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Objective:To investigate the value of a 5-point predictive score based on unenhanced CT combined with blood glucose detection for predicting short-term prognosis in patients with spontaneous cerebral hemorrhage.Methods:A total of 102 patients with spontaneous intracerebral hemorrhage who received treatment in Zhejiang Provincial People's Hospital from March 2020 to March 2022 were included in this study and analyzed retrospectively. Blood glucose level was measured and BAT score was used to evaluate hematoma enlargement. After 30 days, Glasgow Outcome Scale was used to evaluate the prognosis of patients. The relationships between blood glucose and BAT score, and between blood glucose and BAT score and prognosis were analyzed. The value of blood glucose and BAT score for predicting short-term prognosis was analyzed.Results:The Glasgow Outcome Scale results showed that among the 102 patients, 24 patients (23.53%) had poor prognosis. The BAT score and blood glucose level in patients with poor prognosis were (3.13 ± 0.68) points and (11.58 ± 2.30) mmol/L, respectively, which were significantly higher than (2.40 ± 0.59) points and (8.88 ± 1.71) mmol/L in patients with good prognosis ( t = 5.10, 5.30, both P < 0.05). Pearson correlation analysis showed that in patients with spontaneous intracerebral hemorrhage, blood glucose level was positively correlated with BAT score ( r = 0.43, P < 0.05). Spearman correlation analysis showed that in patients with spontaneous intracerebral hemorrhage, blood glucose level and BAT level were positively correlated with prognosis ( r = 0.42, 0.47, both P < 0.05). The receiver operating characteristic curve showed that the area under the curve plotted for BAT score combined with blood glucose level for predicting short-term prognosis was 0.874, which was significantly greater than the area under the curve plotted for BAT score alone for predicting short-term prognosis ( Z = 2.54, P < 0.05). Conclusion:A large proportion of patients with spontaneous intracerebral hemorrhage have a poor prognosis. The patients with a poor prognosis have higher blood glucose levels and BAT scores than those with good prognosis. Blood glucose and BAT score have a high value for predicting the prognosis of patients with spontaneous intracerebral hemorrhage.
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Background: Raised peripheral neutrophil lymphocyte ratio is associated with poorer outcomes in conditions such as severe brain injury, ICH, cardiovascular conditions, cancer.Methods:Retrospective analysis of 96 severe Traumatic Brain injury data treated at our institute over a period of 1 year. The patients were followed up for a period of at least 1 month. The primary outcome of the study was 1 month GOS and the various variables which may be associated with the poor GOS at 1 month follow up. Model based analysis was done for NLCR <24 hrs at 48 hrs and GCS at the time of presentation and discriminative ability of the models were studied by the Area under the curve.Results:Univariate analysis were done of 96 patients of severe traumatic brain injury for various variables such as age, sex, mode of head injury, type of head injury, presenting GCS and NLCR at 24 hrs and 48 hrs to that of GOS at 1 month follow up. Initial GCS <7(p=0.0138) with AUC=0.6689 and peak NLCR (<24 hr) of > 9.6 (AUC=0.931) with a p value of <0.001 with sensitivity of 100% and specificity of 79.27% and peak NLCR (48 hrs) of >12.4 (AUC= 0.973) with a p value of <0.001 with sensitivity of 100% and specificity of 89.02% were associated with unfavourable outcome.Conclusions:High NLCR and initial poor GCS are independent unfavourable prognostic factors in 1 month GOS following severe traumatic head injury.
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Objective:To investigate the effect of continuous intracranial pressure (ICP) and brain oxygen partial pressure (PbtO 2) monitoring and guiding treatment after the application of standard large bone flap decompression and microhematoma removal in patients with severe traumatic brain injury (TBI). Methods:A retrospective analysis was done of 41 patients with TBI in Department of Neurosurgery in the Inner Mongolia People's Hospital from January 2018 to May 2020. Patients with Glasgow coma scale (GCS)<8 points were treatesd with microscopical removal of hematoma and contusion brain tissue and standard large bone flap decompression. Intraoperative intracranial pressure and brain tissue oxygen partial pressure monitoring probes were placed. Postoperatively, continuous intracranial pressure monitoring and partial oxygen pressure monitoring of brain tissue were performed, and target-based treatment under ICP and PbtO 2 monitoring was performed. According to the Glasgow Outcome (GOS) score after six months, patients were divided into a good outcome group (4-5 scores) and a poor outcome group (1-3 scores). There were 26 cases in good prognosis group and 15 cases in poor prognosis group. Linear regression analysis was used to further evaluate the relationship between PbtO 2, ICP and GOS score. The measurement data of normal distribution were compared by independent sample t-test. The counting data were expressed in cases (%), and the comparison between groups was adopted χ 2 inspection. The general linear bivariate Pearson correlation test was used. Results:The mean value of PbtO 2 (17.42±5.34) mmHg in the poor prognosis group was lower than that in the good prognosis group (24.65±5.61) mmHg, with statistical significance ( t=4.04, P<0.001). The mean value of ICP (22.32±3.45) mmHg in the poor prognosis group was higher than that (17.32±3.23) mmHg in the good prognosis group, with statistical significance ( t=4.15, P<0.001). Using PbtO 2 and ICP as independent variables and GOS score after 6 months as dependent variable, a regression equation was established ( Y=4.040 X+7.497; Y=-2.549 X+28.63). The mean value of PbtO 2 was positively correlated with GOS scores after 6 months in patients with severe head injury ( r=0.75, P<0.001). The mean value of ICP was negatively correlated with the prognosis of patients with severe head injury ( r=-0.87, P<0.001). Conclusion:The treatment guided by ICP combined with PbtO 2 monitoring is valuable in improving the prognosis of patients with severe traumatic brain injury after standard decompressive craniectomy, and may improve the prognosis 6 months after the injury.
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OBJECTIVE@#To evaluate recovering consciousness effect of electroacupuncture (EA) on patients after traumatic brain injury (TBI) surgery.@*METHODS@#A total of 100 patients with traumatic coma were randomly divided into an observation group and a control group, 50 cases in each group. The control group was mainly treated with awakening drugs and neurotrophic drugs; on the basis of treatment in the control group, the observation group was treated with EA at Neiguan (PC 6) and Shuigou (GV 26) with disperse-dense wave, 2 Hz/100 Hz in frequency, 0.1-5 mA in intensity. After 30 min of EA, the needles were stayed 60 min. The treatment was performed once a day for 14 consecutive days. The changes in Glasgow coma score (GCS) was observed in the two groups before treatment and after 7, 14 days of treatment; and the two groups were followed up for 3 months after treatment to evaluate the Glasgow outcome scale (GOS) and Barthel index (BI) scores.@*RESULTS@#After 7, 14 days of treatment, the GCS scores of the two groups were higher than those before treatment (<0.05), and the increase degree in the observation group was significantly larger than that in the control group (<0.05). At 3 months of follow-up, the GOS and BI scores of the observation group were better than those of the control group (<0.05).@*CONCLUSION@#Early electroacupuncture intervention can effectively promote the recovery of consciousness after traumatic brain injury surgery, and has a curative long-term effect.
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Humans , Acupuncture Points , Brain Injuries, Traumatic , General Surgery , Therapeutics , Consciousness , ElectroacupunctureABSTRACT
Objective@#To explore the factors affecting the prognosis of children with status epilepticus(SE).@*Methods@#A retrospective review was performed on children and the outcomes were measured by Glasgow Outcome Score (GOS). GOS=5 was defined as a good outcome, and GOS<5 as a bad outcome.@*Results@#(1)Two hundred and ninety-eight children (163 girls and 135 boys) with SE were enrolled.The ages of the patients ranged from 2 months and 7 days to 14 years and 5 months, and 106 cases were at 1-3 years old.There were 154 cases (51.68%) with previous history of convulsion, including 98 cases of epilepsy (63.63%) and 241 new onset SE (80.87%). The most common cause of SE in children was febrile seizure (92 cases, accounting for 30.87%), followed by long-term symptom (81 cases, accounting for 27.18%). A total of 109 cases (41.90%) were treated with Diazepam in time after the convulsion, and 151 cases (58.10%) were treated with antiepileptic drugs such as Phenobarbital sodium or Chloral hydrate after the convulsion.Based on GOS scale, the near-term prognosis was as follows: 254 cases(85.23%) of children with GOS=5, and the remaining 44 cases of GOS<5 points.(2) Recent overall prognostic factors: single factor analysis showed that a total of 12 factors were associated with poor prognosis (P<0.05), including age, Pediatric Intensive Care Unit (PICU), tracheal intubation, previous history of convulsions, developmental delay, new onset of SE, fever, comprehensive onset, refractory SE, electroencephalogram (EEG) abnormality, neuroimaging abnormality and etiology.Multiple factor Logistic regression analysis showed that PICU monitoring was required (OR=4.306, 95%CI: 1.554-11.933, P=0.005), developmental delay (OR=3.054, 95%CI: 1.157-8.066, P=0.024), and abnormal cranial image (OR=2.110, 95%CI: 1.121-3.970, P=0.021) was an independent risk factors for short-term poor prognosis.Comprehensive onset (OR=0.330, 95%CI: 0.139-0.782; P=0.012), and the cause of febrile convulsion (OR=0.688, 95%CI: 0.480-0.987, P=0.042) were prognostic non-risk factor.(3)Recent prognostic factors in PICU monitoring group: the hospitalization time of PICU, developmental delay, the atypical attack type, electroencephalogram abnormality, neuroimaging abnormality, and the etiology of these 6 factors were correlated with the prognosis of PICU group, among which prolonged PICU (OR=36.912, 95%CI: 5.165-263.787, P=0.000) and developmental delay (OR=14.403, 95%CI: 1.725-120.273, P=0.014) were independent risk factors for poor outcome of PICU monitoring group.@*Conclusions@#PICU monitoring, developmental backwardness and abnormal head image are the independent risk factors for poor prognosis.PICU residence time and developmental delay are the independent risk factors for poor short-term prognosis in PICU enrolled children.
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Objective To explore the factors affecting the prognosis of children with status epilepticu(s SE). Methods A retrospective review was performed on children and the outcomes were measured by Glasgow Outcome Score(GOS). GOS=5 was defined as a good outcome,and GOS<5 as a bad outcome. Results (1)Two hundred and ninety-eight children(163 girls and 135 boys)with SE were enrolled. The ages of the patients ranged from 2 months and 7 days to 14 years and 5 months,and 106 cases were at 1-3 years old. There were 154 cases(51. 68% )with pre-vious history of convulsion,including 98 cases of epilepsy(63. 63% )and 241 new onset SE(80. 87% ). The most common cause of SE in children was febrile seizure(92 cases,accounting for 30. 87% ),followed by long-term symp-tom(81 cases,accounting for 27. 18% ). A total of 109 cases(41. 90% )were treated with Diazepam in time after the convulsion,and 151 cases(58. 10% )were treated with antiepileptic drugs such as Phenobarbital sodium or Chloral hy-drate after the convulsion. Based on GOS scale,the near-term prognosis was as follows:254 cases(85. 23% )of chil-dren with GOS=5,and the remaining 44 cases of GOS<5 points.(2)Recent overall prognostic factors:single factor analysis showed that a total of 12 factors were associated with poor prognosis(P<0. 05),including age,Pediatric In-tensive Care Unit(PICU),tracheal intubation,previous history of convulsions,developmental delay,new onset of SE, fever,comprehensive onset,refractory SE,electroencephalogram( EEG)abnormality,neuroimaging abnormality and etiology. Multiple factor Logistic regression analysis showed that PICU monitoring was required( OR=4. 306,95% CI:1. 554-11. 933,P=0. 005),developmental delay(OR=3. 054,95% CI:1. 157-8. 066,P=0. 024),and abnormal cranial image(OR=2. 110,95% CI:1. 121-3. 970,P=0. 021)was an independent risk factors for short-term poor prognosis. Comprehensive onset(OR=0. 330,95% CI:0. 139-0. 782;P=0. 012),and the cause of febrile convulsion (OR=0. 688,95% CI:0. 480-0. 987,P=0. 042)were prognostic non-risk factor.(3)Recent prognostic factors in PICU monitoring group:the hospitalization time of PICU,developmental delay,the atypical attack type,electroencepha-logram abnormality,neuroimaging abnormality,and the etiology of these 6 factors were correlated with the prognosis of PICU group,among which prolonged PICU(OR=36. 912,95% CI:5. 165-263. 787,P=0. 000)and developmental delay(OR=14. 403,95% CI:1. 725-120. 273,P=0. 014)were independent risk factors for poor outcome of PICU monitoring group. Conclusions PICU monitoring,developmental backwardness and abnormal head image are the inde-pendent risk factors for poor prognosis. PICU residence time and developmental delay are the independent risk factors for poor short-term prognosis in PICU enrolled children.
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Objective To evaluate the effect of mild hypothermia combined with hypbaric oxygen (HBO) treatment on secondary brain injury in patients with severe craniocerebral injury.Methods A prospective study was conducted in this study.Forty-two patients with severe craniocerebral injury admitted to hospital within 8 hours were randomly divided into sub-hypothermia combined with HBO treatment group and conventional HBO control group,21 cases in either group.Cerebral hemorrhage and brain edema were calculated by reviewed head CT on the 1st day,15th day and 30th day after injury.GCS (Glasgow Coma Scale) score was calculated at the same time.The number of cases of cerebral infarction was counted in the two groups.GOS (Glasgow Outcome Score) prognosis was scored for both groups of patients six months after injury.Two groups of sample rates were compared using a chi-square test with continuous correction,The intergroup comparisons were analyzed by independent sample t test by using SPSS version 13.0 software.Differences were considered statistically significant if P ＜ 0.05.Results (1) The amount of cerebral hemorrhage and edema in the treatment group were significantly lower than those in the control group on the 15th day and 30th day after injury [(21.71 ±4.3) vs.(26.33 ±5.23);(14.33 ± 1.93) vs.(16.86 ±2.86),P ＜0.05].(2) The GCS score of the treatment group was higher than that of the control group on the 15th day and 30th day after injury [(4.62 ±0.49) vs.(2.49 ±0.56);(9.76 ± 1.37) vs.(8.57 ± 0.92),P ＜ 0.05];(3) There were 2 cases of traumatic cerebral infarction in the treatment group and 9 cases in the control group (x2 =4.434,P =0.035).The GOS score in the treatment group was higher than that in the control group six months after injury [(4.29 ± 0.84) vs.(3.38 ± 0.74),P =0.001].Conclusions Mild hypothermia combined with hyperbaric oxygen treatment can reduce the secondary brain injury and improve the prognosis of patients with severe craniocerebral injury.It is worth further study,the mechanism of hypothermia remains to be further studied.
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ObjectiveTo investigate the effects of minimally invasive key-hole drainage for treating acute subdural hematoma.MethodsThirty-five patients with acute subdural hematoma treated by key-hole drainage were retrospectively analyzed.CT-oriented key-hole drainage was performed to aspirate,liquefy and drain hematoma.The transfixion pin was removed after hematoma was basically cleared within 1 to 3 days.ResultsHematoma volume decrease was greater than 80％ by follow-up CT 24 hours postoperatively.Headache and vomiting in the preoperative conscious patients were significantly relieved after key-hole drainage.Glasgow Outcome Score (GOS) was 5 points in 16 patients,4 points in 15 and 3 points in four six months postoperatively.One patient was complicated with hydrocephalus and two with epilepsy.ConclusionsKey-hole drainage with disposable transfixion pin selective employed for patients with acute subdural hematoma is effective and has few complications.The treatment notably improves prognosis of the patients.
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OBJECTIVE: This study was conducted to assess the clinical significance of traumatic brain stem injury (TBSI) reflected on Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS) by various clinical variables. METHODS: A total of 136 TBSI patients were selected out of 2695 head-injured patients. All initial computerized tomography and/or magnetic resonance imaging studies were retrospectively analyzed according to demographic- and injury variables which result in GCS and GOS. RESULTS: In univariate analysis, mode of injury showed a significant effect on combined injury (p<0.001), as were the cases with skull fracture on radiologic finding (p<0.000). The GCS showed a various correlation with radiologic finding (p<0.000), mode of injury (p<0.002), but less favorably with impact site (p<0.052), age (p<0.054) and skull fracture (p<0.057), in order of statistical significances. However, only GOS showed a definite correlation to radiologic finding (p<0.000). In multivariate analysis, the individual variables to enhance an unfavorable effect on GCS were radiologic finding [odds ratio (OR) 7.327, 95% confidence interval (CI)], mode of injury (OR; 4.499, 95% CI) and age (OR; 3.141, 95% CI). Those which influence an unfavorable effect on GOS were radiologic finding (OR; 25.420, 95% CI) and age (OR; 2.674, 95% CI). CONCLUSION: In evaluation of TBSI on outcome, the variables such as radiological finding, mode of injury, and age were revealed as three important ones to have an unfavorable effect on early stage outcome expressed as GCS. However, mode of injury was shown not to have an unfavorable effect on late stage outcome as GOS. Among all unfavorable variables, radiological finding was confirmed as the only powerful prognostic variable both on GCS and GOS.
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Humans , Brain , Brain Stem , Coma , Imidazoles , Magnetic Resonance Imaging , Multivariate Analysis , Retrospective Studies , Skull FracturesABSTRACT
Introducción: La principal causa de muerte en Colombia son las muertes violentas y de éstas entre 49 por ciento y 70 por ciento corresponden a trauma craneoencefalico. Existen publicaciones en Colombia que indican la epidemiología de esta catastrofe nacional, pero no realizan un seguimiento para conocer el estado neurológico-funcional posterior de estos pacientes. Objetivos: Conocer el estado funcional al a±o en pacientes con trauma craneoencefalico. Métodos: Se realizó seguimiento a una cohorte de personas que ingresaron al Hospital Universitario del Valle, Cali, Colombia, con trauma craneoencefalico entre julio de 2003 y junio de 2004. Ademas de recoger información sociodemogrßfica y clínica, se aplicó la escala Glasgow Outcome Score (GOS) al egreso, al mes y al año de sufrido el trauma. Resultados: Se incluyeron 2,049 pacientes de los cuales 83 por ciento eran hombres. Por escala de Glasgow 53 por ciento con trauma leve, 31 por ciento moderado y 16 por ciento severo. La mortalidad hospitalaria fue de 13 por ciento (10 por ciento en urgencias y según la severidad, 0.3 por ciento, 1.4 por ciento y 8 por ciento, respectivamente). Al año del trauma la mortalidad fue 14 por ciento y el 85 por ciento se encontraba entre un GOS de 4 a 5. Conclusiones: La incidencia de las variables evaluadas en los pacientes con traumatismo craneoencefalico en el presente estudio, son muy semejantes a las series descritas en la literatura mundial. En cuanto al seguimiento a 12 meses el grado de funcionalidad y mortalidad son también semejantes a la de países con alta tecnología y desarrollo.
Introduction: The main cause of death in Colombia is the violence, in which 49 percent to 70 percent correspond to traumatic brain injury (TBI). There are publications in Colombia that expose the epidemiology of this national catastrophe, but there are a few studies that follow the neurological-functional state after the head injury on this patient. Objectives: To know the functional state after one year following a traumatic brain injury on patients. Methods: A cohort of patients that were hospitalized on the Hospital Universitario del Valle, Cali, Colombia, with traumatic brain injury between July 2003 and June of 2004. The Glasgow Outcome Score (GOS) scale was apply when the patient leave the hospital, and at the first and twelve month after the brain injury. Results: 2049 patients were include on the study. 83 percent were men. 53 percent of them were classified as mild TBI, 31 percent moderate and 16 percent severe by the Glasgow Score Scale. The mortality was 13 percent intrahospital (0.3 percent, 1.4 percent y 8 percent of mortality en mild, moderate and severe respectly), and after a year of TBI the mortality was 14 percent, and 85 percent of the patients was on GOS of 4 and 5. Conclusions: The incidences of the variables evaluated on the TBI patients on the present study are similar to the world literature series. After 12 months, the followed up of functional state and the mortality of TBI patients were similar to the data of countries of high technology and developed.
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Cohort Studies , Craniocerebral Trauma , Multiple Trauma , ColombiaABSTRACT
Serial enzymatic determinations by electrophoresis were confined in serum of CK-BB(creatine kinase brain fraction), which were performed on 150 patients with acute head injury. The purpose of this study was to re-evaluate the usefulness of this serum enzyme value as a prognostic correlates. The results obtained are as follows : 1) 125 cases(83.3%) among 150 cases with head injury were revealed as CK-BB positive finding, whereas 25 cases (16.7%) with negative results have generally good outcome. 2) 3 cases (11.5%) of false positive finding were shown among 26 control group with back pain. 3) The maximum value of CK-BB(CK-BBmax) was een within 1st day(38.4%), and 3rd days (80.8%) following injury. 4) The appearance of mean CK-BBmax had two varieties of peak incidence on 1st-and 4th day following injury. 5) The Glasgow Coma Scale(GCS) Score on admission had close relationship to the value of inital CK-BB(CK-BBin) and CK-BBmax, respectively (P or =1 IU.L) to outcome (P or =1 IU/L) to outcome did not (P=0.126). 8) The Glasgow Outcoem Scale (GOS) was strongly correlated to mean GCS Score (P<0.000) and mean CK-BBin (P<0.000), but not to mean CK-BBmzs (P<0.139). 9) The correlationship between mean value of CK-BBin and CK-BBmax was statistically significant only in good recovery and moderate disability group, respectively (P<0.000 & P<0.003).