A Comparison of Glasgow Coma Scale Score with “Full Outline of Unresponsiveness Scale” to Predict Outcome of the Patients with Traumatic Brain Injury Presenting to Emergency Medicine Department

Introduction: In patients presenting to Emergency Department(ED) with traumatic brain injury, it is important to evaluate the neurological status to determine the present clinical status and to predict outcome of the patient. GCS is the most widely used score,but it has some drawbacks which led to the development of other scores such as the Full Outline of Unresponsiveness (FOUR) score. In our study, we compared the GCS and the FOUR scores in patients presenting with traumatic brain injury. Aims: 1) To compare the FOUR score with the GCS score in traumatic brain injury (TBI) patients. 2) To understand the effectiveness of FOUR score as an assessment tool. 3) To assess whether FOUR score is an alternative tool in TBI patients or could be complimentary. Methods: We conducted a prospective observational study at a trauma centre of a tertiary care hospital during January 2019 to March 2019 after taking institutional ethical committee approval. All patients presenting with clinical diagnosis of TBI were evaluated and given a GCS and FOUR score by the emergency physician. Relevant investigations were done and findings were noted. We tabulated all information in Microsoft Excel 2019 and statistical analysis was done with SPSS software. Results: The mean age of study population was 38.295+/- 15.33 years. Male patients were 79% and 21% were female patients. Road traffic accidents contributed highest percentages of causes of TBI (60%). By comparing the median value of FOUR score with mortality and the median value of GCS score with the mortality by using the Mann-Whitney test showed a p-value of ?1, which is statistically non-significant. Conclusions: FOUR score is equally reliable with GCS score. Both have their own significance

Advances in research of the evaluation and management of mild traumatic brain injury / 中华急诊医学杂志

Traumatic brain injury (TBI)has been classified as mild,moderate,or severe,on the basis of the Glasgow coma scale (GCS)score.Mild TBI is estimated to account for 90% of all cases of TBI, and it has become a serious public health problem,with morbidity increasing year by year.At present,there is a lack of accepted uniform definition of mild TBI.Clinically,mild TBI and concussion are interchangeable terms.In recent years,advances in brain imaging,biomarkers determination,and neuropathology have encouraged people to revise and update their knowledge about mild TBI.In view of the high prevalence of mild TBI in the emergency and community,and the absence of the data concerning the long-term effects of mild TBI, further research is needed about how to reduce morbidity and costs, alleviate delayed consequences,and develop evidence-based interventions to improve outcomes.

Effects of very early hyperbaric oxygen treatment on patients with malignant brain edema after surgical operation for severe traumatic brain injury / 中华物理医学与康复杂志

Objective To investigate effects of very early hyperbaric oxygen treatment (HBOT) on patients with malignant brain edema after surgical operation for treatment of severe traumatic brain injury (TBI).Methods A total of 146 patients who suffered from malignant brain edema after last surgical operation for severe TBI were enrolled for this study.According to the intervention time of HBOT,they were randomized into a very early group (HBOT within 3 days after operation,n =55),an ordinary group (HBOT at 4 to 10 days after operation,n =65) and a control group (non-HBOT,n =26).Mortality rate of the 3 groups were recorded within 4 weeks after operation,and GCS (Glasgow Coma Scale) score were assessed in 1,2,3 and 4 weeks after operation.Dynamic head CT scan were performed for detecting brain status and for determine the duration of brain edema.Results The mortality of the very early group,the ordinary group and the control group were 10.9％,7.7％ and 11.5％,respectively,and no statistically significant difference was revealed among the groups (P ＞ 0.05).In very early group,the GCS scores of 1,2,3 and 4 weeks after operation were (8.837 ±3.350),(10.755 ± 3.388),(11.633 ± 3.408) and (12.367 ± 3.408),respectively,with significant difference between the time points 1 week and 2,3 and 4 weeks as well as 2 and 4 weeks after surgery (P ＜0.05),but not between 2 and 3 as well as 3 and 4 weeks after surgery (P ＞ 0.05).In ordinary group,the GCS scores at 1,2,3 and 4 weeks after surgery were (8.509 ±3.042),(9.458 ±3.115),(10.186 ±3.203) and (10.627 ±3.439),respectively,with significant difference between 1 week and 2,3 and 4 weeks after operation (P ＜ 0.05).In control group,the GCS scores at 1,2,3 and4 weeks after surgery were (8.042 ±2.881),(8.417 ±2.962),(8.542 ±3.02) and (8.958 ± 3.043),with no statistical difference among different time points (P ＞ 0.05).When compared with the very early group,the GCS sores of the ordinary group and the control group were significantly lower after intervention (P ＜ 0.05),and the GCS of control group was lower than that of the ordinary group (P ＜ 0.05).As for brain edema duration,the very early group was the shortest among the 3 groups (P ＞ 0.05) Conclusion Very early hyperbaric oxygen treatment could improve consciousness state and alleviate malignant brain edema after surgical operation in TBI patients.

Analysis of risk factor of acute kidney injury after craniocerebral injury / 中华肾脏病杂志

Objective To investigate the incidence and risk factors of acute kidney injury (AKI) after craniocerebral injury.Methods A single cohort of 791 patients who suffered from craniocerebral injury from January 2008 to January 2010 in the Second Hospital of Lanzhou University were prospectively analyzed.Craniocerebral injury was defined according to definite medical history of craniocerebral injury,the verification of CT and Glasgow coma scale (GCS) score.AKI was defined as a relative 50％ increase or an absolute increment of 26.4 μmol/L in Scr within 48 hours and/or urine volume ＜0.5 ml·kg-1·h-1 up to 6 h.Multivariate Logistic regression analysis was used to evaluate possible risk factors associated with post-craniocerebral injury AKI.Results Of the 791 patients,the incidence of AKI was 39.4％.In hospital mortality of AKI patients was 27.9％,which was 5.065 times of non-AKI patients (P＜0.01).The incidence of AKI in patients with lower GCS score (≤8 score,heavy group)was 69.7％,which was significantly higher as compared to moderate and mild groups (P＜0.01).Unconditional multivariate Logistic regression analysis revealed that lower GCS score (≤ 8 score),hypotension (systolic pressure＜90 mm Hg),elderly and male were the independent predictors of AKI episodes,the corresponding OR values were 2.932,2.176,1.789,1.544 respectively.Conclusions AKI is a common complication after craniocerebral injury.Lower GCS score,hypotension,elderly and male are the independent risk factors of AKI in patients after craniocerebral injury.

Changes of hypothalamus corticotropin releasing factor levels in children with acute brain injury / 中国小儿急救医学

Objective To explore the changes of corticotropin releasing factor (CRF) levels secreted by hypothalamus neuron in children with acute brain injury. Methods Fifty-one intracranial-infection children with brain injury and 11 intracranial-noninfection children with brain injury were chosen from pediatric intensive care unit of our hospital. Severities of their brain damage were evaluated by Glasgow score,and CRF level in cerebrospinal fluid (CSF) and serum TNF-α and IL-6 levels were measured by radioimmunoassay. Results There was no significant difference of Glasgow scores between the intracranial infection group and intracranial-noninfection group ( P = 0. 302 6 ), CSF CRF level of intracranial infection group was significantly lower than that of intracranial-noninfection group ( P ＜ 0. 01 ), serum TNF-α and IL-6 levels of intracranial infection group were significantly higher than those of intracranial-noninfection group ( P ＜ 0. 01,P ＜0. 001 ). As comparing to the children with Glasgow score of 6 ～ 7, the levels of CSF CRF and serum TNF-α and IL-6 in children with Glasgow score of 4 ～ 5 were significantly increased ( P ＜ 0. 05, P ＜ 0. 001 ).Conclusion CSF CRF level of the children with acute brain injury is changing, which may be concerned with the secretion of hypothalamus CRF neuron stimulated by TNF-α, IL-6 and hypoxia stress in children with brain injury.

Incidence and Risk Factors of Infection Caused by Vancomycin-Resistant Enterococcus Colonization in Neurosurgical Intensive Care Unit Patients

OBJECTIVE: This study was aimed to identify the incidence and risk factors of vancomycin-resistant enterococcus (VRE) colonization in neurosurgical practice of field, with particular attention to intensive care unit (ICU). METHODS: This retrospective study was carried out on the Neurosurgical ICU (NICU), during the period from January. 2005 to December. 2007, in 414 consecutive patients who had been admitted to the NICU. Demographics and known risk factors were retrieved and assessed by statistical methods. RESULTS: A total of 52 patients had VRE colonization among 414 patients enrolled, with an overall prevalence rate of 6.1%. E. faecium was the most frequently isolated pathogen, and 92.3% of all VRE were isolated from urine specimen. Active infection was noticed only in 2 patients with bacteremia and meningitis. Relative antibiotic agents were third-generation cephalosporin in 40%, and vancomycin in 23%, and multiple antibiotic usages were also identified in 13% of all cases. Multivariate analyses showed Glasgow coma scale (GCS) score less than 8, placement of Foley catheter longer than 2 weeks, ICU stay over 2 weeks and presence of nearby VRE-positive patients had a significantly independent association with VRE infection. CONCLUSION: When managing the high-risk patients being prone to be infected VRE in the NICU, extreme caution should be paid upon. Because prevention and outbreak control is of ultimate importance, clinicians should be alert the possibility of impending colonization and infection by all means available. The most crucial interventions are careful hand washing, strict glove handling, meticulous and active screening, and complete segregation.

Outcome Following Severe Head Injuries in Children

Accidents cause more than half of all childhood deaths, despite early diagnosis and proper treatment. It has showed still high mortality and morbidity. We analyzed the results of treatment of 50 severely head injured children who were admitted to the department of neurosurgery. Wonkwang University Hospital from January, 1984 to March, 1988 and evaluated prognostic factors affecting the outcome. Our conclusions are as follow: 1) We experienced the high mortality in children no more than five years of age. 2) The Glasgow coma scale on admission was a reliable indicator predicting the outcome in severe head injury. 3) The neurological features such as papillary light reflex, oculocephalic reflex and motor respons were good indicators of outcome. 4) Therer was no significant difference in outcome between diffuse brain injury and intracranial mass lesion. 5) The diffuse brain swelling on brain CT scan worsened the outcome. 6) The mortality rate increased in children associated with viscus rupture in head inujury. 7) The overall outcome showed 38% of good recovery, 20% of moderate disability, 10% of severe disability, 4% of vegetative state, and 28% of death.

Clinical Analysis of Severe Head Injury

The present study is made to evaluate prognostic factors in 67 patients with severe head injuries collected from entire 617 head-injured patients who were admitted to the Department of Neurosurgery, Won Kwang University Hospital from January, 1984 to December, 1985. The results were as follows : 1) The mortality rate in the different age group was as follows : 37.8% for patients aged 40 years and less, and 72.7% for those over 40 years old. The difference in mortality was significant. 2) The mortality rate increased steadily as the GCS score on admission decreased. 3) The mortality rate increased steadily in sequence of the motor response of localizing, withdrawal, abnormal flexion, abnormal extension, and flaccidity. The difference in mortality was significant only between abnormal flexion and abnormal extension. 4) The mortality rate was significantly higher in patients without pupillary light reflex than those with reflex. 5) The mortality rate observed in patients operated on for a intracranial mass lesion was 57.1% and the mortality rate in patients not undergoing surgery was 40.6%. The difference was not statistically significant. 6) In the overall outcome of 67 patients, 7.5% made a good recovery, 23.9% were moderately disabled, 11.9% were left severly disabled, 7.4% were vegetative, and 49.3% of the patients died.