Clinical profile and risk factors of mortality in acute febrile encephalopathy in children: an experience from tertiary care center of central India.

Early prediction of outcome in very severe closed head injury

Is the Glasgow Coma Scale Score in Children in the Emergency Department Lower During the Night?

The current prognostic models for mortality and functional outcome after intracerebral hemorrhage (ICH) are not simple enough. To predict the outcome of ICH, a new simple model, ICH index (ICHI), was established and evaluated in this study. Medical records of all cases with ICH in our hospital from January 2008 to August 2009 were reviewed. Multiple linear regression analyses were used to assess the contributions of independent variables to hospital mortality after ICH. Age, serum glucose, white blood cell counts (WBC), and Glasgow Coma Scale (GCS) score were found to be greatly associated with mortality. A formula of ICH index [ICHI = age (years)/10 + glucose (mmol/L) + WBC (10(9) /L) - GCS score] was established. Furthermore, the receiver operating characteristic (ROC) analyses were performed to estimate the predictive value of the ICHI. The model showed an area under the ROC curve (AURC) of 0.923 (95% CI: 0.883-0.963, P < 0.001). The best cut-off value of ICHI for mortality was 18, which gave sensitivity, specificity, and Youden's index of 0.65, 0.95, and 0.60, respectively. The hospital mortality was extremely increased when 18 < ICHI < 28 (mortality 72.0%) and when ICHI ≥ 28 (mortality 100%), in contrast with overall mortality (21.6%). The ICHI can be a simple predictive model and complementary to other prognostic models.

Controversy of Surgical Treatment for Severe Cerebellar Infarction

Secondary injury of cerebral hemorrhage is induced by systemic inflammatory cascades, which are related to perihematomal brain edema, cellular apoptosis, and the disruption of the blood-brain barrier. This study was to specifically elaborate the relationship of circulating/cerebrospinal T lymphocytes and Glasgow Coma Scale (GCS) score at 6 months after intracerebral hemorrhage (ICH). The enrolled patients were divided into 2 groups based on GCS score: the favorable prognosis group (GCS > 12) and unfavorable prognosis group (GCS ≤ 12). T lymphocyte subpopulations were analyzed by flow cytometry. A total of 30 samples of peripheral blood and 17 samples of cerebrospinal fluid were collected and analyzed, including 19 cases and 12 cases in the favorable prognosis group (GCS > 12) respectively. Both CD3+ and CD3+CD4+ T lymphocyte counts on Day 1 after ICH were lower in the peripheral blood of patients with unfavorable prognosis (GCS ≤ 12) (P = .025 and .022, respectively). There were correlation trends between the GCS scores and CD3+ T lymphocyte count (P = .0144), and CD3+CD4+ T lymphocyte count (P = .0135). In cerebrospinal fluid, there was a close correlation between the GCS scores and CD3+CD4+ percentage, CD4+/CD8+ ratio, CD3+ and CD3+CD4+ T lymphocyte counts. The area under the curve of CD4+/CD8+ T lymphocyte ratio was the largest among them (P = .000 and area under the curve = 0.917), with a significantly high specificity and sensitivity (0.917 and 1.000). Based on cerebrospinal fluid samples, the CD4+/CD8+ T lymphocyte ratio on Day 1 after ICH may be a more significant indicator to predict the short-term prognosis at 6 months after ICH.

Bispectral analysis in trauma patients: An observational study

Glasgow Coma Scale (GCS) score is being widely used as a useful predictor to investigate patients with head injury. High red cell distribution width (RDW) values have been independently associated with mortality and poor neurological outcome. However, there are few data available for Spontaneous Intracerebral Hemorrhage (SIH) in maintenance hemodialysis (MHD) patients. This study aimed to evaluate the prognostic value of the combined measurement of RDW and GCS score in MHD patients with SIH. We retrospectively studied 46 MHD patients who was admitted to our hospital for nontraumatic SIH from October 2014 to May 2020. Data including demographic information, cause of renal failure, comorbidities at ESRD, clinical and laboratory parameters at admission were collected from medical records. Univariate and multivariate Logistic regression analysis were performed to identify independent risk factors of the in-hospital Mortality in Hemodialysis Patients with SIH. The receiver operating characteristic curve (ROC) and areas under the curve (AUCs) were determined. The sensitivity and specificity of independent risk factors were calculated for a range of different cutoff points. A total of 46 patients were enrolled in the study. The in-hospital mortality rate was 69.57%. We divided subjects into 2 groups based on the clinical outcomes. Compared with survivors (n = 14), non-survivors (n = 32) had longer hemodialysis vintage (P = .017), lower GCS score (P < .001), higher hemoglobin (Hb) (P = .032) and RDW (P = .009). In multivariate logistic regression analysis, GCS score (OR 0.719, 95% CI 0.546-0.946; P = .018) and RDW (OR 4.549, 95% CI 1.243-0.946; P = .018) were independent risk factors of in-hospital mortality in MHD patients with SIH. The area under the ROC curve (AUC) for GCS score was 0.849 (95% CI 0.729-0.970) while that for RDW was 0.743 (95% CI 0.596-0.891). The AUC for the combined prediction was 0.916 (95% CI 0.828-1.000), with a sensitivity of 90.63% and a specificity of 88.46%. In conclusion, high RDW and low GCS score were useful and independent poor prognostic markers for in-hospital mortality of MHD patients with SIH.

Outcomes Following Penetrating Brain Injuries in Military Settings: A Systematic Review and Meta-Analysis

Objective Both free triiodothyronine (FT3) level and Glasgow Coma scale (GCS) scores have been separately described as prognostic predictors for mortality in hypertensive intracerebral hemorrhage (HICH). This study is conducted to investigate the relationship and prognostic impact of low-T3 syndrome and GCS in HICH patients. Methods Two hundred and thirty patients with HICH, admitted to our hospital from January 2015 to January 2016, were chosen and performed thyroid hormone levels examination (FT3, FT4 and thyroid stimulating hormone [TSH] 3). According to the thyroid hormone results, these patients were divided into low T3 group I (FT3 7.5), and low T3 group II (FT3 2.85 pmol/L). Telephone follow-up was performed every 6 months, and using death or re-bleeding during follow-up period as end point of the event, prognostic values of FT3 level and GCS scores defined by ROC curve in mortality and re-bleeding rate were recorded; survival rate of these patients were analyzed by Kaplan-Meier curves and compared between each two groups; multivariate Cox regression was used to analyze the relations of FT3 level and GCS scores with mortality and re-bleeding rate. Results As compared with normal thyroid function group, low T3 group I had significantly higher re-bleeding rate, percentage of patients with blood loss>30 mL, and rate of breaking into the ventricles, and statistically lower GCS scores at admission and FT3 level (P<0.05); the mean age in patients of low T3 group I was significantly elder than that in patients of normal thyroid function group (P<0.05). ROC results indicated that the sensitivity and specificity of GCS scores in predicting mortality and re-bleeding rate were 63% and 73%, and those of FT3 level were 45% and 73%. Kaplan-Meier curves showed that both low GCS group and low T3 group II had significantly increased mortality and re-bleeding rate as compared with high GCS group and high T3 group (P<0.05). Unified prediction results indicated that patients from low T3 and low GCS group had significantly higher mortality and re-bleeding rate as compared with patients from low T3 and high GCS group, high T3 and low GCS group, and high T3 and high GCS group (P<0.05). Conclusion Low T3 syndrome is common in patients with HICH; FT3 level and GCS scores appear to be important predictors for mortality and recurrence in patients with HICH. Key words: Hypertensive intracerebral hemorrhage; Glasgow coma scale; Free triiodothyronine; Prognosis

To analyze the changes rule of serum procalcitonin (PCT) levels in patients with traumatic brain injury in plateau areas, and to evaluate its value in assessing the severity and prognosis of the patients. A prospective cohort study was conducted. The patients with traumatic brain injury admitted to the critical care medicine departments of Xining Third People's Hospital (at an altitude of 2 260 metres) and Golmud City People's Hospital (at an altitude of 2 780 metres) from May 2018 to September 2022 were enrolled. According to the Glasgow coma scale (GCS) score at admission, the patients were divided into mild injury group (GCS score 13-15), severe injury group (GCS score 9-12), and critical injury group (GCS score 3-8). All patients received active treatment. Chemiluminescence immunoassay was used to measure the serum PCT levels of patients on the 1st, 3rd, 5th, and 7th day of admission. The Kendall tau-b correlation method was used to analyze the correlation between serum PCT levels at different time points and the severity of the disease. The patients were followed up until October 30, 2022. The prognosis of the patients was collected. The baseline data of patients with different prognosis were compared. The Cox regression method was used to analyze the relationship between baseline data, serum PCT levels at different time points and prognosis. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of serum PCT levels at different time points for death during follow-up. Finally, a total of 120 patients with traumatic brain injury were enrolled, including 52 cases in the mild injury group, 40 cases in the severe injury group, and 28 cases in the critical injury group. The serum PCT levels of patients in the mild injury group showed a continuous downward trend with the prolongation of admission time. The serum PCT levels in the severe injury and critical injury groups reached their peak at 3 days after admission, and were significantly higher than those in the mild injury group (μg/L: 3.53±0.68, 4.47±0.63 vs. 0.40±0.14, both P < 0.05), gradually decreasing thereafter, but still significantly higher than the mild injured group at 7 days. Kendall tau-b correlation analysis showed that there was a significant positive correlation between serum PCT levels on days 1, 3, 5, and 7 of admission and the severity of disease (r value was 0.801, 0.808, 0.766, 0.528, respectively, all P < 0.01). As of October 30, 2022, 92 out of 120 patients with traumatic brain injury survived and 28 died, with a mortality of 23.33%. Compared with the survival group, the GCS score, serum interleukin-6 (IL-6) levels, white blood cell count (WBC) in peripheral blood, and PCT levels in cerebrospinal fluid at admission in the death group were significantly increased [GCS score: 5.20±0.82 vs. 4.35±0.93, IL-6 (ng/L): 1.63±0.45 vs. 0.95±0.27, blood WBC (×109/L): 14.31±2.03 vs. 11.95±1.98, PCT in cerebrospinal fluid (μg/L): 11.30±1.21 vs. 3.02±0.68, all P < 0.01]. The serum PCT levels of patients in the survival group showed a continuous downward trend with prolonged admission time. The serum PCT level in the death group peaked at 3 days after admission and was significantly higher than that in the survival group (μg/L: 4.11±0.62 vs. 0.52±0.13, P < 0.01), gradually decreasing thereafter, but still significantly higher than the survival group at 7 days. Cox regression analysis showed that serum IL-6 levels [hazard ratio (HR) = 17.347, 95% confidence interval (95%CI) was 5.874-51.232], WBC in peripheral blood (HR = 1.383, 95%CI was 1.125-1.700), PCT levels in cerebrospinal fluid (HR = 1.952, 95%CI was 1.535-2.482) at admission and serum PCT levels on admission days 1, 3, 5, and 7 [HR (95%CI) was 6.776 (1.844-24.906), 1.840 (1.069-3.165), 3.447 (1.284-9.254), and 6.666 (1.214-36.618), respectively] were independent risk factors for death during follow-up in patients with traumatic brain injury (all P < 0.05). ROC curve analysis showed that the AUC of serum PCT levels on days 1, 3, 5, and 7 for predicting death during follow-up in patients with traumatic brain injury was all > 0.8 [AUC (95%CI) was 0.898 (0.821-0.975), 0.800 (0.701-0.899), 0.899 (0.828-0.970), 0.865 (0.773-0.958), respectively], indicating ideal predictive value. The optimal cut-off value for serum PCT level at 3 days of admission was 1.88 μg/L, with the sensitivity of 78.6% and specificity of 88.0% for predicting death during follow-up. Abnormal expression of serum PCT levels in patients with traumatic brain injury on the 3rd day of admission was found. The serum PCT levels greater than 3 μg/L may be related to severe illness. The serum PCT levels greater than 1.88 μg/L can predict the poor prognosis of patients. Dynamic observation of changes in serum PCT levels has good evaluation value for the severity and prognosis of patients with traumatic brain injury in plateau areas.

To investigate the independent risk factors for short-term mortality in patients with spontaneous cerebellar hemorrhage (SCH) based on Mimics software of medical image control system. The clinical data of SCH patients treated at Shengjing Hospital of China Medical University from January, 2010 to December, 2021 was retrospectively analyzed and compared, including gender, age, underlyin g diseases, Glasgow coma scale (GCS) and blood pressure at admission, laboratory indicators, imaging data, and short-term (3 weeks after onset) survival status. The imaging examination parameters were accurately calculated using Mimics software, including hematoma volume, longest diameter, and maximum cross-sectional area of cerebellar hemorrhage. Multivariate Logistic regression analysis was used to evaluate the independent risk factors for short-term death in SCH patients. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of the four significant factors on short-term mortality in SCH patients. A total of 202 patients with SCH were included, of which 42 patients (20.8%) died within 3 weeks of onset and 160 patients (79.2%) survived. Univariate analysis showed that, compared with the survival group, the death group had significantly higher blood glucose, hematoma volume, hematoma longest diameter, hematoma maximum cross-sectional area, the ratio of hematoma maximum cross-section area and the corresponding posterior cranial fossa area, while GCS score was significantly lower, the distance from hematoma edge to the cerebral aqueduct center, and the distance from hematoma edge to the edge of brainstem were significantly shorter, the differences were statistically significant. Multivariate Logistic regression analysis showed that GCS score at admission [odds ratio (OR) = 0.875, 95% confidence interval (95%CI) was 0.767-0.998], hematoma volume (OR = 1.068, 95%CI was 1.022-1.115), the longest diameter of hematoma (OR = 1.086, 95%CI was 1.049-1.124), and the ratio of hematoma maximum cross-section area and the corresponding posterior cranial fossa area (OR = 1.119, 95%CI was 1.060-1.181) were independent risk factors for short-term mortality in SCH patients (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting short-term death of patients with SCH were 0.738, 0.839, 0.728 and 0.727, respectively. When the GCS score was 12 at admission, the sensitivity was 85.0% and the specificity was 57.1%. When the hematoma volume was 8.40 mL, the sensitivity was 95.2% and the specificity was 65.0%. When the longest diameter of the hematoma was 47.10 mm, the sensitivity was 57.1% and the specificity was 80.6%. When the ratio of hematoma maximum cross-section area and the corresponding posterior cranial fossa area was 0.11, the sensitivity was 88.1% and the specificity was 48.7%. GCS score < 12 on admission, hematoma volume > 8.40 mL, hematoma longest diameter > 47.10 mm, the ratio of hematoma maximum cross-section area and the corresponding posterior cranial fossa area > 0.11 suggest a higher risk of short-term mortality in SCH patients.

Objective To investigate the predictive value of prognosis of the 95% spectral edge frequency （SEF95） and total power （TP） in quantitative electroencephalography （qEEG） in patients with disturbance of consciousness. Methods The patients with disturbance of consciousness admitted in the neurointensive care unit （NICU） in Nanfang Hospital from January 2008 to June 2010 were included. Glasgow Coma Scale （GCS） scores were performed on admission and EEG monitoring was performed simultaneously. The patients were divided into either a survival goup or a death froup according to the survival status of the patients at the time of leaving NICU. The age, sex, hypertension, diabetes, GCS scores, SEF95, and TP were compared between the two groups. A multivariate logistic regression analysis was performed for the above factors. The prognostic indicators were analyzed with the receiver operating characteristic （ROC） curves and the of qEEG predictive ability of death in patients with disturbance ofconsciousness were determined. Results A total of 109 patients with supratentorial lesions were enrolled in the study, 79 of them were in the survival group and 30 of them were in the death group. The GCS scores （5 ±3 vs. 9 ±3, P =0. 000） and SEF95 （7. 0±4. 0 vs. 10. 0 ±4. 0, P = 0. 002） in the death group were significantly lower than those in the survival group. Multivariate logistic regression analysis showed that GCS scores （odds ratio 0. 100, 95% confidence interval 0. 029-0. 353） and SEF95 （odds ratio 0. 853, 95% confidence interval 0. 740-0. 983） were the independent predictors of recent prognosis. ROC curve analysis showed that the lower the GCS scores and SEF95 were, the greater the likelihood of death in patients. When SEF95 was 〈 7. 75, the sensitivity to determine the death was 60. 0%, the specificity was 72. 2%, the posi- tive predictive value was 82. 6%, and the negative predictive value was 45.0% ; when the GCS score was 〈8, the sensitivity to determine the death was 83.3%, the specificity was 73.4%, the positive predictive value was 82. 6%, and the negative predictive value was 45.0%. Conclusions SEF95 helps determine the prognosis of patients with disturbance of consciousness, and it is expected to become an important means of bedside assessment of prognosis in patients with disturbance of consciousness in NICU. Key words: Unconsciousness; Electroencephalography; Glasgow Coma Scale; Prognosis

Recalibrating the Glasgow Coma Score as an Age-Adjusted Risk Metric for Neurosurgical Intervention

Introduction:Acute febrile encephalopathy (AFE) in children is a medical emergency and could be a manifestation of many systemic and central nervous system pathologies. The clinical features of AFE are nonspecific and etiological spectrum variable depending on the studied population.Materials and Methods:A prospective, observational study was carried out including children aged between 1 month and 12 years with AFE admitted to the Pediatric Intensive Care Unit of a tertiary care hospital in Western India. The primary objective was to assess the clinical presentation and etiology of AFE while the secondary objectives were to correlate the clinical and etiological findings and to determine the risk factors associated with mortality.Results:Out of the ninety children with AFE included in this study, male:female ratio was 1.2:1; most of them were aged between 1 and 5 years and came with a history of < 7 days (82.2%). All of them had altered sensorium, about 2/3rd had seizures and 47.8% having a Glasgow Coma Score (GCS) <8. Etiology remained elusive in about 40% of the cases, and viral infections were the most common among the ones with an identifiable cause. A variety of morbidity (shock, disseminated intravascular coagulopathy, respiratory failure, etc.) and high mortality (40%) was observed with risk factors associated with mortality being GCS < 8, the presence of raised intracranial pressure, shock, and respiratory failure.Conclusion:AFE, though a rare diagnosis in children, is associated with significant morbidity and high mortality in a developing country like India.

Circadian variability of the initial Glasgow Coma Scale score in traumatic brain injury patients