Lower Glasgow Coma Scale Score Research Articles

Is prophylactic anti-convulsive treatment necessary in subdural hematomas?

Subdural hematoma (SDH) is usually an emergent clinical condition in neurosurgery. The relationship between the SDH and epilepsy is not well established. Therefore, the use of anti-convulsive treatment in patients with SDH is controversial. The aim of this study is to analyze the presence of seizures in patients who underwent surgery for SDH. Patients who were operated on for SDH in our department between 2016 and 2021 were reviewed retrospectively. Demographic features, Glasgow Coma Scale (GCS) score at admission, type of SDH, location, etiology, type of surgical intervention, presence of seizures, and re-operation were evaluated. There were 175 patients with SDH. There is a statistically significant difference between the frequency of seizures and the type of SDH. More seizures were observed in acute SDH than in the others. There is also a statistically significant difference between the GCS score and the frequency of seizures. Patients with a GCS score <12 at admission had more frequent seizures than patients with a score of 12 or higher. No statistically significant difference was found between factors such as etiology, re-operation, hematoma location, and the development of seizures. Anti-convulsive treatment may be recommended in patients with acute SDH and a low GCS score at admission. Further studies with larger series should be performed to determine the most appropriate anti-convulsive agent for patients with SDH.

Risk stratification of extravasation during semi-automatic intraosseous device use in a pediatric emergency setting.

The semi-automatic intraosseous device (EZ-IO®) is useful for safely securing intraosseous access. There are some complications associated with its use but few studies have examined the risk factors. The present study aimed to investigate the risk factors for extravasation as a complication of EZ-IO use in pediatric patients. This study is a secondary analysis of a previous, monocentric, retrospective study conducted in Japan describing the use of EZ-IO in a pediatric emergency department. The patients included in the study were younger than 16 years of age with EZ-IO use at the Tokyo Metropolitan Children's Medical Center between January, 2013 and August, 2018. The factors analyzed included demographic information (sex, age, weight), Glasgow Coma Scale (GCS), diagnosis, bolus infusion, and lidocaine use. The primary endpoint was the odds ratio (OR) and 95% confidence interval (CI) for extravasation incidence. Seventy-two patients were enrolled; 14 of these had extravasation, 39 (54.2%) had a diagnosis of cardiac arrest, and 50 (69.4%) had a GCS score of 8 or less. Statistical analysis demonstrated that the group with a high GCS score was significantly associated with extravasation: GCS (<13) versus GCS (13≦) (OR: 12.25; 95% CI: 2.54-59.15; p < 0.01), GCS (<8) versus GCS (8≦) (OR: 4.78; 95% CI: 1.34-17.01; p = 0.03). A high GCS score was associated with extravasation in EZ-IO use significantly more often than a low GCS score. No significant difference was found in the other endpoints.

Relationship between platelet indices and red cell distribution width and short-term mortality in traumatic brain injury with 30-day mortality

This study aimed at investigating whether there is a relationship between 7- or 30-day mortality and mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, or red cell distribution width in patients with traumatic brain injury. We retrospectively analyzed intensive care unit patients with traumatic brain injury. We recorded patients' ages; genders; diagnoses; Glasgow Coma Scale scores; length of intensive care unit stay (in days); mean platelet volume, platelet distribution width, platelet count-to-total lymphocyte count ratio, and red cell distribution width values upon hospital admission; and health on the 7th and 30th days of their stays. We analyzed data from 110 patients. Of these, 84 (76.4%) were male and 26 (23.6%) were female. On the 7- and 30-day mortality evaluations, compared to the living patients, the deceased patients had a significantly higher median age and a significantly lower median Glasgow Coma Scale. Thus, increased age and lower Glasgow Coma Scale scores were associated with increased 7- and 30-day mortality rates. mean platelet volume and platelet distribution width values were similar in living and deceased patients. platelet count-to-total lymphocyte count ratio values were lower in deceased patients, but this difference was not statistically significant. Within 30 days after traumatic brain injury, deceased patients' red cell distribution width values were significantly elevated in deceased patients compared to those of living patients. Mean platelet volume, platelet distribution width, and platelet count-to-total lymphocyte count ratio values were not associated with 7- and 30-day mortality, whereas only elevated red cell distribution width was associated with 30-day mortality.

Impaired Kidney Function Portended a Bleak Prognosis for Surgically Treated Hypertensive Intracerebral Hemorrhage Patients

Abstract Purpose: Spontaneous intracerebral hemorrhage (ICH) cases caused by hypertension often have poor prognoses. The use of dehydrant agents, such as mannitol, is common to reduce intracranial pressure and alleviate cerebral edema, but they may also pose a risk of worsening kidney function. This study aimed to investigate the impact of impaired kidney function on the outcomes of surgically treated hypertensive ICH patients. Methods: We conducted a retrospective analysis of a consecutive cohort of patients who underwent surgical intervention due to hypertension-related ICH at our institute between December 1, 2017, and January 31, 2022. Demographic, clinical, radiological, and prognostic data were collected. Patients were categorized into two groups based on 90-day mortality: group A [overall survival (OS) ≤3 months] and group B (OS &gt;3 months). Survival analysis was performed to identify factors associated with poor outcomes. Results: Among the 232 eligible patients, group A exhibited significantly impaired kidney function, as indicated by mean estimated glomerular filtration rate (eGFR) at admission, postoperative, 3-day postoperative, and 7-day postoperative time points (91.9, 82.5, 73.5, 75.2 ml/min/1.73 m²). In contrast, group B did not show significant changes in kidney function (mean eGFR for the corresponding time points: 108.1, 106.5, 111.5, 109.6 ml/min/1.73 m²). The 3-day postoperative eGFR showed the strongest predictive ability for assessing prognosis [areas under the curve (AUC): 0.617, 0.675, 0.737, 0.730]. Univariate and multivariate analyses identified low Glasgow Coma Scale (GCS) score (3–8), ventricle intrusion of hematomas, cardiac failure, larger hematoma volume, infection, and lower 3-day postoperative eGFR as adverse factors for survival. Conclusions: Preserving kidney function is crucial for achieving favorable outcomes in hypertensive ICH cases. Impaired 3-day postoperative eGFR emerged as an independent risk factor for overall survival. Patients with cardiac failure, infection, and larger hematoma volume should receive careful management to improve outcomes.

Socioeconomic Profile is Associated with the Type of Firearm Injuries to the Head and Neck

Socioeconomic status (SES) describes social standing of an individual or a group. SES has been directly associated with violence. The purpose of this study is to measure the association between SES profiles and firearm injuries (FIs) to the head and neck. This cross-sectional study reviewed patients at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to June 2021. The study included patients who sustained FIs to the head and neck. The primary predictor variable was Distressed Community Index as a surrogate for SES. The primary outcome variable was type of FI (assault-induced firearm injury [AFI] or self-inflicted firearm injury [SFI]). Covariates were patient characteristics, distribution, and severity of FI. Univariate and bivariate analyses were calculated. The χ2 test was used for categorical variables. Independent t test was used for continuous variables. Statistical significance was P<.05. Six hundred ninety-four patients met inclusion criteria. AFIs were statistically more frequent in young (AFI= 32.2; SFI= 42.2; P≤.001) and/or Black patients (AFI: n=483, 86.3%; SFI: n=40, 29.9%; P≤.001). Patients who sustained AFIs were statistically more likely to live in areas associated with high Distressed Community Index score (AFI: 64.8, range= 3.7 to 99.7; SFI: 54.4, range= 2.8 to 98; P≤.001). A statistically significant number of SFI patients presented with lower Glasgow Coma Scale score (AFI: 10.7, range= 3 to 15; SFI: 5.5, range= 3 to 15; P≤.001), and/or required tracheostomy (AFI: n=56, 10%; SFI: n=27, 20.1%; P=.005). Patients who lived in economically distressed areas were positively associated with AFIs to the head and neck. However, SFIs were statistically more sever. More studies on the impact of current gun prevention programs and how to be addressed to at-risk populations is needed.

Extracellular Vesicle Levels of Nervous System Injury Biomarkers in Critically Ill Trauma Patients with and without Traumatic Brain Injury.

Moderate/severe traumatic brain injury (TBI) causes injury patterns with heterogeneous pathology producing varying outcomes for recovery. Extracellular vesicles (EVs) are particles containing a myriad of molecules involved in cell signaling. EVs may hold promise as biomarkers in TBI because of their encapsulation, including improved stability/decreased degradation. A subset of subjects with and without TBI from a prospective, observational trial of critically ill trauma patients were analyzed. Total EV levels of glial (glial fibrillary acidic protein; GFAP) and neuronal/axonal (ubiquitin carboxy-terminal hydrolase L1 [UCH-L1], neurofilament light chain [NfL], and total-tau) proteins were measured using single-molecule array technology. Protein levels were winsorized to address outliers and log transformed for analysis. Patients with multiple injuries (n = 41) and isolated body injury (n = 73) were of similar age and sex. Patients with multiple injuries were, as expected, more severely injured with higher Injury Severity Scores (29 [26-41] vs. 21 [14-26], p < 0.001) and lower Glasgow Coma Scale scores (12 [4-13] vs. 13 [13-13], p < 0.001). Total body EVs of GFAP, UCH-L1, and NfL were higher in those with multiple injuries (1768 [932-4780] vs. 239 [63-589], p < 0.001; 75.4 [47.8-158.3] vs. 41.5 [21.5-67.1], p = 0.03; 7.5 [3.3-12.3] vs. 2.9 [2.1-4.8], p < 0.001, respectively). There was a moderate correlation between the Head Abbreviated Injury Score and GFAP (free circulating rho = 0.62, EV rho = 0.64; both p < 0.001). Brain-derived proteins contained in EV holds promise as an informative approach to biomarker measurement after TBI in hospitalized patients. Future evaluation and longitudinal studies are necessary to draw conclusions regarding the clinical utility of these biomarkers.

Retrospective Evaluation of Hematological and Clinical Factors Associated with 30-Day Mortality in 170 Patients Diagnosed with Intracerebral Hematoma in a Single Center in Turkey.

BACKGROUND This retrospective study from a single center in Turkey aimed to evaluate hematological and clinical factors related with 30-day mortality in patients diagnosed with intracerebral hematoma (ICH) between 2013 and 2021. MATERIAL AND METHODS All 170 consecutive patients (>18 years) admitted to the Intensive Care Unit (ICU) with spontaneous ICH were analyzed. Cranial computed tomography was performed in all patients. Venous blood samples were routinely obtained upon admission. Demographic characteristics, blood test results, imaging data, and survival data were retrieved from the institutional digital database. The primary goal of this study was to investigate the role of presenting demographic and clinical characteristics and blood tests in predicting 30-day mortality in patients with spontaneous ICH. RESULTS Receiver operating characteristic curve analysis showed that the Glasgow coma scale (GCS) score (≤9), hematoma volume (>13.4 cm³), hemoglobin (≤13.1 g/dL), international normalized ratio (>1.25), C-reactive protein (CRP) (>7.5 mg/L), and third-day neutrophil-to-lymphocyte ratio (>17.8) could be used to predict 30-day mortality. Patients with low GCS scores (≤9) had a 14.432-fold higher risk of death than other patients (OR: 14.432, 95% CI: 6.421-32.441, P<0.001). Patients with high CRP levels (>7.5) had a 3.323-fold higher risk of death than other patients (OR: 3.323, 95% CI: 1.491-7.405, P=0.003). CONCLUSIONS Tailoring scoring systems to include CRP may be beneficial for predicting spontaneous ICH prognosis. However, further studies assessing CRP and other inflammatory markers are necessary to assess whether inflammatory activity could be associated with worse outcomes in patients with ICH.

Predictive Factors of Outcomes in Acute Subdural Hematoma Evacuation.

This comparative cross-sectional study was conducted in the Departments of Trauma and Neurosurgery, Ayub Teaching Hospital,Abbottabad, Pakistanfrom September 2021 to February 2022to study predictive factors of outcomes in acute subdural hematoma evacuation. A total of 101 patients with confirmed diagnosis of acute subdural hematoma (ASDH) who underwent surgical evacuation by consultant neurosurgeon were included in the study. A detailed clinical proforma was designed to document all the clinical and demographic details of these patients at the time of admission. Glasgow Coma Scale outcome score (GOS)was used to assess the outcome of patients after the surgery. Sociodemographic and clinical parameters were associated withoutcome of surgery in our study participants. Out of 101 patients, 55 (54.5%) were males and 46 (45.5%) were females. Mean age was 43.66±19.66 years with 7.39 as mean Glasgow Coma Scale (GCS) at presentation. Road traffic accident (RTA) 62 (61.4%) was most frequent mechanism of injury followed by fall from height (19.8%) and history of assault (13.9%). In our study, 59 patients had poor outcomes while 42 had good outcomes. Elder age, low GCS at presentation, and use of oral anticoagulant were associated with poor outcomes while pupillary reaction had no effect on the outcome after application of test of significance. More than half of the patients managed with surgical evacuation for acute subdural hematoma as per guidelines at our neurosurgical unit had poor outcomes according toGlasgow Coma Scale. In this study, advancing age (>60 years), low GCS score at presentation, and use of oral anticoagulation therapy emerged as significant risk factors for poor outcomes in participants. Pupillary reaction had no effect on outcomes as per this study but this needsfurther evaluation in future studies.

The reversed De Ritis ratio for predicting in-hospital mortality among intensive care patients with organophosphate poisoning

Introduction The uncontrolled use of pesticides signifies a substantial health hazard. This study was designed to explore the prognostic role of on-admission hepatic aminotransferases [alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and the reversed De Ritis ratio (ALT/AST)] in the prediction of in-hospital mortality among patients with acute organophosphate (OP) poisoning. Patients and methods We conducted a retrospective study based on extracting the required information from the specific medical records for acutely OP-intoxicated patients admitted to the intensive care unit. Results A total of 49 acutely malathion-intoxicated patients were enrolled in the study. The in-hospital mortality rate was 32.7%. Patients were stratified into survivors and non-survivors. Compared to the survivors, the non-survivors had significantly lower Glasgow coma scale scores, mean arterial blood pressure, significantly higher reversed De Ritis ratio (ALT/AST), and ALT and AST activities. The reversed De Ritis ratio (ALT/AST) and ALT demonstrated good discrimination between the survivors and the non-survivors with an area under the curve (AUC) of 0.708 vs 0.781, respectively, however, AST showed satisfactory discrimination, AUC of 0.694. Conclusion Hepatic aminotransferases are useful in predicting in-hospital mortality in acute OP poisoning. ALT is the most specific biomarker. However, the reversed De Ritis ratio (ALT/AST) is the most sensitive one.

Prognostic factors of prolonged disorder of consciousness after stroke: A single centre retrospective study

BackgroundStroke is a common disease in neurology, which often causes prolonged disorder of consciousness (pDOC) and brings a heavy burden to the patient's family and society. This study aims to explore the epidemiological factors of pDOC after stroke and the factors affecting the outcome of consciousness. MethodThe patients that admitted in Tianjin Huanhu Hospital from January 2019 to December 2021 and met the inclusion criteria were selected. Descriptive statistics was initially performed on the relevant factors of the stroke group, and statistical analysis was subsequently performed. Finally, to judge the sensitivity and specificity of the significant factors to the prediction of outcome, the receiver operating characteristic (ROC) curve of the participants was used. ResultThe statistical results showed that the location of brain injury (λ2 = 7.550, P = 0.023), cerebral hernia (λ2 = 7.534, P = 0.006), and Glasgow Coma Scale (GCS) score at onset (t = −2.479, P = 0.017) were statistically significant indicators in the improvement of consciousness in patients with pDOC after stroke. The ROC curve showed that the sensitivity and specificity of predicting the outcome of brain injury site (area under the curve [AUC] = 0.766, 95% confidence interval [CI]: 0.708–0.824) were 0.50 and 0.90, respectively, and that of cerebral hernia (AUC = 0.663, 95% CI: 0.594–0.732) were 0.73 and 0.60, respectively. The GCS score (AUC = 0.660, 95% CI: 0.596–0.724) predicted the outcome with sensitivity and specificity of 0.35 and 0.92, respectively. ConclusionThe incidence rate of pDOC after stroke in men was higher than that in women, and the improvement rate in the consciousness level was significantly higher than that of ischemic–hypoxic encephalopathy. However, the improvement rate of the consciousness level in patients with pDOC after stroke was not related to age and gender. Cerebral hernia occurred at the time of onset, stroke occurred in the brainstem, and the low GCS score at the time of onset was significantly associated with the poor prognosis of consciousness level.

Early Electroencephalographic Features Predicting Cerebral Physiology and Functional Outcomes After Pediatric Traumatic Brain Injury.

We investigated whether early electroencephalographic features predicted intracranial pressure (ICP), cerebrovascular pressure reactivity, brain tissue oxygenation, and functional outcomes in patients with pediatric traumatic brain injury (TBI). This was a retrospective analysis of a prospective data set of 63 patients with pediatric TBI. Electroencephalographic features were collected in the first 24h of recording to predict values of ICP, pressure reactivity index (PRx), and brain tissue oxygenation (PbtO2) through the initial 7days of critical care monitoring, in addition to Glasgow Outcome Scale Extended-Pediatric Revision (GOSE-Peds) scores at 12months. Electroencephalographic features were averaged over all surface electrodes and included seizures, interictal epileptiform discharges, suppression percentage, complexity, the alpha/delta power ratio, and both absolute asymmetry indices and power in beta (13-20Hz), alpha (8-13Hz), theta (4-7Hz) and delta (0-4Hz) bands. Demographic data and injury severity scores, such as the Glasgow Coma Scale (GCS) and Pediatric Risk of Mortality III (PRISM III) scores, at presentation were also assessed. Univariate and multiple linear regression with guided stepwise variable selection was used to find combinations of risk factors that best explain variability in ICP, PRx, PbtO2, and GOSE-Peds values, and best fit models were applied to pediatric age strata. We hypothesized that suppression percentage and the alpha/delta power ratio in the first 24h of recording predict ICP, PRx, PbtO2, and GOSE-Peds values. Best subset model selection identified that increased suppression percentage and PRISM III scores predicted increased ICP (R2 = 79%, Akaike information criterion [AIC] = 332.30, root mean square error [RMSE] = 6.62), with suppression percentages < 5% (slope = - 5687.0, p = 0.0001) and ≥ 45% (slope = 9825.9, p = 0.0000) being predictive of dose of intracranial hypertension. When accounting for age and GCS score, increased suppression percentage predicted increased PRx values, suggestive of inefficient cerebrovascular pressure reactivity (R2 = 53%, AIC = 3.93, RMSE = 0.23), with suppression percentages ≥ 5% (p = 0.0033) and ≥ 45% (p = 0.0027) being predictive of median PRx values ≥ 0.3. Lower GCS scores, the presence of seizures, and increased suppression percentages each were independently associated with higher GOSE-Peds scores (R2 = 52%, AIC = 194.04, RMSE = 1.58), suggestive of unfavorable outcomes, with suppression percentages ≥ 5% (p = 0.0005) and ≥ 45% (p = 0.0000) being predictive of GOSE-Peds scores ≥ 5. At the univariate level, no electroencephalographic or clinical feature was associated with differences in PbtO2 values. Increased electroencephalographic suppression percentage on the initial day of monitoring may identify patients with pediatric TBI at risk of increased ICP, inefficient cerebrovascular pressure reactivity, and unfavorable outcomes.

Red cell distribution width and Glasgow coma scale score as predictors of in-hospital mortality in maintenance hemodialysis patients diagnosed with spontaneous intracerebral hemorrhage.

Glasgow Coma Scale (GCS) score is being widely used as a useful predictor to investigate patients with head injury. High red cell distribution width (RDW) values have been independently associated with mortality and poor neurological outcome. However, there are few data available for Spontaneous Intracerebral Hemorrhage (SIH) in maintenance hemodialysis (MHD) patients. This study aimed to evaluate the prognostic value of the combined measurement of RDW and GCS score in MHD patients with SIH. We retrospectively studied 46 MHD patients who was admitted to our hospital for nontraumatic SIH from October 2014 to May 2020. Data including demographic information, cause of renal failure, comorbidities at ESRD, clinical and laboratory parameters at admission were collected from medical records. Univariate and multivariate Logistic regression analysis were performed to identify independent risk factors of the in-hospital Mortality in Hemodialysis Patients with SIH. The receiver operating characteristic curve (ROC) and areas under the curve (AUCs) were determined. The sensitivity and specificity of independent risk factors were calculated for a range of different cutoff points. A total of 46 patients were enrolled in the study. The in-hospital mortality rate was 69.57%. We divided subjects into 2 groups based on the clinical outcomes. Compared with survivors (n = 14), non-survivors (n = 32) had longer hemodialysis vintage (P = .017), lower GCS score (P < .001), higher hemoglobin (Hb) (P = .032) and RDW (P = .009). In multivariate logistic regression analysis, GCS score (OR 0.719, 95% CI 0.546-0.946; P = .018) and RDW (OR 4.549, 95% CI 1.243-0.946; P = .018) were independent risk factors of in-hospital mortality in MHD patients with SIH. The area under the ROC curve (AUC) for GCS score was 0.849 (95% CI 0.729-0.970) while that for RDW was 0.743 (95% CI 0.596-0.891). The AUC for the combined prediction was 0.916 (95% CI 0.828-1.000), with a sensitivity of 90.63% and a specificity of 88.46%. In conclusion, high RDW and low GCS score were useful and independent poor prognostic markers for in-hospital mortality of MHD patients with SIH.

Hiponatremili hastalarda serum nöron spesifik enolaz düzeyleri ile beyin hasarı arasındaki ilişki

Purpose: In this study, we aimed to investigate the effects of serum neuron specific enolase on the prediction of central nervous system injury and the clinical course in patients to have hyponatremia.&#x0D; Materials and Methods: 75 adult patients with serum sodium levels less than 135 mEq/L were evaluated. The patients were grouped according to serum neuron specific enolase levels (group 1 ≤ 17.0 ng/mL and group 2 &gt; 17.0 ng/mL). The groups were compared according to demographic and laboratory data. &#x0D; Results: The incidence of hypertension, heart failure, and loss of consciousness was significantly higher in group 2 patient. High neuron specific enolase levels were related to lower serum sodium levels. The mean sodium levels were 129.5 ± 4.3 mEq/L and 126 ± 4.5 mEq/L in groups 1 and 2, respectively. Of the patients in group 2 (n = 45), 8 patients with loss of consciousness (low Glasgow Coma Scale scores) (i.e.

The effects of sensory stimuli on the rehabilitation of behaviourally low Glasgow Coma Scale patients

Patients can have low Glasgow Coma Scale scores for a variety of reasons, including traumatic brain injury, post traumatic amnesia, subarachnoid haemorrhage, or because of the location of a brain tumour or brain surgery. It can be exceedingly difficult for family members and loved ones to cope with this phenomenon, as, while their relative is alive, they are not the same person that they were prior to their brain injury or surgery and may no longer be able to communicate or carry out self-caring tasks. Therefore, it is optimal to enhance recovery and rehabilitation as much as possible to ensure the patient regains awareness and independence. Patients often spend the first few months post injury or surgery in an acute hospital setting before moving to a dedicated neurorehabilitation centre. This literature review explores the effect of sensory stimulation, such as music therapy and environmental stimuli, on the rehabilitation of low Glasgow Coma Scale patients.

Outcomes of patients admitted to the ICU for acute stroke: a retrospective cohort

BackgroundAlthough acute stroke is a leading cause of morbidity and mortality worldwide, data on outcomes of stroke patients requiring ICU admission are limited. We aimed to identify factors associated with a good neurological outcome (defined as a modified Rankin Scale score [mRS] of 0–2) 6 months after ICU admission.MethodsWe retrospectively studied consecutive patients who were admitted to the ICU of a French university-affiliated hospital between January 2014 and December 2018 and whose ICD-10 code indicated acute stroke. Patients with isolated subarachnoid hemorrhage or posttraumatic stroke were excluded.ResultsThe 323 identified patients had a median age of 67 [54.5–77] years; 173 (53.6%) were male. The main reasons for ICU admission were neurological failure (87%), hemodynamic instability (28.2%), acute respiratory failure (26%), and cardiac arrest (5.3%). At ICU admission, the Glasgow Coma Scale score was 6 [4–10] and the SAPSII was 54 [35–64]. The stroke was hemorrhagic in 248 (76.8%) patients and ischemic in 75 (23.2%). Mechanical ventilation was required in 257 patients (79.6%). Six months after ICU admission, 61 (19.5%) patients had a good neurological outcome (mRS, 0–2), 50 (16%) had significant disability (mRS, 3–5), and 202 (64.5%) had died; 10 were lost to follow-up. By multivariable analysis, factors independently associated with not having an mRS of 0–2 at 6 months were older age (odds ratio, 0.93/year; 95% confidence interval, 0.89–0.96; P < 0.01) and lower Glasgow Coma Scale score at ICU admission (odds ratio, 1.23/point; 95% confidence interval, 1.07–1.40; P < 0.01).ConclusionsAcute stroke requiring ICU admission carried a poor prognosis, with less than a fifth of patients having a good neurological outcome at 6 months. Age and depth of coma independently predicted the outcome.

Predictors of pneumonia in patients with acute spontaneous intracerebral hemorrhage in Algarve, Southern Portugal

IntroductionFollowing the hyperacute phase of spontaneous intracerebral hemorrhage (SICH), the severest form of stroke, pneumonia emerges as the leading cause of morbidity and mortality. Prevention of stroke associated pneumonia (SAP) is fundamental to improve the prognosis of SICH patients. AimIdentify clinical, sociodemographic and process of care factors associated with occurrence of SAP after SICH in Algarve, southern Portugal. MethodsObservational, retrospective study of community representative consecutive case series of patients with SICH admitted to the sole public hospital in the region. Logistic regression was used to identify predictors of SAP after SICH. ResultsA total of 525 patients were included. The mean age was 71 ( ± 13) years and 64% were men. SAP occurred in 165 (31.5%). Lower Glasgow Coma Scale score (GCS score): ≤ 8 (OR= 2.087; 95% CI= [1.027;4.424]; p = 0.042) and GCS 9–12 (OR= 1.775; 95% CI= [1.030;3.059]; p = 0.039); prolonged emergency room stay (OR= 8.066; 95%CI=[3.082;21.113]; p < 0.001) and hyperactive delirium (OR=2.860; 95% CI= [1.661;4.925]; p < 0.001) increased the likelihood of SAP. Being younger, ≤ 59 years (OR= 0.391; 95% CI= [0.168; 0.911]; p = 0.029) and 60–71 years (OR= 0.389; 95% CI= [0.185; 0.818]; p = 0.013); and having less severe SICH/intracerebral hemorrhage score (ICH score) ≤ 2 (OR=0.601; 95% CI= [0.370; 0.975]; p = 0.039), decreased the risk of SAP. ConclusionAfter SICH, SAP occurs in approximately a third of patients. Non preventable (admission severity, ageing) and potentially preventable (prolonged emergency room stay, hyperactive delirium) determine the occurrence of SAP. Intensification of preventive intervention in high-risk patients, delirium prevention and improvement of the process of care can potentially reduce the occurrence of SAP after SICH.

The predictors of mortality in patients with methyl alcohol intoxication

Aim: Methanol intoxication is a worldwide public health problem. Mortality rates are quite high unless there is early intervention and diagnosis. The aim of this study was to investigate the predictors of mortality in patients with methyl alcohol intoxication. Material and Method: The study included 18 patients admitted to emergency department of our hospital in 2019-2020, who were diagnosed with methanol intoxication. Laboratory parameters and basic features of the patients were recorded. According to the criteria of 2012 Clinical Practice Guideline for Acute Kidney Injury (AKI), patients were diagnosed with AKI. Results: The mean age of the patients was 45.7±15.21 years and 72.2% of those were male. The mortality and AKI rate were 38.9% and 44.4%, respectively. In regression analyses, delay in admission to hospital, low Glasgow coma scale score, AKI development and high lactate level were independent predictors of mortality. According to ROC analyses when lactate level was more than 5.75 mmol/L, mortality rate increased more rapidly. Conclusion: Mortality rate is very high in methanol intoxication. Patients with AKI and high lactate levels should be intervened faster.

A Retrospective Cohort Study on the Clinical Characteristics of Patients with Surgical Blunt Bowel and/or Mesenteric Injuries among Motorcyclists and Car Occupants.

(1) Background: Surgical blunt bowel and/or mesenteric injuries (BBMIs) are rare but challenging for trauma surgeons. Surgical BBMI is associated with specific injury mechanisms, such as direct compression by the handlebar in motorcycle accidents or rapid acceleration and deceleration of the impact forces associated with seatbelt injuries in motor vehicle collisions. However, the discussions on the implications of BBMI and the mechanisms of road traffic accidents remain scarce. This retrospective study assessed the clinical and injury characteristics of surgically proven BBMI among motorcyclists and car occupants based on trauma-registered data obtained from a level I trauma center in Taiwan. (2) Methods: Medical data of 72 motorcyclists and 38 car occupants who had surgical BBMI between January 2009 and December 2020 were reviewed. Patient characteristics, injuries, and outcomes in both groups were compared and analyzed. (3) Results: Motorcyclists with surgical BBMI had a significantly higher Injury Severity Score (median [Q1–Q3], 18 (9–27) vs. 16 (9–18), p = 0.044) and lower Glasgow Coma Scale score (15 (11–15) vs. 15 (15–15), p = 0.034]) than car occupants. Motorcyclists with surgical BBMI had a higher incidence of pelvic fractures (18.1% vs. 2.6%, p = 0.032) and upper limb fractures (23.6% vs. 7.9%, p = 0.042) and a significantly higher rate of chest tube insertion than car occupants (29.2% vs. 10.5%, p = 0.027). However, there were no significant differences in the outcomes of morbidity and mortality between motorcyclists and car occupants with surgical BBMI. (4) Conclusions: This study demonstrated there were no significant differences in outcomes between motorcyclists and car occupants with surgical BBMI. However, motorcyclists with surgical BBMI were injured more severely, along with injuries to the head/neck and extremities, than car occupants.

A Man With Severe Chest Pain after a Motor Vehicle Crash

A 56-year-old man with shortness of breath, severe chest pain, and cold sweats after a motor vehicle crash presented to the emergency department (ED). He had low blood pressure (80/54 mm Hg), tachycardia (118 beats/min), and low Glasgow Coma Scale score (E3V4M5). He was intubated immediately on arrival because of shock. Extended focused assessment with sonography for trauma showed no hemopneumothorax, pericardial effusion, or intra-abdominal free fluid. Portable chest radiography was performed (Figure 1).

The Prognostic Roles of Perihematomal Edema and Ventricular Size in Patients with Intracerebral Hemorrhage.

Conflicting data exist regarding the association of perihematomal edema (PHE) with outcomes after intracerebral hemorrhage (ICH). We performed a post hoc analysis of the ICH Deferoxamine trial to examine whether an early change in ventricular size (VS), as a composite measure of PHE growth and mass effect, intraventricular hemorrhage, and hydrocephalus, is a more accurate predictor of outcome than PHE measures alone. Computerized tomography scans were performed at baseline and after 72-96h. We evaluated measures of PHE and change in VS as predictors of outcome, assessed by a dichotomized modified Rankin Scale score (0-2 versus 3-6), primarily at 90days and secondarily at 30days. A multivariable logistic regression model was fitted for each predictor, with adjustment for the same confounders. A total of 248 participants were included after we excluded those requiring external ventricular drains. On univariate analyses, older age, female sex, lower Glasgow Coma Scale score and baseline temperature, greater ICH volume, absolute PHE volume, edema extension distance at presentation, lesser changes in relative PHE volume and edema extension distance, and an increase in VS were associated with poor outcome. In multivariable analyses, only the increase in VS was associated with lower odds of modified Rankin Scale scores 0-2 at 90days (odds ratio 0.927, 95% confidence interval 0.866-0.970, p = 0.001) and 30days (odds ratio 0.931, 95% confidence interval 0.888-0.975, p = 0.003). Within the context of a randomized controlled trial with standardized imaging and functional assessments, we did not find significant associations between measures of PHE and outcome but documented an independent association between early increase in VS and lower odds of good clinical outcome.