Articles: brain-injuries.
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Multicenter Study
Pediatric traumatic brain injury is inconsistently regionalized in the United States.
Traumatic brain injury is a leading cause of death in children. On the basis of evidence of better outcomes, the American College of Surgery Committee on Trauma recommends that children with severe traumatic brain injury receive care at high-level trauma centers. We assessed rates of adherence to these recommendations and factors associated with adherence. ⋯ Despite evidence for improved outcomes of severely injured children admitted to high-level trauma centers, we found that almost one third of the children with severe traumatic brain injury failed to receive care in such centers. Only 2 of 6 states and less than one fifth of 68 health care referral regions were well regionalized. This study highlights problems with current pediatric trauma care that can serve as a basis for additional research and health care policy.
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Intensive care medicine · Jul 2008
Multicenter StudyMonitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study.
The goals of this study were to elucidate reasons why patients did or did not receive intracranial pressure (ICP) monitoring and to describe factors influencing hospital mortality after severe traumatic brain injury (TBI). ⋯ ICP monitoring may possibly have some beneficial effects, but this needs further evaluation. Patients with severe TBI should be admitted to experienced centers with high patient volumes since this might improve hospital mortality rates.
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Randomized Controlled Trial Multicenter Study
Hypothermia therapy after traumatic brain injury in children.
Hypothermia therapy improves survival and the neurologic outcome in animal models of traumatic brain injury. However, the effect of hypothermia therapy on the neurologic outcome and mortality among children who have severe traumatic brain injury is unknown. ⋯ In children with severe traumatic brain injury, hypothermia therapy that is initiated within 8 hours after injury and continued for 24 hours does not improve the neurologic outcome and may increase mortality. (Current Controlled Trials number, ISRCTN77393684 [controlled-trials.com].).
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Journal of neurotrauma · Jun 2008
Multicenter StudyProgression of traumatic intracerebral hemorrhage: a prospective observational study.
ABSTRACT Preliminary evidence has shown that intracerebral hemorrhages, either spontaneous (sICH) or traumatic (tICH) often expand over time. An association between hemorrhage expansion and clinical outcomes has been described for sICH. The intent of this prospective, observational study was to characterize the temporal profile of hemorrhage progression, as measured by serial computed tomography (CT) scanning, with the aim of better understanding the natural course of hemorrhage progression in tICH. ⋯ This study demonstrates that tICH expansion between the baseline and 24-h CT scans occurred in approximately half of the subjects. The earlier after injury that the initial CT scan is obtained, the greater is the likelihood that the hematoma will expand on subsequent scans. The time frame during which hemorrhagic expansion occurs provides an opportunity for early intervention to limit a process with adverse prognostic implications.
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Letter Multicenter Study
Hypertonic saline after traumatic brain injury in UK neuro-critical care practice.