Articles: traumatic-brain-injuries.
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Recent studies have suggested that skeletal muscle area (SMA) and psoas muscle area (PMA), markers for sarcopenia, are associated with the prognosis of many diseases. However, it remains unclear which of the two is a superior prognostic marker. Thus, the objective of this study was to analyse these markers in patients with traumatic brain injury (TBI). ⋯ Less amount of psoas muscle (PM) was found to be a significant risk factor for the prognosis of patients with TBI. PM was a better prognostic marker than skeletal muscle (SM) in patients with TBI. Further studies are needed to increase our understanding of sarcopenia and TBI.
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Computerized tomography (CT) imaging is a standard part of traumatic brain injury (TBI) evaluation but not all patients require it after mild head injury. Given the increasing incidence of TBI in the United States, there is an urgent need to better characterize CT head imaging utilization in evaluating trauma patients, especially patients at low risk of requiring intervention, such as those presenting with a normal GCS. ⋯ Few patients had moderate/severe head injury when presenting with a GCS 15. However, patients ≥ 50 years, men, and those who suffered falls were at higher risk. Anti-coagulation use was not associated with moderate/severe head injury but did increase the risk of procedural TBI management. Given the cost and associated radiation, reducing CT utilization for younger patients while using a more liberal head CT strategy for high-risk patients may provide substantial patient value.
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Stage 3 acute kidney injury (AKI) has been observed to develop after serious traumatic brain injury (TBI) and is associated with worse outcomes, though its incidence is not consistently established. This study aims to report the incidence of stage 3 AKI in serious isolated TBI in a large, national trauma database and explore associated predictive factors. ⋯ Stage 3 AKI occurred in 0.5% of serious TBI cases. Complications of acute respiratory distress syndrome and catheter-associated urinary tract infections are more likely to co-occur with stage 3 AKI in patients with serious TBI.
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From a pathophysiological point of view, early neurosurgical treatment seems essential to prevent secondary brain injury and has been stated as the "time-is-brain" concept. However, the question immediately rises: "Is there an optimal time window for acute intracranial neurosurgical interventions?" In neurosurgery, treatment modality has been studied far more extensively than timing to surgery ("time-to-surgery"). The majority of acute intracranial neurosurgical interventions are carried out for traumatic brain injury and hemorrhagic or ischemic stroke. ⋯ In acute intracranial neurosurgical interventions, "delayed consent" procedures could play an important role for this field of research. Whether there is an optimal time window for acute intracranial neurosurgical interventions seems difficult to be answered with randomized controlled trials referred to in the current guidelines. Observational designs, such as comparative effectiveness research, and special statistical techniques, may provide a better understanding in the optimal "time-to-surgery."