Victims Of Severe Head Injury Research Articles

Assessment and Management of Cervical Spine Injury in Head Injury Victims: A Tertiary Care Center Experience

Introduction Cervical spine injury is the common missed finding during the head injury. As the victims of the same will be unconscious in most occasions, clinical evaluation is difficult and we need to rely on investigation as well as clinical examination. It is important to rule out and manage appropriately to attain the proper outcome. Patients and Methods Patients with head injury who were less than GCS 8 and clinical evidence of spinal injuries were added in this study at a tertiary trauma care center at South India for past 4 years. Patients were screened with CT C spine along with CT head on initial evaluation. Any evidence of cervical spinal injury in both imaging and/or clinical examination underwent MRI spine. Treatment initiated appropriately. In a series of 524 patients with GCS less than 8 from May 2010 to May 2014, 74 patients underwent MRI spine based on CT C spine and clinical examination pertaining to cervical spine injury. Patients with thoracic and lumbar spinal injuries were excluded from the study. Follow-up made through clinical visits and telephonic enquiry. Results A total of 47 patients had evidence of cervical spine injury in the form of contusions, altered signal changes, spinal stable and unstable fractures, and ligamentous injury. All patients received appropriate treatment including spinal fixation and continuous rehabilitation. Overall, 19 patients presented with unstable spinal fracture which needs stabilization. Overall, eight patients had extensive spinal cord contusions or altered signal changes. Overall, 17 patients had disc bulges or ligamentous injuries with cord signal changes. Overall, two patients had epidural hematoma. Conclusion Assessment and diagnosing the cervical spine injury is a real challenge in severe head injury victims. Strict protocol and appropriate management are the key to the success for the proper outcome. CT C spine and clinical examination during the initial evaluation help in attaining the goal and in early decision making.

Präklinische Versorgung von Traumapatienten in der Luftrettung

In a retrospective study of mission data of ADAC Air Rescue of the years 2000 and 2001 the quality of preclinical care of 1,946 patients with severe head injuries and 1,878 polytraumatized patients was examined. The actual preclinical care of these patients was compared with a catalogue of eleven thesis-like recommendations. These recommendations were previously derived from corresponding publications of national and international specialist companies and were introduced in a binding manner by the senior doctors of the participating air rescue centres. The results of the study show that 73.3% of the severe head injuries were preclinically intubated and 94.4% were supplied with oxygen, 82.2% were analgosedated. 94.8% could be delivered to the hospital of destination. 65.9% had a systolic blood pressure of >120 mmHg upon admission to the hospital. 71.4% of severe head injury victims were equipped with a cervical support, 23.3% had the blood pressure documented. 47.3% reached the hospital of destination in less than 60 minutes. Among polytraumatic patients the intubation was performed in 75.7%, the supply with oxygen in 90.7%, 88.6% of the patients were analgosedated. 78.7% of patients suffering from concomitant head injuries were provided with a cervical support and only 22.8% had a blood sugar measurement documented. A concomitant severe thorax trauma was treated by a thorax drainage in 59.2%. 35.6% of the polytraumata reached the hospital of destination in less than 60 minutes. The work describes the preclinical patient care of severe head injuries and polytraumata, pointing out deficits and presenting optimization possibilities, particularly in the area of training. Furthermore, the work shows the concept of the medical quality management in an air rescue enterprise. The total evaluation of all air rescue centres participating in data collection forms the basis of an external quality comparison. The data evaluation of a single station makes regional strengths and weaknesses visible, deficits can be proven and proposals for optimization be developed. The presentation of the time history of data yields continuous standard information on the state of the patient care at the relevant air rescue location and enables the analysis of improvement concepts based on the updated data.

Advances in management of neurosurgical trauma: USA and Canada.

Traumatic brain and spinal cord injuries continue to pose serious challenges for physicians around the world. In North America, the annual number of serious head and spinal injuries has decreased over the last two decades, and of those patients who reach a hospital, the mortality and long-term morbidity have also declined. The two major reasons for this reduction in death and disability after craniospinal trauma in the United States and Canada appear to be (1) widespread implementation of prevention measures, safety legislation, and public education initiatives; and (2) further improvements in and wider availability of emergency medical systems and regional trauma centers. Improvements in neurocritical care and the implementation of evidence-based treatment guidelines for severe head injury victims may also, in part, be responsible for improved survival rates and reduced disability rates. Unfortunately, numerous clinical trials of putative neuroprotective agents conducted in North America and elsewhere during the 1990s have failed to demonstrate efficacy in head-injured patients. However, methylprednisolone does appear to confer some benefit to a select population of spinal cord injury patients. These advances in the areas of prevention, regional trauma systems, treatment guidelines, and neurocritical care that have influenced survival rates and recovery of function are discussed.

Increased serum S100beta protein concentrations following severe head injury in humans: a biochemical marker of brain death?

This study investigated S100beta protein as a biochemical serum marker of brain damage in severe head injury and brain death victims. Blood samples obtained from 15 patients with severe head injury admitted to the trauma intensive care unit (ICU), five patients with a diagnosis of brain death due to hemorrhage following cerebral aneurysm rupture, and five healthy individuals were investigated. The S100beta protein serum concentrations were analyzed with a immunoradiometric assay kit. The 15 patients with severe head injury were followed up for 6 months. Outcome was considered either death or recovery with ICU discharge. S100beta concentrations were closely related to brain damage. Among the severe head injury victims, higher S100beta concentrations were detected in those patients that progressed to death. The individuals with brain death had similar mean S100beta concentrations, irrespective of its cause (either trauma or vascular rupture). S100beta protein is a promising serum outcome predictor for severe head injury victims and may contribute to the early diagnosis of brain death.

Social role functioning following spinal cord injury

The Katz Adjustment Scale--Relatives Form was completed by the wives of 27 hospital-discharged spinal cord injured (SCI) patients. Their ratings of the spouses' social adjustment and behaviour were compared to available community and psychiatric norms. Overall, spouses rated their SCI husbands as performing significantly more socially inappropriate behaviours compared to ratings of 'normals' but as engaging in significantly less socially inappropriate behaviours compared to the ratings of psychiatric patients. SCI patients were perceived as performing the same levels of social activities as 'normals', but engaging in less free-time activities compared to both 'normals' and psychiatric patients. These results mirror similar analyses comparing moderate and severe head injury victims with normal and psychiatric norms. The implications for rehabilitation and counselling of families of traumatically disabled patients are discussed.

Acute regional cerebral blood flow changes caused by severe head injuries

To evaluate the changes in cerebral blood flow (CBF) that occur immediately after head injury and the effects of different posttraumatic lesions on CBF, 61 CBF studies were obtained using the xenon-computerized tomography method in 32 severely head-injured adults (Glasgow Coma Scale score (GCS) less than or equal to 7). The measurements were made within 7 days after injury, 43% in the first 24 hours. During the 1st day, patients with an initial GCS score of 3 or 4 and no surgical mass had significantly lower flows than did those with a higher GCS score or mass lesions (p less than 0.05): in the first 1 to 4 hours, those without surgical mass lesions had a mean CBF of 27 cc/100 gm/min, which rose to 44 cc/100 gm/min by 24 hours. Patients without surgical mass lesions who died tended to have a lower global CBF than did those with better outcomes. Mass lesions were associated with a high global CBF and bihemispheric contusions with the lowest flows. By 24 hours after injury, global blood flow increased in groups that originally had low flows and decreased in those with very high initial flows, such that by 36 to 48 hours, most patients had CBF values between 32 and 55 cc/100 gm/min. Lobar, basal ganglion, and brain-stem blood flow values frequently differed by 25% or more from global averages. Brain-stem CBF varied the most but did not correlate with clinical signs of brain-stem dysfunction. Double studies were performed at two different pCO2 values in 10 patients with various posttraumatic lesions, and the CO2 vasoresponsivity was calculated. Abnormal CO2 vasoresponsivity was found with acute subdural hematomas and defuse cerebral swelling but not with epidural hematomas. In patients without surgical mass lesions, the findings suggest that CBF in the first few hours after injury is often low, followed by a hyperemic phase that peaks at 24 hours. Global CBF values vary widely depending on the type of traumatic brain injury, and brain-stem flow is often not accurately reflected by global CBF values. These findings underscore the need to define regional CBF abnormalities in victims of severe head injury if treatment is intended to prevent regional ischemia.

Intracranial pressure response to stable xenon inhalation in patients with head injury

Cerebral blood flow measured by xenon-enhanced computed tomography may provide useful information in victims of severe head injury. To assess the effect of stable xenon inhalation on intracranial pressure, intracranial pressure was measured in 17 mechanically ventilated patients with severe head injury undergoing cerebral blood flow studies with xenon-enhanced computed tomography. Under hypocapnic conditions, mean intracranial pressure increased by less than 1 mm Hg ( p < 0.05) late in the inhalation period only in patients whose baseline intracranial pressure was less than 20 mm Hg. It was concluded that under hypocapnic conditions, the magnitude of this increase in intracranial pressure does not prohibit the safe evaluation of cerebral blood flow in victims of head injury using xenon-enhanced computed tomography.

Head injury: The relatives' response

42 male minor and 56 male severe head injury victims, together with their relatives, were assessed in order to understand the nature of the impact of head injury on a close family member. Relatives experienced significant psychosocial difficulties which persisted throughout the year. A two stage model for understanding the causation of relatives' maladjustment is proposed. Rehabilitation programmes for relatives of severe head injury patients should look for vulnerability factors in the relatives, such as their own illness experience, as well as assessing current life stresses, such as the patient's view of his own progress.

Three months after severe head injury: psychiatric and social impact on relatives.

Female relatives of defined groups of consecutive male minor and severe head injury victims were seen at home 3 months after the injury. The relatives of the severely injured suffered significant psychiatric morbidity compared to the minor head injury relatives. They also showed poorer functioning in social roles associated with the home. There was no difference in the vulnerability of either wives or mothers of the head injury victims. It is argued that there is a need for support for the relatives of those who have suffered severe brain injury.

DETECTION OF OCCULT ABDOMINAL TRAUMA IN PATIENTS WITH SEVERE HEAD INJURIES

Among 109 consecutive victims of severe head injury, intra-abdominal injury could not be excluded in 87. These patients were considered to be at risk from occult intra-abdominal hæmorrhage. 60 patients underwent diagnostic peritoneal lavage. 10 of these had a positive lavage, correctly indicating intra-abdominal hæmorrhage. In each case a lesion requiring surgical repair was identified. 49 patients had a negative lavage, and only 1 of these patients subsequently showed signs of a missed intra-abdominal lesion. 13 patients had low systolic blood-pressure (<90 mm Hg) on admission, and 4 of these had positive lavage. Of 47 patients with systolic blood-pressure of 90 mm Hg or greater on admission, 6 had positive lavage. 15 patients were deeply comatose with no eye-opening or verbal response and an extensor or no motor response to painful stimuli. 6 of these had positive peritoneal lavage. We conclude that diagnostic peritoneal lavage should form an integral part of the evaluation of comatose patients with head injury, particularly those whose level of consciousness is most depressed, whether or not clinical signs of shock, abdominal injury, or occult hæmorrhage are present.

Workshop for disabled survivors of severe head injury.

Existing services for the disabled do not cater for the needs of lame-brain survivors of severe head injury who may be capable of productive work though they may never become employable. A grant from the Nuffield Provincial Hospitals Trust made it possible to set up in 1967 a special workshop in premises provided by the regional hospital board. The hospital management committee assumed financial responsibility for the centre after three years, and after five years the Department of Health and Social Security purchased adjoining premises, which will double the present accommodation for about 35 persons. Though 45% of the 101 patients attending the workshop have returned to work, no financial support has yet been received from the Department of Employment. A suitably staffed hostel is needed for patients who live too far away to travel daily to and from the workshop. This undertaking has shown a need for special facilities for some of the victims of severe head injury, who differ in many important ways from other disabled persons.

4. The general management of the victims of severe head injury with particular reference to associated injuries

advantage of being entirely benign, it is certainly painless, and it may give rather more specific information than is possible with the ultra-sound examination. As I indicated when discussing echo-encephalography this may, with many lesions, simply indicate the side upon which it is situated but will give little idea of its actual location. With brain scanning the localization is much more accurate but the precise nature of the lesion may be less definite. One may by implication, however, in most circumstances come to accurate conclusions about the nature of the lesion itself either because of its situation or because of the precise configuration of the increased uptake of radioactive isotope. I am quite sure that the full potential of this method has not yet been realized but its application is clearly less easy than that of echo-encephalography because it requires the presence of skilled radiographers or skilled technicians, whereas the use of the ultrasound apparatus can be acquired by any doctor or similarly trained individual after a very short period of training. With the use of plain radiographs, echoencephalography, and in selected cases brain Injury Oct. 1969