Evaluation of Head Computed Tomography Assessment of Brain Swelling after Acute Traumatic Brain Injury: A Pilot study

Objective To evaluate the interobserver reliability of a new scale created for quantitatively assessing brain swelling in traumatic brain injury (TBI) patients using the computed tomography (CT) findings in three levels. Methods Computed tomography scans of severe head injury patients were randomly selected from a tertiary hospital image database and evaluated by independent groups of neurosurgeons, neurosurgery residents, radiologists, and intensivists from the same hospital. Each specialist assessed the tomographic findings, applying zero to six points in a new scale. The Kappa coefficient was calculated to assess interobserver agreement. Results The highest reliability coefficient was obtained by the neurosurgeons group (0.791; 95% confidence interval [CI]: 0.975­0.607; p < 0.001), followed by the neurosurgery residents group (0.402; 95%CI: 0.569­0.236; p < 0.001) and by the radiologists group (0.301; 95%CI: 0.488­0.113; p < 0.002). The lowest coefficient was found among the intensivists (0.248; 95%CI: 0.415­0.081; p » 0.004). Conclusion The proposed scale showed good reliability among neurosurgeons, and moderate overall reliability. This tomographic classification might be useful to better assist severe TBI victims, allowing to identify the worsening or amelioration of brain swelling, which should be further investigated. The scale seems to be feasible, even in low income countries,where the costof intracranial pressure (ICP)monitoring is higher than thatofCTs.

Protective effect of 17β-estradiol on traumatic brain injury in rats / 中国比较医学杂志

Objective To explore the protective effect of 17β-estradiol on traumatic brain injury in rats.Methods A total of 45 adult male SD rats were divided into 3 groups using the random digit table, 15 rats in each group:the control group only exposed but not injured the brain, the injury group received traumatic brain injury ( TBI) by Feeney’ s method, and the treatment group received the same handling with injury group, and pretreatment with 17β-estradiol peritoneal injection, 1 mg/kg per day for one week.The other two groups were given the same volume of castor oil.At 6 h, 24 h and 48 h after injury, the brain tissue water content, malondialdehyde ( MDA) content and superoxide dismutase ( SOD) activity were measured.Results At 6 h, 24 h and 48 h after injury, the levels of brain tissue water content in the injury group and treatment group were significantly higher than those in the control group ( P0.05).At 24 h and 48 h after injury, the brain tissue water contents in the injury group was ( 105.17 ±0.43 )% and ( 107.54 ±0.39 )%, in the treatment group was (103.26 ±0.42)%and (105.89 ±0.43)%, respectively, showing a significant difference between the two groups ( P0.05).But at 24 h and 48 h after injury, the levels of MDA in the treatment group were significantly lower than those in the injury group [(130.39 ±7.02) μmol/g vs.(149.41 ±8.25) μmol/g, (125.41 ±6.59) μmol/g vs.(157.72 ± 8.93) μmol/L] , and the levels of SOD in the treatment group were significantly higher than thoset in the injury group [(88.46 ±7.17) U/g vs.(80.10 ±4.87) U/mg, (97.31 ±7.89) U/g vs.(84.29 ±6.13) U/g], with a significant difference ( P<0.05 ) between the two groups.Conclusions 17β-estradiol has a protective effect on traumatic brain injury.