GCS Score Research Articles

Post Concussion Syndrome Detection in Post Traumatic Brain Injury Patients

Introduction: Some post-trauma brain injury patients who were treated and declared to be discharged or continued at home experienced a collection of somatic, cognitive, and psychosocial symptoms. This study was conducted to determine the initial condition of the patient when admitted to the hospital with the incidence of post-concussion syndrome.
 Method: This study uses a prospective cohort approach. In this study identified functional changes in patients such as cognitive disorders and sleep disturbances with respect to severity. Cognitive impairment was measured using the Mini-Mental State Examination (MMSE) and sleep disturbance was measured using the Insomnia Severity Index (ISI). The sample were 49 patients of traumatic brain injury in the emergency department of PKU Muhammadiyah Gombong Hospital.
 Results: The Age (p=0.000), GCS initial score (p=0.023), hospital admission diagnosis (p=0.000) and length of stay (p=0.000) had a relationship with the cognitive status of post-trauma brain injury patients. While the initial GCS score (p = 0.000) and the initial diagnosis of hospital admission (p = 0.001) had a relationship with sleep disturbances in post-trauma brain injury patients.
 Conclusions: Age, initial GCS score, hospital admission diagnosis and length of stay have a relationship with cognitive level in post-trauma brain injury patients. Initial GCS scores and early diagnosis of hospital admission have a relationship with sleep disturbances in post-trauma brain injury patients. These factors can be used as an initial identification when a patient enters the hospital emergency room and a consideration for the type of treatment and therapy given.

Risk factors, management, and outcomes in isolated parafalcine or tentorial subdural hematomas

IntroductionIndications for hospitalization in patients with parafalcine or tentorial subdural hematomas (SDH) remain unclear. This study derived and validated a clinical decision rule to identify patients at low risk for complications such that hospitalization can be avoided. MethodsA multicenter retrospective medical record review of adult patients with parafalcine or tentorial SDHs was completed. The primary outcome was significant injury, defined as injury that led to neurosurgery, discharge to another facility, or death. A multivariable logistic regression was performed to identify variables independently associated with the outcome in the derivation cohort. These variables were then validated on a separate cohort from a different institution abstracted without knowledge of the identified variables. ResultsIn the derivation cohort, 134 patients with parafalcine/tentorial SDHs were identified. The mean age was 63 ± 19 years with 82 (61%) male. Seventy-one (53%) had significant injuries. Variables independently associated with significant injury included: age over 60, adjusted odds ratio (aOR) 3.46 (95% CI 1.24, 9.62), initial Glasgow Coma Scale score below 15, aOR =7.92 (95% CI 2.78, 22.5), and additional traumatic brain injuries (TBIs) on computerized tomography (CT), aOR =5.97 (95% CI 2.48, 14.4). These three variables had a sensitivity of 71/71 (100%, 95% CI 96, 100%) and specificity of 12/63 (19%, 95% CI 10, 31%). The validation cohort (n = 83) had a mean age of 62 ± 22 years with 50 (60%) male. The three variables had a sensitivity of 36/36 (100%, 95% CI 92, 100%) and specificity of 7/47 (15%, 95% CI 6.2, 28%). All 39 (100%, 95% CI 93, 100%) patients from both cohorts who underwent neurosurgery had additional TBI findings on their CT scan. ConclusionsPatients with parafalcine/tentorial SDHs who are under 60 years with initial GCS scores of 15 and no addition TBIs on CT are at low risk and may not need hospitalization. Furthermore, patients with isolated parafalcine/tentorial SDHs are unlikely to undergo neurosurgery. Prospective, external validation with a larger sample size is now recommended. Study typeRetrospective Cohort Study.

Systemic immune inflammation index and peripheral blood carbon dioxide concentration at admission predict poor prognosis in patients with severe traumatic brain injury.

Recent studies have shown that systemic inflammation responses and hyperventilation are associated with poor outcomes in patients with severe traumatic brain injury (TBI). The aim of this retrospective study was to investigate the relationships between the systemic immune inflammation index (SII = platelet × neutrophil/lymphocyte) and peripheral blood CO2 concentration at admission with the Glasgow Outcome Score (GOS) at 6 months after discharge in patients with severe TBI. We retrospectively analyzed the clinical data for 1266 patients with severe TBI at three large medical centers from January 2016 to December 2021, and recorded the GOS 6 months after discharge. The receiver operating characteristic (ROC) curve was used to determine the best cutoff values for SII, CO2, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR), and chi-square tests were used to evaluate the relationships among SII, CO2 and the basic clinical characteristics of patients with TBI. Multivariate logistic regression analysis was used to determine the independent prognostic factors for GOS in patients with severe TBI. Finally, ROC curve, nomogram, calibration curve and decision curve analyses were used to evaluate the value of SII and coSII-CO2 in predicting the prognosis of patients with severe TBI. And we used the multifactor regression analysis method to build the CRASH model and the IMPACT model. The CRASH model included age, GCS score (GCS, Glasgow Coma Scale) and Pupillary reflex to light: one, both, none. The IMPACT model includes age, motor score and Pupillary reflex to light: one, both, none. The ROC curves indicated that the best cutoff values of SII, CO2, PLR, NLR and LMR were 2651.43×109, 22.15mmol/L, 190.98×109, 9.66×109 and 1.5×109, respectively. The GOS at 6 months after discharge of patients with high SII and low CO2 were significantly poorer than those with low SII and high CO2. Multivariate logistic regression analysis revealed that age, systolic blood pressure (SBP), pupil size, subarachnoid hemorrhage (SAH), SII, PLR, serum potassium concentration [K+], serum calcium concentration [Ca2+], international normalized ratio (INR), C-reactive protein (CRP) and co-systemic immune inflammation index combined with carbon dioxide (coSII-CO2) (P < 0.001) were independent prognostic factors for GOS in patients with severe TBI. In the training group, the C-index was 0.837 with SII and 0.860 with coSII-CO2. In the external validation group, the C-index was 0.907 with SII and 0.916 with coSII-CO2. Decision curve analysis confirmed a superior net clinical benefit with coSII-CO2 rather than SII in most cases. Furthermore, the calibration curve for the probability of GOS 6 months after discharge showed better agreement with the observed results when based on the coSII-CO2 rather than the SII nomogram. According to machine learning, coSII-CO2 ranked first in importance and was followed by pupil size, then SII. SII and CO2 have better predictive performance than NLR, PLR and LMR. SII and CO2 can be used as new, accurate and objective clinical predictors, and coSII-CO2, based on combining SII with CO2, can be used to improve the accuracy of GOS prediction in patients with TBI 6 months after discharge.

Effect of integrated perioperative rehabilitation intervention under the fast-track surgery concept on stress and complications in patients undergoing craniocerebral injury surgery.

To observe the intervention effect of perioperative rehabilitation intervention of integrated medical care the concept of FTS on stress response and postoperative complications in patients undergoing craniocerebral injury surgery. 70 patients with Traumatic brain injury (TBI) admitted to the Department of Neurosurgery of our Hospital from January 2019 to December 2021 were as the research objects and were divided into general group and FTS group according to the random number table method, with 35 cases in each group. The general group was intervened with perioperative basic nursing measures for TBI, and the FTS group was intervened with perioperative rehabilitation model of integrated medical care under the concept of FTS on the basis of the general group. The two groups of patients were compared in hemodynamic indexes (heart rate, mean arterial pressure), stress hormone levels (CORT, GLU, E), changes in motor neurological function (GCS score, NHISS score, FMA score), occurrence of postoperative complications (infection, pressure sores, rebleeding, central hyperthermia), short-term quality of life (SF-36) before and after the intervention. After intervention, the levels of HR, MAP, COR, GLU, and E were significantly lower in FTS group than in the general group (all P < 0.05). After intervention, the Fugl-Meyer score and Barthel index score of upper and lower extremities in both groups were significantly higher than those before intervention, and the FTS group was higher than the general group, and the difference was statistically significant (P < 0.05). After the intervention, the NIHSS scores were significantly lower in both groups than before the intervention, and the FTS group was lower than the general group, and the differences were statistically significant (P < 0.05). Short-term physical function, somatic pain, physical function, general health status, social function, energy, mental health, and emotional function scores were significantly higher in the FTS group than in thegeneral group, and all differences were statistically significant (P < 0.05). The total incidence of infection, pressure ulcers, rebleeding, central high fever and other complications in the FTS group was significantly lower than that in the general group (P < 0.05). The implementation of integrated perioperative rehabilitation interventions under the concept of FTS for patients with TBI can significantly alleviate patients' stress, promote recovery, reduce the incidence of complications, and improve short-term quality of life, which is worthy of clinical promotion.

Case report of CT-guided lung biopsy complicated by air embolism

Rationale: Cerebral arterial air embolism is a rare but potentially fatal complication of Computed Tomography (CT)-guided lung biopsy. Hyperbaric oxygen (HBO2) is the first line of treatment for arterial gas embolism and needs to be administered immediately after the event. Early HBO2 can reduce the mortality rate of cerebrovascular air embolism. Patient concerns: A 65-year-old woman was diagnosed with a pulmonary nodule with a diameter of approximately 0.8 cm in the right lower lung. The patient developed consciousness, convulsions, and arrhythmia after CT-guided lung biopsy. Diagnosis: Cranial CT revealed arborizing/linearly distributed gas in the right temporal, parietal, and occipital lobes and left frontal and parietal lobes. Chest CT showed a small amount of pneumothorax. Interventions: The patient was administered HBO2 twice and also received other medical treatments and bone flap decompressive craniectomy. Outcomes: The patient developed multiple acute cerebral infarctions and even brain herniation complicated with acute myocardial infarction. Three months after the event, the patient’s consciousness was still “open eyes coma” and GCS score was 8t points (E4VtM4). Head CT showed multiple cerebral infarctions and softening lesions. ECG showed sinus rhythm, normal range of the electrocardiogram axis, T wave change, and low voltage on the limb leads. Lessons: Cerebral arterial air embolism is a serious complication of CT-guided lung biopsy. The recommended standard HBO2 should be used as early as possible. However, too severe injury caused by severe arterial air embolism may not be significantly improved by one to two sessions of HBO2.

Case report of CT-guided lung biopsy complicated by air embolism

Rationale: Cerebral arterial air embolism is a rare but potentially fatal complication of Computed Tomography (CT)-guided lung biopsy. Hyperbaric oxygen (HBO2) is the first line of treatment for arterial gas embolism and needs to be administered immediately after the event. Early HBO2 can reduce the mortality rate of cerebrovascular air embolism. Patient concerns: A 65-year-old woman was diagnosed with a pulmonary nodule with a diameter of approximately 0.8 cm in the right lower lung. The patient developed consciousness, convulsions, and arrhythmia after CT-guided lung biopsy. Diagnosis: Cranial CT revealed arborizing/linearly distributed gas in the right temporal, parietal, and occipital lobes and left frontal and parietal lobes. Chest CT showed a small amount of pneumothorax. Interventions: The patient was administered HBO2 twice and also received other medical treatments and bone flap decompressive craniectomy. Outcomes: The patient developed multiple acute cerebral infarctions and even brain herniation complicated with acute myocardial infarction. Three months after the event, the patient’s consciousness was still “open eyes coma” and GCS score was 8t points (E4VtM4). Head CT showed multiple cerebral infarctions and softening lesions. ECG showed sinus rhythm, normal range of the electrocardiogram axis, T wave change, and low voltage on the limb leads Lessons: Cerebral arterial air embolism is a serious complication of CT-guided lung biopsy. The recommended standard HBO2 should be used as early as possible. However, too severe injury caused by severe arterial air embolism may not be significantly improved by one to two sessions of HBO2.

HYPERGLYCEMIA AS A PREDICTOR OF OUTCOME IN PAEDIATRIC SEVERE TRAUMATIC BRAIN INJURY PATIENTS UNDERWENT SURGERY: A SINGLE CENTER EXPERIENCE FROM EASTERN INDONESIA FROM 2017-2022.

The aim: Traumatic Brain Injury (TBI) remains a significant health burden worldwide. This study aimed to describe, determine and recommendation concerning the impact of hyperglycemia on pediatric TBI. Materials and methods: Paediatric trauma patients with severe TBI event were identified and admitted to our Dr. Soetomo General Hospital, Surabaya, the regional Trauma Center of East Java, Indonesia between calendar year of 2017 and 2022. Our institutions trauma database was utilized to select the patient included in this study. Patients with GCS ≤ 8 who underwent neurosurgical interventions were included to the study. Neurosurgical interventions are craniotomy for clot evacuation and decompressive craniectomy. We excluded patients with GCS > 8 and/or treated with conservative therapy (no surgery needed). Data collected for analysis as independent variables included patient age, admission GCS score and admission serum glucose score, mechanism of injury, type of intracranial lesion and type of surgery. Outcome of the patients included was examined at discharge which sub-grouped by Glasgow Outcomes Scale (GOS) score. Independent variables were entered into the logistic model in a stepwise fashion with a significant cutoff of p< 0,05. Results: Patients with worse neurological outcomes (GOS score 1-2) had a mean serum glucose value of over 200 mg/dL. Patients who died (GOS score of 1) had higher mean admission glucose values (226.44 ± 62,00) than the patients who had survived with a GOS score of 3 (139.80 ± 10.87), 4 (87), or 5 (134). Patients who resulted in a vegetative state (GOS score of 2) had higher mean admission serum glucose values than patients who were discharged with a GOS score of 5 (205.14 ± 36.17 vs. 134; p = 0.003). Conclusions: Hyperglycaemia in pediatric TBI patients that underwent neurosurgical intervention is associated with worse outcomes, even mortality. We believe that prospective evaluation of glucose normalization in the context of acute management of pediatric head injuries is both appropriate and necessary for the next study.

COVID-19 Impact on Intraparenchymal Hemorrhage and Surgical Outcomes: A Comprehensive Analysis.

To investigate the possible association between COVID-19 infection and intraparenchymal hemorrhage (IPH) by examining changes in the preoperative and postoperative periods, mortality, and the impact of COVID-19 on IPH survival times. This cross-sectional retrospective analysis included 82 IPH cases operated on and treated between January 2021 and March 2023. Brain computed tomography/magnetic resonance imaging scans were used to confirm the diagnosis of IPH and provide evidence of neurological damage. The information was gathered using a predesigned form of hospital records. Participants were included if they had a positive COVID-19 result or displayed no symptoms, indicating a past infection. The study included 82 people, nine (11%) of who tested positive for COVID-19 and 73 (89%) tested negative. There was no difference in mortality rates between the two groups (p=0.651). The hematoma volume decreased from the preoperative (82.4 ± 42.4) to the postoperative (23.7 ± 44.8) measurement (p < 0.001). The midline shift value decreased from the preoperative (9.26 ± 4.71) to the postoperative (5.16 ± 5.06) assessment (p < 0.001). Patients without COVID-19 infection had a mean survival time of 31.5 days and a median survival time of 23 days, whereas patients with COVID-19 infection had a survival time of 25.7 days and a median survival time of 8 days. Our findings show that hematoma volume and midline shift improve significantly after surgery, although GCS scores remain unaltered. Except for AST and ALT levels, there were no significant differences in mortality rates, demographic, clinical, and most laboratory results between COVID-19-positive and COVID-19-negative patients.

14-Day Mortality Predictive Factors in Surgically Treated Supratentorial Spontaneous Intracerebral Hemorrhage: A Retrospective Analysis of 44 Patients

Background: Spontaneous intracerebral hemorrhage accounts for 10-15% of cerebrovascular events. Various modalities of patient management, both conservatively and surgical. Despite its deadly nature and extensive studies, there is no standard model for predictive factors in intracerebral hemorrhage-related mortality. Methods: A retrospective cohort analysis on patients with supratentorial spontaneous intracerebral hemorrhage who received surgical treatment for clot evacuation. Factors including age, sex, initial Glasgow Coma Scale score, the volume of the clot, existing intraventricular hemorrhage, existing subarachnoid hemorrhage, signs of cerebral herniation from head CT-Scan, duration of the surgery, and surgical technique were analyzed. Results: Data for 44 patients were included in this study. The mean age was 54.68 ±12.79 years old, with 64.6% of the sample being males. The mean GCS score of the sample is 9.3 ± 3.15. Subarachnoid hemorrhage was noticed in 34.1% of cases. Intraventricular hemorrhage extension was found in 27.3% of cases. Cerebral herniation on CT-scan was noticed in 50% of cases. Based on surgical characteristics, the mean surgical time is 194.84 ± 54.84 mins. Almost two-thirds of the cases performed craniectomy procedure 28 (63.6%). We found that subarachnoid hemorrhage (OR 5.77 [1.12 – 29.7]; p = 0.036) and cerebral herniation (OR 8.26 [1.91- 35.7]; p = 0.005) were considered as significant factors in predicting 14-day mortality after multivariate analysis. Conclusions: Subarachnoid hemorrhage and cerebral herniation are good predictors of 14-day mortality in patients with sICH who are surgically treated. Earlier and shorter duration of the surgery showed no correlation to the outcome.

Adverse outcomes of GHB use: Analysis of ambulance attendances in metropolitan and regional Victoria.

Gamma-hydroxybutyrate (GHB) use and attributable harms have been increasing in Australia, however changes over time, including the impact of COVID-19 lockdowns and restrictions on harms requiring an ambulance attendance, are unknown. This study utilised a novel population-based surveillance system to identify the types of GHB-related harms between January 2018 and 31 December 2021 in Victoria, Australia. A cross-sectional, retrospective analysis of all GHB-related ambulance attendances between January 2018 and 31 December 2021 in Victoria, Australia was undertaken. Paramedic clinical notes and Glasgow Coma Scale scores were used to assess conscious state. Event codes were classified using dispatch information available in the database. Crude rates (per 100,000 population) and descriptive analyses were calculated for metropolitan and regional settings. Adjusted Odds ratios (aOR) with 95% confidence intervals [95% CI] were used to assess the relationship between GCS severity and polysubstance combinations with GHB. There were 6,836 ambulance attendances for GHB recorded during the study period. A statistically significant increase in GHB-related attendance numbers was observed State-wide in 2019 (n=1,402, p<0.001) and 2020 (n=2,622, p<0.001), when comparing year on year attendances. While both numbers and rates (per 100,000 population) of GHB-related attendances were significantly lower in regional areas, significant increases were evident in both metropolitan and regional areas in 2019 and 2020 (both p<0.001). Attendances involving GHB and alcohol had higher odds of a severe GCS score (aOR:1.25; 95%: 1.04-1.49; p<0.019). A high proportion of GHB-attendances involved harms of significant concern including: overdose (56%) and a loss of, or altered state of consciousness (45%). We observed increases in GHB-related ambulance attendances over time in both metropolitan and regional areas, placing a significant burden on ambulance services. Our study demonstrates the value of using ambulance surveillance to obtain representative data on acute GHB-related harms.

Treatment of pediatric patients with traumatic brain injury by Dutch Helicopter Emergency Medical Services (HEMS).

Sparse data are available on prehospital care by Helicopter Emergency Medical Service (HEMS) for pediatric patients with traumatic brain injury (TBI). This study focusses on prehospital interventions, neurosurgical interventions and mortality in this group. We performed a retrospective analysis of pediatric (0-18 years of age) patients with TBI treated by Rotterdam HEMS. From January 2012 to December 2017 415 pediatric (<18 years of age) patients with TBI were included. Intubation was required in in 92 of 111 patients with GCS ≤ 8, 92 (82.9%), compared to 12 of 77 (15.6%) with GCS 9-12, and 7 of 199 (3.5%) with GCS 13-15. Hyperosmolar therapy (HSS) was started in 73 patients, 10 with a GCS ≤8. Decompressive surgery was required in 16 (5.8%), nine patients (56.3%) of these received HSS from HEMS. Follow-up data was available in 277 patients. A total of 107 (38.6%) patients were admitted to a (P)ICU. Overall mortality rate was 6.3%(n = 25) all with GCS ≤8, 15 (60.0%) died within 24 hours and 24 (96.0%) within a week. Patients with neurosurgical interventions (N = 16) showed a higher mortality rate (18.0%). The Dutch HEMS provides essential emergency care for pediatric TBI patients, by performing medical procedures outside of regular EMS protocol. Mortality was highest in patients with severe TBI (n = 111) (GCS≤8) and in those who required neurosurgical interventions. Despite a relatively good initial GCS (>8) score, there were patients who required prehospital intubation and HSS. This group will require further investigation to optimize care in the future.

Application of logistic regression, support vector machine and random forest on the effects of titanium dioxide nanoparticles using macroalgae in treatment of certain risk factors associated with kidney injuries

The use of titanium dioxide (TiO2) nanoparticles in many biological and technical domains is on the rise. There hasn't been much research on the toxicity of titanium dioxide nanoparticles in biological systems, despite their ubiquitous usage. In the current investigation, samples were exposed to various dosages of TiO2 nanoparticles for 4 days, 1 month, and 2 months following treatment. ICP-AES was used to dose TiO2 into the tissues, and the results showed that the kidney had a significant TiO2 buildup. On the other hand, apoptosis of renal tubular cells is one of the most frequent cellular processes contributing to kidney disease (KD). Nevertheless, the impact of macroalgal seaweed extract on KD remains undetermined. In this work, machine learning (ML) approaches have been applied to develop prediction algorithms for acute kidney injury (AKI) by use of titanium dioxide and macroalgae in hospitalized patients. Fifty patients with (AKI) and 50 patients (non-AKI group) have been admitted and considered. Regarding demographic data, and laboratory test data as input parameters, support vector machine (SVM), and random forest (RF) are utilized to build models of AKI prediction and compared to the predictive performance of logistic regression (LR). Due to its strong antioxidant and anti-inflammatory powers, the current research ruled out the potential of using G. oblongata red macro algae as a source for a variety of products for medicinal uses. Despite a high and fast processing of algorithms, logistic regression showed lower overfitting in comparison to SVM, and Random Forest. The dataset is subjected to algorithms, and the categorization of potential risk variables yields the best results. AKI samples showed significant organ defects than non-AKI ones. Multivariate LR indicated that lymphocyte, and myoglobin (MB) ≥ 1000 ng/ml were independent risk parameters for AKI samples. Also, GCS score (95% CI 1.4–8.3 P = 0.014) were the risk parameters for 60-day mortality in samples with AKI. Also, 90-day mortality in AKI patients was significantly high (P < 0.0001). In compared to the control group, there were no appreciable changes in the kidney/body weight ratio or body weight increases. Total thiol levels in kidney homogenate significantly decreased, and histopathological analysis confirmed these biochemical alterations. According to the results, oral TiO2 NP treatment may cause kidney damage in experimental samples.

Evaluation of the outcome in ischemic stroke acute period

Introduction. As a major cause of both temporary and permanent disability, ischemic stroke is the most common type of cerebrovascular accident (CVA).&#x0D; Objective. To assess fatal outcome probability in the acute period of ischemic stroke.&#x0D; Materials and methods. We performed post-hoc analysis of the fatal outcome probability in the patients with acute ischemic stroke at the Neurology Department of the Ufa Emergency Hospital, the Republic of Bashkortostan, Russian Federation. The analysis included data from the randomly selected medical records of 31 patients with fatal outcomes and 55 patients discharged with favorable outcomes.&#x0D; Results. The patients with fatal outcomes were significantly (p 0.001) older, with more severe strokes and a higher prevalence of disorders of consciousness, medical co-morbidities, and recurrent strokes as compared to the group of patients with favorable outcomes. Regression coefficients showed that brain herniation, kidney and liver disease, post-infarction cardiosclerosis, diabetes mellitus, and atrial fibrillation were associated with a higher probability of the fatal outcome. Increased severity of disorders of consciousness, NIHSS and mRS scores, specific blood tests values, age, and heart rate were associated with a more probable fatal outcome, while elevated hemoglobin, total protein, red blood cells, and lymphocytes, a higher GCS score, and a history of hypotensive drug therapy were associated with a less probable fatal outcome.&#x0D; Multivariate analysis showed that the stroke fatal outcome was related with the age, a NIHSS score, and elevated creatinine and total bilirubin levels.&#x0D; Conclusion. The detected predictors of the stroke fatal outcome can be used as reference points to choose management strategy for patients in the acute period of ischemic stroke.

Risk factors and predictors of acute gastrointestinal injury in stroke patients

PurposeThis prospective study investigates the incidence, risk factors, biological markers, and predictors of acute gastrointestinal injury (AGI) in patients with stroke. MethodsThe study involved a total of 98 patients with acute cerebrovascular disease were included. According to the ESICM, the definition of AGI in intensive care patients is classified as grade 0, I, II and III. Patients’ demographics, serological indicators (e.g., urea nitrogen, albumin, D-lactate, α-GST, neutrophil count and lymphocyte count), relevant scores (NIHSS score, GCS score, APACHE II score), length of hospital stay as well as the 7-day and 28-day mortality were recorded. ResultsIn 98 patients, the incidence of AGI was 90.8 %. The APACHE II, NIHSS, GCS and Hs-mGPS scores significantly increased the odds of a higher AGI grade (P < 0.05). Also, current use of antibiotics and the presence of pneumonia significantly increased the probability of a higher AGI grade (P < 0.05). NLR, diabetes and dehydrating drugs increased the probability of AGI grade II and III (P < 0.05). Finally, an early commencement of endovascular treatment significantly reduced the incidence of AGI class III (P < 0.05). Patients with higher AGI grades had longer hospital stays and higher 28-day mortality (P < 0.05). ConclusionThe degree of the neurological deficit in stroke patients (high NIHSS score, low GCS score) in this study was associated with the development of AGI. The patients' gastrointestinal barrier function continued to deteriorate during the week of onset. The APACHE II score, NRL score and HS-mGPS score have some predictive value for the occurrence of AGI in stroke patients.

Efficacy and Safety of Tranexamic Acid in Preventing Rebleeding after Subarachnoid Hemorrhage: A Randomized Controlled Trial

Background: Recent studies have indicated that early, short-course therapy with Tranexamic Acid (TXA) along with standard treatment for prevention of ischemia in aneurysmal Subarachnoid Hemorrhage (SAH) may be beneficial in preventing rebleeding and improving outcome. The study aimed to assess the efficacy and safety of short-course early administration of TXA combined with standard treatment to prevent rebleeding after SAH.&#x0D; Materials and methods: Seventy-four patients suffering from SAH verified on Computed Tomography (CT) scan within 72 hours after the primary hemorrhage were randomized into two treatment arms [37 received TXA and standard treatment (Experimental group), 37 received standard treatments only (Control group)]. TXA 1 gm was given intravenously slowly over 10 minutes, followed by 1 gm iv eight hourly up to a maximum of 72 hours. They were followed up for one month to observe rebleeding and outcome by Glasgow Outcome Scale.&#x0D; Results: Effective sample size was 70 (35 in TXA, 35 in the no-TXA group) due to the dropout of 4 patients. Out of 70 patients, 21 (30%) had rebleeding, and most of the rebleeding (95.23%) occurred after 72 hours of the initial event. Patients who had rebleeding had comparably lower GCS scores at presentation. Out of 21 rebleeding cases, 20 (95.23%) died within one month from the symptom onset. There was no significant difference (p=0.434) in rebleeding rate in TXA-treated patients (25.7%) versus non-TXA patients (34.3%). Treatment with TXA had no beneficial effect on one-month outcome (p&gt;0.05).The adverse events were similar in the two groups and none of the patients had a seizure.&#x0D; Conclusions: Early short course TXA was tolerable as add-on to standard treatment of SAH but had no significant beneficial effect in reducing rebleeding and in improving one-month outcome.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (2); July 2022; Page 25-29

The effect of blood pressure variability on the prognosis of patients with acute cerebral hemorrhage: Possible mechanism

Antihypertensive therapy in the acute phase of intracerebral hemorrhage (ICH) can reduce hematoma expansion. Numerous studies have demonstrated that blood pressure variability secondary to antihypertensive therapy has adverse effects on neurological outcomes, but the conclusions are diverse, and the mechanism of this occurrence is unknown. The aim of this research was to analyze the impact of blood pressure variability after antihypertensive treatment on the prognosis of patients with acute ICH, along with the possible mechanism. A total of 120 patients within 20 h of onset of ICH were divided into a good prognosis group (mRS ≤ 2 points) and a poor prognosis group (mRS ≥ 3 points) according to their 90-day mRS scores. The basic patient information, NIHSS score, GCS score, mRS score at 90 days after admission, head CT examination at admission and 24 h and CTP examination at 24 h were collected from some patients. The blood pressure values of patients were collected within 24 h, and multiple blood pressure variation (BPV) parameters within 1 and 24 h were calculated. (1) After excluding confounding factors such as age, whether the hematoma ruptured into the ventricle, confounding signs, amount of bleeding, edema around the hematoma, NIHSS on admission, operation or non-operation, and 24-h hematoma increment, the fourth quartile systolic blood pressure (SBP) maximum and minimum difference within 1 h [OR: 5.069, CI (1.036-24.813) P = 0.045] and coefficient of continuous variation (SV) within 24 h [OR: 2.912 CI (1.818-71.728) P = 0.009] were still independent factors affecting the 90-day mRS in ICH patients. (2) There was a negative correlation between SBP SV and CBF in terms of the difference between the contralateral side and the perihematomal region at 24 h (Rs = -0.692, P = 0.013). Blood pressure variability after antihypertensive therapy in acute ICH is one of the influencing factors for 90-day mRS in patients. A 1-h dramatic drop in SBP and 24-h SBP SV may affect the long-term prognosis of patients by reducing whole cerebral perfusion.

CSF Indices in Autoimmune Encephalitis: Promising Predictors of Treatment Response

Objective To study CSF Indices and their association with prognosis of autoimmune encephalitis. Background Till date, there is no published data on use of CSF indices in diagnosing or prognosticating of autoimmune encephalitis. Design/Methods This retrospective, single-center (AIMS, Kochi, India) cohort study included 60 adult patients with autoimmune encephalitis who were first admitted from August 2016 till November 2021. We used a univariate binary logistic regression for the entire cohort (n = 60) or the cohort of seronegative cases (n = 54) and a two-tailed Fisher's exact test for a small group of seropositive cases (n = 6). A Chi-square test was performed to describe the results in rare cases if logistic regression failed to work. Results In the entire cohort (n = 60) a statistically significant association was found between a good fast treatment response and a total count of cells in the CSF more than 4 cells/mm3 (OR 4.571, 95% CI 1.31–15.956, p = 0.017), IgG Local Synthesis (OR 7.273, 95% CI 1.562–33.863, p = 0.011), and Integrative Parameter of Local IgG Synthesis proposed by Ziadie M. et al. (OR 5.318, 95% CI 1.271–22.250, p = 0.022). Good fast response was defined as an improvement with single agent from the first line therapy by mRS-9Q of at least 3 points in case of severe disease and at least 2 points in case of moderately severe disease at the time of discharge. Higher Albumin Index values associated with higher odds of having poor GCS Score (OR 1.165, 95% CI 1.011–1.343, p = 0.035). In the cohort of seronegative cases (n = 54) we obtained similar results. In the cohort of seropositive cases (n = 6), none of the patients had a good fast response. Conclusions In our research, evidence of Local IgG Synthesis in CNS and CSF total cell count more than 4 cells/mm3 showed association with a good and fast treatment response in patients with autoimmune encephalitis.

Factors Associated With Receiving Inpatient Rehabilitation After Traumatic Brain Injury in A County Hospital System

<h3>Research Objectives</h3> To characterize factors associated with inpatient rehabilitation for individuals with Traumatic Brain Injury (TBI) presenting to an Emergency Department (ED) at a local county hospital. <h3>Design</h3> Retrospective Chart Review. <h3>Setting</h3> Emergency Department. <h3>Participants</h3> Patients (n=904) with International Classification of Diseases (ICD) codes consistent with possible TBI (i.e., motor vehicle collisions, motor vehicle accidents, falls, polytrauma, traumatic brain injury, and concussion). <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Inpatient rehabilitation (Yes/No) after moderate-severe TBI as defined by the TBI Model Systems criteria (trauma-related imaging abnormalities, loss of consciousness >30 minutes, post-traumatic amnesia >24 hours, and/or Glasgow Coma Scale score < 13). <h3>Results</h3> Of the 904 patients, 152 met criteria for a moderate-severe TBI based on the TBI Model Systems criteria. Most of the patients with TBI (67.1%) went home after their time in the ED and did not go directly to inpatient rehabilitation. Compared to the patients that did receive inpatient rehabilitation (n=31), those that did not (n=121) were more likely to be uninsured (21.5% vs. 6.5%), Spanish speakers (20.7% vs. 9.7%), and ethno-racial minorities (57.9% vs. 35.5%). Additionally, patients that received inpatient rehabilitation sustained more severe injuries as noted by lower GCS scores, intubation/sedation at time of admission, or not being able to walk or swallow at discharge from the ED. <h3>Conclusions</h3> In our study, similar to prior research, factors like insurance status,3 race,4,5,6 primary language spoken, and injury severity differed between patients that did versus those that did not receive inpatient rehabilitation. Future research should assess potential reasons for these differences and work to improve access to rehabilitation after TBI. <h3>Author(s) Disclosures</h3> The authors report no conflicts of interest.

Prognostic Significance of Admission Lymphocyte-to-Monocyte Ratio in Patients with Spontaneous Intracerebral Hemorrhage: A Retrospective Study

BackgroundAcute spontaneous intracerebral hemorrhage (sICH) is a morbid and deadly form of stroke. The lymphocyte-to-monocyte ratio (LMR) and systemic immune-inflammation index (SII) are two novel markers of systemic inflammation. We aimed at investigating the predictive value of LMR and SII in patients with sICH.MethodsWe retrospectively evaluated patients who were hospitalized for sICH at the First Affiliated Hospital of Zhengzhou University from September 2019 to July 2020. According to the 3-month modified Rankin Scale (mRS) score, we considered a good prognosis group (mRS: 0–2) and a poor prognosis group (mRS ≥ 3 or death). A logistic regression analysis was used to identify the factors affecting the prognosis at 3 months.ResultsA total of 171 patients with sICH were enrolled. A lower LMR measured at 24 h of admission was an independent predictor of 3-month prognosis (OR: 0.392, 95% CI 0.281–0.547, p < 0.001). A lower GCS score measured at 24 h after admission was an independent predictor of 3-month prognosis (OR: 0.821, 95% CI 0.747–0.902, p = 0.023). A previous heart disease was an independent predictor of 3-month prognosis (OR: 6.307, 95% CI 1.381–30.196, p = 0.021). SII measured at 24 h of admission was not an independent predictor of 3-month prognosis. Combining the results obtained by each indicator, the final curve showed an AUC of 0.850, indicating a satisfactory predictive performance. The receiver operating characteristic curves showed that the sensitivity of LMR was 93.07% (95% CI 86.2–97.2), while the specificity was 52.86% (95% CI 40.6–64.9). The sensitivity of GCS score was 76.77% (95% CI 67.2–84.7), while the specificity was 60.29% (95% CI 47.7–72.05). The sensitivity of SII was 91.09% (95% CI 83.8–95.8), while the specificity was 37.14% (95% CI 25.9–49.5). The DeLong test showed that the predictive value of LMR was higher than SII (p = 0.0001).ConclusionsIn patients with sICH, LMR showed an independent predictive value for anticipating 3-month prognosis.

Description of Blood Pressure of Intracerebral Hemorrhage Patients in Tertiary Hospitals in Indonesia

Background: Stroke is one of the serious health problems that has a high mortality rate and is the leading cause of death worldwide. Intracerebral hemorrhage (ICH) is a subtype of stroke that often causes severe disability or death and is associated with greater morbidity and mortality than ischemic stroke. The main risk factor for intracerebral hemorrhage is hypertension. Objective: This study aims to identify the description of the blood pressure of ICH stroke patients in RSUD Dr. Soetomo Surabaya as tertiary hospital in Indonesia. Methods: This study is a retrospective descriptive study, using medical record data of ICH stroke patients at RSUD Dr. Soetomo Surabaya during the period of January 2019 to December 2019 involving 206 patients. Result: Research shows that the number of hemorrhagic stroke patients in RSUD Dr. Soetomo Surabaya is 206 patients. The majority of hemorrhagic stroke patients are female (52.9%) with an age range of over 35 years old (98.5%). A total of 109 patients (59,2%) did not work, as many as patients (58.7%) with a GCS score of 13-15. A total of patients (69.4%) had a history of hypertension, and 59.2% were in stage 2 hypertension. Conclusion: ICH stroke patients in Dr. Soetomo Surabaya in 2019 mostly occured in women aged over 35 years, not working, with a GCS score of 13-15, and has a history of hypertension. The highest blood pressure is in category of stage 2 hypertension.