Moderate Head Injury Patients Research Articles

Pengaruh Pemberian Posisi Head Up 30° Terhadap Tingkat Kenyamanan Pasien Cedera Kepala Di Ruang Instalasi Gawat Darurat RSUD Tidar Kota Magelang: Case Report

Background: Head injury is a pathophysiological event that occurs after trauma to the head which can cover every part of the head consisting of the scalp, bones and brain tissue or all the organs in the head. Objective: To determine the effect of providing Head Up 30⁰ position on the comfort level of head injury patients. Method: The method in this research is to use a case report with the nursing intervention of providing a Head Up 30⁰ position to the comfort level of head injured patients, carried out for 4 observations every 15 minutes. Results: From the results of the research, nursing intervention was carried out, namely by providing Head Up 30⁰ position for 4 observations every 15 minutes. The results showed that there was a change in comfort level before and after Head Up 30⁰ position was carried out. Conclusion: Based on the results of research conducted by researchers regarding the effect of providing Head Up 30⁰ position on the comfort level of head injury patients in instalation emergency RSUD Tidar, Magelang City obtained from the results of case study research through intervention, it can be concluded that Head Up 30⁰ therapy has an effect on changes. comfort level of mild to moderate head injury patients with changes in oxygen saturation values increasing, intracranial pressure decreasing, and pain scale decreasing.

Cerebral Perfusion and Functional Outcome in Pediatric Head Injury Patients.

To evaluate the usefulness and degree of perfusion abnormalities in pediatric head injury patients by using computed tomography perfusion (CTP) and to assess its co-relation with neurologic outcome based on Glasgow Outcome Scale Extended Pediatric revision (GOSE-P). Prospective evaluation of pediatric head injury patients who were taken for CTP after admission and then on discharge. We evaluated 5 regions of interest: orbitofrontal cortex, internal capsule, thalamus, caudate nucleus, and sensorimotor cortex for cerebral blood perfusion. The patient's clinical and radiologic findings were analyzed, correlated with cerebral blood flow (CBF) and MTT (mean transient time), and the outcome assessed using the GOSE-P scale on 3-month follow-up. Both CBF and MTT showed a correlation with the GOSE-P scale. In mild head injury patients, the Pearson correlation of GOSE-P with mean CBF and mean MTT was -0.11 and 0.56, respectively (P < 0.05) in the sensorimotor cortex; in moderate head injury patients the Pearson correlation of GOSE-P with mean CBF in the caudate nucleus and mean MTT in the internal capsule was -0.32 and 0.36, respectively (P < 0.05); and in severe head injury patients, the Pearson correlation of GOSE-P with mean CBF and mean MTT was -0.78 and 0.56, respectively (P < 0.05) in the caudate nucleus, which had the highest Pearson co-relation among the regions studied. We conclude that CBF and MTT are 2 important radiologic parameters that can be used as prognostic indicators in pediatric head injury patients.

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.&#x0D; 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.&#x0D; 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).&#x0D; Conclusion. RNL can predict outcomes in moderate head injury patients with intracerebral hemorrhage.

Comparison of Lymphocyte Neutrophil Ratio in Head Injury Patients with Blood and without Intracranial Bleeding in Dr. M. Djamil Hospital

A B S T R A C TBackground: Head injuries occur every 15 seconds worldwide, with patientsdying every 12 minutes. The value of the Neutrophil Lymphocyte Ratio (NLR) is afactor that influences the assessment and prognostic value of patients withintracranial hemorrhage and without intracranial hemorrhage in head injury.The aim of this study was to determine the relationship between increased NLRbased on the severity of head injury patients with or without intracranialhemorrhage. Methods: This study is a retrospective cross sectional study of headinjury patients with hemorrhage and without intracranial hemorrhage who weretreated at Dr. M. Djamil Hospital Padang in 2020 from May to December 2020.Data was collected in the Medical Records Department of Dr. M. Djamil HospitalPadang who met the inclusion and exclusion criteria. Results : A total of 92patients were included in the inclusion criteria for this study. The results showedthat the mean NLR value in head injury patients was 11.72 with a variation of7.31. The mean NLR level based on the severity of mild head injury was 10.15with a variation of 6.38. The mean NLR level of moderate head injury severity was12.70 with a variation of 7.09. The mean NLR level of severe head injury, was14.69 with a variation of 9.30. The results showed that there was no difference inthe mean of NLR levels in mild head injury patients with hemorrhage and withoutintracranial hemorrhage. The results showed that there was a significantrelationship between NLR levels in moderate head injury patients withhemorrhage (14.20) and without intracranial hemorrhage (7.20) (p value = 0.029),whereas in severe head injury it could not be assessed because there was nosample without hemorrhage. Conclusion: There is an association betweenincreased NLR and intracranial bleeding in moderate head injury patients

PENGARUH PEMBERIAN OKSIGEN DAN ELEVASI KEPALA 30º TERHADAP TINGKAT KESADARAN PADA PASIEN CEDERA KEPALA SEDANG

Head injury is directly or indirectly mechanical injuries that resulted wound in the scalp, skull fracture, tear the lining of the brain, and brain damage, and neurological disorders. The basic method for brain protection of head injury patients are freeing the airway and giving adequate oxygenation. Giving oxygen and headv elevation 30° of head are the appropriate action for the moderate head injury classification to launch the cerebral oxygen perfusion and to increase consciousness level. The purpose of this research were to determine the GCS before and after giving oxygenation with and position 30 ° of head and to analyze the effect of giving oxygen and headv elevation30 °of head to change the levels of consciousness of moderate head injury patients. This research was an Quasi-Experimental study with 10 respondents. The test were used Paired Sample T-test Test. The results showed that there was an effect of giving oxygen and headv elevation 30 °of head toward to change the level of consciousness of moderate head injury patients. GCS average value before was 10.10 and GCS average after 12.90 value was with p value was 0.000. &#x0D; &#x0D; Keywords : Levels of Consciousness GCS, Moderate Head Injury, Position 30° of the Head

Trauma-induced coagulopathy: Incidence and outcome in patients with isolated traumatic brain injury in a level I trauma care center in India

Context:Trauma-induced coagulopathy (TIC) is life-threatening in head injury patients, and there is a lack of Indian data on its incidence and outcome.Aims:In this study, incidence and outcome related to coagulopathy were assessed in patients with moderate-to-severe isolated traumatic brain injury (iTBI).Settings and Design:A prospective observational study carried out in patients admitted within 24 h of injury.Materials and Methods:One hundred patients with moderate-to-severe iTBI were included. Samples for coagulation tests (prothrombin time [PT], PT index [PTI], international normalization ratio [INR], activated partial thromboplastin time, and platelet count) were collected at 5 points of time for 72 h. TIC was diagnosed if any three readings were abnormal during this period. Patients were also followed up posthospital discharge using the Glasgow Outcome Score (GOS) at 1 and 3 months.Statistical Analysis:Data were analyzed using SPSS ver. 21. Logistic regression analysis was employed to determine individual coagulation test as best predictors for mortality. P < 0.05 was considered statistically significant.Results:The incidence of TIC was found to be 62%; it was 63.75% in severe head injury and 55% in moderate head injury patients. Deranged INR at the time of hospital admission (odds ratio [OR] 4.38) and PTI at 24 h (OR 3.913) are highly predictive of mortality. There was no significant difference in GOS score at 1 and 3 months.Conclusions:The incidence of TIC in our study was 62% among iTBI patients. It contributes to increased mortality at 1 and 3 months. However, the neurological outcome was not different in between the groups.

Effect of Progesterone Versus Erythropoietin on Neurological Outcome after Traumatic Brain Injury

AbstractBackground: Traumatic Brain Injury (TBI) is a global health problem. Preclinical trials in animals shows that early injection of progesterone after experimental TBI decreased brain edema, neuronal loss, and behavioral deficits. Erythro-poietin (EPO) attenuates TBI due to its neuroprotective actions and its effect on erythropoiesis.Aim of Study: The aim of this study was to evaluate the effect of progesterone hormone versus erythropoietin on neurological outcome of patients with moderate traumatic brain injury.Material and Methods: The patients were randomly as-signed to 3 equal groups (35 in each group). Group C (control): Standard care and treatment. Group P (progesterone): Standard care + progesterone 1mg/kg IM and then once/12 hours for 5 consecutive days. Group E (erythropoietin): Standard care + EPO IV 40,000IU within 6hr of the time of injury. The modified Marshall CT scan classification: Was obtained at admission and day 7. GCS: Daily evaluations over the initial 14-day period, adverse experiences, surgical procedures, intracranial complications and intake & output of fluids were recorded. Disability Rating Scale (DRS) were measured on admission and after 1 Mon., length of ICU & hospital stay and complications were measured.Results: There was statistically significant increase in GCS in group P compared to group C and E. There was statistically significant improvement in DRS in group P compared to group C and E on admission and after one month. There was statistically significant decrease in the length of ICU and hospital stay in group P compared to group C and E.Conclusion: Progesterone hormone and erythropoietin improved neurological outcome in moderate head injury patients in the form of improvement in GCS and DRS and decrease in the length of ICU and hospital stay with better outcome in progesterone in comparison with erythropoietin.

Computed tomography predictors for in-hospital mortality in severe and moderate head injury patients

Background:Traumatic brain injury is single leading cause of death and disability following injury. Clinical information collected at baseline and computed tomography (CT) brain scan findings may predict in-hospital mortality rate. The aim of this study was to evaluate which features on the admission CT scan might add significantly to other baseline clinical information for predicting mortality in patients with head injury.Methods: Baseline CT scans were reviewed for patients with moderate and severe head injuries from head injury registry from October 2007 to October 2009. Baseline demographic and injury status and outcome at discharge or death were recorded. Details from the CT scan using marshals grading was used along with other CT scan findings. CT characteristics like diffuse cerebral edema, mass lesions like extra dural haemotoma, subdural haemotoma, intra parenchymal haemorrhage, traumatic sub arachnoid haemorrhage, intra ventricular haemorrhage, basal cisterns, midline shift were evaluated. All the patients were classified into marshalls divisions. If required repeated scans were evaluated and the worst CT scan has been taken into consideration. Results:211 CT scans were read from patients with moderate severe head injuries. Out of the 24 patients in grade I, 4 died accounting for 16.666%. In grade II out of 47 patients 9 died accounting for 19.148%. In grade III out of 24 patients 5 died accounting for 20.833%. In grade IV out of 30 patients 11 died accounting for 36.666%. In grade V out of 76 patients 20 died accounting for 27.631%. In grade VI out of 10 patients 6 died accounting for 60%. In this study of 211 patients 55 died accounting for 26.06%.Conclusions:Marshall`s CT grading holds good for mortality prediction in moderate and severe head injury patients. Status of basal cisterns and midline shift serves as independent predictors for in-hospital mortality.

Skandinaviske retningslinjer for akutt håndtering av voksne pasienter med minimal, lett eller moderat hodeskade

BACKGROUND In 2000, the Scandinavian Neurotrauma Committee (SNC) published evidence-based guidelines for the management of minimal, mild or moderate head injuries. Since then, considerable new evidence has emerged on the clinical use of these guidelines and on the radiation risks associated with computer tomographic (CT) examinations. The SNC has recently published updated Scandinavian guidelines. Here we present the Norwegian version of the updated guidelines with emphasis on the professional recommendations and the reasons the new guidelines were necessary, plus comments from the Norwegian authors.MATERIALS AND METHODS A task force appointed by the SNC compiled recommendations based on a systematic, evidence-based review. These recommendations were revised through consensus in the SNC and through consultation with relevant clinical experts.RESULTS A blood test of the brain injury biomarker S100B is for the first time recommended as an initial diagnostic measure for mild head injury patients with low risk. Of these patients, CT examination is only recommended for those who show a pathologically elevated S100B. CT examination is still the recommended routine for moderate head injury patients and for mild head injury patients with medium to high risk. An updated information sheet on head injuries has also been compiled for patients and their relatives.CONCLUSION The SNC recommends the implementation of these guidelines in Norway.

Evaluation of the Scandinavian guidelines for head injuries based on a consecutive series with computed tomography from a Norwegian university hospital

BackgroundThis study prospectively assesses clinical characteristics and management of consecutive minimal, mild and moderate head injury patients referred for CT scans. Compliance with the Scandinavian head injury guidelines and possible reasons for non-compliance is explored.MethodsFrom January 16th 2006 to January 15th 2007, 1325 computed tomography (CT) examinations due to minimal, mild or moderate head injury according to the Head Injury Severity Scale (HISS) were carried out at our University Hospital. When ordering a CT scan due to head trauma, physicians were asked to fill out a questionnaire.ResultsGuideline compliance was impossible to assess in 49.5% of all cases. This was due to non-assessable or missing key variables necessary in the decision making algorithm. One or more key variables for HISS classification were not assessable in 34.4% as it was unknown whether there had been loss of consciousness (LOC), duration of LOC was unknown or it was impossible to assess amnesia or focal neurologic deficits. Definite compliance with both CT and admittance recommendations in guidelines was seen in only 31.2%. In 54.2% of patients with minimal head injuries who underwent CT scans, imaging was not necessary according to guidelines. 59.1% of all patients were admitted to hospital, however only 23.7% of these were admitted because of the head-injury alone. Age < 4 years, possible medical cause of injuries, severe headache/nausea or vomiting and the presence of non-traumatic CT findings were independently associated with non-assessable compliance with Scandinavian guidelines. Suspicion of influence of alcohol was inversely associated to non-compliance.ConclusionsDespite the prospective study design, guideline compliance was not assessable in nearly half of the patients. Patients with isolated head injuries and available and obtainable complete clinical information necessary for guideline-based decision making are not dominating in a head injury population.

Single photon emission computed tomography evaluation in patients with mild to moderate head injury

Head injury is a major cause of disability and death in adults. The commonest pathological substrate in patients dying with blunt head injury is ischemic brain damage. Evaluation of cerebral perfusion is currently not a standard practice. We reviewed the medical records of 40 patients with Mild & Moderate Head Injury (GCS 9–14) who had 43 SPECT brain perfusion studies (Tc99m-ECD). They were evaluated in relation to GCS, NCCT (TCDB) grading, timing of scan and other factors. It was found that some degree of hypoperfusion in SPECT was noted in most, with moderate head injury patients having more severe hypoperfusion than those with mild head injury. Also, hypoperfusion was more marked during the first 24 hours of injury. In univariate analysis of various factors on the outcome, severe hypoperfusion and moderate/severe hypoperfusion emerged as significant predictors of unfavourable outcome (P values 0.05 and < 0.001 respectively). With respect to the area of hypoperfusion, parietal involvement had more impact on neurological outcome than other areas (P = 0.07). Bilateral involvement and other factors had no significant relationship with outcome. In multivariate analysis using binary logistic regression, severe hypoperfusion was found to have significant effect on outcome independent of GCS, CT category and timing of SPECT (P=0.02).

Relationship between markers of lipid peroxidation, thiol oxidation and Glasgow coma scale scores of moderate head injury patients in the 7 day post-traumatic period

Objective: Epidemiologic works reveal that moderate head injury (MHI) is more frequent and a substantial number of these patients develop complications resulting in neurological disabilities. Reactive oxygen species (ROS) play a major role in post-traumatic neuronal damage following traumatic head injury. Thus, the current study analysed the post-traumatic changes in the erythrocyte markers of oxidative damage and the relationship between these parameters and Glasgow coma scale (GCS) scores of MHI patients during the 7 day study period.Methods: Peripheral venous blood samples were taken at the time of hospital admission (d1 of injury) and on d7 from 25 MHI patients (admission GCS score>8). These were compared with samples from 25 healthy individuals (normal controls, NC). GCS scores were recorded at the same time points of the study period. Erythrocyte lipid peroxidation (LP) and thiol oxidation levels were estimated and compared with that of NC. The relationship between GCS scores and erythrocyte markers were also studied.Results: Erythrocyte thiobarbituric acid reactive substance (TBARS) levels reflecting lipid peroxidative damage remained significantly elevated at both time points of the study period in MHI patients as compared to NC (p<0.001). There was a significant decrease in the level of non-protein thiols in MHI patients as compared to NC (p<0.01) at the same time points of the study. However, on d7 there were no further significant changes in the markers of oxidative damage in MHI patients as compared to on d1.Conclusion: These findings suggest that a condition of oxidative stress occurs during the entire post-traumatic period in MHI patients and the utility of markers of oxidative damage in the prognosis of head injury needs to be addressed in further works.

Role of invasive ICP monitoring in patients with traumatic brain injury: An experience of 98 cases

The outcome of patients with head injury depends upon several factors, and most important among them is the raised intracranial pressure. ICP monitoring using subdural Richmond bolt system was used in 98 cases of TBI. The age range was 9–75 years; there were 78 adults and 20 children. This included 52 cases of severe HI and 46 cases with moderate HI.The GCS range was 4–10(mean: 5.6). Mortality was 64% in severe HI (34/52) and 9.5% in moderate HI patients (4/42). ICP ranged from 6–28mm Hg in moderate HI (mean 11.6 mm) and 8–42mm Hg in severe HI (mean 19.6 mmHg). Of 98 cases of HI, 41(41.8%) patients were operated (26 had moderate HI and 15 cases had severe HI. Seventy-three (74.5%) cases had single/multiple contusions in frontal/temporal regions while 25/73(25.5%) patients had diffuse axonal injury (10 cases) and thin subdural hematoma (15 cases). Fifty-seven patients were managed conservatively with decongestants, elective ventilation and continuous ICP monitoring for 3 days. Of these, 16(43%) had moderate HI and 41(71%) cases had severe HI. In the absence of intracranial hypertension (ICP <10 mm Hg), good recovery (Glasgow outcome scale: 4–5) was noted in 8/57(14%) cases in conservative group and in 4/41(9.7%)cases in operative group. In patients with ICP in 11–20 mm range, good recovery was noted in 6/41(14.6%) patients in operative group and in 9/ 57(15.8%) patients managed conservatively. When the ICP was >20 mm Hg, 10/41(24.3%) operated patients expired while only 6/57(10.5%) patients in conservative group expired. ICP malfunction after day 1 was noted in 27 cases ((27.5%) while ICP site infection/CSF leak was noted in 8 cases (8.2%). Outcome was related to severity of head injury and intracranial hypertension. Outcome was better in patients of moderate HI after surgery than in severe HI patients. Mortality was higher in patients operated in the presence of intracranial hypertension than in those managed conservatively. ICP monitoring was associated with a high blockage (27.5%) and infection rate (8.2%). ICP monitoring improved overall outcome in moderate head injury patients.

Effect of CP101,606, a novel NR2B subunit antagonist of the N-methyl-D-aspartate receptor, on the volume of ischemic brain damage off cytotoxic brain edema after middle cerebral artery occlusion in the feline brain.

The purpose of this study was to test the hypothesis that the neuroprotective compound CP101,606 will ameliorate the increase in lactate, retard the development of cytotoxic edema, and decrease the infarct volume after ischemic stroke. Seventeen adult cats were allocated to control (n = 7) and CP101,606-treated groups (n = 10). Transorbital middle cerebral artery occlusion was performed under anesthesia. Extracellular fluid lactate by microdialysis as well as infarct volume measurement by triphenyltetrazolium chloride (TTC)-stained section, with and without neuroprotective agents, was used to determine the value of these potential "surrogate markers" of ischemic damage. The control group showed an increased dialysate lactate (15.5% increase) at 30 minutes and a peak (332.0% increase) in dialysate lactate at 1 hour after middle cerebral artery occlusion compared with the drug-treated group. Significant differences between control and drug-treated groups were seen in the rate of fall of the apparent diffusion coefficient at both 1 and 5 hours. A close correlation was seen between the 1- and 5-hour apparent diffusion coefficient maps and the TTC-stained sections. There was a significantly smaller lesion in the CP101,606-treated group (62.9% reduction in infarct size compared with the control group; P < .001). CP101,606 ranks very highly among the current neuroprotection candidates for clinical trials, and its excellent safety record in both animals and phase II studies in conscious, moderate head injury patients suggests that it will be highly effective in human occlusive stroke.

Moderate head injury: completing the clinical spectrum of brain trauma.

We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3-8; moderate, 9-12; and minor, 13-15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow-up examinations at 3 months. In contrast to patients with minor head injury, half as many were students (17%) and twice as many were intoxicated (53%). Seventy-five patients were studied with computed tomographic (CT) scanning; 30% of the scans were negative and 31% showed a space-occupying mass. As reported by Gennarelli et al. in patients with severe head injuries, those with moderate head injury and subdural hematoma had a very poor outcome: 65% died or were severely disabled and none made a good recovery as measured by the Glasgow Outcome Scale. At 3 months, 38% of the moderate head injury patients had made a good recovery compared with 75% of the minor head injury patients. Within the good recovery category, however, there was much disability (headache, 93%; memory difficulties, 90%; difficulties with activities of daily living, 87%), and only 7% of the patients were asymptomatic. The Halstead-Reitan Neuropsychological Battery in an unselected subset (n = 32) showed significant deficits on all test measures. Sixty-six per cent of the patients previously employed had not returned to work, compared to 33% of the minor head injury patients. The major predictors of unemployment after minor head injury were premorbid characteristics (age, education, and socio-economic status). In contrast, all predictors in moderate head injury were measures of the severity of injury (length of coma, CT diagnosis, GCS on discharge). We conclude that: (a) moderate head injury, not described previously in the literature, results in mortality and substantial morbidity intermediate between those of severe and minor head injury; (b) unlike minor head injury, the principal predictors of outcome after moderate head injury are measures of the severity of injury; and (c) more attention should be directed to patients with moderate head injury than to those with the most severe injuries, in whom brain damage is probably irreversible and all forms of management have demonstrated little success.