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Introducción: el trauma craneoencefálico es una de las principales causas de morbimortalidad infantil en Colombia, sus secuelas impactan gravemente la calidad de vida de los pacientes y la evidencia científica actual de los factores asociados al trauma es escasa. Objetivo: analizar los factores asociados al desarrollo de secuelas por trauma craneoencefálico en menores de 15 años que consultaron a un hospital de Medellín entre 2010 y 2014. Materiales y métodos: estudio de cohorte retrospectivo. Se incluyeron 812 pacientes en un periodo de 5 años, de los cuales 294 no cumplieron los criterios de inclusión. Se evaluaron variables sociodemográficas, clínicas y se estimó la incidencia de secuelas con el método estadístico de Wilson. El riesgo relativo se calculó mediante regresión log-binomial. Resultados: en total se analizaron 518 pacientes. La mediana de edad fue de 5 años, el 64,3 % eran hombres, el 75,4 % de los participantes tenía un trauma leve y el 5 % un trauma grave. Las caídas fueron la principal causa (64,2 %), seguidas de los accidentes de tránsito (25,3 %). La incidencia de secuelas fue del 7.3 % (IC: 5,4 % - 9,9 %). Conclusiones: la carga de enfermedad en el paciente posterior a TCE representa un problema de salud pública. La probabilidad de desarrollar una secuela en este estudio fue del 7,3 %, la cual se relaciona con los siguientes factores que se identifican en el servicio de urgencias: lesión difusa, una escala de Glasgow al ingreso moderada o grave y sufrir un accidente de tránsito.
Background: traumatic brain injury is one of the main causes of infant morbidity and mortality. The sequelae after trauma seriously impact the quality of life of patients and the scientific evidence of associated factors is scarce. Objective: to analyze the factors associated with the development of sequelae due to head trauma in children under 15 years old who went to the emergency room of a hospital in Medellín between 2010 and 2014. Materials and methods: retrospective cohort study. 812 patients were included in a period of 5 years, of which 294 did not meet the inclusion criteria. Sociodemographic and clinical variables were evaluated and the incidence of sequelae was estimated with 95 % confidence intervals using the Wilson statistical method. The relative risk was calculated using log-binomial regression. Results: a total of 518 patients were analyzed. The median age was 5 years, 64,23 % were male children, 75,4 % had mild trauma, and 5 % suffered severe trauma. Falls were the main cause (64,2 %), followed by traffic accidents (25,3 %). The incidence of sequelae was 7,3 % (CI: 5,4% - 9,9 %). Conclusions: the burden of disease in the patient after TCE represents a public health problem. The probability of developing a sequel in this study was 7,3 %, which is related to the following factors that identify in the emergency department: diffuse injury, a moderate or severe Glasgow scale on admission, and suffering a traffic accident.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Rehabilitation , Brain Injuries, Traumatic , Craniocerebral Trauma , Pediatrics , Risk Factors , ColombiaABSTRACT
Não há dúvidas sobre os prejuízos na vida humana, extensivos à família e sociedade como um todo, abrangendo todos os aspectos funcionais das pessoas envolvidas, além do indivíduo, originados dos traumatismos cranioencefálico, agudos e crônicos, externos ou internos: acidentes, atropelamentos, quedas, crimes, acidente vascular cerebral, doenças com neurodegeneração progressiva, resultando em estados demenciais. Ao longo de meio século, houve a introdução contínua de medicamentos, com resultados usualmente contraditórios e frustrantes, exigindo novas tentativas com outras classes farmacológicas. No todo, a limitação se faz sentir na impossibilidade de reversão ou mesmo de mera estabilização dos danos neurológicos, e inocuidade em termos de estimulação da neuroplasticidade. Uma exceção parece ser uma nova abordagem: a estimulação cerebral profunda por pulsos sonoros de baixa frequência (Transcranial Pulse Stimulation, ou TPS). Ainda pouco conhecida, a não ser em alguns centros de tratamento, tem se mostrado ser um acréscimo válido, por complementar os programas multidisciplinares de reabilitação
There is no doubt about the damage to human life, also extended to family and society as a whole, regarding all the functional aspects of those involved, not only the patient itself, which originates from traumatic brain injury, acute or chronic, for external or internal reasons, such as accidents, run overs, falls, crimes, stroke, progressive neurodegenerative diseases that result in dementia states. Over half a century, drugs have been continuously introduced, however their results have constantly been contradictory and frustrating, requiring new attempts with other pharmacological classes. Overall, the limitation is felt in the impossibility of reversing or even merely stabilizing the neurological damage and inefficacy regarding neuroplasticity stimulation. One exception seems to be a new approach, the non-invasive brain stimulation by low-frequency sound pulses (Transcranial Pulse Stimulation, or TPS). Except for some treatment centers, TPS is still unknown, however it has shown to be a valid adjunct in multidisciplinary rehabilitation programs
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Objective To investigate the effect of different optimization algorithms on accurate reconstruction of traffic accidents. Methods Non-dominated sorting genetic algorithm-II ( NSGA-II), neighborhood cultivation genetic algorithm (NCGA) and multi-objective particle swarm optimization (MOPSO) were used to optimize the multi-rigid body dynamic reconstruction of a real case. The effects of different optimization algorithms on convergence speed and optimal approximate solution were studied. The optimal initial impact parameters were simulated as boundary conditions of finite element method, and the simulated results were compared with the actual injuries. Results NCGA had a faster convergence speed and a better result in optimization process. The kinematic response of pedestrian vehicle collision reconstructed by the optimal approximate solution was consistent with the surveillance video. The prediction of craniocerebral injury was basically consistent with the cadaver examination. Conclusions The combination of optimization algorithm, rigid multibody and finite element method can complete the accurate reconstruction of traffic accidents and reduce the influence of human factors.
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Craniocerebral war injury, mainly caused by weaponry equipment and wartime conditions during warfare, are characterized by high difficulty in treatment and evacuation as well as high mortality rate. The field surgical treatment of craniocerebral war injury is not only related to injury characteristics, but also to factors such as war scale, combat style, combat area and weapon power. In recent years, there have been few comprehensive reports on the characteristics and field surgical treatment of craniocerebral war injury in China. Therefore, the authors reviewed the research progress in the characteristics and field surgical treatment of craniocerebral war injuries in foreign armies since 2001, with the aim to provide a reference for relevant basic researches and war injury treatment in China.
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Traumatic brain injury (TBI) is much more complex considering the unique pathophysiological changes under high-altitude hypoxic environment. Moreover, because of limited source of medical transportation and facilities at high altitude, TBI patients often lack urgent and standard treatment and have to be transported to the district medical center at high altitude or even the neurotrauma center at plain region as soon as possible. The transportation has high risk and takes serious effect on lives and prognosis of the TBI patients. Up to date, the evacuation and support process for TBI patients in the western plateau region of China has been improved through years of practice, but there are still deficiencies compared to the Critical Care Air Transport Team (CCATT). The authors sought to discuss certain issues related to medical evacuation and support after TBI at high altitude from aspects of early damage control operation and timely safety medical transportation, aiming to improve the survival rate, neurological outcomes and life quality for these patients.
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Posttraumatic acute diffuse brain swelling (PADBS) is a relatively common severe traumatic brain injury (TBI). Since it can lead to acute intracranial hypertension in a short time, the illness can be acute and critical, with a high disability and fatality rate. The pathogenesis of PADBS is still unclear, with the current theory consisting of acute cerebral vasodilation, cerebral edema and intracranial venous circulation disorder. For PADBS, there is still a lack of unified diagnostic criteria, and the indications and timing of decompression craniectomy remain controversial. The authors review the research progress in the pathogenesis, diagnosis and treatment of PADBS, hoping to provide some new ideas for its treatment.
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Objective:To explore the application value of ventricular intracranial pressure monitoring (V-ICPM) in the treatment of unilateral temporal lobe cerebral contusion.Methods:A retrospective cohort study was conducted to analyze the clinical data of 295 patients with unilateral temporal lobe cerebral contusion admitted to 904th Hospital of PLA Joint Support Force from January 2014 to August 2021, including 172 males and 123 females; aged 14-78 years [(46.3±14.7)years]. V-ICPM was used in 136 patients (V-ICPM group), who received surgical or non-surgical treatment according to the monitoring, while not in 159 patients (non-V-ICPM group), who received routine surgery or non-surgical treatment. The two groups were compared in terms of the rates of intracranial hematoma clearance by craniotomy, decompressive craniectomy (DC) and dehydration and osmotic therapy during hospitalization, use time of 20% mass fraction of mannitol and 30 g/L hypertonic salt, displacement rate of brain midline structure of head CT≥10 mm after discharge, rate of intracranial infection, hydrocephalus and epilepsy, and Glasgow Outcome Scale (GOS) at 6 months after discharge.Results:All patients were followed up for 6-12 months [(8.9±2.1)months]. During hospitalization, the rate of intracranial hematoma clearance by craniotomy and the rate of DC in V-ICPM group were 35.3% (48/136) and 8.1% (11/136), lower than 47.2% (75/159) and 22.0% (35/159) in non-V-ICPM group ( P<0.05 or 0.01). There was no significant difference between the two groups in the rate of dehydration and osmotic therapy or the use time of mannitol (all P>0.05). The use time of hypertonic salt in V-ICPM group was (7.2±2.5)days, more than (4.1±1.8)days in non-V-ICPM group ( P<0.05). After discharge, the displacement rate of brain midline structure of head CT in V-ICPM group was 29.4% (40/136), lower than 42.8% (68/159) in non-V-ICPM group ( P<0.05). There was no significant difference between the two groups in the rate of intracranial infection, hydrocephalus and epilepsy (all P>0.05). Six months after discharge, the good rate of GOS in V-ICPM group was 91.2% (124/136), significantly better than 81.8% (130/159) in non-V-ICPM group ( P<0.05). Conclusion:For unilateral temporal lobe cerebral contusion, V-ICPM is associated with reduced rate of craniotomy exploration and DC, decreased incidence of complications and improved prognosis of the patients in spite of longer use time of hypertonic salt.
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Objective:To observe the effect of neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression in the treatment of craniocerebral injury complicated with temporal uncinate herniation.Methods:A total of 80 patients with craniocerebral trauma and temporal uncinate herniation hospitalized in Lanling County People′s Hospital from January 2017 to October 2020 were retrospectively included and divided into the observation group and the control group according to the surgical methods, with 40 patients in each group. Surgical procedures were performed by the same group of experienced neurosurgeons. The observation group was treated with neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression, while the control group was treated with large bone flap decompression only. Cephalic CT was reexamined before and 48 h after the surgery to compare the appearance rates of cisterna ambiens and suprasellar cistern. Intracranial pressure (ICP) was monitored at 3, 5 and 7 d after the surgery, and the scores of Glasgow coma scale(GCS) was recorded. Drainage time, postoperative cerebral edema and cerebral infarction complications were recorded and compared between the two groups. Six months after the surgery, the prognosis was assessed by the Glasgow prognostic scale (GPS).Results:The occurrence rates of cisterna ambiens and suprasellarcistern in the observation group were higher than those in the control group: 67.50%(27/40) vs. 45.00%(18/40), 65.00%(26/40) vs. 42.50%(17/40), χ2 = 4.11, 4.07, P<0.05. The ICP value in the observation group at 3, 5 and 7 d after the surgery were significantly lower than those in the control group, and the scores of GCS in the observation group were significantly higher than those in the control group, there were statistical differences( P<0.05). There was no statistically significant difference in drainage time between the two groups ( P>0.05). The incidence of postoperative cerebral edema in the observation group was lower than that in the control group:7.50%(3/40) vs. 25.00%(10/40), χ2 = 4.50, P<0.05. The incidence of postoperative cerebral infarction in the observation group was lower than that in the control group, and the volume of cerebral infarction was smaller than that in the control group: 5.00%(2/40) vs. 22.50%(9/40), (6.68 ± 1.75) cm 3 vs. (8.20 ± 2.15) cm 3, there were statistical differences ( P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group: 7.50%(7/40) vs. 40.00%(16/40), χ2 = 4.94, P<0.05. Six months after the surgery, the rate of good prognosis in the observation group was higher than that in the control group: 62.50%(25/40) vs. 35.00%(14/40), χ2 = 6.05, P<0.05. Conclusions:Neuroendoscope-assisted drainage with lumbar cistern and large bone flap decompression in the treatment of craniocerebral trauma and temporal uncinate herniation has good efficacy and safety.
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Objective:To analyze the injury factors and prognosis of children with traumatic brain injury (TBI), and to explore the risk factors affecting its severity, so as to provide evidence for the prevention and intervention of TBI in children.Methods:A total of 6 040 children with TBI who were admitted to the Department of Neurosurgery of Children's Hospital of Soochow University from January 1, 2011 to December 31, 2020 were selected. The injury factors and prognosis were retrospectively analyzed. Univariate and multivariate Logistic regression analysis was used to analyze the factors affecting the severity of TBI in children.Results:Of the 6 040 children, 3 681 were males and 2 359 were females. The patients aged 1 to 3 years accounted for the highest proportion (34.0%, 2 056/6 040), and most of them were mild injuries (93.2%, 5 631/6 040). The main injury sites of children with TBI were road (35.9%, 2 167/6 040) and home (31.1%, 1 881/6 040), and the main causes of injury were falling from height (34.9%, 2 107/6 040) and falling (34.5%, 2 085/6 040). Children aged 1 to 3 years were most likely to be injured at home(41.9%, 861/2 056), mainly due to falling from height, while children aged 4 to 6 years were most likely to be injured on the road(43.8%, 828/1 891), mainly due to falling. Logistic regression analysis showed that children's residence, the presence of multiple injuries and the location of brain injury were independent influencing factors for the severity of TBI in children ( χ2=6.58, 138.15, 4.25, all P <0.05). Conclusions:TBI in children aged 1 to 3 years mainly occurred at home, and in children aged 4 to 6 years mainly occurred on the road. Falling from height and falling are the main causes of TBI in children. The society, schools and families should take targeted prevention education and intervention measures according to different age groups. Children who live in rural areas, have multiple injuries, and have multiple brain injury sites are more severely injured. In the process of treating children with TBI, the severity can be quickly predicted based on this, and the treatment efficiency of children with TBI can be improved.
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Objective:To explore the effect of different blood sodium levels on the condition and prognosis of patients with severe craniocerebral injury.Methods:A retrospective cohort study was conducted on 150 cases of severe craniocerebral injury admitted to Zhangye People′s Hospital Affiliated to Hexi University from January 2020 to October 2022. According to the five blood sodium values measured on the first day after admission and during the peak period of brain edema (2-4 days after injury) and 7 days after injury, 102 cases of blood sodium metabolic disorder, 43 cases of low sodium group: average blood sodium value<135 mmol/L, 59 cases of high sodium group: average blood sodium value>145 mmol/L. The characteristics of sodium ion metabolism imbalance and the relationship between serum sodium level and Glasgow coma score (GCS), Glasgow prognosis score (GOS) and APACHE Ⅱ score at 2 weeks after injury were analyzed. Measurement data with normal distribution were represented as mean±standard deviation ( ± s), and comparison between groups was conducted using the t-test. count data were expressed as cases or percentages(%), and comparison between groups was conducted using the Chi-square test. Results:The imbalance rate of sodium metabolism in the acute phase after injury was 68.00%(102/150), including 57.84%(59/102) of hypernatremia and 42.16%(43/102) of hyponatremia. The imbalance rate of sodium metabolism at 7 days after injury was significantly higher than that immediately after injury. Hypernatremia occurred earlier than hyponatremia and lasted longer than hyponatremia ( P<0.05). There was no correlation between the low sodium group and the scores of GCS ( R=0.523), GOS ( R=0.367), APACHE Ⅱ ( R=-0.453) ( P>0.05), but the scores of GCS ( R=-0.448) and GOS ( R=-0.486) were negatively correlated with the blood sodium level of the high sodium group ( P<0.05), and the high sodium group was positively correlated with the scores of APACHE Ⅱ ( R=0.477, P<0.05). Conclusions:Patients with severe craniocerebral injury are often accompanied by blood sodium disorder. Hyponatremia can be corrected in a short time and has no effect on the patient′s condition and prognosis. However, hypernatremia seriously affects the recovery of consciousness, prognosis and quality of life of the injured.
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AIM:To observe the efficacy and safety of flurbiprofen axidate in postoperative analgesia in patients with craniocerebral injury. METHODS: A total of 60 patients with acute craniocerebral injury admitted to the Department of Neurosurgery in our hospital from May 2021 to May 2023 were selected. They were randomly divided into flurbiprofen axetil group (flurbiprofen + fentanyl analgesia) and fentanyl group (fentanyl analgesia), and the CPOT score of analgesia target was ≤3 points. The onset time of analgesia, the dosage of fentanyl within 48 h, and the occurrence times of nausea and vomiting, upper gastrointestinal hemorrhage, bradycardia and hypotension during analgesia treatment were observed in the two groups. Serum CRP, IL-6, TNF-α, NSE and S100β protein levels were detected before and 24 h and 48 h after the operation. RESULTS: There were no significant differences in gender, age, BMI, admission GCS score between the two groups. When analgesia reached the target value of CPOT score ≤3 points, the time required for flurbiprofen ester group was shorter than that of fentanyl group (P0.05). CRP, IL-6, TNF - α, NSE and S100β in flurbiprofen axetil group were significantly lower than those in fentanyl group at 24 h and 48 h after operation (P<0.05). CONCLUSION: Flurbiprofen exate can reduce the amount of analgesic fentanyl in patients with craniocerebral injury, and has anti-inflammatory effect to reduce brain injury, and can be effectively and safely used in the analgesic management of patients with craniocerebral injury.
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Introdução: O traumatismo cranioencefálico é um evento incapacitante e de importância mundial com expressiva morbimortalidade mundial. Objetivo: analisar as evidências científicas internacionais sobre o processo de enfermagem no cuidado ao adulto com traumatismo cranioencefálico. Método: Revisão integrativa, realizada em seis bases de dados de fevereiro a março de 2020. Os descritores ''pacientes internados'', ''cuidados críticos'', ''cuidados de enfermagem'', ''processo de enfermagem'', ''traumatismos craniocerebrais'' e ''traumatismo múltiplo'' foram cruzados por meio de operadores booleanos AND e OR. Os estudos foram analisados pelo método de redução de dados, contrapondo-se, o que gerou a síntese. Resultados: Ressalta-se o monitoramento hemodinâmico, a aplicação da escala de coma de Glasgow e a atualização de um plano de cuidados como parte do processo de enfermagem. Além disso, cabe-se destaque a necessidade de elaboração dos diagnósticos e intervenções de enfermagem. Conclusão: Existe uma lacuna com relação a formulação de diagnósticos de enfermagem e intervenções ligadas ao processo de enfermagem, como também a descrição dos parâmetros ideais a serem verificados na monitorização das pessoas.
Introducción: El traumatismo craneoencefálico es un acontecimiento incapacitante de importancia mundial, con una importante morbilidad y mortalidad en todo el mundo. Objetivo: Analizar las evidencias científicas internacionales sobre el proceso de enfermería en el cuidado de personas adultas con lesión cerebral traumática. Método: Revisión integradora, realizada en seis bases de datos, de febrero a marzo de 2020. Los descriptores fueron "pacientes hospitalizados", "cuidados críticos", "cuidados de enfermería", "proceso de enfermería", "lesión cerebral traumática" y "lesión cerebral traumática múltiple". Se cruzaron mediante los operadores booleanos AND y OR. Los estudios se analizaron mediante el método de reducción de datos y la contrastación generó la síntesis. Resultados: Se destaca la monitorización hemodinámica, la aplicación de la escala de coma de Glasgow y la actualización de un paquete de cuidados como parte del proceso de enfermería. Además, hay que destacar la necesidad de elaborar diagnósticos e intervenciones de enfermería. Conclusión: Existe un vacío en cuanto a la formulación de diagnósticos e intervenciones vinculado al proceso de enfermería, así como en la descripción de los parámetros ideales que deben verificarse en el seguimiento de personas.
Introduction: Traumatic brain injury is a disabling event of worldwide importance with significant morbidity and mortality worldwide. Objective: The aim was to analyze the international scientific evidence on the nursing process of caring for adult patients with traumatic brain injury. Method: This was an integrative review conducted from February to March 2020 in six databases. The descriptors "hospitalized patients", "critical care", "nursing care", "nursing process", "traumatic brain injury" and "multiple traumatic brain injury" were matched through the Boolean operators AND/OR. The studies were analyzed through a data reduction method: they were contrasted with each other. This in turn generated the synthesis. Results: The results highlight the hemodynamic monitoring, the application of the Glasgow coma scale, and the update of a care package as part of the nursing process. Furthermore, the results also highlight the need to develop nursing diagnoses and interventions. Conclusion: There is a gap regarding the formulation of nursing diagnoses and interventions linked to the nursing process, as well as the description of the ideal parameters to be checked when monitoring patients.
Subject(s)
Critical Care , Craniocerebral Trauma/nursing , Nursing CareABSTRACT
ABSTRACT Purpose: To evaluate the clinical features of pediatric patients with acute-onset, unilateral transient acquired blepharoptosis. Methods: In this retrospective study, the clinical records of patients between April 2015 and June 2020 were reviewed for evaluation of demographic features, accompanying neurological and ophthalmologic manifestations, symptom duration, etiological cause, and imaging findings. Patients with congenital and acquired blepharoptosis with chronic etiologies were excluded. Results: Sixteen pediatric patients (10 boys and 6 girls) with acquired acute-onset unilateral transient blepharoptosis were included in this study. The patients' mean age was 6.93 ± 3.16 years. The most commonly identified etiological cause was trauma in 7 patients (43.75%) and infection (para-infection) in 5 patients (31.25%). In addition, Miller Fisher syndrome, Horner syndrome secondary to neuroblastoma, acquired Brown's syndrome, and pseudotumor cerebri were identified as etiological causes in one patient each. Additional ocular findings accompanied blepharoptosis in 7 patients (58.33%). Blepharoptosis spontaneously resolved, without treatment, in all the patients, except those with Miller Fisher syndrome, neuroblastoma, and pseudotumor cerebri. None of the patients required surgical treatment and had ocular morbidities such as amblyopia. Conclusion: This study demonstrated that acute-onset unilateral transient blepharoptosis, which is rare in childhood, may regress without the need for surgical treatment in the pediatric population. However, serious pathologies that require treatment may present with blepharoptosis.
RESUMO Objetivo: Avaliar as características clínicas de pacientes pediátricos com blefaroptose adquirida unilateral, transitória e de início agudo. Métodos: Neste estudo retrospectivo, foram revisados prontuários clínicos entre abril de 2015 e junho de 2020. Os pacientes foram avaliados em termos de características demográficas, manifestações neurológicas e oftalmológicas associadas, duração dos sintomas, etiologia e achados de imagem. Foram excluídos pacientes com blefaroptose congênita e com blefaroptose adquirida de etiologia crônica. Resultados: Foram incluídos neste estudo 16 pacientes pediátricos (10 masculinos e 6 femininos) com blefaroptose adquirida transitória unilateral de início agudo. A média de idade dos pacientes foi de 6,93 ± 3,16 anos. As causas etiológicas mais comumente identificadas foram trauma em 7 pacientes (43,75%) e infecção (casos parainfecciosos) em 5 pacientes (31,25%). Além disso, a síndrome de Miller-Fisher, a síndrome de Horner secundária a neuroblastoma, a síndrome de Brown adquirida e pseudotumor cerebral foram determinados como causas etiológicas em um paciente cada uma. Achados oculares adicionais estavam associados à blefaroptose em 7 pacientes (58,33%). Foi observada a resolução espontânea da blefaroptose, sem tratamento, em todos os pacientes, exceto nos pacientes com síndrome de Miller-Fisher, neuroblastoma e pseudotumor cerebral. Nenhum paciente precisou de tratamento cirúrgico. Morbidades oculares, como ambliopia, não foram encontradas em nenhum paciente. Conclusão: Este estudo demonstrou que a blefaroptose transitória unilateral de início agudo, rara na infância, pode regredir sem a necessidade de tratamento cirúrgico na população pediátrica. No entanto, também não deve ser esquecido que patologias graves que requerem tratamento podem se apresentar com blefaroptose.
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A tomografia computadorizada (TC) é exame de escolha para rastreamento de lesões no traumatismo cranioencefálico (TCE). Apesar disso, seu uso rotineiro no TCE leve é controverso O objetivo desta revisão foi avaliar o impacto da aplicação de diretrizes de manejo e conduta de TCE leve quanto à solicitação de TC de crânio. É busca realizada nas bases de dados LILACS, Medline, PubMed, SciELO, utilizando descritores do MeSH e DeCS. A busca inicial identificou 30.191 artigos. Após remoção de publicações duplicadas, seleção pelo título, seleção pelo resumo, restaram 25 publicações, que foram lidas na íntegra e cinco incluídas na presente revisão sistemática. Em conclusão, os artigos analisados apresentaram, em média, redução de 25,8% na solicitação de TC de crânio quando aplicadas as diretrizes, e orientam que protocolos para TCE leve são ferramentas eficientes para auxiliar a prática médica, impactando positivamente quando aplicados na população, devendo sempre ser levado em conta a avaliação clínica.
Computed tomography (CT) is the exam of choice for tracking injuries in traumatic brain injury (TBI). Despite this, its routine use in mild TBI is controversial. The objective of this review was to evaluate the impact of applying guidelines for the management and conduct of mild TBI on the request for CT of the head. A search was carried out in the LILACS, Medline, PubMed, SciELO databases, using MeSH and DeCS descriptors. The initial search identified 30,191 articles. After removal of duplicate publications, selection by title, selection by abstract, 25 publications remained, which were read in full and five were included in this systematic review. In conclusion, the articles analyzed showed, on average, a 25.8% reduction in the request for cranial CT when the guidelines were applied, and guide that protocols for mild TBI are efficient tools to assist medical practice, positively impacting when applied to the population. , and clinical evaluation should always be taken into account.
Subject(s)
Humans , Tomography, X-Ray Computed , Diagnostic Techniques, Neurological , Craniocerebral Trauma , Skull , Brain Injuries, TraumaticABSTRACT
The patient, a 50-year-old male, was admitted to the hospital on April 1, 2020 with the chief complaint of "confusion with vomiting for 1 hour due to falling from height ", and the emergency craniotomy was performed. Intermittent fever with a maximum temperature of 38 ℃ occurred 3 days after the surgery, and the inflammation indexes were all higher than the upper limit of the reference values. Recurrent fever remained despite after empirical anti-infection treatment. On April 12, the patient was treated with vancomycin combined with meropenem after cerebrospinal fluid specimens routine and biochemical tests suggested intracranial infection. After 48 hours of cultivating the cerebrospinal fluid and blood specimens, some small, clear, needle-like colonies were found and they were identified as Mycoplasma humanum by using 16S rRNA gene. Eventually, the patient died due to the severity of the disease and complications.
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Objective:To screen important genes and characterize their functions and signaling pathways by weighted gene co-expression network analysis (WGCNA) on the gene expression profile of brain tissue after traumatic brain injury (TBI) so as to provide a reference for the mechanism research and treatment of TBI.Methods:The rat TBI gene expression profile GSE2871 was downloaded from the Gene Expression Omnibus (GEO). The expression profile of 8 799 genes of all 47 rat brain tissue samples was analyzed by WGCNA. After calculating and selecting the β-weighted soft threshold, undirected weighted gene network was constructed to identify gene sets with a high degree of correlation. Sample information was obtained from the database to calculate the correlation between each trait of the samples and modules. Gene ontology (GO) analysis and KEGG pathway analysis were performed for the genes in modules related to injury severity and sampling side in order to unvail the biological processes and pathways involved. The gene-module correlation and gene-trait correlation in these key modules were calculated and hub genes were selected.Results:All the rat brain tissue samples and genes in GSE2871 were included in the WGCNA analysis. A total of 22 modules were obtained, which were marked as modules A to V. Modules E, G, T and U were significantly associated with the sampling side. Modules E and G were significantly related to injury severity . GO analysis and KEGG pathway analysis indicated that the genes in modules E and G with significant relation to injury severity and sampling side were mainly implicated in leukocyte migration, cell chemotaxis, various immune response regulation, etc. The involved pathways included antigen processing and presentation pathways, cell factor-cytokine receptor interaction, interleukin-17 signaling pathway, etc. While modules T and U with significant relation to the sampling side were mainly implicated in hypoxia response, cell metabolism, cell membrane ion channel regulation, signal transduction, etc. The pathways involved were neurodegenerative disease signaling pathways, ribosomes, autophagy, neuroactive ligand-receptor interactions, etc. Among the key modules significantly relating to traits, Tuba1b/1c, Ifitm3, Cebpd, Nfkbia, Serinc3, Pmpcb and Cyp4a8 were selected as hub genes of the above key modules.Conclusion:The genes significantly relating to rat TBI are mainly involved in pathophysiological links such as immune activation, inflammatory response, abnormal energy metabolism, calcium channel disorders, abnormal autophagy and cell apoptosis.
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Objective:To investigate the predictive value of mechanism Glasgow age blood pressure score (MGAPS), revised trauma score (RTS) and modified rapid emergency medicine score (mREMS) in predicting the mortality risk of patients with acute traumatic brain injury (TBI) within 24 hours.Methods:A case control study was performed for clinical data of 1 156 patients with acute TBI admitted to Affiliated Hospital of Nantong Hospital from January to December of 2020, including 745 males and 411 females; aged 18-100 years [(59.9±15.1)years]. Glasgow coma score (GCS) was 3-15 points [15(9, 15)points]. The patients were divided into death group ( n=87) and survival group ( n=1 069) according to death or not within 24 hours. Vital signs, general data, MGAPS, RTS and mREMS were documented at emergency visit. Differences in the specific scores and severity levels of the patients using the three scoring systems were compared between the two groups. Receiver operating characteristic (ROC) curve was plotted for the three scoring systems based on the specific scores and severity levels of the patients. While the area under the curve (AUC), sensitivity, specificity, optimal threshold and Youden index were determined to estimate the value of the three scoring systems in predicting death risk in patients with acute TBI within 24 hours. Results:Death group showed significantly decreased scores in MGAPS [17(12, 19)points] and RTS [5.0(4.1, 6.0)points] and significantly increased score in mREMS [9(7, 12)points] when compared with survival group (all P<0.01). The proportion of moderate- and high-risk patients for MGAPS and proportion of high-risk patients for RTS and mREMS in death group were significantly higher than those in survival group (all P<0.01). As indicated by the ROC curve plotted based on the specific scores, mREMS had the maximum AUC (0.88), followed by MGAPS (0.86) and RTS (0.86); the sensitivity of mREMS, MGAPS and RTS was similar (80.5%, 86.2% and 82.8%, respectively), while mREMS showed the highest specificity (83.4%) compared to MGAPS (78.0%) and RTS (82.3%); the optimum threshold of mREMS, MGAPS and RTS, was 6 points, 6.08 points and 20 points; the Youden index of MGAPS, RTS and mREMS was 0.64, 0.64 and 0.65. As indicated by the ROC curve plotted based on the injury severity, MGAPS had the highest AUC (0.84), followed by RTS (0.70) and mREMS (0.59); MGAPS also had the highest sensitivity (92.0%), higher than RTS (47.1%) and RTS (18.4%); when mREMS showed the highest specificity(98.8%) compared to RTS (93.7%) and MGAPS (68.8%); the optimal threshold of MGAPS, RTS and mREMS was 22 points, 4 points and 13 points; the Youden index of MGAPS, RTS and mREMS was 0.61, 0.41 and 0.17. Conclusions:MGAPS, RTS and mREMS can be predictive in assessing the mortality risk of patients with acute TBI within 24 hours. mREMS has the highest prediction value, with an optimal threshold of 6 points when the risk assessment is made in accordance with specific scores of the patients. MGAPS has the highest prediction value when the risk assessment is assessed by the injury severity.
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Objective:To compare the application effect of electrotome flap separation and neuro dissector in standard large decompressive craniectomy (SLDC).Methods:From January 2020 to December 2020, 40 patients with severe craniocerebral injury who met the standard and planned to undergo SLDC were randomly divided into two groups: 20 patients in the electrotome separation group and 20 patients in the nerve dissector group. The time of flap seperation, the degree of edema and atrophy of temporal muscle on the operation side were compared between the two groups.Results:There was no significant difference in the time of flap separation between the two groups [(20.91±12.33)min vs (29.92±12.69)min, t=1.799, P>0.05]. The patients in the two groups had different degrees of temporal muscle edema 48 hours after operation. The degree of temporal muscle edema in the electrotome separation group was more serious than that in the nerve dissector group [(18.82±5.23)cm 3 vs (10.71±3.69)cm 3,t=7.314, P<0.05]. The degree of temporal muscle atrophy in the electrotome separation group was higher than that in the nerve dissector group [(8.26±2.38)cm 3 vs (6.72±2.13)cm 3,t=2.314, P<0.05]. Conclusions:In SLDC surgery, there was no significant difference in flap separation time between electrotome separation flap method and neuro dissector flap separation method, but the latter had less damage to temporal muscle and less atrophy of temporal muscle after operation.
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Objective:To explore the best negative pressure standard of sputum aspiration in patients with severe craniocerebral injury, so as to achieve the best sputum aspiration effect and maintain relatively stable intracranial pressure.Methods:Totally 120 patients with severe craniocerebral injury admitted to the Department of Neurosurgery of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January to December 2019 were selected by convenience sampling method. According to the random number table method, patients were divided into 4 different negative pressure sputum aspiration groups: 75 mmHg (1 mmHg=0.133 kPa) group, 100 mmHg group, 150 mmHg group, 200 mmHg group, with 30 patients in each group. The levels of intracranial pressure and SpO 2, sputum cleaning time and mucosal injury were observed and compared in 4 groups: 1 min before sputum aspiration, 1 min after sputum aspiration and during sputum aspiration. Results:Comparison of intracranial pressure and SpO 2 in sputum aspiration among the four groups: intracranial pressure in 200 mmHg group was (22.23 ± 4.80) mmHg, which was higher than 75 mmHg group (16.33 ± 2.71) mmHg, 100 mmHg group (17.70 ± 2.32) mmHg, 150 mmHg group (17.20 ± 2.11) mmHg ( q=8.29, 6.58, 7.23), and SpO 2 was 0.906 ± 0.048, which was lower than 0.956 ± 0.013, 0.946 ± 0.018, 0.952 ± 0.023 in the other three groups ( q=7.81, 6.08, 6.69), with statistical significance (all P<0.01). There were statistically significant differences in intracranial pressure ( F=10.55) and SpO 2 ( F=36.57) among the four groups 1 min after sputum aspiration ( P<0.01);the 200 mmHg group had the highest intracranial pressure (15.63 ± 3.64) mmHg; the 100 mmHg group was (12.50 ± 1.48) mmHg and 150 mmHg group was (12.60 ± 1.00) mmHg, which had lower intracranial pressure than the 75 mmHg group (14.03 ± 2.86) mmHg. The sputum cleaning time was (35.53 ± 5.71) s in 75 mmHg group which was the longest and the shortest in 200 mmHg group (24.27 ± 3.22) s, with statistical significance among the four groups ( F=47.81, P<0.01). The incidence of airway mucosal injury in 200 mmHg group was 33.33% (10/30),which was higher than that in the other three groups, and the difference was statistically significant ( χ2=15.41, P<0.01). Conclusions:For patients with severe craniocerebral injury, artificial airway sputum viscosityⅠ-Ⅱ degree, suction negative pressure of 100-150 mmHg can better maintain the stability of intracranial pressure, control the decline of SpO 2 and prevent the damage of airway mucosa, and effectively reduce the adverse effects of sputum aspiration on patients with severe craniocerebral injury.
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Objective:To investigate the effects of esketamine on the behavior of post-traumatic stress disorder(PTSD).Methods:Thirty-six adult male SD rats were randomly divided into three groups. The mouse craniocerebral trauma model was established by cortical impact injury method. The Sham group ( n=12) only opened the bone window without craniocerebral trauma. The TBI group( n=12) and the TBI+ ES group( n=12) were subjected to cortical trauma; Immediately after trauma, the TBI+ ES group was intraperitoneally injected with esmketamine (10 mg/kg, once every two hours, three times in total), and the TBI group and Sham group were intraperitoneally injected with equal volume 0.9% sodium chloride solution. The results of sugar water preference test, open field test on day 16 and elevated cross maze test on day 17 were collected to analyze PTSD like behavior changes, and Morris water maze test was used to evaluate the learning and memory ability of rats in each group from day 18 to 23 after craniocerebral trauma. After the experiment, the rats were euthanized and the brain tissues were taken. The expression levels of brain-derived neurotrophic factor (BDNF), synaptic protein PSD95 and synaptophysin (Syp) were analyzed by Western blot. The measurement data of normal distribution were expressed as mean ± standard deviation ( ± s). One way ANOVA was used for multi group comparison, SNK- q test was used for post pairwise comparison, and LSD method was used for repeated measurement data. Results:In the TBI group, the preference rate of sugar water, the number of moving grids, the number of standing upright, the residence time of open arm, the number of open arm entry, the escape latency and the number of crossing platform [(75.8±4.9)%, (30.9±4.1) grids, (12.4±2.6) times, (40.3±8.5) s, (6.8±2.3) times, (30.0±4.6) s and (7.0±2.5) times] were significantly lower than Sham group [(85.3±4.4)%, (40.5±5.4) grid, (17.3±2.7) times, (95.8±12.4) s, (15.3±3.1) times, (18.3±7.8) s, (15.7±2.6) times] ( P< 0.05); In TBI+ ES group, the sugar water preference rate, the number of moving grids, the number of upright times, the time of open arm stay, the number of open arm entry, the number of escape latency and the number of crossing platform position [(82.9±5.5)%, (35.5±5.5) grids, (15.1±2.4) times, (68.4±9.7) s, (12.1±3.2) times, (22.3±8.8) s and (12.5±4.1) times] were significantly higher than those in TBI group ( P<0.05). The expression levels of BDNF, PSD95 and Syp in TBI+ ES Group [0.43±0.08), (0.22±0.02), (0.31±0.04)] were higher than those in TBI group [0.19±0.02), (0.20±0.02), (0.24±0.01)], the difference was significant ( P<0.05), and they were lower than those in Sham group [0.89±0.11), (0.45±0.12), (0.57±0.15)], and the difference was significant ( P<0.05). Conclusion:Esticketamine significantly reduce PTSD-like behavior in TBI rats and play a neuroprotective role, which may be a potential medicinefor PTSD treatment.