Articles: brain-injuries.
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Journal of critical care · Dec 2024
Surrogates may not accurately estimate resilience and spirituality in neurologically critically ill patients.
Surrogates often provide substituted judgement for neurologically critically ill patients. Resilience and spirituality are understudied constructs in this patient population. In this study we examine how accurately surrogates estimate measures of resilience and spirituality for neurologically critically ill patients. ⋯ Surrogate evaluations lack systematic bias, but may not estimate resilience and spirituality reliably for neurologically critically ill patients.
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Pediatric emergency care · Dec 2024
Pediatric Emergency Medicine Physicians' Perspectives of Concussion in Young Children.
Traumatic brain injury (TBI) during early childhood (before 6 years) is prevalent, accounting for rising rates of emergency department visits. These injuries may lead to postconcussive symptoms, which may be subtle and difficult to diagnose in young children. Inadequate discharge counseling may lead to prolonged duration of symptoms and possible developmental delays. We aimed to explore pediatric emergency medicine (PEM) physicians' perspectives on "concussion" terminology, diagnosis, and management, specifically in a young child with mild TBI. ⋯ Variability exists among PEM physicians in diagnosis and management of concussions in young children. Discomfort with lack of reliability of symptoms and underappreciation of typical early childhood characteristics may account for findings. Educational initiatives, age-appropriate clinical tools and treatment-guided outcomes research are needed to guide PEM physicians in the care of young children with head injuries.
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Pediatric emergency care · Dec 2024
External Validation of the Surgical Intervention for Traumatic Injuries Scale in Children.
The Surgical Intervention for Traumatic Injuries (SITI) scale is intended to predict the likelihood of needing surgical decompression among patients with traumatic brain injury (TBI). We sought to examine the performance of the SITI score to predict likelihood of acute neurosurgical intervention for children with TBI. ⋯ A SITI score of less than 2 is associated with nonoperative management. However, clinicians should not be falsely reassured by a low score in patients with depressed skull fractures.
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Traumatic brain injury is a prevalent condition that affects millions worldwide with no clear understanding or effective therapeutic management available. Military soldiers have a high risk of exposure to blast-induced traumatic brain injury (bTBI). Furthermore, alcohol drinking is common in this population, and studies have shown that post-TBI alcohol exposure can result in memory loss. ⋯ However, extended alcohol drinking for up to three weeks post mbTBI impaired long-term memory and was accompanied by intensified oxidative stress in brain regions associated with memory and anxiety. These findings, as well as those from previous in vitro TBI/alcohol studies, suggest a pathological synergy of physical force and post-impact alcohol exposure. This knowledge could potentially aid in establishing guidelines for TBI victims to avoid further injury to their brains as well as to help maximize their recovery following TBI.
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To assess the utility of initial computed tomography (CT)-derived optic nerve sheath diameter (ONSD), Glasgow Coma Scale (GCS) score, Rotterdam CT score, and other factors in predicting subsequent surgical intervention in patients with nonconcussive traumatic brain injury (TBI) who did not undergo immediate surgery. ⋯ Initial GCS and Rotterdam CT scores could anticipate the need for subsequent surgery among patients with nonconcussive TBI who did not undergo immediate surgery, whereas ONSD could not.