Lower Glasgow Coma Scale Score Research Articles

Longitudinal Patterns of Functional Connectivity in Moderate-to-Severe Traumatic Brain Injury.

Longitudinal neuroimaging studies aid our understanding of recovery mechanisms in moderate-to-severe traumatic brain injury (TBI); however, there is a dearth of longitudinal functional connectivity research. Our aim was to characterize longitudinal functional connectivity patterns in two clinically important brain networks, the frontoparietal network (FPN) and the default mode network (DMN), in moderate-to-severe TBI. This inception cohort study of prospectively collected longitudinal data used resting-state functional magnetic resonance imaging (fMRI) to characterize functional connectivity patterns in the FPN and DMN. Forty adults with moderate-to-severe TBI (mean ± standard deviation [SD]; age = 39.53 ± 16.49 years, education = 13.92 ± 3.20 years, lowest Glasgow Coma Scale score = 6.63 ± 3.24, sex = 70% male) were scanned at approximately 0.5, 1-1.5, and 3+ years post-injury. Seventeen healthy, uninjured participants (mean ± SD; age = 38.91 ± 15.57 years, education = 15.11 ± 2.71 years, sex = 29% male) were scanned at baseline and approximately 11 months afterwards. Group independent component analyses and linear mixed-effects modeling with linear splines that contained a knot at 1.5 years post-injury were employed to investigate longitudinal network changes, and associations with covariates, including age, sex, and injury severity. In patients with TBI, functional connectivity in the right FPN increased from approximately 0.5 to 1.5 years post-injury (unstandardized estimate = 0.19, standard error [SE] = 0.07, p = 0.009), contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury (estimate = -0.21, SE = 0.11, p = 0.009), and marginally declined afterwards (estimate = -0.10, SE = 0.06, p = 0.079). Functional connectivity in the DMN increased from approximately 0.5 to 1.5 years (estimate = 0.15, SE = 0.05, p = 0.006), contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury (estimate = -0.19, SE = 0.08, p = 0.021), and was estimated to decline from 1.5 to 3+ years (estimate = -0.04, SE = 0.04, p = 0.303). Similarly, the left FPN increased in functional connectivity from approximately 0.5 to 1.5 years post-injury (estimate = 0.15, SE = 0.05, p = 0.002), contained a slope change in the opposite direction, from positive to negative at 1.5 years post-injury (estimate = -0.18, SE = 0.07, p = 0.008), and was estimated to decline thereafter (estimate = -0.04, SE = 0.03, p = 0.254). At approximately 0.5 years post-injury, patients showed hypoconnectivity compared with healthy, uninjured participants at baseline. Covariates were not significantly associated in any of the models. Findings of early improvement but a tapering and possible decline in connectivity thereafter suggest that compensatory effects are time-limited. These later reductions in connectivity mirror growing evidence of behavioral and structural decline in chronic moderate-to-severe TBI. Targeting such declines represents a novel avenue of research and offers potential for improving clinical outcomes.

Awareness Among the Patients Under General Anesthesia: A Cross-Sectional Study.

Introduction Unless specifically asked, many patients may be hesitant to discuss their experiences. Some people might not recall what happened right after surgery, but they might remember it 1-2 weeks later. We undertook the current study to estimate the incidence of awareness among patients under general anesthesia (GA). Methodology We conducted a cross-sectional, analytical study for three months. The study included patients who underwent functional endoscopic sinus surgery(FESS), septoplasty, mastoidectomy, or laparoscopic appendicectomy under general anesthesia. Patients who refused to take part and had lowGlasgow Coma Scale(GCS) scores (less than 9)or didn't meet extubation criteria were all excluded from the study. We used a pre-validated semi-structured questionnaire for data collection. It had two sections. The first one includes demographic details, and the second section contains the modified Bricequestionnaire. By using this questionnaire, we classified the patients as A, B, and C. Class A experiences are those that were remembered under anesthesia or surgery and were confirmed or disproved by the attending medical personnel present in the operating room. Class B, which stands for "potential awareness," was defined as a state in which the patient could not specifically recollect any occurrence that occurred during anesthesia or surgery but could have made connections between memories and the surgical procedure. We define Class C as a lack of recalled intraoperative events with probable memories of scenarios from the immediate pre- or postoperative period. We analyzed the data collected using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results About 240 patients took part in this study. Most of the people (68%) were men in the age group of 31 to 50 years. About 2% of the patient's experience awareness during general anesthesia. Only 2.5% of patients experienced dreaming. The association between awareness and comorbidity was statistically significant (P < 0.001). Conclusion It is about to know that our study results suggest that awareness had an association with comorbidity among the patients undergoing surgery under general anesthesia.

Analysis of Clinical Characteristic and Risk Factors for Short-Term Prognosis of Moyamoya Disease with Intraventricular Hemorrhage in Adults

Intraventricular hemorrhage (IVH) is the most common type of hemorrhage in moyamoya disease (MMD) with intracerebral hemorrhage (ICH), but the risk factors affecting the short-term prognosis of MMD with IVH in adults are still unclear. We retrospectively analyzed patients of MMD with IVH between January 1, 2018 and January 31, 2020 in the First Affiliated Hospital of Zhengzhou University. According to the modified Rankin Scale (mRS) score at 3 months after discharge, the patients were divided into mRS score ≤2 (good prognosis) group and mRS score >2 (poor prognosis) groups. Univariate and multivariate logistics regression analysis was used to analyze the risk factors affecting the short-term prognosis of adult MMD with IVH. Univariable analyses showed that patients in the poor prognosis group had a significantly older age of onset (48.48 ± 8.34 vs. 43.74 ± 5.44 years; P= 0.002), ahigher percentage of hypertension (57.97% vs. 33.33%; P= 0.014), a higher percentage of tracheotomy (23.19% vs. 2.56%; P= 0.005), a lower Glasgow Coma Scale (GCS) score (7.90 ± 3.58 vs. 11.19 ± 2.56; P= 0.000), a higher Graeb score (7.46 ± 4.04 vs. 5.23 ± 1.93; P= 0.002), and treatment methods (P= 0.000). Multiple logistic regression analysis showed that the lower GCS score (odds ratio [OR],1.761; P= 0.001) and higher Graeb score (OR, 1.767; P= 0.002) were independently associated with the poor prognosis of MMD with IVH, and surgery treatment (OR,0.032; P= 0.000) was independently related to the good prognosis of MMD with IVH. Among patients with MMD with IVH, the lower GCS score and higher Graeb score are independent risk factors for poor prognosis, whereas in patients with MMD with IVH, surgery treatment acts as a protective factor.

Retrospective Evaluation of Patients with Spontaneous Intracerebral Hematomas

To investigate the relationship among the modified Rankin scores of patients who had intracerebral hematomas at discharge, demographic characteristics of the patients, and the characteristics of the hematoma. In this study, patients diagnosed with intracerebral hematoma and treated at the Ministry of Health Ankara Training and Research Hospital Neurosurgery Clinic between January 2010 and December 2020 were examined retrospectively. The age, gender, comorbidity, anticoagulant?antiaggregant use, and Glasgow Coma Scale score of the patients were obtained from hospital records. The modified Rankin scale (mRS) was used to assess patients at discharge. Herein, a total of 114 patients with supratentorial intracerebral hematoma were evaluated. The modified Rankin score ranged from 0 to 6, with a mean score of 3.47 ± 2.26. When the patients were evaluated based on their discharge status, the mortality rate was 33.3% (n=38). Fifty percent of the patients who used anticoagulant?antiaggregant died. High mRS scores were seen more frequently in advanced age. Among the other diseases of the patients, hypertension and the use of anticoagulant? antiaggregant were found to be statistically significant with high mRS scores (p < 0.001). Patients with low Glasgow Coma Scale score at the time of admission had significantly higher mRS scores (p < 0.001). Patients with advanced age, hypertension, and anticoagulant?antiaggregant use had a higher mRS score after hematoma formation. Preventable risk factors for spontaneous intraparenchymal hematomas are among the leading causes of disability, and early detection and treatment of underlying diseases are critical for hematoma prevention. Awareness about risk factors should be the priority to improve early diagnosis and reduce treatment disability rates.

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.

Intraoperative blood flow monitor for aneurysm clipping

Background: Both indocyanine green videoangiography (ICG-VA) and flowmetry were considered beneficial in preventing parent artery compromise during aneurysm surgery. However, the appropriate strategy that should be used remains controversial. The objective of the study is to assess the outcomes of aneurysm clipping through flowmetry or ICG-VA monitoring. Materials and Methods: This retrospective cohort study included 75 patients who underwent aneurysm clipping with vascular patency monitoring. In total, 42 patients underwent flowmetry monitoring and 33 ICG-VA monitoring. Preoperative disease severity and functional outcomes were assessed using the World Federation of Neurosurgical Societies (WFNS) grading system and the modified Rankin scale, respectively. Results: As compared with ICG-VA, flowmetry group had nonsignificant higher incidence of clip modification (31.7% vs. 18.2%, P = 0.29) and residual neck (22% vs. 10%, P = 0.218). Besides Fisher grade, flowmetry monitoring (Crude odds ratio [OR] = 0124, P = 0.015), young age, and anterior communicating artery location were the independent risk factors for vasospasm based on multivariate analysis. The incidence of parent artery compromise did not differ between both groups. Old age, poor preoperative WFNS grade, low Glasgow coma scale (GCS) score, left-side location, and long hospital stay were associated with poor functional outcomes in the univariate analysis. However, only the GCS score was considered a prognostic factor in the multivariate analysis (Adjusted OR = 0.03, P = 0.034). Conclusion: Both monitoring methods have similar functional outcomes. Although not influencing outcome, the flowmetry group has a higher incidence of angiographic vasospasm than the ICG-VA group. The vessel preparation for flowmetry monitoring is more complicated than that for ICG-VA; thus, we recommend ICG-VA for routine monitoring. Flowmetry may be applicable in distal aneurysms when hemodynamic insufficiency in a parent artery is suspected.

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.