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Objective:To explore the value of Glasgow coma score (GCS) combined with optic nerve sheath diameter (ONSD) in predicting the death risk of patients with cerebrocardiac syndrome (CCS).Methods:From January 2021 to September 2021, 83 patients with CCS secondary to severe traumatic brain injury (sTBI) in our hospital were collected and divided into a survival group ( n = 37) and death group ( n = 46) according to CCS-related death. The clinical data including age, sex, underlying diseases, head CT imaging manifestations, electrolytes, blood glucose, C-reactive protein (CRP), neuron-specific enolase (NSE), lactate dehydrogenase (LDH), creatine kinase (CK), creatine phosphokinase isoenzyme (CKMB), intracranial pressure (ICP), ONSD, cardiac color ultrasound, acute physiology and chronic health evaluationII (APACHEⅡ ) and GCS were analyzed and compared between the two groups. The proportion and dosage of vasoactive drugs used at admission, daily fluid balance volume during hospitalization, total amount of sedative and analgesic drugs, and average daily dose were analyzed and compared between the two groups. The independent risk factors for CCS-related death were analyzed using multivariate logistic regression. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the independent risk factors in CCS-related death. Results:In this study, 55.4% of the patients died of CCS. The ONSD, ICP change rate, right ventricular Tei index and NSE in the death group were higher than those in the survival group, with statistically significant differences ( P < 0.05), while the GCS in the death group was significantly lower than that in the survival group, with a statistically significant difference ( P < 0.01). ONSD ( OR = 23.890, 95% CI: 5.526-103.286, P < 0.001), GCS ( OR = 17.066, 95% CI: 1.476-197.370, P = 0.023) and ICP change rate ( OR = 0.060, 95% CI: 0.007-0.477, P = 0.008) were the independent risk factors for CCS-related death. The area under the ROC curve (AUC = 0.897) of ONSD combined with GCS in evaluating CCS-related death was larger than that of ONSD, ICP change rate alone and the corresponding AUC of 1/GCS (0.876, 0.785, 0.800, respectively), with the advantages of non-invasive, dynamic monitoring and low inspection costs. Conclusions:The mortality rate of CCS is high. ONSD, GCS and ICP change rates are independently correlated with the death of CCS patients. ONSD combined with GCS is an ideal indicator for clinical prediction of CCS-related death.
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Introduction@#Road traffic injuries are among the leading causes of preventable death, claiming around 7000 lives every year. Furthermore, road traffic can injure or disable thousands more every year in the Philippines. @*Objectives@#This study determined the hospital length-of-stay patterns and risk factors for a prolonged length of stay in a tertiary hospital after road traffic injury. @*Methods@#A retrospective cohort study was conducted to determine the determinants of the length of stay in the Philippine General Hospital (PGH) among road traffic injury victims for the year 2016. Length of stay was recorded according to the median. The other variables were cross-tabulated against the length of stay, and each of their crude odds ratios along with corresponding p-values were presented. Continuous variables were analyzed using Wilcoxon Mann-Whitney U-test. The predictor model for the determinants of prolonged length of stay in the hospital was built using forward selection. Likelihood-ratio test was used to compare the model with and without the exposure variable. @*Results@#A total of 427 road traffic injury victims were admitted to the Philippine General Hospital in 2016. The mean age of the patients was 31.55 years (±14.97) with a median age of 29 years. The majority of patients were males (82.4%) and single (60.8%). Most patients were riding a motorcycle during the time of the accident (64.2%) while 20% were pedestrians. The majority of the victims were intoxicated (74.3%) and were not using helmets (57.1%) at the time of the accident. Most of the victims received first aid (69.2%) and the mean time of admission was 3.03 (±13.31) days while the median time to admission was 12 hours. Receiving first aid (p<0.01), availed services (p<0.01), and married civil status (p=0.04) were found to be strongly associated with length of hospital stay. Without controlling for any confounders, pay patients (OR = 3.46, 95% CI: 1.3, -9.87), elective patients (OR = 7.88, 95% CI: 2.64, 31.61), and those in non-trauma wards (OR=2.07, 95% CI: 1.29, 3.36) had higher odds for longer hospitalization stay. On the other hand, those who did not receive first aid (OR = 0.55, CI:0.35, 0.85) had lower odds for prolonged hospitalization. Those who suffered face injury and did not suffer external injuries had a higher mean rank, suggesting a longer length of hospital stay. On the other hand, upon controlling variables found to be associated with previous studies, those with low Glasgow coma scale (GCS) scores were 2.77 times (95% CI: 1.13, 6.91) more likely to stay longer in the hospital. @*Conclusion@#The type of victim, mortality status, age, and sex were found to be important determinants of prolonged hospitalization. To lessen the number of fatalities and road trauma injuries, laws on road safety should be strictly and properly implemented. Shared responsibility of all road users is also important in improving the safe usage of roads.
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Length of Stay , Accidents, Traffic , Wounds and InjuriesABSTRACT
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
Background: Apart from head injury many patients present to the tertiary care hospital in unconscious state, the etiology of which is obscure in most of the cases. The present study was conducted with on objective to provide insight into the clinical features and diagnostic methods to know the aetiology of patients with non-traumatic cases of altered sensorium and to study the outcome of these patients.Methods: This is an observational study on 100 patients of altered sensorium of non-traumatic origin during the period from October 2012 to September 2014 conducted in the Department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. All patients were selected for the study based on the inclusion exclusion criteria. Detailed history, clinical evaluation, laboratory investigations like neuroimaging studies etc. were carried out. Statistical data analysis was done using Graph pad Prism 6 and Microsoft Excel. P value <0.0001 was considered statistically extremely significant.Results: Out of 100 patients of altered sensorium, 64 were males and 36 were females. All patients were in the age group of 19 to 89 years. Cerebrovascular accident was the most common aetiology of altered sensorium followed by metabolic encephalopathy and infection. Altered sensorium in patients with CVA carries a high mortality. Metabolic causes and younger age indicated a better prognosis, patients with low (Glasgow Coma Score) GCS score of 3 to 4 had poorer prognosis.Conclusions: The results suggest that clinical assessments yield accurate predictive information about the potential for recovery in cases of altered sensorium. So, this study concludes that empirically based estimates of prognosis in the neurologically severely ill provides great reassurance to those involved in a decision-making process, including patients’ families and physicians.
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Objective To investigate the correlation between the entropy index and Glasgow coma scale (GCS) score in patients with acute brain injury (ABI), and to explore the feasibility of using entropy index to assess the extent of brain damage. Methods A prospective study was conducted. 101 patients with ABI admitted to intensive care unit (ICU) of the First People's Hospital of Changshou from May 2015 to May 2017 were enrolled. The values of reaction entropy (RE) and state entropy (SE) within 24 hours after ICU admission were collected, and the GCS score was recorded. A linear regression analysis of RE and SE values and GCS scores was conducted. Receiver operating characteristic (ROC) curve was plotted, and the value of entropy index in evaluating the severity of ABI was analyzed. Results 101 patients with ABI were finally enrolled in the analysis, with mild in 22 patients (GCS score 13-15), moderate in 35 patients (GCS score 9-12), and severe in 44 patients (GCS score 3-8). With the increase severity of brain damage, the values of RE and SE, and GCS score were gradually decreased (RE values in patients with mild, moderate and severe brain injury were 89.77±5.28, 75.37±4.86 and 50.61±9.89, SE values were 79.91±6.11, 65.20±5.44 and 40.68±9.41, and GCS scores were 14.00±0.82, 10.43±1.15 and 5.32±1.75). There was no significant difference in entropy index or GCS score among patients with different degrees of brain injury (all P < 0.01). Correlation analysis showed that the RE value was positively correlated with the GCS score (r2= 0.974, P = 0.000), SE and GCS scores also showed linear positive correlation (r2= 0.962, P = 0.000). ROC curve analysis showed that the area under ROC curve (AUC) of RE for diagnosis of ABI in patients with severe brain injury was 0.914, when the optimal cut-off value was 53.5, the Youden index was maximum (0.753), the sensitivity was 91.2%, and the specificity was 84.1%. The AUC of SE was 0.916, when the optimal cut-off value was 41.5, the Youden index was maximum (0.730), the sensitivity was 91.2%, and the specificity was 81.8%. The AUC of RE for diagnosis of mild brain injury was 0.884, when the optimal cut-off value was 69.5, the Youden index was maximum (0.651), the sensitivity was 72.7%, and the specificity was 92.4%. The AUC of SE was 0.897, when the optimal cut-off value was 58.5, the Youden index was maximum (0.676), the sensitivity was 72.7%, and the specificity was 94.9%. Conclusions The entropy index RE and SE values of ABI patients were gradually decreased with the severity of brain damage, which was positively correlated with GCS score. As an objective, continuous and real-time method, entropy index could be used as a new tool for the evaluation and monitoring of ABI.
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Background: Head injury (HI) is a common condition presenting to Emergency Departments (EDs), accounting for a significant proportion of morbidity and mortality of the productive age of the world’s population. Aim: This study aims to highlight head injured patients’ epidemiological pattern as seen in the Emergency Department of the Delta State University Teaching Hospital (DELSUTH), Oghara, Nigeria. Methodology: This was a prospective study of all consecutive head injured adult patients seen in the ED of DELSUTH from January to December, 2014. The variables assessed included age, gender, aetiology, severity of injury and mortality. Glasgow Coma Scale (GCS) was used to assess the severity of head injury. Results: Eighty-eight head injured patients were seen in the ED in the period under review. The mean age was 32.80±12.50 years. Age range was 17-85 years. The most affected persons were from 25-34 years of age (31.8%). The male: Female ratio was 9 to 1. On aetiology, 4.4% of the patients had a fall, 13.6% were assaults and 81.9% had Road Traffic Accident (RTA). In terms of severity of injury, 49 (55.7%) of the patients had mild HI, 20.4% had moderate head injury and 23.8% had severe HI. RTA was the sole aetiology of head trauma for those 45 years and above (22.7%). Six (6.8%) of the patients died while receiving treatment at the ED before transfer for further specialised care. Conclusion: Head injury is a major contributor to trauma admissions in the ED. The economically most productive age groups and the male sex are mostly affected. RTA is still a major cause of head injury in our society. There is therefore the need for the education of road users on road safety measures and for the government to improve on the state of the roads. Increased funding for pre-hospital and specialist neurosurgical facilities and personnel will also ensure that head injured patients get the best care possible.
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Objective To explore the significance of warning score of potential critical disease in predicting changes in patients with traumatic brain injury. Methods The clinic information of 75 patients with traumatic brain injury who were treated in the People's Hospital of Huangshan Affiliated to Wannan Medical College from Jan. to Dec. 2013 were analyzed retrospectively. The warning score of potential critical disease, modified early warning score( MEWS)and glasgow coma score( GCS)of all patients and the rates of changes in patients were calculated. Results Of 75 patients enrolled,60 were survived and 15 were died. Seventy-five patients were performed 448 times of warning score of potential critical disease,MEWS and GCS. The maximum, minimum of warning score of potential critical disease were 24 and 0,and the median score(P25,P75)was 4(2, 7). The maximum,minimum of MEWS were 24 and 0,and the median score( P25,P75 )was 4( 3,7 ). The maximum,minimum of GCS were 8 and 3,and the median score(P25,P75)was 5(4,7). The area under ROC of warning score of potential critical disease was 0. 76(95%CI =0. 66 -0. 86,P ﹤0. 01),Youden index was 0. 42 when score was taken 5. 5. The area under the ROC of MEWS was 0. 71( 95%CI =0. 61 -0. 81,P﹤0. 01),Youden index was 0. 4 when taken 3. 5 score. The area under the ROC of GCS was 0. 51(95%CI=0. 37-0. 63,P=0. 99),Youden index was 0. 27 when score was taken 4. 5. Conclusion The warning score of potential critical disease is effective to predict changes in conditions of patients with multiple injuries and better than MEWS and GCS.
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INTRODUCCIÓN: el trauma craneoencefálico severo es una de las principales causas de hospitalización y mortalidad en niños mayores de un año. OBJETIVO: conocer y evaluar las secuelas intelectuales que provoca el traumatismo craneoencefálico severo en estos pacientes. MÉTODOS: se realizó un estudio prospectivo, longitudinal, descriptivo, cuyo universo estuvo constituido por 84 niños mayores de un año de edad con trauma craneoencefálico severo, en un periodo de inclusión desde 1998 a 2008, con un seguimiento de la rehabilitación motora hasta 5 años posterior a la inclusión (hasta 2013). Las variables a estudiar fueron: la edad, el sexo, las causas directas del accidente y las manifestaciones clínicas encontradas en el examen físico. Se determinó el coeficiente de inteligencia y seguimiento a la evolución en el tiempo a través de la escala de repercusiones de Glasgow. RESULTADOS: la causa fundamental de las lesiones craneoencefálicas fueron los accidentes. El sexo de mayor incidencia fue el masculino, y el grupo de edad, el comprendido entre 5-9 años. Se clasificó al 61 % de los pacientes como retrasados mentales moderados, el 32,2 % retrasados mentales leves y el 3,4 % retrasados mentales graves y profundos, respectivamente. Fallecieron 7 niños. La evaluación de la rehabilitación al año confirmó que el 76,6 % de los pacientes mantenían discapacidad severa, y a los 5 años solo el 29,9 % era incapaz de vivir independiente. CONCLUSIONES: los traumatismos craneoencefálicos severos provocan secuelas intelectuales graves en los niños, y no se logra una rehabilitación favorable hasta el año del egreso hospitalario. Los grupos más vulnerables a sufrir traumatismo craneoencefálico son los niños mayores de 5 años y del sexo masculino, y la causa fundamental que lo provocó fue, dentro de los accidentes, las caídas de altura.
INTRODUCTION: severe traumatic brain injury is one of the main causes of hospitalization and mortality in children aged over one year. OBJECTIVE: to identify and to assess the intellectual sequelae that severe traumatic brain injuries cause in these pediatric patients. METHODS: a prospective, longitudinal and descriptive study of 84 over one-year old children suffering severe traumatic brain injuries in the inclusion period of 1998 through 2008, with a follow-up motor rehabilitation up to 5 years (until 2013). The study variables were age, sex, direct causes of accident and clinical manifestations observed on the physical exam. The intelligence quotient and follow-up of progress in the course of time were determined according to the Glasgow Outcome Scale. RESULTS: accidents were the main cause of brain injuries. The most affected were boys and the 5 to 9 years-old group. Sixty one percent of these patients had moderate mental retardation, 32.2 % mild retardation and 3.4 % severe and deep retardation. Seven died. The assessment of the rehabilitative treatment one year after confirmed that 76.6 % of these children kept their severe disability and 5 year after, just 29.9 % of them were unable to manage themselves. CONCLUSIONS: severe traumatic brain injuries cause awful intellectual sequelae in children and favorable rehabilitation is not accomplished till one year of discharge from the hospital. The most vulnerable groups are over 5 years-old children and males, and the fundamental cause of these severe brain injuries were, among the accidents, falls from a high place.
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Humans , Statistics on Sequelae and Disability , Glasgow Outcome Scale , Craniocerebral Trauma/etiologyABSTRACT
Objective To study the clinical significance of early changes in cerebral oxygen and glucose metabolism in patients with cerebral hemorrhage and with Glasgow coma score (GCS) of 5-8 caused by acute hypertension in order to find relationship between those changes and prognosis.Methods From January 1,2011 to June 30,2012,a cohort of 43 patients with cerebral hemorrhage caused by acute hypertension were enrolled for retrospective study.Radial artery and internal jugular vein were separately cannulated retrogradely for collecting blood for blood gas analysis and blood glucose tests carried out 24 hours after the onset of the cerebral hemorrhage and then every 6-8 hours and as any major changes in physical signs of patients occurred.And this monitoring kept for consecutive 3 days.The data of these laboratory findings were analyzed and calculated to determine internal jugular vein oxygen saturation (SjVO2),cerebral oxygen utilization rate (CEO2),cerebral arterio-venous oxygen difference (AVDO2),arterio-venous blood glucose difference (V-Aglu),arterio-venous lactic acid difference (V-Alac) and absolute value of carbon dioxide pressure difference between jugular vein and artery (V-APCO2).All patients met the diagnostic criteria of hypertensive cerebral hemorrhage revised by the 4th National Academic Conference on cerebrovascular disease in 1995 requiring diagnosis confirmed by brain CT,admitted within 24 hours of onset,Glasgow coma score (GCS) 5-8 and a history of hypertension.Exclusion criteria were:cerebral hemorrhage caused by traumatic intracranial hematoma,spontaneous subarachnoid hemorrhage,arteriovenous malformation and Moyamoya disease,intracranial tumor apoplexy,cerebral bleeding derived from the disturbance of blood coagulation system,and cerebral hemorrhagic infarction.According to the short-term prognosis,the patients were divided into the death group and the survival group.Then the differences in biomarkers mentioned above between two groups were compared to find the relationship between levels of those biomarkers and outcomes of patients.Thereafter,the results of this retrospective study inspired us to carry out a prospective and double blind study in another 23 patients from July 2012 to January 2013 for further confirming the validity of these biomarkers to predict the short-term outcomes of patients.The statistical analysis was performed with SPSS 16.0 software (SPSS,USA) and a P ＜ 0.05 was considered significant.Numerical values were given as means ± SD unless stated otherwise.For statistical analyses,normality was assessed before choosing the relevant comparative test and nonparametric tests was used in cases as the normality test failed.Results Of 43 patients with cerebral hemorrhage for retrospective analysis,there were 27 male and 16 female with M/F ratio =1.7:1,aged from 49 to 81 with mean 66.2 ± 15.3 years and their GCS scores were 5-8.of them,there were 28 patients suffered from basal ganglia hemorrhage,6 cerebella hemorrhage,5 pons cerebelli hemorrhage and 4 lobe hemorrhage.There were 25 patients with supratentorial hematoma in volume of no less than 30 mL and 10 infratentorial hematoma in volume of no less than 10 mL of them,11 patients were treated with craniotomy and evacuation of hematoma or decompression craniotomy and rest were treated with conservative strategy.Compared with the death group,the CEO2,AVDO2,V-AGlu,V-ALac in the survival group decreased significantly (P ＜ 0.05),while V-APCO2 and SjvO2 increased significantly (P ＜ 0.05).In the subsequent prospective study,the accuracy rate of the levels of SjvO2 ＜ 52％,AVDO2 ＞ 83％ for predicting prognosis was 78.3％.Conclusions The cerebral oxygen and glucose metabolism was obviously abnormal in hypertensive cerebral hemorrhagic patients with GCS score of 5-8 among the death group,and especially the anaerobic metabolism was apparently increased.It was also found that the risk threshold (SjvO2 ＜ 52％,AVDO2 ＞83％) was in close relationship with patients'death expectation.
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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
25) and in the group with complication of craniocerebral injury (P25) were significantly increased compared with other groups (P5) showed significunt difference as compared with that of with other groups (P
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5 days.Blood gas analysis and blood pressure were determined at admitted day.Meanwhile,peripheral white blood cells at d1,3,5,and blood glucose were measured every day,respectively.GCS at d1,3,5 and hyperglycemia scorce(HS) were evaluated.Results Of the 82 studied patients,36 cases died.Univariate analysis showed that hypotension,lower GCS,higher peripheral white blood cells and HS were the independent death risk factors(Pa0.05).In multivariate logistic regression,the factors significantly associated with an increase in mortality were hypotension,lower GCS and higher HS.Conclusion Lower GCS,higher HS and hypotension are associated with poor outcome of children with severe trauma brain injury.
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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).
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Humans , Back Pain , Brain , Cerebral Hemorrhage , Coma , Contusions , Craniocerebral Trauma , Creatine , Electrophoresis , Head , Incidence , Phosphotransferases , Skull FracturesABSTRACT
We analysed a series of 35 patients with primary cerebellar hemorrhage, diagnosed by computerized tomography scanning from 1985 to 1988. They constituted 6.6% of spontaneous intracerebral hemorrhage(35 out of 530) who were admitted during the same period. There were 13 men and 22 women. The site of hemorrhage was vermis in 15 patients and hemisphere in 20 patients. On admission, the Glasgow Coma Scale(GCS) value was less than 10 in 15 patients(42.3%) and not less than 10 in 20 patients(57.1%). Quadrigeminal cistern was normal in 11 patients(31.4%), partially obliterated in 15 patients(42.9%) and completely obliterated in 9 patients(25.7%). The largest diameter of the hematoma was less than 3cm in 15 patients(42.9%) and larger than 3cm in 20 patients(57.2%). Hydrocephalic change was observed in 21 patients(60%). The hematoma was removed via suboccipital craniectomy in 16 patients(45.7%) and managed conservatively in 11 patients(31.4%). In 8 patients(22.9%), external ventricular drainage was performed. The method of treatment was different according to the GCS value on admission, the status of the quadrigeminal cistern, the presence of hydrocephalic change, and the size of hematoma. Overall mortality rate was 22.9%. These results suggested that the conservative treatment can be done in patients with (1) high GCS value(not less than 10), (2) patent quadrigeminal cistern, (3) absent hydrocephalic change, and (4) small sized hematoma(less than 3cm). If not surgical treatment should be considered.
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Female , Humans , Male , Coma , Drainage , Hematoma , Hemorrhage , MortalityABSTRACT
We present a retrospective study on the characteristics of head injury in the aged(not less than 60 years of age). We selected 213 patients who were admitted to the Soonchunhyang University Chonan Hospital due to head injury from September 1986 to December 1989. For comparison, data from 889 patients who were less than 60 years of age during similar study period was used. In the aged, pedestrian traffic accident, slip or fall, and unknown trauma were common and a cause of head injury. While passenger's traffic accident and assault were more common in the young(less than 60 years of age). The initial Glasgow coma score(GCS) of 9-12 was more common in the aged, while that of 13-15 was more common in the young. The rate of intracranial mass lesion was 46.9% in the aged, while that of the young was 29.6%. Hemorrhagic contusion/intracerebral hematoma and subdural hematoma were common in the aged, while epidural hematoma was the most common lesional type in the young. The diffuse lesions were more common in the young. The frequency of the delayed lesions was 15.2% in the aged, while that of the young was 6.4%. Intracranial mass lesion without skull fracture was commonly observed in the aged. The probability of mass lesion was highest in the patients with GCS value of 9-12. It was highest(88.6%) in the aged patients with GCS value of 9-12. The rate of operative treatment was similar. However, for the patients who had no skull fractures or whose GCS value were 13-15, operations were more frequently performed in the aged than the young. The outcome of the aged was good recovery in 59.7%, moderate disability in 11.3%, severe disability/vegetative state in 4.7%, death in 16.9%, and transfer or self-discharged in 8.5%. That of the young was good recovery in 74.0% moderate disability in 7.6%, severe disability/vegetative state in 2.3%, death in 8.8%, and transfer or self-discharged in 7.3%. The mortality rate of the aged was 18.5% and that of the young was 9.5%. There were no significant differences in the rates of skull fracture, combined injuries, death due to extracranial causes, and the life span of the dead. This study revealed that the causes of head injury in the aged differ from those the young, and the rates of intracranial mass lesion and delayed were high, which increased the proportion of the patients with GCS value 9-12, operative treatment without skull fracture, and made the prognosis of the aged poor.
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Humans , Accidents, Traffic , Coma , Craniocerebral Trauma , Head , Hematoma , Hematoma, Subdural , Mortality , Prognosis , Retrospective Studies , Skull FracturesABSTRACT
A series of 1000 consecutive head injuries was presented. Traffic accident was the major cause of head injury(77.1%). Unlikely to the other reports in Korea, 1) passenger's traffic accident was slightly more common than pedestrian traffic accident, 2) traffic accidents related to motorcycles and bicycles were more common, and 3) traffic accident to the tractor shared 3.2% of the traffic accident. Transportation of the patients was not delayed in this medium sized city. Glasgow coma score on arrival was 3-8 in 15.4%, 9-12 in 11.2%, and 13-15 in 73.4%. Cranial vault fracture was observed in 31.6%. The presence of vault fracture was closely related to the rate of operation and the mortality. CT brain scan was performed in 720 patients. Abnormal findings were observed 365 patients(50.7%), including 233 cases of mass lesions and 101 cases of diffuse lesions. Epidural hematoma was the most common mass lesion. The rate of operation was 14.9%, and the operative morality was 30.6%. Outcome at discharge was good recovery 729, moderate disability 78, severe disability 21, vegetative state 3, and death 96. There were 73 cases who were self-discharged or transferred to other hospitals. Overall case fatality rate was 10.4%.
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Humans , Accidents, Traffic , Brain , Coma , Craniocerebral Trauma , Epidemiology , Head , Hematoma , Korea , Morals , Mortality , Motorcycles , Persistent Vegetative State , TransportationABSTRACT
Objective To investigate the value of multivoxel proton magnetic resonance spectroscopy(1H-MRS) in contusion and laceration area of mild-to-moderate traumatic brain injury(TBI) in adults.Methods Twenty-eight TBI patients definitely diagnosed were recruited in this study,including 16 moderate TBI whose Glasgow coma scores were in 9-12 and 12 mild TBI whose Glasgow coma scores were in 13-15.The spectrum for NAA,Cho,Cr and other metabolite peaks in contusion and laceration area were measured and NAA/Cr,NAA/Cho,Cho/Cr ratios were calculated for each voxel.Results In multivoxel 1H-MRS for the lesion areas,the ratios of NAA/Cr,NAA/Cho and Cho/Cr changed significantly compared with those of 16 normal controls(P0.05).Conclusion Multivoxel 1H-MRS may have an important clinical value in detecting and assessing early mild-to-moderate brain trauma.NAA/Cr ratio of the injured region can reflect the severity of cerebral injury.