been developed and validated, including the Revised Trauma Score (RTS) and the Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP) score. However, these scores are complex to calculate or have low prognostic abilities for trauma mortality. Therefore, we aimed to develop and validate a trauma score that is easier to calculate and more accurate than the RTS and the MGAP score. ⋯ We report an easy-to-use trauma score with better prognostication ability for in-hospital mortality compared to the RTS and MGAP score. Further studies to test clinical applicability of the novel score are warranted.
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Randomized Controlled Trial Multicenter Study
Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial.
Tranexamic acid reduces surgical bleeding and decreases mortality in patients with traumatic extracranial bleeding. Intracranial bleeding is common after traumatic brain injury (TBI) and can cause brain herniation and death. We aimed to assess the effects of tranexamic acid in patients with TBI. ⋯ For the Arabic, Chinese, French, Hindi, Japanese, Spanish and Urdu translations of the abstract see Supplementary Material.
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Randomized Controlled Trial Multicenter Study Comparative Study
Subperiosteal vs Subdural Drain After Burr-Hole Drainage of Chronic Subdural Hematoma: A Randomized Clinical Trial (cSDH-Drain-Trial).
The use of a subdural drain (SDD) after burr-hole drainage of chronic subdural hematoma (cSDH) reduces recurrence at 6 mo. Subperiosteal drains (SPDs) are considered safer, since they are not positioned in direct contact to cortical structures, bridging veins, or hematoma membranes. ⋯ Although the noninferiority criteria were not met, SPD insertion led to lower recurrence rates, fewer surgical infections, and lower drain misplacement rates. These findings suggest that SPD may be warranted in routine clinical practice.