Head Injury Group Research Articles

Observed differences in nutrition management at two time points spanning a decade in critically ill trauma patients with and without head injury

BackgroundNutritional needs of trauma patients admitted to the intensive care unit may differ from general critically ill patients, but most current evidence is based on large clinical trials recruiting mixed populations. ObjectiveThe aim of the study was to investigate nutrition practices at two time points that span a decade in trauma patients with and without head injury. MethodsThis observational study recruited adult trauma patients receiving mechanical ventilation and artificial nutrition from a single-centre intensive care unit between February 2005 to December 2006 (cohort 1), and December 2018 to September 2020 (cohort 2). Patients were categorised into head injury and non–head injury subgroups. Data regarding energy and protein prescription and delivery were collected. Data are presented as median [interquartile range]. Wilcoxon rank-sum test assessed the differences between cohorts and subgroups, with a P value ≤ 0.05. The protocol was registered with the Australian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001816246). ResultsCohort 1 included 109 patients, and 112 patients were included in cohort 2 (age: 46 ± 19 vs 50 ± 19 y; 80 vs 79% M). Overall, nutrition practice did not differ between head-injured and non–head-injured subgroups (all P > 0.05). Energy prescription and delivery decreased from time point one to time point two, regardless of subgroup (Prescription: 9824 [8820–10 581] vs 8318 [7694–9071] kJ; Delivery: 6138 [5130–7188] vs 4715 [3059–5996] kJ; all P < 0.05). Protein prescription did not change from time point one to time point two. Although protein delivery remained constant from time point one to time point two in the head injury group, protein delivery reduced in the non–head injury subgroup (70 [56–82] vs 45 [26–64] g/d, P < 0.05). ConclusionIn this single-centre study, energy prescription and delivery in critically ill trauma patients reduced from time point one to time point two. Protein prescription did not change, but protein delivery reduced from time point one to time point two in non–head injury patients. Reasons for these differing trajectories require exploration. Study registrationTrial registered at www.anzctr.org.au. Trial ID: ACTRN12618001816246.

Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study.

Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. We examined a subset (n = 15,764) of the PROTECT study, a cohort assessing risk factors for cognitive decline (ages between 50 and 90 years). Participants completed cognitive assessments annually for 4 years. Cognitive tests were grouped using a principal components analysis (PCA) into working memory, episodic memory, attention, processing speed, and executive function. Lifetime TBI severity and number were retrospectively recalled by participants using the Brain Injury Screening Questionnaire (BISQ). Linear mixed models (LMMs) examined the effect of severity of head injury (non-TBI head strike, mTBI, and moderate-severe TBI) and number of mTBI at baseline and over time. mTBI was considered as a continuous and categorical variable (groups: 0 mTBI, 1 mTBI, 2 mTBIs, 3 mTBIs, and 4+ mTBIs). Of the participants 5725 (36.3%) reported at least one mTBI and 510 (3.2%) at least one moderate-severe TBI, whereas 3711 (23.5%) had suffered at worst a non-TBI head strike and 5818 (32.9%) reported no head injuries. The participants had suffered their last reported head injury an average (standard deviation, SD) of 29.6 (20.0) years prior to the study. Regarding outcomes, there was no worsening in longitudinal cognitive trajectories over the study duration but at baseline there were significant cognitive deficits associated with TBI. At baseline, compared with those without head injury, individuals reporting at least one moderate-severe TBI had significantly poorer attention (B = -0.163, p < 0.001), executive scores (B = -0.151, p = 0.004), and processing speed (B = -0.075, p = 0.033). Those who had suffered at least a single mTBI also demonstrated significantly poorer attention scores at baseline compared with the no head injury group (B = -0.052, p = 0.001). Compared with those with no mTBI, those in the 3 mTBI group manifested poorer baseline executive function (B = -0.149, p = 0.025) and attention scores (B = -0.085, p = 0.015). At baseline, those who had suffered four or more mTBIs demonstrated poorer attention (B = -0.135, p < 0.001), processing speed (B = -0.072, p = 0.009), and working memory (B = -0.052, p = 0.036), compared with those reporting no mTBI. TBI is associated with fixed, dose, and severity-dependent cognitive deficits. The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities.

Outcomes and Predictors of Outcome with Cisternostomy in the Management of Traumatic Brain Injury—A Prospective Observational Study at a Tertiary Centre

Abstract Background Traumatic brain injury (TBI) is a major cause of morbidity and mortality in young individuals. Goal of management in TBI patients is mainly focused on the secondary injury. Since the cisterns and the brain communicate, it would be possible to decrease the pressure in both these compartments by opening the cisterns to the atmospheric pressure. Objective To study the outcomes and predictors of outcome with cisternostomy in the management of TBI. Methods A single tertiary care center's prospective observational study of outcomes with cisternostomy with intraoperative intracranial pressure (ICP) monitoring. Patients were evaluated clinically and radiologically with Marshall CT score. They were categorized into mild, moderate, and severe head injury groups based on Glasgow coma scale (GCS) score. Outcomes were evaluated with Glasgow outcome scale (GOS) score. Results A total of 25 patients with TBI were enrolled in this study. They underwent cisternostomy with intraoperative ICP monitoring. They were categorized into 4 groups based on the age. In our study, mortality rate was 32%. As much as 48% had good recovery at 3 months follow-up with GOS 4 and 5. Mean ICP after cisternostomy was 6.36 ± 1.91 mm Hg. In our study, there was decrease in ICP after cisternostomy. Conclusion Age, time interval from trauma to surgery, and ICP showed prognostic importance on outcomes. Cisternostomy can efficiently decrease the ICP in the TBI patients and reduce postoperative complications.

Epidemiology and clinical characteristics of posttraumatic hospitalized patients with symptoms related to venous thromboembolism: a single-center retrospective study.

The aim of this study was to investigate the epidemiology of trauma inpatients with venous thromboembolism (VTE) symptoms diagnosed using computed tomographic angiography (CTA) in Korea. In total, 7,634 patients admitted to the emergency department of Gachon University Gil Medical Center, a tertiary hospital, and hospitalized between July 1, 2018 and December 31, 2020 were registered for this study. Of these patients, 278 patients who underwent CTA were enrolled in our study. VTE was found in 120 of the 7,634 patients (1.57%), and the positive diagnosis rate of the 278 patients who underwent CTA was 43.2% (120 of 278). The incidence of VTE was statistically significantly higher among those with severe head and neck injuries (Abbreviated Injury Scale, 3-5) than among those with nonsevere head and neck injuries (Abbreviated Injury Scale, 0-2; P=0.038). In a subgroup analysis, the severe and nonsevere head and neck injury groups showed statistically significant differences in known independent risk factors for VTE. In logistic regression analysis, the adjusted odds ratio of severe head and neck injury (Abbreviated Injury Scale, 3-5) for VTE was 1.891 (95% confidence interval, 1.043-3.430). Trauma patients with severe head and neck injuries are more susceptible to VTE than those with nonsevere head and neck injuries. Thus, physicians must consider CTA as a priority for the diagnosis of VTE in trauma patients with severe head and neck injuries who show VTE-associated symptoms.

Correlation Between Traumatic Brain Injuries and Callus Formation in Long bone Fractures.

Orthopaedic aphorism teaches that fractures of long bones when associated with head injuries frequently heal with excessive callus and at a faster rate than normal. However, the evidence on this subject is flimsy and the aphorism remains unsubstantiated. Numerous studies have been conducted evaluating the possible humoral and other factors involved leading to excess callus formation in patients with a head injury. This study was designed to evaluate the effects of a traumatic head injury on bone healing in adults with a diaphyseal fracture of the lower limb. Fiveteen patients with a closed fracture of tibia or femur and associated head injury (cases) and 15 patients with a closed fracture of tibia or femur without an associated head injury (controls) were included in the study. All patients were evaluated in terms of various serum parameters, including IL-6, growth hormone, PTH, LDH, prolactin levels, and ALP. Head injuries were graded as mild, moderate, or severe. Ventilatory support if required was noted. Serum prolactin was repeated at 5weeks. Patients were followed up with serial radiographs, and the volume of callus formed was calculated and compared. The mean value of growth hormone, interleukin-6 levels, and prolactin levels at 5weeks were found to be higher in patients with head injuries, and the difference was highly significant (p = 0.001). The severity of head injury also correlated proportionately with the spike in IL-6 levels. There was more pronounced callus formation in patients with head injury group when compared to the controls. This difference was significant at all intervals. There was higher volume of callus noted at the end of 6months in patients with severe head injury (GCS < 7) when compared to patients with moderate head injury (GCS > 7). The patients with severe head injury were naturally under ventilator support for a prolonged period compared to those with moderate head injury. It was thus indiscernible if the excess callus observed is due to the humoral cascade or as an effect of prolonged ventilation. Patients with head injuries show elevated parathyroid hormone levels, growth hormone levels at the time of injury, and elevated prolactin levels 5weeks after the trauma-all of which might contribute to enhanced osteogenesis. Interleukin-6 levels are also elevated and the levels correlate to severity of head injury. Head injury triggers a humoral cascade invloving interleukin-6, parathyroid hormoe, growth hormone, and prolactin that contributes to enhanced fracture healing.

Pattern of inflicted injuries to motorcyclists referred to Hazrat-E-Rasoul Akram hospital in Tehran during 2015 - 2016.

Introduction:In recent years, road accidents have been one of the leading causes of death in Iran, with the majority of victims being motorcyclists. Accurate knowledge of the pattern of injuries to those injured is a strategy to reduce the consequences of these fatal accidents. The aim of this study was to investigate the pattern of injuries to motorcyclists.Methods:The present study was a cross-sectional study that was performed in Rasoul Akram (PBUH) Educational and Medical Center in Tehran. The information was extracted from 500 hospital records of the patients admitted due to motorcycle accidents from September 2015 to September 2016, which was recorded in the data collection checklist.Results:About 67.9% of the injured did not have head injuries and 32.0% of the sample group suffered head injuries. Out of 160 people from the head injury group, 7.2% have Abbreviated Injury Scale (AIS) index = 1 and 93.8% have AIS ≥ 2. A total of 82% of the injured had no neck injuries and 18.0% of the sample group had neck injuries. Of these, 72.2% had AIS = 1 and 17.8% had AIS ≥ 2. About 65.0% of the injured did not have facial injuries and 35.0% of the sample group suffered facial injuries.Conclusion:An accurate knowledge of the pattern of injuries to this group of injured, providing pre-hospital services, timely diagnosis and treatment and the use of corrective and effective factors, has an effective role in reducing the incidence and consequences of this deadly accident.

Evaluation of Electrolyte Imbalance in Patients With Traumatic Brain Injury Admitted in the Central ICU of a Tertiary Care Centre: A Prospective Observational Study.

IntroductionElectrolyte imbalance is a salient finding in traumatic brain injury which can derail their clinical course of recovery in physical and cognitive health while prolonging the hospital stay.ObjectiveThis study aims to understand the variation in electrolyte profile that occurs in traumatic brain injury patients which can help in better patient management.Materials and method50 trauma patients with head injury (Group A) and 50 patients without head injury (Group B) admitted in Central ICU (CICU) under the Department of Anaesthesiology, Assam Medical College and Hospital (AMCH) were selected and analysed with regard to their electrolyte variability.ResultAll trauma patients with head injury developed an imbalance to one or more electrolytes. Then mean electrolyte level in trauma patients with a head injury and in trauma patients without head injury were 139.3±7.45 vs 143.65±8.89, p<0.05 (sodium), 3.49±0.44 vs 3.88±0.49, p<0.05 (potassium), 7.81±0.5 vs 8.9± 0.35, p<0.05 (calcium) and 2±0.33 vs 2.47±0.41, p<0.05 (magnesium) respectively. Also, patients in the head injury group had a higher incidence of hypoalbuminemia than patients without head injury 2.47±0.67 vs 2.83±0.74 (p<0.05).ConclusionWe conclude that traumatic brain injury patients have a greater risk of electrolyte imbalance, viz. hyponatremia, hypokalaemia, hypocalcaemia as well as hypomagnesemia, and hypophosphatemia along with hypoalbuminemia.

Head Injury Exposure in Veterans Presenting to Memory Disorders Clinic: An Observational Study of Clinical Characteristics and Relationship of Event-Related Potentials and Imaging Markers.

Objective: Traumatic brain injury (TBI) and repetitive head impacts (RHI) related to blasts or contact sports are commonly reported among military service members. However, the clinical implications of remote TBI and RHI in veterans remains a challenge when evaluating older veterans at risk of neurodegenerative conditions including Alzheimer's disease (AD) and Chronic Traumatic Encephalopathy (CTE). This study aimed to test the hypothesis that veterans in a memory disorders clinic with remote head injury would be more likely to have neurodegenerative clinical diagnoses, increased rates of amyloid PET positivity, higher prevalence of cavum septum pellucidi/vergae, and alterations in event-related potential (ERP) middle latency auditory evoked potentials (MLAEPs) and long latency ERP responses compared to those without head injuries.Methods: Older veterans aged 50–100 were recruited from a memory disorders clinic at VA Boston Healthcare system with a history of head injury (n = 72) and without head injury history (n = 52). Patients were classified as reporting prior head injury including TBI and/or RHI exposure based on self-report and chart review. Participants underwent MRI to determine presence/absence of cavum and an ERP auditory oddball protocol.Results: The head injury group was equally likely to have a positive amyloid PET compared to the non-head injury group. Additionally, the head injury group were less likely to have a diagnosis of a neurodegenerative condition than those without head injury. P200 target amplitude and MLAEP amplitudes for standard and target tones were decreased in the head injury group compared to the non-head injury group while P3b amplitude did not differ.Conclusions: Veterans with reported remote head injury evaluated in a memory disorders clinic were not more likely to have a neurodegenerative diagnosis or imaging markers of neurodegeneration than those without head injury. Decreased P200 target and MLAEP target and standard tone amplitudes in the head injury group may be relevant as potential diagnostic markers of remote head injury.

Characteristics of fall\u2010related head injury versus non\u2010head injury in the older adults

BackgroundThis study aimed to examine the characteristics of older adults patients who suffered a head injury after a ground-level fall in comparison to non-head injury patients as well as the factors associated with severity in those with head injury only.MethodsPatients were classified into two groups, the head injury group and the non-head injury group. The characteristics were compared and factors associated with head injury were evaluated. Factors relating to severe injury in the head injury group were also investigated.ResultsThe head injury group comprised 42 % of a study subjects. Male sex; fall time of 18:00–23:59; fall location of medical facility, transportation area, and public or commercial facility; fall in an outdoor area; fall during daily activity; alcohol ingestion; fall from stairs; non-slippery floor conditions; concrete flooring; sloped flooring; and presence of obstacles on the floor were risk factors for head injury in the older adults after a ground-level fall. Male sex and age over 70 years; fall time of 00:00–05:59; fall in a residential facility; fall in an indoor area; fall during daily activity; fall from stairs; non-slippery floor conditions; and presence of obstacles on the floor were factors associated with severe injury in the head injury group.ConclusionsMale sex with advanced age, indoor fall, and the presence of obstacles on the floor were risk factors for severe injury in the head injury group in older adults individuals who suffered a ground-level fall. It is necessary to develop appropriate ground-level fall prevention programs by evaluating the individual and environmental characteristics of older adults patients.

Reporting of Concussion-Like Symptoms After Cycling Crashes: A Survey of Competitive and Recreational Cyclists.

Cycling crashes are common among recreational and competitive riders and may result in head and bodily trauma. Information is limited regarding the signs and symptoms of head injury (HI) after cycling crashes, medical treatment, and recovery. To evaluate concussion-like symptom reporting after cycling crashes with or without HI in recreational and competitive cyclists and to assess crash characteristics and follow-up medical care. Cross-sectional study. Voluntary online survey. A convenience sample of 780 cyclists residing in the United States: 528 males, 249 females, 2 gender queer/nonbinary, and 1 transgender female. Survey-based, self-reported signs and symptoms of HI, including the third edition of the Sport Concussion Assessment Tool (SCAT3) symptom checklist, loss of consciousness, posttraumatic amnesia, and helmet damage. Of the participants, 403 reported crashes in the previous 2 years. Cyclists who self-reported no significant injury after their crash were excluded, leaving 77 HI reporters (HI group) and 260 trauma controls (TC group). The HI group more frequently reported experiencing 17 of the 22 symptoms on the SCAT3 symptom checklist. The HI group described a 4-fold higher incidence of loss of consciousness (HI = 13/77 [16.9%] versus TC = 11/2600 [4.2%]) and memory loss immediately after the crash (HI = 44/77 [57.1%] versus TC = 37/260 [14.2%]). The HI group reported major, noncosmetic helmet damage 2.5 times more frequently than the TC group (HI = 49/77 [63.6%] versus TC = 67/260 [25.8%]). The findings suggest that a standardized concussion assessment is needed for cyclists who experience major trauma.

Complicated mild traumatic brain injury in older adults: Post-concussion symptoms and functional outcome at one week post injury

ABSTRACTPrimary Objective: Mild Traumatic Brain Injury (MTBI) is commonly categorized as complicated when injury severity criteria are mild, but an intracranial abnormality is present on acute neuroimaging. The current study examined whether functional outcomes differed at one week post injury among older adult patients based on injury severity and acute computed tomography (CT) findings.Research Design: Participants (≥55 years-old; n = 173) presenting sequentially to the emergency department with a head injury were divided into three groups: complicated MTBI (positive CT; n = 22), uncomplicated MTBI (negative CT; n = 68), and mild head injury (unperformed CT, no documented loss of consciousness or post-traumatic amnesia; n = 83).Methods and Procedures: At one week post injury, the Modified Rankin Scale (i.e., difference score between pre/post-injury ratings; ∆MRS), Glasgow Outcome Scale-Extended (GOS-E), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ) were administered.Main Outcomes and Results: Participants differed on the ∆MRS and GOS-E, but not the RPQ. The complicated MTBI group had worse GOS-E ratings than the uncomplicated MTBI and mild head injury groups and worse ∆MRS than the mild head injury group, but the uncomplicated MTBI and mild head injury groups did not differ on either outcome.Conclusions: Macrostructural abnormality on CT was associated with worse functional outcome at one week post MTBI.

Megapol İstanbul’da 3 yaş altı çocuklarda orta ve ağır şiddetteki kafa travma nedeni olarak; yüksekten düşme ve araba kazası

Objective: We aimed to evaluate the most common causes of moderate and severe head injury at age 3 and younger. Material and Methods: This is a retrospective study that included 157 children (105 males and 52 females) at 3 years of age or younger who were admitted to our emergency unit for moderate or severe head injury between June 2001 and December 2008. Data on patient age, gender, cause of trauma, clinical signs and symptoms, length of hospitalization, radiological findings, surgery, additional injuries, postoperative and late complications, and mortality were examined. Results: The mean age of the patients was 21.05 months. The most common presentation was deterioration in consciousness. The most common cause of moderate head injury was a fall from 1–2 m at 7–12 months of age, and for severe head injury it was a motor vehicle accident at 19–24 months of age. The most common radiological finding in all groups was a linear fracture. In the moderate head injury group, 16 epidural hematomas (EDH), four subdural hematomas (SDH), two dura-brain lacerations, and two depressed fractures required surgery. In the severe head injury group, 6 SDHs and 5 EDHs required surgery. The major postoperative complications were meningitis, rhinorrhea, epileptic seizures, and subdural fluid collection. The overall mortality rate was 3.18% (5 of 157 patients). Conclusions: In our series of moderate and severe head trauma in patients younger than 3 years, the most common cause of trauma was falling from 1–2 m. For prevention, family caregivers must watch crawlers and toddlers closely.

Tau protein (MAPT) as a possible biochemical marker of traumatic brain injury in postmortem examination

MAPT is a neuronal protein that plays an important role in axonal stabilization, neuronal development, and neuronal polarity. MAPT release into the CSF and blood has been interpreted as indicative of axonal injury as its elevated levels were observed in olympic boxers even after a mild head trauma suggesting minor CNS injuries. In our study we wanted to check the potential relevance of MAPT examination for forensic purposes. The study was carried out using cases of head injury group and cases of sudden death (cardiopulmonary failure, no injuries of the head — control group) provided by forensic pathologists at the Department of Forensic Medicine, Medical University of Warsaw. CSF and blood were collected within 24h after death using suboccipital puncture and femoral vein puncture. Serum and cerebrospinal fluid Tau protein concentrations were compared using an enzyme-linked immunosorbent assay (elisa). Brain specimens (frontal cortex) were collected during forensic autopsies. Sections were stained histologically (hematoxylin-eosin) and immunohistochemically with anti human Tau antibody, anti glial fibrillary acid protein (GFAP), anti human macrosialin (CD68) or anti human endothelial cells (CD34). In our study we documented that elevated levels of serum and CSF MAPT may also be considered a marker for mild traumatic brain injury and traumatic brain injury (mTBI and TBI). An increase in CSF and serum levels of MAPT in the absence of visible macroscopic traumatic CNS changes indicates that even minor head injuries may result in changes at the neuronal level that could remain undiagnosed during regular forensic autopsy and routine histopathological examination.

Agonies and nuances of geriatric head injury: experience of a tertiary care institute of Western India

Background: Traumatic brain injury (TBI) is the most common cause of mortality and morbidity in emergency surgical department. The basic aim of the present study is to analyze the clinical profile, prognostic factors, impact of comorbidities on outcome and complications of traumatic brain injury in elderly patients.Methods: The study is retrospective analysis of hospital records of all admitted patients of head injury above 60 years of age over last five years at a tertiary care institute of India.Results: There were 94 males and 61 females in our study with male to female ratio of 1.54:1. The average age of male patients were 68.55 years and female patients were 64.50 years. Fall was the most common cause of head injury (59.3%) followed by road traffic accidents (36.8%) and assault was the least common (3.9%). Mortality was more in moderate and severe head injury groups with more propensity among females with comorbidities.Conclusions: Our study highlights that geriatric TBI carries a significant morbidity and mortality in India despite of advances in trauma care.

СКЛАДНОЩІ КОМПЛЕКСНОЇ КЛІНІЧНОЇ ДІАГНОСТИКИ ГОСПІТАЛЬНОЇ ПНЕВМОНІЇ НА ТЛІ ЧЕРЕПНО-МОЗКОВОЇ ТРАВМИ

Госпітальна пневмонія (ГП) утримує одну з лідируючих позицій у структурі внутрішньолікарняної захворюваності та смертності. ГП є одним із найнебезпечніших інфекційних ускладнень тяжкої черепно-мозкової травми (ЧМТ). Клінічна діагностика пневмонії при травмі досі залишається складним завданням, яке продовжують вирішувати.Мета дослідження – з’ясувати особливості клініко-лабораторної діагностики ГП, що розвинулася на тлі тяжкої ЧМТ.Матеріали і методи. Усього обстежено 166 хворих, в т. ч. 58 хворих з ізольованою тяжкою ЧМТ (перша група) і 108 пацієнтів із ЧМТ, перебіг якої ускладнився розвитком ГП (друга група). У всіх хворих другої групи ГП було підтверджено наявністю інфільтратів на рентгенограмі органів грудної клітки (РГ ОГК). Діагноз ГП встановлювали згідно з міжнародними рекомендаціями та чинним Українським протоколом діагностики та лікування пульмонологічних захворювань у дорослих (наказ МОЗ України №128 від 19.03.2007 р.). В обох групах ураховували скарги, фізикальне обстеження хворих та лабораторні дослідження, загальноприйняті в діагностиці ГП.Результати досліджень та їх обговорення. Отримано такі показники. Середній бал за шкалою коми Глазго (ШКГ) у першій групі склав (12,0±3,0) бала, в другій – (10,3±3,3) бала. Середня тривалість штучної вентиляції легень (ШВЛ) у першій групі була (4,2±2,7) доби, а в другій – (9,7±6,8) доби.Середня частота серцевих скорочень (ЧСС) виявилася в першій групі (77,9±10,3) та (95,0±11,3) другій групах. Середній показник температури тіла був(37,1±0,5) у першій та (38,7±0,8) – у другій групах. В першій групі показник швидкість осідання еритроцитів (ШОЕ) був (8,8±4,9) мм/год, лейкоцити – 8,0х109±3,3, лейкоцитарний індекс інтоксикації (ЛІІ) (2,0±0,8) од. У другій групі показник ШОЕ був(30,6±13,4) мм/год, лейкоцити – 20,4х109±6,6, ЛІІ (5,9±3,4) од.Висновки. Загальноприйняті клінічні та лабораторні методи діагностики госпітальної пневмонії мають різний (часто низький) рівень чутливості й специфічності, внаслідок чого жоден, окремо взятий критерій, не може бути золотим стандартом діагностики ГП. Беручи до уваги клінічну значимість ГП і високий ризик її розвитку в пацієнтів із ЧМТ, на сьогодні актуальним є питання дослідження нових методів діагностики ГП з урахуванням найбільш чутливих показників та їх комплексного застосування.

Clinical and demographic characteristics of patients with nosocomial pneumonia against a background of severe traumatic brain injury

Introduction. Nosocomial pneumonia (NP) is one of the most dangerous infectious complications of severe traumatic brain injury (TBI). According to some researchers, NP formed 0.5–1 % of hospitalized patients and in patients of ICU – NP develops with a frequency from 15 to 65 %. The aim of our study was to determine the clinical and demographic characteristics of patients with NP, developed on the background of severe TBI. Materials and Methods. 166 patients had been examined, including 58 patients with isolated severe head injury (group 1) and 108 patients with traumatic brain injury, which were complicated by the development of NP (group 2). Results. Out of the first group patients 50 (86.2 %) were men, 8 (13.8 %) were women. The average age of patients in this group was 49.2 ± 15.2 years. Out of the first group patients 89 (82.4 %) were men, 19 (17.6 %) were women. The average age of patients in this group was 48.2 ± 16.7 years. The average length of in-patient treatment was 14.1 ± 6.2 days in patients of the 1 st group versus 38.7 ± 17.6 days in patients of the 2 nd group. In the 1 st group 41 (70.7 %) were non-smokers, 10 (17.2 %) smokers 10 cigarettes per day, 10 to 20 cigarettes per day – 3 (5.2 %), more than 20 cigarettes per day – 4 (6.9 %). In the 2 nd group 40 (37.0 %) were non-smokers, 33 (30.6 %) smokers 10 cigarettes per day, 10 to 20 cigarettes per day – 16 persons (14.8 %), more than 20 cigarettes per day – 19 (17.6 %). Conclusions. In demographic structure of the NP, developed on the background by TBI, young men were dominated. The mean duration of hospital treatment of patients with NP increased 2.7 times compared with the patients with TBI uncomplicated by NP. Most patients of both the 1 st and the 2 nd groups were overweight (more than 50 % of patients). There is a significant percentage of the unemployed. A larger percentage of people who consume alcohol in the 2 nd group of patients could be indicative of their poor social adaptation and difficult social conditions. Significantly greater number of smokers among the patients of the 2 nd group confirms the importance of smoking as a risk factor of the NP development on the background of TBI.

Outcome Predictors in Pediatric Head Trauma: A Study of Clinicoradiological Factors.

Introduction:Traumatic injuries are the leading cause of death and a major cause of disability among children. About 70%–80% of the accidental deaths in pediatric age group result directly from central nervous system lesions.Methods:The purpose of our study was to study all the patients of ≤18 years of age with head or spinal injury admitted in neurointensive care unit at our center, an apex trauma center in a developing country, between June 2009 and September 2011. We retrospectively analyzed various factors including type of injury, mode of injury, admission Glasgow coma score (in case of head injury), and mortality rate.Observations:The study population consisted of 264 injured children. Mean age was 8.3 ± 5.6 years (range 5 months to 18 years). Forty percent of patients were within 1–5-year age group. Head injury accounted for 89% of cases and 11% of cases were spinal injury patients. Low-velocity trauma was the most common mode of injury, accounting for 74% of the cases. The percentage of patients with mild, moderate, and severe head injury were 38%, 15%, and 47%, respectively, in the head injury group. Mortality in head injury patients was 18% and in spinal injury patients was 9%. Operative intervention was done in 56% of patients. Predictors of mortality included severe head injury, hospital stay <7 days, pneumothorax, the presence of hypotension, and deranged coagulation parameters.Conclusions:Head injury is much more common than spinal injury in pediatric patients and fall from height being the most common mode of injury. Severe head injury, hospital stay <7 days, pneumothorax, presence of hypotension, and deranged coagulation parameters are predictors of poor outcome.

Mortality of head injuries in Sub-Saharan African countries: The case of the university teaching hospitals of Cameroon

BackgroundReliable data on severe head injury mortality is rarely reported in Sub-Saharan African countries and in Cameroon in particular. It was for this reason that for the first time ever a prospective study was carried out during a one year period in the university hospitals and some selected regional and district hospitals in Cameroon. Materials and methodsAll the patients admitted for head injury in the emergency units of the selected hospitals were enrolled and followed up over a period of one month. ResultsA total of 2835 consecutive patients were included with a sex ratio M/F=3.7/1. One hundred and seventy nine (179) patients lost to follow up were not included. The mortality rate was 77% in the severe head injury group, 16% in the moderate head injury group and 1% in the mild head injury group. In the group of severely injured patients, the mortality rates were very high in the academic hospitals (Laquintinie Hospital of Douala, General Hospital of Douala, Yaounde Central Hospital, and Yaounde University Hospital; 83%, 83%, 81%, and 73% respectively) and in the Regional Hospital of Garoua (84%). ConclusionMortality rates associated with head injury remain very high in Cameroon, and this is likely true in many countries across Sub-Saharan Africa. The figures approach the mortality expected in the natural history of the disease. Strategic plans should be taken at the local and national levels as in the case of maternal mortality and HIV infections.

Mild head injury and attention deficit hyperactivity disorder in children.

Post-concussion syndrome is a well-described complication following moderate and severe head trauma but whether it occurs after mild head injury in children remains unclear. The aim of this study was to evaluate whether exposure to mild head injury with potential additional risk factors (non-surgical lesion on computed tomographic, high kinetic trauma, or Glasgow Coma Scale <15) is associated with attention deficit hyperactivity disorder (ADHD) after the head trauma. This study was performed in an emergency department on children admitted between 2009 and 2013. It compared victims of mild head injury aged 6-16years with matched children presenting isolated non-surgical forearm fracture (ratio1/2). ADHD was assessed using Conners' Global Index-Parent short version 3-40months after the trauma. The patients were compared using chi-square test or Fisher's exact test, t test or u-test as appropriate with a p value set at 0.05. During the study period, 676 patients were admitted for mild head injury. Among them, 34 (5%) fulfilled the inclusion criteria and were compared with 64 matched patients admitted for a forearm fracture. The groups were comparable. ADHD was observed in both groups (18% in the mild head injury group, 11% in the control group) with no significant differences between groups. The prevalence was high when compared to an expected frequency of 3.5-5.6% in children aged 6-12years in the general population. These results suggest that pre-existing ADHD may have contributed to injury proneness in both groups and does not argue for a specific risk of ADHD induced by mild head injury. The diagnosis of ADHD should be evoked at admission of children aged 6-16years presenting with a trauma.

Base deficit and serum lactate concentration in patients with post traumatic convulsion.

Introduction:Traumatic brain injury is a major cause of morbidity and mortality worldwide, and has been reported to be one of the risk factors for epileptic seizures. Abnormal blood lactate (LAC) and base deficit (BD) reflects hypoperfusion and could be used as metabolic markers to predict the outcome. The aim of this study is to assess the prognostic value of BD and LAC levels for post traumatic convulsion (PTC) in head injury patients.Materials and Methods:All head injury patients with PTC were studied for the demographics profile, mechanism of injury, initial vital signs, and injury severity score (ISS), respiratory rates, CT scan findings, and other laboratory investigations. The data were obtained from the trauma registry and medical records. Statistical analysis was done using SPSS software.Results:Amongst 3082 trauma patients, 1584 were admitted to the hospital. Of them, 401 patients had head injury. PTC was observed in 5.4% (22/401) patients. Out of the 22 head injury patients, 10 were presented with the head injury alone, whereas 12 patients had other associated injuries. The average age of the patients was 25 years, comprising predominantly of male patients (77%). Neither glasgow coma scale nor ISS had correlation with BD or LAC in the study groups. The mean level of BD and LAC was not statistically different in PTC group compared to controls. However, BD was significantly higher in patients with associated injuries than the isolated head injury group. Furthermore, there was no significant correlation amongst the two groups as far as LAC levels are concerned.Conclusion:Base deficit but not lactic acid concentration was significantly higher in head injury patients with associated injuries. Early resuscitation by pre-hospital personnel and in the trauma room might have impact in minimizing the effect of post traumatic convulsion on BD and LAC.