ABSTRACT
BACKGROUND: The lack of viable organs for transplantation led to the creation in Argentina of the Glasgow 7 Program based on the detection and follow-up of acute neurologic patients admitted with Glasgow scores ≤7 in selected hospitals. The objective of this study was to determine the likelihood of hospitalized acute neurologic patients progressing to brain death (BD) based on several variables, including age, sex, and admission diagnosis. METHODS: This study was a retrospective cohort analysis of data obtained from the SINTRA (Procurement and Transplantation National Information System) database between 2006 and 2015. Independent variables included the following: age, sex, and diagnosis at admission; ischemic stroke; spontaneous intracerebral hematoma (SIH); subarachnoid hemorrhage (SH); anoxia, meningitis; penetrating head injury (PHI); closed head injury; and tumors. A multivariate analysis was performed adjusting the diagnosis at admission according to age and sex. RESULTS: A total of 31,877 patients were included: 19,308 (61%) patients died and 9736 (30%) evolved to BD. Overall, 36% of women and 28% of men evolved to BD (relative risk, 0.87 [95% confidence interval (CI), 0.86-0.89]; P < .001). In the multivariate analysis adjusted for age and sex, we observed the following: SIH OR, 1.79 (95% CI, 1.69-1.9; P < .001); ischemic stroke OR, 0.82 (95% CI, 0.73-0.92; P < .001); SH OR, 2.33 (95% CI, 2.16-2.52; P < .001); anoxia OR, 0.71 (95% CI, 0.64-0.79; P < .001); closed head injury OR, 0.41 (95% CI, 0.38-0.43; P < .001); PHI OR, 2.64 (95% CI, 2.38-2.94; P < .001); and tumors OR, 1.07 (95% CI, 0.93-1.24; P = .31). CONCLUSIONS: Thirty percent of the patients who entered the Glasgow 7 Program evolved with BD. The characteristics most likely to result in BD were age, female sex, PHI, SH, and SIH.
Subject(s)
Brain Death/pathology , Brain Diseases/pathology , Glasgow Outcome Scale/statistics & numerical data , Adult , Aged , Argentina , Cerebral Hemorrhage/pathology , Disease Progression , Female , Humans , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Stroke/pathology , Subarachnoid Hemorrhage/pathologyABSTRACT
OBJECTIVE: Evaluate the Glasgow outcome scale (GOS) at discharge (GOS-HD) as a prognostic indicator in patients with traumatic brain injury (TBI). METHOD: Retrospective data were collected of 45 patients, with Glasgow coma scale <8, age 25±10 years, 36 men, from medical records. Later, at home visit, two measures were scored: GOS-HD (according to information from family members) and GOS LATE (12 months after TBI). RESULTS: At discharge, the ERG showed: vegetative state (VS) in 2 (4%), severe disability (SD) in 27 (60%), moderate disability (MD) in 15 (33%) and good recovery (GR) in 1 (2%). After 12 months: death in 5 (11%), VS in 1 (2%), SD in 7 (16%), MD in 9 (20%) and GR in 23 (51%). Variables associated with poor outcome were: worse GOS-HD (p=0.03), neurosurgical procedures (p=0.008) and the kind of brain injury (p=0.009). CONCLUSION: The GOS-HD was indicator of prognosis in patients with severe TBI.
Subject(s)
Brain Injuries/rehabilitation , Disability Evaluation , Glasgow Outcome Scale/statistics & numerical data , Patient Discharge/statistics & numerical data , Adolescent , Adult , Brain Injuries/diagnosis , Female , Humans , Male , Prognosis , Prospective Studies , Recovery of Function , Retrospective Studies , Severity of Illness Index , Young AdultABSTRACT
OBJECTIVE: Evaluate the Glasgow outcome scale (GOS) at discharge (GOS-HD) as a prognostic indicator in patients with traumatic brain injury (TBI). METHOD: Retrospective data were collected of 45 patients, with Glasgow coma scale <8, age 25±10 years, 36 men, from medical records. Later, at home visit, two measures were scored: GOS-HD (according to information from family members) and GOS LATE (12 months after TBI). RESULTS: At discharge, the ERG showed: vegetative state (VS) in 2 (4%), severe disability (SD) in 27 (60%), moderate disability (MD) in 15 (33%) and good recovery (GR) in 1 (2%). After 12 months: death in 5 (11%), VS in 1 (2%), SD in 7 (16%), MD in 9 (20%) and GR in 23 (51%). Variables associated with poor outcome were: worse GOS-HD (p=0.03), neurosurgical procedures (p=0.008) and the kind of brain injury (p=0.009). CONCLUSION: The GOS-HD was indicator of prognosis in patients with severe TBI.
OBJETIVO: Avaliar a escala de resultados de Glasgow (ERG) à alta hospitalar (ERG-ALTA) como indicador prognóstico em pacientes com traumatismo cranioencefálico (TCE). MÉTODO: Dados retrospectivos de 45 pacientes (36 homens), com escala de coma de Glasgow <8, idade 25±10 anos, foram coletados do prontuário médico. Posteriormente, em visita domiciliar, foram pontuadas duas medidas: ERG-ALTA (de acordo com informações de familiares) e ERG TARDIA (após 12 meses do TCE). RESULTADOS: Por ocasião da alta hospitalar, a ERG evidenciou: estado vegetativo (EV) em 2 (4%); incapacidade grave (IG) em 27 (60%), incapacidade moderada (IM) em 15 (33%) e boa recuperação (BR) em 1 (2%). Após 12 meses: morte em 5 (11%), EV em 1 (2%), IG em 7 (16%), IM em 9 (20%) e BR em 23 (51%). Variáveis associadas com má evolução foram: pior ERG-ALTA (p=0,03); procedimentos neurocirúrgicos (p=0,008) e o tipo de lesão cerebral (p=0,009). CONCLUSÃO: A ERG-ALTA foi indicador adequado de prognóstico tardio em pacientes com TCE grave.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Brain Injuries/rehabilitation , Disability Evaluation , Glasgow Outcome Scale/statistics & numerical data , Patient Discharge/statistics & numerical data , Brain Injuries/diagnosis , Prognosis , Prospective Studies , Recovery of Function , Retrospective Studies , Severity of Illness IndexABSTRACT
Determinar los factores de riesgo para lesiones inadvertidas en pacientes laparotomizados por trauma abdominal en el Servicio de Cirugía General del Hospital Manuel Núñez Tovar de Maturín, durante el período enero-septiembre 2008. Estudio prospectivo, transversal, descriptivo y observacional para identificar la incidencia de las lesiones inadvertidas en los pacientes traumatizados moderados o graves, sometidos a laparotomía exploradora durante el período de estudio. Se evalua la edad, sexo, tipo de lesión inadvertida, hora y día del ingreso, índice de Glasgow, estabilidad hemodinámica, índices de trauma (ATI, RTI) y estudios imagenológicos entre otras variables. Hubo un total de 97 pacientes con 384 lesiones, de las cuales, 42 fueron inadvertidas. El análisis univariante de las variables relacionadas con las lesiones no detectadas demostró: un RTI mayor de 9 puntos (R.R=2,45), inestabilidad hemodinámica (R.R=2,18), el Glasgow < 13 puntos (R.R=1,85), puntaje de ATI > 15 (R.R=1,71), y trauma múltiple (R.R=1,62). Fueron identificados varios factores de riesgo para lesiones inadvertidas por lo que se recomienda insistir en la valoración terciaria de todos los pacientes traumatizados.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Child , Middle Aged , Glasgow Outcome Scale/statistics & numerical data , Magnetic Resonance Imaging/methods , Abdominal Muscles/injuries , Urogenital System/injuries , Abdominal Injuries/physiopathology , Thoracic Injuries/etiology , Musculoskeletal Physiological Phenomena , Tomography/methodsABSTRACT
BACKGROUND: The aim of the present study was to evaluate the technical viability of the unilateral pterional approach to simultaneously treat symmetrical bilateral aneurysm (mirror image) of the middle cerebral arteries (SBAMCA) and to determine the morbidity and mortality rates of this approach. METHODS: Forty-six patients with SBAMCA underwent unilateral pterional craniotomy within a period of 9 years. Most patients were women (24, 80.0%) and mean age was 40.7 years. RESULTS: Obliteration of the contralateral aneurysm was not possible in 16 patients (34.8%) because of brain edema in 8 patients operated on during the acute phase, lateral projection of the aneurysm in 3, a very long contralateral M1 segment in 4, and the presence of atheromatous plaques at the MCA bifurcation and aneurysm neck in 1. The remaining 30 patients (65.2%) were submitted to the proposed treatment. Final evaluation showed that 26 patients (86.7%) were Glasgow Outcome Scale (GOS) V, 1 patient (3.3%) was GOS IV, 2 patients (6.6%) were GOS III, and 1 patient (3.3%) was GOS I. CONCLUSIONS: The unilateral pterional surgical approach to treat SBAMCA is a technically viable procedure associated with low morbidity and mortality. However, it requires a neurosurgeon experienced in cerebral aneurysm surgery and the appropriate technical conditions.