Concomitant Traumatic Brain Injury Research Articles

Traumatic maxillofacial injuries: Patterns, outcomes, and long-term follow-up of a military cohort.

Maxillofacial trauma poses a distinct challenge on the modern battlefield, and data on its long-term implications are scarce. The aim of this study was to investigate maxillofacial injury characteristics, outcomes, and complications along the continuum of care among hospitalized military personnel from the pre-hospital setting through long-term rehabilitation. A registry-based study was undertaken of three national trauma and rehabilitation registries: The Israel Defense Forces Trauma Registry (IDF-TR), which records pre-hospital data. The Israeli National Trauma Registry for in-hospital data and the Israel Ministry of Defense Rehabilitation Department (MOD-RD) registry contain long-term disability data. The cohort comprised IDF soldiers who suffered maxillofacial injuries between 1997 and 2020. A total of 672 patients with maxillofacial injuries were included in the study, and 6.4% of all trauma admissions were related to maxillofacial injuries. Of these, 366 (54%) were injured in non-military (NMC) circumstances, and 306 (46%) were wounded in military circumstances (MC). The mechanisms of injury were mainly traffic-related among the NMC group compared with an explosion in the MC group. Maxillofacial fractures were frequently associated with traumatic brain injuries with higher rates in the NMC group than in the MC group (55% vs. 30%, p < .001). In a multivariate analysis, zygomatic and orbital fractures were associated with higher odds of concomitant head injury. The most common categories of long-term disability included central nervous system disorders, skull injuries, epilepsy, hearing impairment, ophthalmologic conditions, and post-traumatic stress disorder. Maxillofacial injuries are often associated with concomitant traumatic brain injury. Long-term disabilities associated with these injuries included the central nervous system, hearing, ophthalmologic impairments, and post-traumatic stress disorder.

Management of Traumatic Atlantooccipital Dissociation at a Level 1 Trauma Center: A Retrospective Case Series

Atlantooccipital dislocation (AOD) is a highly unstable and often neurologically devastating injury to the craniocervical junction that typically results from high-energy trauma. Management of these devastating injuries is complex, with prognostication difficult due to high rates of concomitant intracranial and systemic injuries. This report highlights advances in management of AOD andappropriate implementation of operative adjuncts including neuronavigation and the use of intraoperative neuromonitoring. All patients with AOD presenting to a high-volume, level 1 trauma center between January 2015 and August 2021 were retrospectively identified through a prospectively maintained database of patients presenting with traumatic spine injuries. Medical records, including imaging reports, clinical documentation, and intraoperative neurophysiological reports were reviewed. A total of 11 patients were identified with patterns of injury consistent with AOD. Fifty-five percent of patients survived until discharge. 73% of patients underwent surgery for stabilization. All 4 patients with preoperative neurologic deficits who underwent surgery had monitorable transcranial motor evoked potentials and somatosensory evoked potentials. Two experienced significant motor recovery postoperatively, and 2 did not survive to discharge. Blunt cerebrovascular injuries were identified in 73% of patients. AOD is encountered with increasing frequency. The identification and management of this specific injury is complicated by the volume and severity of associated injuries, especially concomitant traumatic brain injury. Timely recognition is critical and the use of surgical adjuncts including intraoperative neurophysiologic monitoring and surgical navigation can increase the safety and success of these procedures while also providing prognostic information on potential for motor recovery.

Predictors of Blunt Cerebrovascular Injury, Stroke, and Mortality in Patients with Cervical Spine Trauma

Blunt cerebrovascular injury (BCVI), defined as blunt traumatic injury to the carotid or vertebral arteries, is associated with significant risk of stroke and mortality. Cervical spine trauma is a recognized risk factor for BCVI. The objective of this study was to identify significant predictors of BCVI and its sequelae in patients with known cervical spine injury. Patients from 2007 to 2018 with blunt cervical spine injury diagnoses were identified in the National Trauma Data Bank. Multivariable logistic regression models were used to identify patient baseline and injury characteristics associated with BCVI, stroke, and mortality. We identified 229,254 patients with cervical spine injury due to blunt trauma. The overall rate of BCVI was 1.6%. Factors associated with BCVI in patients with cervical spine injury included lower Glasgow Coma Scale, motor vehicle crash, higher Injury Severity Score, concomitant traumatic brain or spinal cord injury, and current smoking status. BCVI was a strong predictor of stroke (odds ratio, 8.2; 95% confidence interval, 5.7-12.0) and was associated with mortality (odds ratio, 1.7; 95% confidence interval, 1.3-2.2). Stroke occurred in 3.3% of patients with BCVI versus 0.02% for patients without BCVI. While BCVI is rare following cervical spine injury due to blunt trauma, it is a significant predictor of stroke and mortality. The risk factors associated with BCVI, stroke, and mortality identified here should be used in the development of more effective predictive tools to improve care.

Underreporting of Traumatic Brain Injuries in Pediatric Craniomaxillofacial Trauma: A 20-Year Retrospective Cohort Study.

Despite clinical concerns associated with pediatric traumatic brain injuries (TBIs), they remain grossly underreported. This is the first retrospective study to characterize concomitant pediatric TBIs and craniomaxillofacial (CMF) trauma patients, including frequency, presentation, documentation, and outcomes. An institutional review board-approved retrospective cohort study was performed to identify all pediatric patients presenting with CMF fractures at a high-volume, tertiary trauma center between the years 1990 and 2010. Patient charts were reviewed for demographic information, presentation, operative management, length of stay, mortality at 2 years, dentition, CMF fracture patterns, and concomitant TBIs. Data were analyzed using two-tailed t tests and chi-square analysis. A value of P≤ 0.05 was considered statistically significant. Of the 2966 pediatric CMF trauma patients identified and included for analysis [mean age, 7 ± 4.7 years; predominantly White (59.8%), and predominantly male (64.0%)], 809 had concomitant TBI (frequency, 27.3%). Only 1.6% of the TBI cases were documented in charts. Mortality at 2 years, length of stay in the hospital, and time to follow-up increased significantly from mild to severe TBIs. Concomitant TBIs were more common with skull and upper third fractures than CMF trauma without TBIs (81.8% versus 61.1%; P < 0.05). Concomitant TBIs were present in a significant number of pediatric CMF trauma cases but were not documented for most cases. CMF surgeons should survey all pediatric CMF trauma patients for TBI and manage with neurology and/or neurosurgery teams. Future prospective studies are necessary to characterize and generate practice-guiding recommendations. Risk, II.

Early start of thromboprophylaxis does not increase risk of intracranial hematoma progression in multiply injured patients with traumatic brain injury

ABSTRACT Background Venous thromboembolism (VTE) in severely injured patients with severe traumatic brain injury (TBI) is a risk during the clinical course. Data on the safety of an early initiation of pharmacological VTE prophylaxis in severely injured patients with concomitant severe TBI is sparse. Methods Admissions to our level-1-trauma center between January 2015 and December 2018 were screened. Patients suffering from severe TBI (Abbreviated Injury Scale (AIS) of the head ≥3) and at least one further AIS ≥ 3 in any other body region were included. Demographic data, thromboembolic events, and progression of the intracranial hemorrhage were extracted from the patient’s charts. According to the first application of pharmacological thromboprophylaxis (VTEp), patients were categorized either to the early, the late (later than 24 h) or the no therapy group. Results In 79 patients (early: n = 35, late: n = 29, no therapy: n = 15) the Injury Severity Score (ISS) was 36.7 ± 12.7 points (AIShead 4.1 ± 0.8). No differences were found regarding the progression of the intracranial hemorrhage after initiation of the VTE prophylaxis (adj. p = 0.8). The VTE rate was low (n = 1, 1.6%). Conclusion In severely injured patients with severe TBI, the early administration of pharmacological thromboprophylaxis did not result in a higher rate of intracranial hematoma progression.

Intraoperative Systemic Heparin is Safe for Treatment of Blunt Thoracic Aortic Injury with Concomitant Traumatic Brain Injury

Grading blunt thoracic aortic injuries (BTAI) is a key determinant for reporting and treatment of this condition, but provides no guidance for the safety of intraoperative heparin for patients with concurrent traumatic brain injury (TBI). We sought to compare the impact of intraoperative systemic heparinization on outcomes after thoracic endovascular aneurysm repair (TEVAR) for patients with TBI. We also compared University of Washington (UW) and Society for Vascular Surgery (SVS) grading systems.

604 From admission to discharge: a total friction burn review from a single institution

IntroductionMost friction burns are adequately managed in an outpatient setting. However, many require hospital admission, operative excision, and extended care especially those that present at trauma or burn centers. There is a wide variance in friction burn management. Our goal is to review the etiology, management, and outcomes of such burns warranting hospitalization.MethodsWe conducted a retrospective review of all friction burns admitted to a single, American Burn Association verified burn center from January 1, 2016 to December 31, 2020. Individual chart analysis was performed using data from the hospital’s burn registry. Statistical analysis was performed using Chi-square and Wilcoxon rank-sum test with p< 0.05 being significant.ResultsEighty-two patients met the inclusion criteria. Mean age was 35.4 years (95% CI 31.6-39.2). The overall mean Total Body Surface Area (TBSA) was 9.0 % (95% CI 7.5-10.6), and mean TBSA of 3rd degree burns was 1.1 % (95% CI 0.6-1.7). The most common mechanism of injury was motorcycle collision (45, 55%), followed by pedestrian struck by automobile (13, 16%). Fifty-four individuals (65%) had a concomitant injury. The most common topical agent used was silver sulfadiazine (52%), followed by bacitracin (21%). Sixteen patients (20%) required ICU level of care. Twenty-eight (34%) patients required surgery for their friction burns and 15 (18%) ultimately required a split-thickness skin graft. The mean number of operations was 2.4 (95% CI 1.6-3.1).Overall, the operative group was younger (29.9 vs 38.3 years, p=0.026), more likely to have a concomitant traumatic brain injury (25% vs 7%, p=0.027) and had a longer hospital length of stay (17.5 vs 3.9 days, p< 0.001). Both groups had a similar overall TBSA (8.5% vs 10.0%, p=0.35), but the operative group had larger surface area comprised of 3rd degree burns (3.05% vs 0.2%, p< 0.001). Eighty-one patients survived with the sole death due to massive hemoptysis.ConclusionsFriction burns resulting in hospital admission are associated with high-energy traumatic mechanisms and concomitant injuries. Patients who need operative intervention of their burns typically require multiple procedures often culminating in a split-thickness skin graft.

Delayed Endovascular Repair With Procedural Anticoagulation: A Safe Strategy for Blunt Aortic Injury

Blunt aortic injury (BAI) and traumatic brain injury (TBI) are the leading causes of death after blunt trauma. The purposes of this study were to identify predictors of mortality for BAI and to examine the impact of procedural heparinization during thoracic endovascular aortic repair (TEVAR) on neurologic outcomes in patients with BAI/TBI. Patients with BAI were identified over an 8 year period. Age, gender, severity of injury and shock, time to TEVAR, morbidity, and mortality were recorded and compared. Multivariable logistic regression (MLR) was performed to determine independent predictors of mortality. Youden's index determined optimal time to TEVAR. A total of 129 patients were identified. The majority (74%) were male with a median age and injury severity score (ISS) of 40 years and 29, respectively. Of these, 26 (20%) had a concomitant TBI. Patients with BAI/TBI had higher injury burden at presentation (ISS 37 vs. 29, P=0.002; Glasgow Coma Scale [GCS] 6 vs. 15, P<0.0001), underwent fewer TEVAR procedures (31 vs. 53%, P=0.039), and suffered increased mortality (39 vs. 16%, P=0.009). All TEVARs had procedural anticoagulation, including patients with TBI, without change in neurologic function. The optimal time to TEVAR was 14.8hr. Mortality increased in TEVAR patients before 14.8hr (8.7 vs. 0%, P=0.210). MLR identified TEVAR as the only modifiable factor that reduced mortality (odds ratio 0.11; 95% confidence interval 0.03-0.45, P=0.002). TEVAR use was identified as the only modifiable predictor of reduced mortality in patients with BAI. Delayed TEVAR with the use of procedural heparin provides a safe option regardless of TBI with improved survival and no difference in discharge neurologic function.

Influence of age on acute traumatic spinal cord injury in Saint Petersburg, Russia.

Retrospective cohort study. To evaluate influence of age after traumatic spinal cord injury (TSCI). 13 specialized hospitals with neurosurgical departments of Saint Petersburg, Russia. Charts of all patients admitted with TSCI to the city hospitals 2012-2016. Demographic and clinical characteristics, surgical interventions, complications, mortality rate, and hospital stays were recorded. 311 patients with TSCI were included. TSCI was more common in younger age. Mean age (SD) was 42.4 (16.8) years. Patients were divided into four age groups: 18-29, 30-44, 45-59 and ≥60 years. The group ≥60 years had the lowest percentage of concomitant traumatic brain injury (TBI), 25%, versus 43% in TSCI < 60 years, p < 0.05. Low falls were the most frequent cause in patients aged 60 years and older, and led to less severe neurological deficits (p < 0.05). Complications were most frequent in motor complete TSCI (AIS A and AIS B) and in persons with combined TSCI and TBI at older age. Total complication rate was 67% at the age of ≥60 years versus 38% <60 years in TSCI with TBI (p < 0.05). Respiratory complications occurred in 67% ≥45 years versus 45% <45 years, p < 0.05. In-hospital mortality rate after TSCI was higher in the oldest age group. Respiratory complications are common and the in-hospital mortality is higher among elderly people. Older patients with TSCI and TBI are at high risk for complications.

Spinal cord injury-induced cognitive impairment: a narrative review

Spinal cord injury is a serious damage to the spinal cord that can lead to life-long disability. Based on its etiology, spinal cord injury can be classified as traumatic or non-traumatic spinal cord injury. Furthermore, the pathology of spinal cord injury can be divided into two phases, a primary injury phase, and a secondary injury phase. The primary spinal cord injury phase involves the initial mechanical injury in which the physical force of impact is directly imparted to the spinal cord, disrupting blood vessels, axons, and neural cell membranes. After the primary injury, a cascade of secondary events begins, expanding the zone of neural tissue damage, and exacerbating neurological deficits. Secondary injury is a progressive condition characterized by pro-inflammatory cytokines, reactive oxygen species, oxidative damage, excitatory amino acids such as glutamate, loss of ionic homeostasis, mitochondrial dysfunction, and cell death. This secondary phase lasts for several weeks or months and can be further subdivided into acute, subacute, and chronic. One of the most frequent and devastating complications developed among the spinal cord injury population is cognitive impairment. The risk of cognitive decline after spinal cord injury has been reported to be 13 times higher than in healthy individuals. The exact etiology of this neurological complication remains unclear, however, many factors have been proposed as potential contributors to the development of this disorder, such as concomitant traumatic brain injury, hypoxia, anoxia, autonomic dysfunction, sleep disorders such as obstructive sleep apnea, body temperature dysregulation, alcohol abuse, and certain drugs. This review focuses on a deep understanding of the pathophysiology of spinal cord injury and its relationship to cognitive impairment. We highlight the main mechanisms that lead to the development of this neurological complication in patients with spinal cord injury.

Future Perspectives in Spinal Cord Repair: Brain as Saviour? TSCI with Concurrent TBI: Pathophysiological Interaction and Impact on MSC Treatment.

Traumatic spinal cord injury (TSCI), commonly caused by high energy trauma in young active patients, is frequently accompanied by traumatic brain injury (TBI). Although combined trauma results in inferior clinical outcomes and a higher mortality rate, the understanding of the pathophysiological interaction of co-occurring TSCI and TBI remains limited. This review provides a detailed overview of the local and systemic alterations due to TSCI and TBI, which severely affect the autonomic and sensory nervous system, immune response, the blood–brain and spinal cord barrier, local perfusion, endocrine homeostasis, posttraumatic metabolism, and circadian rhythm. Because currently developed mesenchymal stem cell (MSC)-based therapeutic strategies for TSCI provide only mild benefit, this review raises awareness of the impact of TSCI–TBI interaction on TSCI pathophysiology and MSC treatment. Therefore, we propose that unravelling the underlying pathophysiology of TSCI with concomitant TBI will reveal promising pharmacological targets and therapeutic strategies for regenerative therapies, further improving MSC therapy.

Damaged brain accelerates bone healing by releasing small extracellular vesicles that target osteoprogenitors

Clinical evidence has established that concomitant traumatic brain injury (TBI) accelerates bone healing, but the underlying mechanism is unclear. This study shows that after TBI, injured neurons, mainly those in the hippocampus, release osteogenic microRNA (miRNA)-enriched small extracellular vesicles (sEVs), which targeted osteoprogenitors in bone to stimulate bone formation. We show that miR-328a-3p and miR-150-5p, enriched in the sEVs after TBI, promote osteogenesis by directly targeting the 3′UTR of FOXO4 or CBL, respectively, and hydrogel carrying miR-328a-3p-containing sEVs efficiently repaires bone defects in rats. Importantly, increased fibronectin expression on sEVs surface contributes to targeting of osteoprogenitors in bone by TBI sEVs, thereby implying that modification of the sEVs surface fibronectin could be used in bone-targeted drug delivery. Together, our work unveils a role of central regulation in bone formation and a clear link between injured neurons and osteogenitors, both in animals and clinical settings.

Influence of Antibiotic Management on Microbial Selection and Infectious Complications After Trauma.

Background: The inflammatory response and post-traumatic complications like infections play an important role in the pathophysiology of severe injuries. This study examines the microbiological aspects in anti-infective treatment of trauma patients and their inflammatory response in post-traumatic infections complications.Patients and Methods: A retrospective analysis of prospectively collected data in trauma patients (ISS ≥ 16) over a 1-year period (01/2018 to 12/2018) is provided. Patient population was stratified into severely injured patients without post-traumatic infection (inf-PT), and severely injured patients who developed an infection (inf+PT).Results: Of 114 trauma patients, 45 suffered from post-traumatic infection during the first 10 days of hospitalization. Severely injured patients with concomitant traumatic brain injury (PT+TBI) showed the highest rate of post-traumatic infection. Pro-inflammatory reaction was tracked by levels of Interleukin (IL-)6 (day 3: inf+T 190.8 ± 359.4 pg/dL > inf-PT 56.2 ± 57.7 pg/mL (mean ± SD); p = 0.008) and C-Reactive-Protein (CRP, day 3: inf+PT 15.3 mg/dL > inf-PT 6.7 mg/dL, p = 0.001) which were significantly higher in trauma patients who develop an infectious complication and showed a significant positive correlation with the occurrence of infection. The leading entity of infection was pneumonia followed by infections of the urinary tract mainly caused by gram-negative Enterobacteriaceae. 67.5% of all trauma patients received single-shot antibiosis during initial care in trauma bay. The development of secondary colonization was not relevant positively correlated with single-shot antibiosis (r = 0.013, p = 0.895) and prophylactically calculated antibiotic administration (r = 0.066, p = 0.500).Conclusion: Severely injured trauma patients have an increased risk for development of infectious complications, which mainly is pneumonia followed by infection of the urinary tract mainly caused by gram-negative Enterobacteriaceae. Based on the data in this study, the one-time antibiotic and prophylactic calculated use of antibiotics, like Cephalosporins must be critically discussed in terms of their role in the development of post-traumatic infections and microbial selection.

Expression of HO1 and PER2 can predict the incidence of delirium in trauma patients with concomitant brain injury

Intensive care unit (ICU)-acquired delirium is associated with adverse outcome in trauma patients with concomitant traumatic brain injury (TBI), but diagnosis remains challenging. Quantifying circadian disruption by analyzing expression of the circadian gene period circadian regulator 2 (PER2) and heme oxygenase 1 (HO1), which determines heme turnover, may prove to be potential diagnostic tools. Expression of PER2 and HO1 was quantified using qPCR from blood samples 1 day and 7 days after trauma. Association analysis was performed comparing mRNA expression levels with parameters of trauma (ISS—injury severity score), delirium, acute kidney injury (AKI) and length of ICU stay. 48 polytraumatized patients were included (equal distribution of TBI versus non-TBI) corrected for ISS, age and gender using a matched pairs approach. Expression levels of PER2 and HO1 were independent of age (PER2: P = 0.935; HO1: P = 0.988), while expression levels were significantly correlated with trauma severity (PER2: P = 0.009; HO1: P < 0.001) and longer ICU length of stay (PER2: P = 0.018; HO1: P < 0.001). High expression levels increased the odds of delirium occurrence (PER2: OR = 4.32 [1.14–13.87]; HO1: OR = 4.50 [1.23–14.42]). Patients with TBI showed a trend towards elevated PER2 (OR = 3.00 [0.84–9.33], P = 0.125), but not towards delirium occurrence (P = 0.556). TBI patients were less likely to develop AKI compared to non-TBI (P = 0.022). Expression levels of PER2 and HO1 correlate with the incidence of delirium in an age-independent manner and may potentially improve diagnostic algorithms when used as delirium biomarkers.Trial registration: German Clinical Trials Register (Trial-ID DRKS00008981; Universal Trial Number U1111-1172-6077; Jan. 18, 2018).

QS2: The Underreporting Of Traumatic Brain Injuries In Pediatric Craniomaxillofacial Trauma - A 20 Year Retrospective Cohort Study

Purpose:Despite clinical concerns associated with traumatic brain injuries (TBIs), they remain grossly underreported: 46% of TBIs in adult craniomaxillofacial (CMF) trauma patients remained unrecorded at discharge. This has not been studied in the pediatric CMF trauma population. Consequently, this is the first retrospective study to characterize concomitant pediatric TBI and CMF trauma patients, including incidence, presentation, documentation, and outcomes. The authors hypothesize that TBI in pediatric CMF trauma is associated with worse prognosis and remains under-recorded.Methods:An IRB-approved retrospective cohort study was performed to identify all pediatric patients presenting with CMF fractures at a high volume, tertiary trauma center between January 1st, 1990 to December 31st, 2010. Patients were included if they were (1) age younger than 15 years and (2) confirmed presence of CMF injury by means of imaging, radiology report, and physical examination. Patient charts were reviewed for demographic information, dentition stage, CMF fracture patterns, mechanism of injury, presentation, need for operative management, length of stay, and mortality at 2 years. Charts were reviewed to identify concomitant TBIs, defined as intracranial injury, cerebral hemorrhage, brain concussion, epilepsy or seizures (post-traumatic), and traumatic brain injury (documented). Data was analyzed using two-tailed Student’s t-tests and chi square analysis. Point-biserial correlation coefficients were calculated between a continuous and dichotomous variable; Pearson correlation coefficients were calculated between continuous variables. A P value ≤ 0.05 was considered statistically significant.Results:Of the 2966 pediatric CMF trauma patients identified and included for analysis (mean age of 7 +/- 4.7 years old, predominantly white, 59.8%, and male, 64.0%), 809 had concomitant TBI (frequency of 27.3%). Only 13 of the 809 TBI cases were documented in charts (1.6%). Concomitant TBI with CMF trauma patients were more likely to be male (69.1% vs 62%, P < 0.05), and be caused by blunt injury (98.9% vs. 95.5%, P < 0.05), compared to CMF trauma patients without TBI. TBI patients had a higher mortality rate at two years (8.0% vs 4.8%, P < 0.05). Mortality at two years, length of stay in hospital, and time to follow up significantly increased from mild to severe TBIs. Concomitant TBI and CMF trauma patients were also more likely to present with skull & upper third fractures than CMF trauma without TBI (81.8% vs 61.1%, P < 0.05).Conclusion:In this 20-year retrospective review, concomitant TBI injuries were present in a significant number of pediatric CMF trauma cases (27.3%) but was not documented for most cases. Given the importance of initial management and long-term care in TBI patients, it is critical for clinicians to remain vigilant for and manage TBIs in pediatric CMF trauma patients in collaboration with appropriate neurology and/or neurosurgery teams. Future prospective studies are necessary to better characterize TBI patient injury patterns and outcomes to generate practice guiding recommendations for this patient population.

Traumatic Atlanto-Occipital Dislocation-A Comprehensive Analysis of All Case Series Found in the Spinal Trauma Literature.

Traumatic atlanto-occipital dislocation (TAOD) is one of the most devastating traumatic injuries, generally associated with immediate death after high-energy trauma. The aim of this study was to perform a systematic literature review of all cases series of TAOD and present the current state of this entity. A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only case series with at least 5 cases were included in the analysis. We focused on survival rates, diagnostic methods, delays in diagnosis, outcomes, and cases successfully treated nonoperatively. A total of 17 articles were included (16 retrospective and 1 prospective study) with 341 patients. Six studies included pediatric patients only. The mean Glasgow Coma Scale at admission was ≤8 in all studies. Many different diagnostic criteria were used, but none of them had high accuracy. The overall mortality rate was 34.8%, but the studies' designs were heterogeneous (some included only survivors). A high rate of concomitant traumatic brain injury was documented in some studies. We found it interesting that some patients were treated with cervical immobilization (37/341; 10.8%), which was generally used in less unstable injuries; however, the majority of patients were managed with an occipito-cervical fusion (193/341; 56.5%). TAOD is a devastating traumatic injury, with a high mortality rate. An MRI may be recommended when there are subtle findings of TAOD and a normal computed tomography scan, such as subarachnoid hemorrhage in the posterior fossa, upper cervical injuries, or consistent neurological findings. Further studies are necessary to identify patients with mild MRI findings and TAOD that may be managed nonoperatively.

Extracorporeal detoxification for septic complications in children during the acute period of severe combined craniocerebral trauma

BACKGROUND: The clinical application of extracorporeal detoxification methods in patients with severe concomitant traumatic brain injury has several features and limitations due to intracranial hypertension, traumatic cerebral edema, and the risk of their growth during extracorporeal detoxification. The modern literature presents the results of using extracorporeal detoxification methods in severe concomitant trauma in children. However, practically no data are available on the possibility of their use in severe concomitant craniocerebral trauma, which determines the relevance of research in this direction.&#x0D; AIM: This study aims to improve the treatment results of affected children with severe concomitant craniocerebral trauma with the addition of septic complications using extracorporeal detoxification methods.&#x0D; MATERIALS AND METHODS: The experience using extracorporeal detoxification methods, including prolonged veno-venous hemodiafiltration combined with LPS sorption and plasma separation membrane in patient intensive care with severe concomitant craniocerebral trauma complicated by sepsis and septic shock development, is presented.&#x0D; RESULTS: The use of extracorporeal detoxification methods contributed to eliminating septic shock, stabilization of hemodynamic and internal homeostasis parameters, and regression of multiple organ failure in patients with severe concomitant traumatic brain injury. Monitoring the intracranial pressure and preventing disequilibrium syndrome development enabled avoiding an increase in intracranial hypertension in studied patients.&#x0D; CONCLUSIONS: Timely and adequate use of extracorporeal detoxification methods improves the clinical course of the acute period of traumatic illness in children with severe concomitant traumatic brain injury. The safe use of efferent therapy methods in patients with severe concomitant traumatic brain injury is ensured by invasive monitoring of intracranial pressure and preventing the development of disequilibrium syndrome.

Damage Control the Liver and Spleen in Case of Concomitant Injury: Literature Review

Until now, the issues of diagnosis and treatment tactics for abdominal injuries remain relevant and far from resolved. The complexity of their diagnosis is often due to the erasure of clinical manifestations, simultaneous damage to various organs of the abdominal cavity and the presence of combined injuries. Thus, concomitant traumatic brain injury with impaired consciousness leads to an increase in the probability of неundiagnosed injuries to internal organs. The state of shock distorts the clinical picture of the "acute abdomen", and the more severe it is, the less pronounced the symptoms of intra-abdominal catastrophe become.

Predicting neurosurgical clearance in the polytrauma patient with concomitant traumatic brain injury

The goal of this study is to develop a model based on previously used prognostic predictors in traumatic brain injury (TBI) patients with polytrauma, which will facilitate the decision-making of whether to clear these patients for non-cranial surgery. Data of eligible patients was obtained from a trauma database at a Level I trauma and academic tertiary referral center in the United States. The number of days seen by the neurosurgical service prior to clearance, injury severity score (ISS), post-trauma day 0 (PTD 0) of Glasgow Coma Score (GCS), intracranial pressure (ICP) score and computed tomography (CT) score, as well as the changes in GCS, ICP score and CT score between PTD 0 and day of clearance were the variables used in developing the model. The Neurosurgical Clearance Model (NCM) was developed using data from 50 patients included in the study. Patients were cleared by neurosurgeons 1.6 days later than it would appear possible based on a retrospective review of the patients’ clinical conditions. A single model equation was developed, the ultimate result of which is a clearance probability value. The best cutoff clearance probability value was found to be 0.584 (or 58.4%) using Receiver Operator Characteristic curve analysis. Our data suggests that neurosurgeons are risk-averse in clearing polytrauma patients for non-cranial surgery. This pilot NCM, if reproduced and validated by other groups and in larger prospective studies, may become a useful tool to assist clinicians in this often-difficult decision-making process.

Critical traumatic brain injury is associated with worse coagulopathy.

As thromboelastography (TEG) becomes the standard of care in patients with hemorrhagic shock (HS), an association between concomitant traumatic brain injury (TBI) and coagulopathy by TEG parameters is not well understood and is thus investigated. Retrospective analysis of trauma registry data at a single level 1 trauma center of 772 patients admitted with head Abbreviated Injury Scale (AIS) score of 3 and TEG studies between 2014 and 2017. Patients were stratified to moderate-severe TBI by head AIS scores of 3 and 4 (435 patients) and critical TBI by head AIS score of 5 (328 patients). Hemorrhagic shock was defined by base deficit of 4 or shock index of 0.9. Statistical analysis with unpaired t tests compared patients with critical TBI with patients with moderate-severe TBI, and patients were grouped by presence or absence of HS. A comparison of TBI data with conventional coagulation studies was also evaluated. In the setting of HS, critical TBI versus moderate-severe TBI was associated with longer R time (p = 0.004), longer K time (p < 0.05), less acute angle (p = 0.001), and lower clot strength and stability (maximum amplitude [MA]) (p = 0.01). Worse TBI did not correlate with increased fibrinolysis by clot lysis measured by the percentage decrease in amplitude at 30 minutes after MA (p = 0.3). Prothrombin time and international normalized ratio failed to demonstrate more severe coagulopathy, while partial thromboplastin time was found to correlate with severity of TBI (p = 0.01). In patients with critical TBI, the presence of HS correlated with a statistically significant worsening of all parameters (p < 0.05) except for clot lysis measured by the percentage decrease in amplitude at 30 minutes after MA (LY-30). Thromboelastography demonstrates that, with and without hemorrhagic shock, critical TBI correlates with a significant worsening of traumatic coagulopathy in comparison with moderate/severe TBI. In HS, critical TBI correlates with impaired clot initiation, impaired clot kinetics, and impaired platelet-associated clot strength and stability versus parameters found in moderate-severe TBI. Hemorrhagic shock correlates with worse traumatic coagulopathy in all evaluated patient groups with TBI. Conventional coagulation studies underestimate TBI-associated coagulopathy. Traumatic brain injury-associated coagulopathy is not associated with fibrinolysis. Prognostic/epidemiological, level IV; prognostic/epidemiological, level III.