Emergent Neurosurgical Intervention Research Articles

Characteristics and Injury Patterns in Traumatic Brain Injury Related to E-Scooter Use in Riga, Latvia: Multicenter Case Series.

Background and Objectives: In recent years, electronic scooters (e-scooters) have gained popularity, whether for private use or as a publicly available transportation method. With the introduction of these vehicles, reports of e-scooter-related accidents have surged, sparking public debate and concern. The aim of this study was to analyze the epidemiological data, characteristics, and severity of traumatic brain injury (TBI) related to e-scooter accidents. Materials and Methods: This retrospective case series evaluated patients who were admitted to the three largest neurosurgery clinics in Riga, Latvia, from the time period of April to October in two separate years-2022 and 2023-after e-scooter-related accidents. The data were collected on patient demographics, the time of the accident, alcohol consumption, helmet use, the type of TBI, other related injuries, and the treatment and assessment at discharge. Results: A total of 28 patients were admitted with TBI related to e-scooter use, with a median age of 30 years (Q1-Q3, 20.25-37.25), four individuals under the age of 18, and the majority (64%) being male. In 23 cases, the injury mechanism was falling, in 5 cases, collision. None were wearing a helmet at the time of the injury. Alcohol intoxication was evident in over half of the patients (51.5%), with severe intoxication (>1.2 g/L) in 75% of cases among them. Neurological symptoms upon admission were noted in 50% of cases. All patients had intracranial trauma: 50% had brain contusions, 43% traumatic subdural hematoma, and almost 30% epidural hematoma. Craniofacial fractures were evident in 71% of cases, and there were fractures in other parts of body in three patients. Six patients required emergency neurosurgical intervention. Neurological complications were noted in two patients; one patient died. Conclusions: e-scooter-related accidents result in a significant number of brain and other associated injuries, with notable frequency linked to alcohol influence and a lack of helmet use. Prevention campaigns to raise the awareness of potential risks and the implementation of more strict regulations should be conducted.

Trends in prehospital cervical collar utilization in trauma patients: Closer, but not there yet.

This study aims to assess the change in cervical spine (C-spine) immobilization frequency in trauma patients over time. We hypothesize that the frequency of unnecessary C-spine immobilization has decreased. A retrospective chart review of adult trauma patients transported to our American College of Surgeons-verified Level I trauma center from January 1, 2014, to December 31, 2021, was performed. Emergency medical services documentation was manually reviewed to record prehospital physiology and the application of a prehospital cervical collar (c-collar). C-spine injuries were defined as cervical vertebral fractures and/or spinal cord injuries. Univariate and year-by-year trend analyses were used to assess changes in C-spine injury and immobilization frequency. Among 2906 patients meeting inclusion criteria, 12% sustained C-spine injuries, while 88% did not. Patients with C-spine injuries were more likely to experience blunt trauma (95% vs. 68%, p < 0.001), were older (46 years vs. 41 years, p < 0.001), and had higher Injury Severity Scores (31 vs. 18, p < 0.001). They also exhibited lower initial systolic blood pressures (108 mm Hg vs. 119 mm Hg, p < 0.001), lower heart rates (92 beats/min vs. 97 beats/min, p < 0.05), and lower Glasgow Coma Scale scores (9 vs. 11, p < 0.001). In blunt trauma, c-collars were applied to 83% of patients with C-spine injuries and 75% without; for penetrating trauma, c-collars were applied to 50% of patients with C-spine injuries and only 8% without. Among penetrating trauma patients with C-spine injury, all patients either arrived quadriplegic or did not require emergent neurosurgical intervention. The proportion of patients receiving a c-collar decreased in both blunt and penetrating traumas from 2014 to 2021 (blunt-82% in 2014 to 68% in 2021; penetrating-24% in 2014 to 6% in 2021). Unnecessary C-spine stabilization has decreased from 2014 to 2021. However, c-collars are still being applied to patients who do not need them, both in blunt and in penetrating trauma cases, while not being applied to patients who would benefit from them.

Abstract Number ‐ 26: Results from Flat‐Panel CT as a predictor following Mechanical Thrombectomy

Introduction Flat‐panel CT provides quick and effective parenchymal cross‐sectional imaging. Pre‐thrombectomy, flat‐panel can be obtained to evaluate ischemic stroke patients for thrombectomy candidacy in cases where the traditional CT scanner is bypassed. Post‐thrombectomy images obtained from flat‐panel CT are also effective in evaluating complications such as contrast extravasation, hemorrhage, or increased core size. Findings on flat‐panel CT may provide information to guide decisions such as blood pressure goals, antiplatelet or anticoagulation regimen, thrombolytic reversal, and the need for emergent neurosurgical intervention in rare cases. Methods We analyzed 93 thrombectomy cases from 2021 to 2022, where flat‐panel CT was obtained, with follow‐up CT and MRI. Demographics were reviewed for this series of cases. Cases where stratified and compared depending on results on flat‐panel CT. Medical records were reviewed for changes in management. The local IRB approved the project, and consent was waived according to institutional guidelines. Results For our patient population, the median age was 70; race was 59% Caucasian, 40% African American, and 1% Hispanic; and gender was 46% female and 54% male. From the flat‐panel CT, we had the following results: Flat‐panel CT was normal in 68% of cases, 20% had contrast extravasation, 9% showed evidence of contrast extravasation vs. hemorrhage, 2% had hemorrhage during the procedure, and 1% had contrast retained in the vessels. On follow‐up CT, 35% had no change, 16% had contrast extravasation, 8% had SAH, 4% had contrast extravasation vs. hemorrhage, 3% had hemorrhagic transformation, 1% had IVH, 1% had petechial hemorrhages, and 31% had no follow‐up CT. On MRI, 20% had hemorrhagic transformation, 41% had no hemorrhage, 6% had microhemorrhages, 10% had petechial hemorrhages, 2% had ICH, 1% had 1 IVH, 1% had SAH, 1% had contrast extravasation, 17% of the cases had no follow‐up MRI. Based on flat‐panel CT, results for normal and contrast extravasation were as follows (Table 1.). Therapy was altered by the flat‐panel CT results in 10 cases. The main change in therapy was a delay in restarting antiplatelet and anticoagulation therapy, which took place in 9 cases. Conclusions Post thrombectomy flat‐panel CT is a useful screen post thrombectomy for high‐risk findings such as contrast extravasation and hemorrhagic transformation. Further studies are needed to determine ideal management in cases of contrast extravasation or hemorrhage on flat‐panel CT.

Cerebellar hematoma in severe hemophilia with inhibitor on emicizumab prophylaxis: a case report

BackgroundEmicizumab is a novel prophylactic medication used to treat patients with hemophilia A. It is indicated to minimize the frequency of bleeding episodes and the severity of serious bleeding in patients with hemophilia A utilizing inhibitors. However, some cases of bleeding episodes have been reported, and more data are needed regarding their management and expected outcomes.Case presentationWe report a case of a 4-year-old Saudi Arabian boy with severe hemophilia A who presented with a post-traumatic cerebral hemorrhage. The patient, with high titer inhibitors, was on emicizumab prophylaxis therapy. On hospital admission, he received tranexamic acid (10 mg intravenously, every 6 hours), and recombinant activated factor VII 120 µg/kg every 2 hours for 2 days then every 4 hours for 4 days. On follow-up, the patient showed no signs of neurological deficit. There was no need for emergency neurosurgical intervention since the bleeding had been controlled throughout the first 2 days. There were no recorded thrombotic sequelae or neurological complications, with complete resolution within 10 days.ConclusionsThis case implies that low-dose recombinant activated factor VII might be used safely and effectively with patients with hemophilia A on emicizumab prophylaxis, to reduce the risk of cerebral hemorrhage or another episode of serious bleeding along with its long-term complications.

Spontaneous rupture of an arachnoid cyst in an adult: illustrative case.

Arachnoid cysts are common intracranial mass lesions frequently discovered as incidental findings on radiographic imaging. It is routine practice to monitor these lesions as a large majority remain stable. Although traumatic cyst rupture is a known risk, it is rare for patients to present with spontaneous rupture. The authors report the case of a 32-year-old patient who required emergent neurosurgical intervention for spontaneous rupture of a left hemispheric arachnoid cyst. Patients with ruptured arachnoid cysts can present with vague, nonspecific symptoms that may delay diagnosis. If not diagnosed and treated promptly, arachnoid cyst rupture can progress to a neurosurgical emergency as the subdural collection may cause extensive mass effect and even cerebral herniation.

Glomus jugulare tumor presenting as papilledema – A rare case report

A 54-year-old male presented with headache and blurring of vision in both eyes for 2 months. Ocular examination showed bilateral lateral rectus palsy with papilledema, suggestive of raised intra-cranial pressure. A computed tomography scan of the brain revealed an expansile infiltrating soft tissue lesion causing lysis of the right petrous and jugular fossa, suggestive of a Jugular fossa tumor. The patient’s blood pressure was high at all times despite regular medications because of the glomus tumor’s supposed release of catecholamines. Elective surgery was planned; however, the patient developed a fatal tumor rupture within 4 months of diagnosis, for which emergency neurosurgical intervention and intensive care support were given, but he succumbed to death. Tumors obstructing the jugular outflow can cause increased intra-cranial pressure and vision loss, requiring prompt neurosurgical intervention.

Clinically important intracranial abnormalities in children presenting with first focal seizure.

Management of pediatric patients presenting with first seizure is challenging, especially with regards to emergent neuroimaging. The rate of abnormal neuroimaging findings is known to be higher in focal seizures than in generalized seizures, but those intracranial abnormalities are not always clinically emergent. In this study, we aimed to determine the rate and indicators for clinically important intracranial abnormalities that change acute management in children presenting with a first focal seizure to the pediatric emergency department (PED). This study was conducted retrospectively in the PED at a University Children`s Hospital setting. The study population consisted of patients aged between 30 days and 18 years with first focal seizure and who had emergent neuroimaging at the PED between the years 2001 and 2012. There were 65 eligible patients meeting the study criteria. Clinically important intracranial abnormalities requiring emergent neurosurgical or medical intervention were detected in 18 patients (27.7%) at the PED. Four patients (6.1%) underwent emergent surgical procedures. Seizure recurrence and the need for acute seizure treatment in the PED were significantly associated with clinically important intracranial abnormalities. Neuroimaging study yielding of 27.7% shows that first focal seizure must be evaluated meticulously. From the emergency department`s point of view; we suggest that first focal seizures in children should be evaluated with emergent neuroimaging, if possible with magnetic resonance imaging. Especially patients with recurrent seizures at presentation requires more careful evaluation.

Non-traumatic Spontaneous Spinal Subdural Hematoma in a Patient with Acute Paraplegia

Acute non-traumatic spinal subdural hematoma (SSDH) is a rare clinical condition in the emergency medicine practice and difficult to diagnose during the primary physical examination. It mostly occurs at thoracal vertebra levels due to trauma, use of anticoagulants, medical procedures such as acupuncture, arteriovenous malformations, hematological disorders or space-occupying lesions. Here, we discussed an elderly female patient who was not on anticoagulant and described sudden loss of muscle strength and sensation in both lower extremities. Initial laboratory and imaging including brain computerized tomography (CT) and magnetic resonance imaging (MRI) were in normal range. Her secondary examination revealed anesthesia under the T4 dermatome level. Cervical spine-MRI imaging revealed a subdural hematoma significantly compressing the spinal cord on the C7-T1 dermatome segments. Any emergency neurosurgical intervention was not considered and the patient was interned in the neurosurgical clinic for conservative treatment and further examination. Patient , with no progress seen in consecutive MRI scans, was discharged after offering an outpatient check-up. We recommend secondary physical examination in emergency department (ED). In the case of appearance of sensory deficits of certain dermatomes, spine-MR imaging may lead to put the diagnose early in ED.

Cerebral abscess as a neurosurgical emergency in Eisenmenger syndrome: illustrative case.

Eisenmenger syndrome caused by severe pulmonary arterial hypertension in congenital heart disease can cause multisystemic involvement and is a risk factor for development of cerebral abscess. Cerebral abscess, if not detected and treated in a timely manner, can present as acute neurosurgical emergency. The authors reported a case of cerebral abscess in a patient with Eisenmenger syndrome. The patient presented with acute neurological deterioration with mass effect and cerebral infarcts and received emergency neurosurgical intervention. A further literature search was done to identify prior reported cases of cerebral abscess with Eisenmenger syndrome. Patients with Eisenmenger syndrome have compromised cardiorespiratory status, and decision for neurosurgical intervention should be given careful consideration. Multidisciplinary team management along with preoperative optimization of the patient should be used.

Congenital nephrogenic diabetes insipidus and the trauma injured brain: A case report

Diabetes insipidus is commonly attributed as post-surgical complication of neurosurgical procedures. The case presented here describes the antithesis, where a young man with nephrogenic diabetes insipidus requires emergency neurosurgical intervention. Complex treatment goals and fluid strategies are discussed. Keywords: nephrogenic diabetes insipidus; fluid management; traumatic brain Injury.

Congenital Nephrogenic Diabetes Insipidus and the Trauma Injured Brain: A Case Report

Diabetes insipidus is commonly attributed as post-surgical complication of neurosurgical procedures. The case presented here describes the antithesis, where a young man with nephrogenic diabetes insipidus requires emergency neurosurgical intervention. Complex treatment goals and fluid strategies are discussed.

Cosmetic results of autologous bone cranioplasty after decompressive craniectomy for traumatic brain injury based on a patient questionnaire

BackgroundDecompressive craniectomy (DC) after traumatic brain injury (TBI) is a common surgical procedure. Cranioplasty (CP) is undertaken as a routine secondary operation following DC. In neurosurgical trauma centers, patients who require CPs compete with other patients who require emergency neurosurgical intervention and they are not given enough priority. MethodsA retrospective study was conducted of patients who had undergone autologous bone CP after DC for TBI over three years in a 3rd level trauma center in Mexico. All families were administered a questionnaire to assess how the patient judged the cosmetic result of CP. ResultsA total of 29 patients agreed to participate in this study. 25 patients (86.2%) were satisfied with the aesthetic result and 4 patients (13.8%) were no satisfied with their CP. 4 cases (13.8%) reported medical complications related to CP. Unsatisfied patients complained most likely about the dented aesthetic look, with a moderate negative correlation between this and cosmetic outcome (ρ = −0.483, P = 0.001). Patient age (ρ = 0.194, P = 0.314) and defect size (ρ = 0.156, P = 0.419) was not related to the assessment of the aesthetic result. A strong negative correlation between postoperative infection and the grade of satisfaction (ρ = −0.710, P = 0.001) was also observed. ConclusionsBased on our results, overall most of the patients were satisfied with their CP with an acceptable complication rate.

Management of Minor Traumatic Brain Injury in an ED Observation Unit.

IntroductionTraumatic intracranial hemorrhages (TIH) have traditionally been managed in the intensive care unit (ICU) setting with neurosurgery consultation and repeat head CT (HCT) for each patient. Recent publications indicate patients with small TIH and normal neurological examinations who are not on anticoagulation do not require ICU-level care, repeat HCT, or neurosurgical consultation. It has been suggested that these patients can be safely discharged home after a short period of observation in emergency department observation units (EDOU) provided their symptoms do not progress.MethodsThis study is a retrospective cross-sectional evaluation of an EDOU protocol for minor traumatic brain injury (mTBI). It was conducted at a Level I trauma center. The protocol was developed by emergency medicine, neurosurgery and trauma surgery and modeled after the Brain Injury Guidelines (BIG). All patients were managed by attendings in the ED with discretionary neurosurgery and trauma surgery consultations. Patients were eligible for the mTBI protocol if they met BIG 1 or BIG 2 criteria (no intoxication, no anticoagulation, normal neurological examination, no or non-displaced skull fracture, subdural or intraparenchymal hematoma up to 7 millimeters, trace to localized subarachnoid hemorrhage), and had no other injuries or medical co-morbidities requiring admission. Protocol in the EDOU included routine neurological checks, symptom management, and repeat HCT for progression of symptoms. The EDOU group was compared with historical controls admitted with primary diagnosis of TIH over the 12 months prior to the initiation of the mTBI protocols. Primary outcome was reduction in EDOU length of stay (LOS) as compared to inpatient LOS. Secondary outcomes included rates of neurosurgical consultation, repeat HCT, conversion to inpatient admission, and need for emergent neurosurgical intervention.ResultsThere were 169 patients placed on the mTBI protocol between September 1, 2016 and August 31, 2019. The control group consisted of 53 inpatients. Median LOS (interquartile range [IQR]) for EDOU patients was 24.8 (IQR: 18.8 – 29.9) hours compared with a median LOS for the comparison group of 60.2 (IQR: 45.1 – 85.0) hours (P < .001). In the EDOU group 47 (27.8%) patients got a repeat HCT compared with 40 (75.5%) inpatients, and 106 (62.7%) had a neurosurgical consultation compared with 53 (100%) inpatients. Subdural hematoma was the most common type of hemorrhage. It was found in 60 (35.5%) patients, and subarachnoid hemorrhage was found in 56 cases (33.1%). Eleven patients had multicompartment hemorrhage of various classifications. Twelve (7.1%) patients required hospital admission from the EDOU. None of the EDOU patients required emergent neurosurgical intervention.ConclusionPatients with minor TIH can be managed in an EDOU using an mTBI protocol and discretionary neurosurgical consults and repeat HCT. This is associated with a significant reduction in length of stay.

Abstract P296: Utility of Routine Transfer for Patients Administered Intravenous Alteplase for Ischemic Stroke

Introduction: Intravenous Alteplase is currently the only approved medical therapy for treatment of acute ischemic stroke (AIS). Although complications are uncommon, AIS patients receiving IV Alteplase are routinely transferred to higher level stroke centers for monitoring. This resource intensive treatment paradigm is of unclear medical benefit. Methods: We reviewed the stroke thrombolysis database of a single comprehensive stroke center. All presumed AIS patients who received IV Alteplase without thrombectomy from 01/01/2015 to 12/31/2019 were included. Baseline demographics including age, sex, race, ethnicity, comorbidities, and NIHSS were abstracted. Complication rates including angioedema, intracranial and extracranial hemorrhage were recorded. To determine the utility of routine transfer, medical and surgical/neurosurgical interventions to treat complications of Alteplase administration were studied. Complication rates in the transfer and non-transfer cohorts were compared via Fischer’s exact test. Results: Three hundred eighteen patients were reviewed and 222 consecutive AIS patients (median age 67 [IQR 55.5-77], female 48.6%, median NIHSS 5 [IQR 2-10], transfers 54.5%) were eligible for our analysis. Complication rates were not statistically different between transfer and non-transfer patients. Four (1.8%) patients suffered symptomatic intracranial hemorrhage (sICH). All sICH patients received cryoprecipitate and aggressive blood pressure management; none underwent emergent neurosurgical intervention. Conclusion: The overall rate of complications post-Alteplase administration for AIS patients was similarly low between transfer and non-transfer patients. These findings call into question the utility of routine transfer of AIS patients treated with Alteplase. Further study of alternative post-Alteplase monitoring strategies, including remote specialist management via telemedicine, should be considered.

Intracranial peripherally enhancing lesions in cardiac transplant recipients: A rare case series and literature review

Intracranial peripherally enhancing lesions in immunosuppressed solid organ transplant recipients represent a unique diagnostic and management dilemma due to the vast array of differentials that demand consideration. Diagnosis of the underlying pathology is often guided by the use of magnetic resonance imaging (MRI). We present the first published case series of three cardiac transplant recipients with significantly atypical neuroradiological findings contrary to the tenets of contemporary literature. Our rare case series consists of: (1) A sterile Mycobacterium pyogenic abscess mimicking glioblastoma multiforme due to an immunosuppressed state (2) Epstein Barr Virus encephalitis masquerading as Central Nervous System Post-Transplant Lymphoproliferative Disorder (3) An unusual case of partially treated disseminated Nocardiosis warning of the need to consider the immunosuppressed state and partial treatment response obfuscating classical MRI appearances. We utilise these unprecedented cases as the basis of a literature review to understand the pathophysiology behind the peculiar imaging findings in this rarefied cohort of transplant recipients, and rationalise why the MRI findings in each instance contradicts the accepted imaging patterns. In the setting of potential unreliability of neuroradiology in this immunosuppressed unique subgroup, we hope to impart to clinicians that definitive diagnosis obtained by emergent neurosurgical intervention may be necessary to accurately and expediently guide further medical management.

Computed tomography scans prior to transfer to a pediatric trauma center: Transfer time effects, neurosurgical interventions, and practice variability.

Many nontrauma centers perform computed tomography (CT) on injured children prior to transfer to a pediatric trauma center (PTC), but the institutional variability and clinical impact of this practice is unclear. This study evaluated the association of pretransfer CT with transfer delays, the likelihood of emergent neurosurgical intervention among patients who underwent pretransfer head CT, and the effects of transfer distance on prevalence and regional variability of pretransfer CT. All injured children transferred from outlying nontrauma centers to a single freestanding PTC from 2009 to 2017 were included. Patients were categorized by undergoing pretransfer CT head alone, CT of multiple/other areas, or no CT. Transfer time (referring hospital arrival to PTC arrival) was compared between CT groups, using multivariable modeling to adjust for covariates. Neurosurgical interventions were compared between patients with normal and abnormal Glasgow Coma Scale (GCS) scores. The prevalence of pretransfer CT among referring centers was compared, with stratification by transfer distance. Of 2,947 transfer patients, 1,225 (42%) underwent pretransfer CT (29%, head CT alone; 13%, other/multiple CT). Transfer times were significantly longer for patients who underwent pretransfer head CT or multiple CT (287 or 298 minutes vs. 260 minutes, p < 0.0001) after adjustment for baseline characteristics, injury severity, and transfer distance. Among patients with normal pretransfer GCS who received a pretransfer head CT, the likelihood of urgent neurosurgical intervention was 1.3%. Prevalence rates of pretransfer CT by referring center varied from 15% to 94%; prevalence increased with increasing transfer distance but demonstrated wide variability among centers of similar distance. Pretransfer CT, whether of the head alone or multiple areas, is associated with delays in transfer to definitive care. Among patients with pretransfer GCS 15, the risk of urgent neurosurgical intervention is very low. Wide variability in pretransfer CT use between referring centers suggests opportunity for development of standardized protocols. Economic/decision, level III.

The effect of hospital safety-net burden on outcomes, cost, and reportable quality metrics after emergent clipping and coiling of ruptured cerebral aneurysms.

Safety-net hospitals deliver care to a substantial share of vulnerable patient populations and are disproportionately impacted by hospital payment reform policies. Complex elective procedures performed at safety-net facilities are associated with worse outcomes and higher costs. The effects of hospital safety-net burden on highly specialized, emergent, and resource-intensive conditions are poorly understood. The authors examined the effects of hospital safety-net burden on outcomes and costs after emergent neurosurgical intervention for ruptured cerebral aneurysms. The authors conducted a retrospective analysis of the Nationwide Inpatient Sample (NIS) from 2002 to 2011. Patients ≥ 18 years old who underwent emergent surgical clipping and endovascular coiling for aneurysmal subarachnoid hemorrhage (SAH) were included. Safety-net burden was defined as the proportion of Medicaid and uninsured patients treated at each hospital included in the NIS database. Hospitals that performed clipping and coiling were stratified as low-burden (LBH), medium-burden (MBH), and high-burden (HBH) hospitals. A total of 34,647 patients with ruptured cerebral aneurysms underwent clipping and 23,687 underwent coiling. Compared to LBHs, HBHs were more likely to treat black, Hispanic, Medicaid, and uninsured patients (p < 0.001). HBHs were also more likely to be associated with teaching hospitals (p < 0.001). No significant differences were observed among the burden groups in the severity of subarachnoid hemorrhage. After adjusting for patient demographics and hospital characteristics, treatment at an HBH did not predict in-hospital mortality, poor outcome, length of stay, costs, or likelihood of a hospital-acquired condition. Despite their financial burden, safety-net hospitals provide equitable care after surgical clipping and endovascular coiling for ruptured cerebral aneurysms and do not incur higher hospital costs. Safety-net hospitals may have the capacity to provide equitable surgical care for highly specialized emergent neurosurgical conditions.

Neuroimaging of Traumatic Brain Injury.

The purpose of this article is to review conventional and advanced neuroimaging techniques performed in the setting of traumatic brain injury (TBI). The primary goal for the treatment of patients with suspected TBI is to prevent secondary injury. In the setting of a moderate to severe TBI, the most appropriate initial neuroimaging examination is a noncontrast head computed tomography (CT), which can reveal life-threatening injuries and direct emergent neurosurgical intervention. We will focus much of the article on advanced neuroimaging techniques including perfusion imaging and diffusion tensor imaging and discuss their potentials and challenges. We believe that advanced neuroimaging techniques may improve the accuracy of diagnosis of TBI and improve management of TBI.

Outcomes of emergency neurosurgical intervention in neuro-critical care patients with traumatic brain injury at Cork University Hospital

Traumatic Brain Injury (TBI) is a major cause of death and disability; the leading cause of mortality and morbidity in previously healthy people aged under 40 in the United Kingdom (UK). There are currently little official Irish statistics regarding TBI or outcome measures following TBI, although it is estimated that over 2000 people per year sustain TBI in Ireland. We performed a retrospective cohort study of TBI patients who were managed in the intensive care unit (ICU) at CUH between July 2012 and December 2015. Demographic data were compiled by patients’ charts reviews. Using the validated Glasgow outcome scale extended (GOS-E) outcome measure tool, we interviewed patients and/or their carers to measure functional outcomes. Descriptive statistical analyses were performed. Spearman’s correlation analysis was used to assess association between different variables using IBM’s Statistical Package for the Social Sciences (SPSS) 20. In the 42-month period, 102 patients were identified, mainly males (81%). 49% had severe TBI and 56% were referred from other hospitals. The mean age was 44.7 and a most of the patients were previously healthy, with 65% of patients having ASA I or II. Falls accounted for the majority of the TBI, especially amongst those aged over 50. The 30-day mortality was 25.5% and the mean length of hospital stay (LOS-H) was 33 days. 9.8% of the study population had a good recovery (GOS-E 8), while 7.8% had a GOS-E score of 3 (lower sever disability). Patients with Extra-Dural haemorrhage had better outcomes compared with those with SDH or multi-compartmental haemorrhages (p = 0.007). Older patients had a higher mortality, with the highest mortality (37.5%) among those over 50 years old (p = 0.009). TBI is associated with significant morbidity and mortality. Despite the young mean age and low ASA the mortality, morbidity and average LOS-H were significant, highlighting the health and socioeconomic burden of TBI.

Use of Telemedicine During Interhospital Transport of Children With Operative Intracranial Hemorrhage.

To analyze the impact of an intervention of using telemedicine during interhospital transport on time to surgery in children with operative intracranial hemorrhage. We performed a retrospective chart review of children with intracranial hemorrhage transferred for emergent neurosurgical intervention between January 1, 2011 and December 31, 2016. We identified those patients whose neuroimaging was transmitted via telemedicine to the neurosurgical team prior to arrival at our center and then compared the telemedicine and nontelemedicine groups. Mann-Whitney U and Fisher exact tests were used to compare interval variables and categorical data. Single-center study performed at Johns Hopkins Hospital. Patients less than or equal to 18 years old transferred for operative intracranial hemorrhage. Pediatric transport implemented routine telemedicine use via departmental smart phones to facilitate transfer of information and imaging and reduce time to definitive care by having surgical services available when needed. Fifteen children (eight in telemedicine group; seven in nontelemedicine group) met inclusion criteria. Most had extraaxial hemorrhage (87.5% telemedicine group; 85.7% nontelemedicine group; p = 1.0), were intubated pre transport (62.5% telemedicine group; 71.4% nontelemedicine group; p = 1.0), and arrived at our center's trauma bay during night shift or weekend (87.5% telemedicine group; 57.1% nontelemedicine group; p = 0.28). Median trauma bay Glasgow Coma Scale scores did not differ (eight in telemedicine group; seven in nontelemedicine group; p = 0.24). Although nonsignificant, when compared with the nontelemedicine group, the telemedicine group had decreased rates of repeat preoperative neuroimaging (37.5% vs 57%; p = 0.62), shorter median times from trauma bay arrival to surgery (33 min vs 47 min; p = 0.22) and from diagnosis to surgery (146.5 min vs 157 min; p = 0.45), shorter intensive care stay (2.5 vs 5 d) and hospitalization (4 vs 5 d), and higher home discharge rates (87.5% vs 57.1%; p = 0.28). Telemedicine use during interhospital transport appears to expedite definitive care for children with intracranial hemorrhage requiring emergent neurosurgical intervention, which could contribute to improved patient outcomes.