2022
DOI: 10.1136/tsaco-2021-000859
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Controversies and evidence gaps in the early management of severe traumatic brain injury: back to the ABCs

Abstract: Traumatic brain injury (TBI) accounts for around 30% of all trauma-related deaths. Over the past 40 years, TBI has remained a major cause of mortality after trauma. The primary injury caused by the injurious mechanical force leads to irreversible damage to brain tissue. The potentially preventable secondary injury can be accentuated by addressing systemic insults. Early recognition and prompt intervention are integral to achieve better outcomes. Consequently, surgeons still need to be aware of the basic yet in… Show more

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Cited by 8 publications
(3 citation statements)
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“…Smaller observational trials have suggested no efficacy of platelet transfusion after TBI despite documented thrombocytopenia or other platelet dysfunction (whether or not the individuals were being treated with antiplatelet agents). 22,30 Neither the most current Brain Trauma Foundation guidelines 39 nor recent discussions of these guidelines 40,41 make recommendations regarding the assessment or treatment of coagulopathy, and a recent meta-analysis suggests that the specific issue of platelet transfusion in response to trauma-associated platelet deficits in number and/or function is in equipoise and should be addressed by randomized controlled trials. 34 Our study supports this last assertion, suggesting that older TBI patients bear an excess and overt physiologic burden for clinically relevant thrombocytopenia for which effective transfusion strategies might improve outcomes but for which no clear evidence currently exists.…”
Section: Discussionmentioning
confidence: 99%
“…Smaller observational trials have suggested no efficacy of platelet transfusion after TBI despite documented thrombocytopenia or other platelet dysfunction (whether or not the individuals were being treated with antiplatelet agents). 22,30 Neither the most current Brain Trauma Foundation guidelines 39 nor recent discussions of these guidelines 40,41 make recommendations regarding the assessment or treatment of coagulopathy, and a recent meta-analysis suggests that the specific issue of platelet transfusion in response to trauma-associated platelet deficits in number and/or function is in equipoise and should be addressed by randomized controlled trials. 34 Our study supports this last assertion, suggesting that older TBI patients bear an excess and overt physiologic burden for clinically relevant thrombocytopenia for which effective transfusion strategies might improve outcomes but for which no clear evidence currently exists.…”
Section: Discussionmentioning
confidence: 99%
“…From January 2018 to December 2020, trauma patients with an initial GCS score of less than thirteen were retrospectively enrolled through the trauma registry in our institution. The primary exclusion criteria included (1) patients who had out-of-hospital cardiac arrest (OHCA) or died in the ED without further interventions, (2) patients with blood alcohol concentrations greater than 30 mg/dL or positive drug tests (morphine, ketamine, 3,4methylenedioxymethamphetamine, benzodiazepine, amphetamine and cannabinoids) that may result in unconsciousness, (3) patients with an M6 status (a GCS defect because of E3 or less/V4 or less), (4) patients with positive results on routine head CT scans (epidural hematoma, subdural hematoma, subarachnoid hemorrhage, intracerebral hemorrhage, intraventricular hemorrhage, skull fractures or brain swelling), (5) patients who died within 24 h after admission without sufficient evaluation and observation, (6) burn injury patients and (7) patients with missing values.…”
Section: Methodsmentioning
confidence: 99%
“…Several prognostic factors predicting improvement in consciousness status and functional outcomes for TBI patients have been well studied [5]. A low initial GCS score has been reported to be associated with significantly poorer outcomes [6, 7]. In addition, delayed airway management in trauma patients may also result in higher mortality and morbidity [8].…”
Section: Introductionmentioning
confidence: 99%