Articles: brain-injuries.
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Randomized Controlled Trial Multicenter Study Observational Study
The Outcome of Severe Traumatic Brain Injury in Latin America.
Traumatic brain injury (TBI) disproportionately affects lower- and middle-income countries (LMIC). The factors influencing outcomes in LMIC have not been examined as rigorously as in higher-income countries. ⋯ Mortality from severe TBI is high in Latin American LMIC, although the rate of favorable recovery is similar to that of high-income countries. Demographic factors such as race and study site played an outsized role in predicting outcome; further research is required to understand these associations.
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Randomized Controlled Trial
Compliance of tranexamic acid administration to trauma patients at a level-one trauma centre.
Introduction Current practice for the treatment of traumatic hemorrhage includes fluid resuscitation and the administration of blood products. The administration of tranexamic acid (TXA) within 8 hours of injury has been shown to significantly reduce mortality in a large, prospective, randomized controlled trial. As a result, TXA is widely used in trauma centres to manage trauma patients with major bleeding. The primary aim of this study was to assess the compliance of TXA administration at a level-one trauma centre in Hamilton, Ontario, Canada.
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Randomized Controlled Trial
Cerebral metabolic effects of strict versus conventional glycaemic targets following severe traumatic brain injury.
Optimal glycaemic targets for patients with severe traumatic brain injury remain unclear. The primary objective of this microdialysis study was to compare cerebral metabolism with strict versus conventional glycaemic control. ⋯ Compared with conventional glycaemic targets, strict blood glucose control was associated with lower mean levels of cerebral glucose and an increased frequency of abnormally low glucose levels. These data support conventional glycaemic targets following traumatic brain injury.
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Randomized Controlled Trial
Efficacy of melatonin for sleep disturbance following traumatic brain injury: a randomised controlled trial.
The study aimed to determine the efficacy of melatonin supplementation for sleep disturbances in patients with traumatic brain injury (TBI). ⋯ Melatonin supplementation over a 4-week period is effective and safe in improving subjective sleep quality as well as some aspects of objective sleep quality in patients with TBI.
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Journal of neurotrauma · Jan 2018
Randomized Controlled Trial Multicenter StudyCause and timing of death and sub-group differential effects of erythropoietin in the EPO-TBI study.
The EPO-TBI study randomized 606 patients with moderate or severe traumatic brain injury (TBI) to be treated with weekly epoetin alfa (EPO) or placebo. Six month mortality was lower in EPO treated patients in an analysis adjusting for TBI severity. Knowledge of possible differential effects by TBI injury subtype and acute neurosurgical treatment as well as timing and cause of death (COD) will facilitate the design of future interventional TBI trials. ⋯ However, EPO appeared more effective in patients with an injury type not requiring a neurosurgical operation prior to intensive care unit (ICU) admission (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14-0.61, p = 0.001, p for interaction = 0.003) and in this subgroup, fewer patients died of cerebral causes in the EPO than in the placebo group (5% compared with 14%, p = 0.03). In conclusion, most TBI deaths were from cerebral causes that occurred during the first 2 weeks, and were related to withdrawal of care. EPO appeared to specifically reduce cerebral deaths in the important subgroup of patients with a diffuse type of injury not requiring a neurosurgical intervention prior to randomization.