Head Injury Patients Research Articles

Electrolyte Disturbance in Patients with Head Injury in Neuro ICU, EMCH, Savar, Dhaka, Bangladesh

Background: A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head. Head injuries are also commonly referred to as brain injury or traumatic brain injury (TBI), depending on the extent of the head trauma. Serum electrolyte abnormalities (SEAs) may occur due to the initiation of destructive inflammatory and biochemical cascades of primary brain injury or as a result of interventions such as hyperosmolar therapy. Objective: To evaluate the electrolyte disturbance in patients with head injury in Neuro ICU, Enam Medical College & Hospital, Savar, Dhaka, Bangladesh. Methodology: It was cross sectional observational study carried out by Department of Neuro ICU, Dhaka during the period of 2017-2021. Total 37 head injury patients were included. Data were collected using a structured questionnaire containing all the variables of interest. Data was processed and analyzed with the help of computer program SPSS for windows version 25. Results: This study shows maximum (45.9%) were 15-35 years. The mean age was 30.97±18.49 years (range 2 years-71 years). Majority (94.6%) were male and only 5.4% were female. Most common head injury were due to road traffic accident (75.7%), followed by fall from height which contributes 56 (18.9%). Among 37 patients 28 (75.7%) patients normal serum sodium level, hyponatremia seen in 7 (18.9%) patients and 2 (5.4%) had hypernatremia. Hypokalemia observed in 21 (56.8%) patients, hyperkalemia in 7 (18.9) patients and 9 (24.3%) patients had normal potassium level. Hypochloremia were present in 21 (56.8%) patients, hyperchloremia in 7 (18.9%) patients and in 9 (24.3%) patients no change in serum chloride. Conclusion: Serum sodium, potassium and chloride abnormalities are common in head injury patients in this study. They are associated with higher risk of mortality and can be expected to occur in patients with abnormalities in specific clinical, radiological and acid-based parameters.

Role of computed tomography in traumatic head injury evaluation

Background: Cranio-cerebral injuries are most common cause of hospital admission following trauma, and it is associated with long-term morbidity and mortality. CT is the single primary modality in the evaluation of patients with acute head injuries. Objective: To assess the prognostic significance of CT in the outcome of a patient of head injury. To observe the sequential anatomic progress of pathologic processes as a response of the brain to head injury and their correlation with Glasgow Coma Scale. Materials and Methods: This study was carried in patients of head injury. The patients with a head injury, craniofacial trauma who underwent CT scanning were included in the study. Patients were scanned using dual Slice CT, Siemens somatom Emotion duo. A P-value of less than 0.05 was considered statistically significant. Results: Total 100 patients were included, incidence of head injuries was more in males than females. Headache was the commonest presentation. Contusions were the most common intraparenchymal injury found in 48, followed by EDH in 46 patients, followed by SDH and SAH which accounted for 43 and 27 respectively. Intraparenchymal hematoma was found in 20 of patients and DAI in 13, intraventricular hemorrhage in 8 patients. Keywords: Injury, Brain, Report, Patient, Computed Tomography, Head Injury, Traumatic Brain Injury, Diffuse Axonal Injury

Post-Concussion Syndrome Latent Onset Related to Intracranial Lesion on Head Injury Patient in Dr. M. Djamil General Hospital Padang

Background. Post-concussion syndrome is associated with damaged axons in patients with a mild head injury but little is known about their consequences for brain tissue. This study aims to examine the relationship between latent onset post-concussion and intracranial lesions in head injury patients at Dr. M. Djamil General Hospital Padang.
 Methods. The research design is an analytical observational study with a cross-sectional approach. A total of 25 patients with head injuries participated in this study with inclusion criteria being hospitalized patients alive without physical and mental disabilities and patients diagnosed with latent onset post-concussion syndrome (PCS) without any additional diagnoses for patients with a history of trauma.
 Results. The average age of the respondents in this study was 34.08 ± 17.45 years and more than half of the respondents were male, namely 18 (72%) respondents. half of respondents with persistent PCS symptoms > 6 months experienced EDH, as many as 5 (55.6%) respondents, ICH 2 (66.7%) respondents, and cerebral contusion 6 (60%) respondents. The results of statistical tests showed that there was no relationship between latent onset PCS and lesion appearance (p>0.05). The results of statistical tests showed that there was no relationship between latent onset PCS and the degree of head injury (p>0.05).
 Conclusion. There is no significant relationship between post-concussion syndrome (PCS) latent onset with a degree of head injury and lesion description in head injury patients at Dr. M. Djamil General Hospital Padang.

Neutrophil-Lymphocyte Ratio Related to Patients Outcome in Moderate Head Injury Patients with Intracerebral Hemorrhage

Background. Head injury is still a major health problem that is a common cause of disability and death. Moderate head injuries are quite common with outcomes varying patient examination of neutrophils and lymphocytes is quite routinely carried out in health services and the combination of these two values has a stronger predictive value for assessing outcomes in patients because it describes an inflammatory reaction. The GOS is a commonly used scale for classifying patient outcomes. This study aimed to determine the relationship between the ratio of neutrophil-lymphocytes (RNL) to the Glascow outcome scale (GOS) in moderate head injury patients with intracerebral hemorrhage.
 Methods. This study has a cross-sectional with samples from moderate head injury patients with CT scan images of intracerebral hemorrhage in Dr. M. Djamil Padang in 2021 and 2022. The data comes from medical records and observations of samples that meet the inclusion and exclusion criteria, 36 subjects participated in this study.
 Results. Most of the subjects (61.1%) were male. A total of 55.6% of subjects had RNL ≥ 7.35 with 44.4% of subjects having poor GOS. In this study, a statistically significant relationship was found between the ratio of neutrophil- lymphocytes in patients with moderate head injury with intracerebral hemorrhage and the Glasgow outcome scale (p-value = 0.005).
 Conclusion. RNL can predict outcomes in moderate head injury patients with intracerebral hemorrhage.

245 Changing Demographics of Head Injury During the COVID-19 Pandemic

Abstract Introduction Studies have shown that men are more likely to sustain head injuries (HI) due to a higher likelihood of participation in high-risk behaviours. However, the COVID-19 lockdown caused substantial alterations to the daily routines of the Welsh population. We aimed to describe the demographical changes of HI patients caused by this large-scale restriction of public social activity. Method A retrospective review of our neurosurgical referral database was performed between 1/1/19 to 31/12/20 to extract patient demographics and referral outcomes (admission/advice only) of adult head injury patients. Referrals during lockdown in Wales (26/3/20 – 1/6/20 and 31/10/20 and 2/12/20) were compared with non-lockdown periods in 2019 and 2020. Results There was no significant difference in HI referral volume in 2019 (n = 1228) vs 2020 (n = 1179) (OR: 0.71; 95% CI: 0.53 – 0.96, p = 0.02). Women were less likely to be admitted in 2019 (OR: 0.60, 95%CI: 0.39 – 0.91, p = 0.02) and 2020 (OR: 0.52, 95%CI: 0.31–0.88, p = 0.01). We observed evidence of interaction by age and sex in lockdown vs non-lockdown (p = 0.02). Most strikingly, there was higher odds of admission in women aged 40–70 years during lockdown (OR: 10.4, 95%CI: 1.13 – 95.8, p = 0.04). Conclusions We observed significant demographical shifts in HI during lockdown periods, with striking increases in admission rates of men under 40 years and women aged 40–70. The cause of these substantial changes need clarification and have important public health implications. Given likely reduced road traffic accidents during lockdown, other factors such as alcohol or assault need considering.

Literature Study: Factors Affecting Prognostics of Head Injury Patients

Head injury is often referred to as “the silent epidemic” remains a public health problem and is the largest contributor to mortality and record among all injuries. The aim of this study was to identify the prognostic factors in head injury patients based on a literature study. The research design used in this study was a literature study with a sample of 15 journals, Google Scholar (n=3), Pubmed (n=4), proQuet(n=4), Science Direct (n=4). The results of this study are that there are factors that influence the prognostication of head injury patients including age (11 journals), GCS (Glasgow Coma Scale) (11 journals), gender (3 journals), and hematoma (4 journals). Prognostic factors of head injury were found in 15 journals, including age, GCS (Glasgow Coma Scale), gender, and hematoma.

Demonstrasi Memprediksi Gangguan Cerebral Pada Orang Dengan Trauma Kepala Melalui Pengukuran Tekanan Darah

Introduction: Head injury is leading cause of death and disability. Brain cells around the injury will be functionally impaired. If the brain was widespread and bleeding, it has an impact on the failure of blood pressure controls mechanisms because blood pressure is one of the indicators in the prognosis of head injury patients. Objective: the community was able to identify blood pressure measurement, the community was able to say hello before taking blood pressure, the community was able to prepare blood pressure equipment, the community was able to preparing client before taking blood pressure, and the community was able to taking blood pressure on client. Method: a demonstration method was use in this community service. Result: the community was able to identify blood pressure measurement in good category (88.9%),, The community was able to say hello before taking blood pressure in good category (88.9%), the community was able to prepare blood pressure equipment in good category (74.1%), the community was able to prepare client before taking blood pressure in good category (74.1%), and the community was able to taking blood pressure the very good category (63.0%). Conclusion: The activity of demonstration taking blood pressure by community to predicting cerebral disorders in people with head injury was effective

OCULOMOTOR DEFICIT IN MILD TRAUMATIC HEAD INJURY AN INSTITUTIONAL STUDY

INTRODUCTION: Traumatic head injury can be mild causing a bump, laceration or contusion with or without a disturbance of conciousness. It can be a moderate or severe injury depending upon clinical parameters of Post traumatic Amnesia (PTA) and/or a disturbence of Conciousness and Presenting GCS . Oculomotor decit following mild Head Injury can be Considered in checklist while discharging the Patients, as it is one of the commonest and important symptoms experienced by them. Several Studies have shown in Populations with contusions and neuronal injury that vision and eye movements are closely tied to the functionality of the Brain. In our Study we found 31 patients out of 178 having changes in visuomotor Performances. Optimal management of Patients that is used based on the type of injury and ndings according to institutional Protocol. Most of the oculomotor Symptoms improved with Conservative management via regular follow-up. AIMS AND OBJECTIVES: To Study the frequency and various types of visuomotor decit in mild traumatic head injury, its co-relation and further evaluation on the resolution of visual abnormalities in patients after 3 months. MATERIALS AND METHODS: The study design is prospective and was conducted between January and December 2021 at Gauhati Medical College and Hospital. The data of 178 patients were collected in the mentioned hospital and evaluation was done during the discharge and followup after 3 months. The signicance test was carried out using Pearson's Chi-Square and Fisher's Exact Test were conducted. RESULT: It was found by Pearson's Chi-Square and Fisher's Exact Test that the number of patients having oculomotor abnormalities in mild traumatic head injury is signicant (P<0.005). Moreover, 74.19% of patients showing oculomotor abnormalities had no Extraocular muscle abnormalities during discharge which increased to 93.54% and the rest 6.45% of patients showed partial improvement. No patient was found to have 4th nerve palsy, 83.87% of OM (patients with oculomotor abnormalities) patients had no 3rd nerve palsy during discharge which increased to 93.54%. CONCLUSION: the study concluded that there is a signicant number of mild traumatic head injury patients with visual abnormalities which can be resolved effectively by conservative management within 3 months. It is suggested that more follow-up and research required for more prompt treatments.

The Link Between Skull Fracture and Extradural Hematoma in Head Injury Patients who came to a Tertiary Care Hospital in Pakistan

Aim: The purpose of our current study is to see if there is any connection between skull fracture and extradural hematoma in head injury patients who came to the tertiary care hospital in Pakistan. Methods: From January 2020 to December 2021, this descriptive research was conducted at Chandka Medical College, Shaheed Mohtrama Benazir Bhutto Medical University Larkana. The research comprised those patients who have undergone extradural hematoma surgery during study period. Normal skull X-rays being taken, and the type and position of fractures were documented on the X-rays, CT scan, and during surgery. The frequency of skull fracture linked through extradural hematoma was studied in different ages. SPSS version 24.0 was utilized to investigate our current findings. Results: A sum of 130 individuals were operated on for extradural hematoma. In 70 cases, a linear fracture was seen, and in 18 individuals, a depressed skull fracture was seen. Another ten individuals with no radiologically evident fracture reported discovered to also have a fracture line intra-operatively. As a result, 87 (78 percent) of the participants suffered a skull fracture. Here remained no statistically important variation in occurrence of skull fracture among age ranges. Conclusion: Although there is a significant link between skull fracture and extradural hematoma, a normal X-ray does not rule out extradural hematoma. Keywords: Skull fracture, extradural hematoma, head injury, Tertiary Care Hospital, Larkana, Pakistan.

An Analysis of Aetiology, Pattern and Outcome of Head Injury in Trauma Patients

Abstract Background: Head injury is considered as a major health problem in developed and developing nations. Analysis of etiology, patterns, and outcome of head injury in trauma patient is essential for understanding and planning for better management. Materials and Methods: The prospective observational study carried out among patients who presented with head injury at the tertiary care hospital, Mumbai from July 2015 to July 2017. Demographic details recorded were age, sex, blood pressure on arrival, Glasgow Coma Scale (GCS) score, the interval between injury and admission, associated injury, co-morbidities, hospital stay, and outcome. Results: The age group at which maximum patients of head injury were admitted was 18-29 years (31%) followed by 40-49 years (21%). Eighty one percent patients were males and 19% patients were females, the male to female ratio being 4:1. Road traffic accidents (36% cases) were the commonest cause leading to acute head injury followed by accidental fall (21% cases). 47% patients presented with mild head injury according to GCS. Conclusion: Head injuries mainly caused by vehicular accidents and affect mainly the young men. Road traffic accidents were the commonest mode of head injury, but railway accident had the worst outcome in our study. Factors associated with outcome were Pre-hospital delay, GCS on arrival, Blood pressure on arrival, Associated injury, Need for ventilator support, CT scan findings.

Incidence of mortality and its predictors among patients with head injury admitted to adult intensive care unit at AaBET and ALERT hospitals, Addis Ababa, Ethiopia.

Traumatic head injury, referred to as the "silent epidemic", remains a growing public health concern and the leading cause of mortality in young adults, with a disproportionate burden of disability and death occurring in low-income and middle-income countries, including Ethiopia. However, estimates of the traumatic brain injury burden from low and middle-income countries are scarce. The aim of this study was to assess outcome and its associated factors among patients with head injury admitted to the Adult Intensive care unit at AaBET and ALERT hospitals, Addis Ababa, Ethiopia. Institution-based retrospective cohort study was conducted at AaBET and ALERT hospitals from February 01, 2019 to January 30, 2020. All head injury patients' records were reviewed. A structured checklist was used to collect data. Binary logistic regression analysis was used to identify factors associated with death among head injury patients. Out of 205 patients, 178 (86.8%) improved, while 27 (13.2%) died. Road traffic accident was the most common cause of head injury (Adjusted odds ratio (AOR) = 46.3%). Patients with pulse rate admission (AOR = 1.49), NA + level (3.48), type of head injury (AOR = 3.67), mechanical ventilation (AOR = 4.70) were significant predictors of death among patients with head injuries. The incidence of death among head injury patients was 13.2% (27). Road traffic accident was the leading cause of head injury. Pulse rate, plasma sodium level, penetrating head injury, being on a mechanical ventilator were predictors of death among traumatic head injury (THI) patients treated for head injuries. Prevention of road traffic accidents and continuous awareness creation about the consequences of a road traffic accident is recommended.

A Retrospective Study of Microbial Profile of Head Injury and Stroke Patient Admitted in EMCH, Savar, Dhaka, Bangladesh

Introduction: Many head injury patients have reduced consciousness, are prone to aspiration of oral secretions, and are likely to develop pneumonia. Respiratory tract infection (RTI), especially pneumonia, is a very common disease in Neurosurgical Intensive Care Units (NSICU). Objective: To evaluate the microbial profile of head injury and stroke patients admitted to EMCH, Savar, Dhaka, Bangladesh. Methods: It was a retrospective study conducted at Enam Medical College & Hospital, Savar, Bangladesh from 2017-to 2021. A total of 46 patients admitted with a head injury and stroke patient were enrolled in this study. Data were collected using a structured questionnaire containing all the variables of interest. Data were processed and analyzed with the help of the computer program SPSS for windows version 25. Results: This study shows 84.8% males and 15.2% females. The mean age was 42.54±18.09 years. Pathogens found in culture samples were tracheal aspirate C/S (54.3%), urine C/S (26.1%), catheter tip C/S (13%), and the tip of the ET tube C/S (4.3%). Main attributed pathogens were staph. aureus (47.8%), Klebsiella spp (37%), E. coli (32.6%), streptococcus (2.2%), acinetobacter SPP (2.2%) and pseudomonas SPP (2.2%).Conclusion: This study shows staph. aureus, Klebsiella spp, and E. coli are the most common pathogen isolated. Therefore, careful microbial profile and antibiotic susceptibility testing are necessary for the prevention of pathogens as well as an effective treatment.

Study of various modalities of management and outcome in patients of head injury at a tertiary hospital

Study of various modalities of management and outcome in patients of head injury at a tertiary hospital

Head injury case with blunt force traumatic: Case report

Child abuse has negative impact for children including emotional performance, mental dysfunction, and decrease intelligence. According to the 2014 Surveillance Report of Traumatic Brain Injury, in the United States, there are approximately 2.87 million head injury patients. Head injury, or so-called head trauma, is a blunt force/sharp force on the head or face that results in temporary cerebral dysfunction. It is one of the leading causes of death and disability in the productive age group, primarily traffic accidents. A boy went to the emergency room at Bhayangkara Kediri Hospital. There was swelling on the left head, expanding on the forehead and bruising on the left ear. Also found signs of sodomy marks in the form of abrasions around the anus. There are also bruises on the back and neck of the end. For a definitive diagnosis, the results of the CT scan were that the patient obtained extensive cerebral contusion and caused the deviation of the midline structure to the right as far as ± 0.9 cm with subgaleal hematoma and the dilation of cerebral blood vessels. In cases of head injury due to blunt trauma, blood infiltration will be found in the layers of the scalp and muscles in the direction of the trauma. The presence of blood infiltration is an intravital sign of evidence of extravasation of blood cells in the tissue. Another finding may be a skull base fracture in the posterior fossa caused by a direct blow to the occipital region. At the base of the skull, a fracture in the posterior fossa can cause symptoms such as bleeding from the nose, mouth, and ears, damage to the cranial nerves and cause raccoon eyes. In head injuries caused by blunt trauma can also cause subarachnoid hemorrhage and subdural hemorrhage due to rupture of the superior cerebral vein and “bridging vein” due to pressure/trauma it can cause death, to distinguish subarachnoid hemorrhage from subdural hemorrhage needs to be done sprinkling with water.

The Outcome Predictors of the Patients with Traumatic Brain Injury; A Cross-Sectional Study.

To probe the factors associated with the outcomes of traumatic brain injury (TBI) patients admitted to emergency department (ED). This is a cross-sectional study that data gathering was performed via census methods, retrospectively. During one year, all head injury's patients who admitted to the ED of a tertiary center in Tehran, Iran were included. Age, gender, mechanism of injury, Glasgow coma scale (GCS) and injury severity score (ISS) on admission, presence of extra-cranial injuries, findings of brain computed tomography (CT), duration of hospitalization, and in hospital outcomes were recorded. Outcome's assessment for survivors was performed within a 6 months-period after discharge based on Glasgow outcome scale (GOS). The variables and outcomes' association were assessed. Totally, 506 patients were evaluated with the mean age of 36.77±21.1 years that 411 (81.2%) were men. Follow up at 6-months post injury was feasible in 487 (96.2%) patients; 59 (11.7%) out of 506 eligible patients died. Logistic regression analysis showed the association between assessed variables and patients' outcome as follows: age>65 years (OR: 12.21; p<0.001), GCS on admission <8 (OR: 62.99; p<0.001), presence of traumatic Intracerebral hemorrhage (ICH) in brain CT scan (OR: 20.11; p=0.010), duration of hospitalization ≥ 5 days (OR: 0.28; p=0.001). The findings of the current study distinguished some variables that were associated with the poor outcome of the patients with TBI. Therefore, TBI patients with any of these risk factors may need close continues monitoring, early ICU admission, and some other special extra care in ED.

A progressive revival of semivegetative patient of head injury with ayurvedic treatment

A progressive revival of semivegetative patient of head injury with ayurvedic treatment

Basal Cisternostomy in Head Injury: More Questions than Answers.

Cisternostomy has recently been reintroduced in the setting of severe TBI as an adjuvant surgical technique for decreasing brain edema and refractory intracranial hypertension. However, there is not much clarity regarding its role in head injury. Study the effect of cisternostomy on intracranial pressure, morbidity, and mortality in head-injured patients. We conducted a single-center quasi-experimental study between November 2018 and November 2020. All candidates for decompressive hemicraniectomy (DHC) were divided into two groups: DHC-BC (undergoing basal cisternostomy with DHC) and DHC (undergoing DHC alone). We compared the impact of surgery on decreasing ICP and clinical outcomes in both groups. During the study duration, we admitted 659 head-injury patients. Forty patients were included in the study (9 in the DHC-BC group and 31 in the DHC group). Both the groups were comparable in terms of baseline clinical characteristics such as age, gender, preoperative GCS, head injury severity, radiological features, and opening ICP. Patients in both groups had a decline in ICP following surgery. The mean closing pressure in the DHC-BC group (11.3 ± 5.9) was significantly higher than that in the DHC group (5.3 ± 3.5) (P = 0.003). The mean drop in ICP in the DHC-BC group was 14.4 ± 11.5 while that in the DHC group was 18.9 ± 12.4 (P = 0.359). The average total number of hours of ICP >20 mm Hg and intracranial hypertension index were higher for the DHC-BC group. The average number of days of stay in the ICU and hospital were lower for the DHC-BC group (7.0 ± 6.1 and 15.0 ± 20.2, respectively) compared to the DHC group (10.6 ± 9.3 and 19.3 ± 13.9, respectively). The 30-day mortality rate was higher for the DHC-BC group (66.6%) than the DHC group (32.2%). The mean GCS at discharge was better in the DHC-BC group (11.7 ± 2.9) compared to 10.5 ± 3.7 in the DHC group, while 11.1% of patients in the DHC-BC group had a favorable outcome (1-month GOS-E) compared to 9.7% patients in the DHC group. Our preliminary single-center study failed to show a clear benefit of adding basal cisternostomy to decompressive hemicraniectomy in patients with head injuries.

Improved Hemodynamic Status of Head Injured Patients in the Emergency Unit (ER): Literature Review

Background: Head injury is a serious problem that can lead to death and even death. Handling of head injuries starts from protecting the brain with blood flow to the brain so that hypoxia or brain ischemia does not occur. Hemodynamics is the result of measuring systolic and diastolic blood pressure, pulse rate, and respiratory rate.&#x0D; Objectives: This literature review aims to find out what interventions can be done when there is an increase in hemodynamic status in head injury patients&#x0D; Methods: This database search was conducted by searching on google scholars with the keywords head injury, hemodynamics. The inclusion criteria of this literature review are articles that were researched within the last 5 years with the year published 2015-2020, full text, using the Indonesian language, the article that used is the article.&#x0D; Results: Interventions that can be done when there is an increase in hemodynamic status in head injury patients are giving oxygen and increasing 30o, giving oxygen through a simple mask and head position 30o, giving head-up position 30o compared to 15o position, giving nasal prong oxygenation therapy and murotal therapy Al-Qur'an for 30 minutes 3 times/day.&#x0D; Conclusion: All interventions resulting from this literature review were in the form of giving oxygen and increasing the head 30o, giving oxygen through a simple mask and head position 30o, giving the head position 30o compared to 15o position, giving nasal branch oxygenation therapy, and murotal Al-Qur'an therapy for 30 minutes 3 times/day.

The Impact of a Cervical Collar on Intracranial Pressure in Traumatic Brain Injury Patients: A Systematic Review and Meta-Analysis

Purpose: Although the use of a cervical collar in the prehospital setting is recommended to prevent secondary spinal cord injuries and ensure spinal immobilization, it is not known what effects this has on raising intracranial pressure (ICP) in traumatic brain injury (TBI) patients. In the absence of studies measuring ICP in the prehospital setting, the aim of this study was to systematically review the data related to ICP changes measured after presentation at the hospital in patients who had arrived wearing cervical collars. Methods: We searched Medline (PubMed), Embase, CINAHL, and Google Scholar for studies that investigated in-hospital ICP changes in TBI patients arriving at the hospital wearing collars. Titles, abstracts, and full texts were then searched for inclusion in the study. A narrative synthesis, as well as a meta-analysis, was performed. Results: Of the 1006 studies identified, only three met the inclusion/exclusion criteria. The quality of the three included studies was moderate and the risk of bias was low. All three studies used the Laerdal Stifneck collar, but all studies showed an increase in ICP after application of the collar. A further three studies that measured ICP but did not fit the systematic search were also included due to low patient numbers. A meta-analysis of the pooled data confirmed a significant increase in ICP, although between the four studies, only 77 patients were included. The meta-analysis also confirmed that after removal of the collar, there was a significant decrease in ICP. Conclusions: Our study suggests that the use of a cervical collar increases ICP in TBI and head injury patients, which may have detrimental effects. However, due to the extremely low sample size from all six studies, caution must be exercised when interpreting these data. Thus, further high-quality research is necessary to unequivocally clarify whether cervical collars should be used in patients with TBI.

Challenges and Outcomes of COVID-19 Positive Neurosurgical Patients: An Institutional Experience With Emphasis on Modifications of Neurosurgical Practice.

Introduction: There has been a drastic reduction in the number of neurosurgeries performed during the COVID-19 pandemic due to a multitude of challenges prompting restructuring of neurosurgical services. The present study describes the challenges and outcomes of non-elective neurosurgical procedures done on COVID-19 positive patients along with the modifications in neurosurgical practice during the pandemic.Methods: A retrospective study was done in the Department of Neurosurgery over a period of one year and three months. Demographic and clinical details including outcomes of the COVID-19 positive patients, who had undergone non-elective neurosurgical interventions, were collected.Results: Ten patients (3.8%) were COVID-19 positive out of 262 neurosurgical interventions done. The age of the patients ranged from 5 days to 78 years with five males and five females. Out of the 10 patients, five were neurotrauma cases including one patient of head injury with craniovertebral junction injury. The patient with craniovertebral junction injury underwent foramen magnum decompression with C1 lateral mass-C2 pedicle screw on the right and C0-C2 pedicle screw and rod fixation on the left. The rest of the neurotrauma cases underwent craniotomy or burr-hole craniostomy followed by evacuation. Only one patient (10%) had postoperative 30-day mortality. The rest nine patients (90%) survived the post-operative 30-day mortality. The various modifications incorporated in the neurosurgical practice included categorizing the emergency room into various zones, a separate operating theatre for COVID-19 patients, limiting the number of operating members as well as minor modifications in the operating procedures.Conclusions: The postoperative surgical outcome is favorable in COVID-19 positive patients with modifications of the existing neurosurgical practices.