RESUMO
Objective: to determine the effects of application of anti-adhesive films [OrthoWrap[TM]] in traumatic decompressive craniectomy on prevention of adhesion formation and facilitation of subsequent cranioplasty
Methods: this was a retrospective cohort study being performed in ShahidRajaei hospital [Shiraz Level I trauma center] during a 12-month period [from March 2012 to April 2013] including 93 patients undergoing traumatic decompressivecraniectomy.Patients who received OrthoWrap[TM] during the initial craniectomy [n=44] were compared to those who did not [n=49]. Two study groups were matched regarding the baseline characteristics. The perioperative indices including the surgical time, amount of bleeding, transfusion and 6-month Glasgow Outcome Scale [GOS] were compared between two study groups
Results: there was no significant difference between two study groups regarding the baseline characteristics. We found that the cranioplasty duration [113.3 +/- 33.2 vs. 146.9 +/- 34.9 minutes; p<0.001] and amount of intraoperative bleeding [182.1 +/- 98.3 vs. 270.6 +/- 77.6 mL; p=0.043] was significantly lower in those who had OrthoWrap[TM] compared to control group. The final GCS [p=0.052] as well as GOSE [p=0.653] was comparable between groups. The infection rate was comparable between two study groups [p=0.263]
Conclusion: application of OrthoWrap[TM] during decompressive craniectomy in those with severe traumatic brain injury is associated with shorter duration of operation and less intraoperative bleeding in subsequent cranioplasty. Infection rate and neurologic outcome was comparable between study groups
RESUMO
Objective: To determine the diagnostic value of serum white blood cell [WBC] count, fever [>38[degree]C] and WBC rise [>10%] for bacterial meningitis in patients with severe traumatic brain injury [TBI]
Method: This cross-sectional study was conducted in Shahid Rajaei hospital affiliated with Shiraz University of Medical Sciences during a 1-year period from 2013 to 2014. We included consecutively all the patients with severe TBI admitted to our center during the study period who were febrile [>38[degree]C orally] and underwent lumbar puncture [LP] and analysis and culture of cerebrospinal fluid [CSF]. Laboratory analysis of CSF and blood were performed within 2 hours of LP. CSF culture was considered the gold standard for diagnosis of bacterial meningitis. The sensitivity, specificity, positive and negative predictive value [PPV, NPV] of peripheral blood WBC count, fever [>38[degree]C] and WBC rise [>10%] was determined according to the CSF culture
Results: Overall we included242 consecutive patients with severe TBI. The mean age of the participants was 32.8 +/- 17.4 years. Acinetobacter was the most common organism found in the CSF cultures. The sensitivity and specificity of peripheral WBC count [>10,000]was 48.4% [95% CI: 0.42-0.56] and 47% [95% CI: 0.37-0.58] respectively. The PPV and NPV was 13.1% [95% CI: 0.33-0.52] and 84.8% [95% CI: 0.42-0.61], respectively. The AUC for WBC count was 0.478 [95% CI: 0.37-0.58] indicating low accuracy for the diagnosis of bacterial meningitis. The AUC for WBC rise [>10%] and temperature >38[degree]C was0.460 [95% CI: 0.351-0.569] and 0.517 [95% CI: 0.410-0.624] respectively, both indicating low accuracy for diagnosis of bacterial meningitis
Conclusion: The results of the current study indicates that peripheral blood leukocyte count, fever [>38[degree]C] and WBC rise [>10%] is a non-reliable marker for diagnosis of bacterial meningitis in patients with severe TBI