Contusion Progression Following Traumatic Brain Injury: A Review of Clinical and Radiological Predictors, and Influence on Outcome

Adatia, Krishma; Newcombe, Virginia; Menon, David

doi:10.1007/s12028-020-00994-4

Cited by 58 publications

(81 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current study came in accordance with a research which was conducted by Adatia et al (16) and demonstrated that, progression of cerebral contusions occurs in up to 75% of patients with TBI whatever the age and this contributes to subsequent clinical deterioration and requirement for surgical intervention. On the contrary, Ushewokunze et al (17) demonstrated that, acute subdural hematoma was the commonest pathology for elderly TBI, which corresponds with a coroner's report that subdural hematoma was the commonest lesion of the deceased elderly persons with head injuries (18) .…”

Section: Discussionsupporting

confidence: 91%

Pattern and Outcome of Traumatic Brain Injury in Geriatric Population in Emergency Hospital Mansoura University

Attia

Nabeeh

Ismael

et al. 2021

The Egyptian Journal of Hospital Medicine

View full text Add to dashboard Cite

Background: Traumatic brain injury (TBI) is a critical public health and socioeconomic problem throughout the world, making epidemiological monitoring of incidence, prevalence and outcome of TBI necessary. In addition, TBI in elderly patients is a neglected global disease burden. The main cause is fall, followed by motor vehicle accidents. Severe trauma in elderly population imposes a significant health care burden and is associated with substantial morbidity and mortality. Objective: To determine the pattern and outcome of traumatic brain injury in geriatric population in order to improve the management of geriatric trauma patients at Emergency Hospital Mansoura University. Patients and methods: This was a prospective observational clinical study, which was conducted on 206 elderly trauma patients presented and admitted to Emergency Hospital Mansoura University (a level one trauma center with about 250,000 visit and 25,000 trauma cases per year) over a year from December 2019 to December 2020. Results: Polytrauma was the commonest type with only 35% of the studied cases were isolated head injury. Most cases had multiple lesions (63.6%) with only 36.4% of which had single lesion. The majority of cases had no associated injuries, with few cases had scalp injury (16.5%) and free abdominal fluid of various degrees (27%). The average period of hospital stay was 10.42 ± 3.110, while the average period of ICU stay was 7.75 ± 4.538. The average GOS among the studied cases was 4.83 ± 2.965 and the majority of which (359%) died (grade 5). Conclusion:The current study demonstrated that, TBI in elderly cases is a life threatening condition with a high mortality rate in which falling from height (FFH) was the predominant mode.

show abstract

Section: Discussionsupporting

confidence: 91%

Pattern and Outcome of Traumatic Brain Injury in Geriatric Population in Emergency Hospital Mansoura University

Attia

Nabeeh

Ismael

et al. 2021

The Egyptian Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…Our study found that sustaining a contusion was associated with lower odds for mortality (OR = 0.09, P = 0.015). These findings agree with a study by Adatia, Newcombe & Menon (2020) , in which mortality due to brain contusions has been linked to the ability to predict their clinical or radiological deterioration before progression. Using lessons learned from a study on determinants of outcome of extra-axial hematoma ( Ssebakumba et al, 2020 ), it was possible for the attending clinicians in this study to predict which patients with contusions would deteriorate by risk stratification based on their smoking status, admission GCS, systolic BP, initial contusion size and location and co-existence of extra-axial hematoma and cerebral edema on brain CT image, to discern who needed an emergency decompressive craniectomy.…”

Section: Discussionsupporting

confidence: 91%

Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda

Matovu

Kirya

Galukande

et al. 2021

PeerJ

View full text Add to dashboard Cite

Background Traumatic brain injury (TBI) is a growing public health concern that can be complicated with an acute stress response. This response may be assessed by monitoring blood glucose levels but this is not routine in remote settings. There is a paucity of data on the prevalence of hyperglycemia and variables associated with mortality after severe TBI in Uganda. Objective We aimed to determine the prevalence of hyperglycemia in patients with severe TBI and variables associated with 30-day mortality at Mulago National Referral Hospital in Uganda. Methods We consecutively enrolled a cohort 99 patients patients with severe TBI. Serum glucose levels were measured at admission and after 24 h. Other study variables included: mechanism of injury, CT findings, location and size of hematoma, and socio-demographics. The main outcome was mortality after 30 days of management and this was compared in patients with hyperglycemia more than 11.1 mmol/L to those without. Results Most patients (92.9%) were male aged 18–30 years (47%). Road Traffic Collisions were the most common cause of severe TBI (64.7%) followed by assault (17.1%) and falls (8.1%). Nearly one in six patients were admitted with hyperglycemia more than 11.1 mmol/L. The mortality rate in severe TBI patients with hyperglycemia was 68.8% (OR 1.47; 95% CI [0.236–9.153]; P = 0.063) against 43.7% in those without hyperglycemia. The presence of hypothermia (OR 10.17; 95% CI [1.574–65.669]; P = 0.015) and convulsions (OR 5.64; 95% CI [1.541–19.554]; P = 0.009) were significant predictors of mortality. Conclusion Hypothermia and convulsions at admission were major predictors of mortality in severe TBI. Early hyperglycemia following severe TBI appears to occur with a tendency towards high mortality. These findings justify routine glucose monitoring and could form the basis for establishing a blood sugar control protocol for such patients in remote settings.

show abstract

“…Thus, there is ample opportunity to intervene if proper treatment can be identi ed. While much is known about predictors of hemorrhage progression following TBI [2], surprisingly little has been written about the temporal progression of these lesions. Fundamental questions therefore remain unanswered, such as: When do traumatic intracranial lesions stop progressing?…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…Several well-written studies have provided some answers. Among the various subtypes of intracranial bleeds, contusions seem to be the most likely to progress, and in the majority of cases this occurs within the rst 24 hours after injury [2]. However, limitations to these studies have restricted their clinical applicability.…”

Section: Introduction Backgroundmentioning

confidence: 99%

“…Relative volume changes, ranging from 5 to 50 %, have also been used to de ne lesion progression, although these de nitions were generally decided upon in a somewhat arbitrary manner [3,6,7,10,[12][13][14][15]17]. Most studies have also primarily focused on traumatic contusions [2], ignoring the simultaneous progressions of traumatic subarachnoid (tSAH), subdural (SDH) and epidural hemorrhages (EDH).…”

Section: Introduction Backgroundmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Impact of Hemorrhagic Lesion Progression Following Moderate-to-Severe Traumatic Brain Injury: An Observational Cohort Study

Fletcher‐Sandersjöö

Tatter

Tjerkaski

et al. 2021

Preprint

View full text Add to dashboard Cite

Background Hemorrhage progression following traumatic brain injury (TBI) is not fully understood, and preventing it would be a potential therapeutic opportunity in TBI management. The aim of this study was to determine how non-operated hemorrhagic lesions progress following TBI, and how this affects outcome. Methods This was a retrospective observational cohort study of adult patients (≥ 15 years) with moderate-to-severe TBI. Hemorrhage volumes were calculated from computed tomography (CT) scans using semi-automated volumetric segmentation. Results In total, 643 patients were included, with a median Glasgow Coma Scale of 7. Contusions were the most common form of traumatic intracranial hemorrhage. The mean total lesion volume on the first CT scan was 4.29 ml, and the mean lesion progression volume (LPV), i.e. the increase in volume from first CT scan until the lesion had stopped progressing, was 3.85 ml. Contusions showed a significantly larger LPV than SDH and EDH (p < 0.001). The median lesion progression time (LPT), i.e. the time from injury until all lesions had stopped progressing, was 5.98 hours, with contusions progressing for a longer time than tSAH, SDH and EDH (p < 0.001). Hemorrhage progression also slowed exponentially over time, with almost no further expansion occurring 24 hours after trauma. In multivariable regression analysis, LPV was independently associated with 12-month Glasgow Outcome Score after adjusting for known TBI outcome predictors (p < 0.001). Conclusions Contusions were the most common form of traumatic intracranial hemorrhage, and exhibited both a larger LPV and longer LPT than extra-axial hematomas. Regression analysis indicated that LPV was independently related to, and possibly a driver of, unfavorable outcome. Interventions to prevent lesion progression are therefore likely to improve outcome in TBI patients. Moreover, this study suggests a wider window of opportunity to prevent lesion progression than what has previously been suggested.

show abstract

Contusion Progression Following Traumatic Brain Injury: A Review of Clinical and Radiological Predictors, and Influence on Outcome

Cited by 58 publications

References 65 publications

Pattern and Outcome of Traumatic Brain Injury in Geriatric Population in Emergency Hospital Mansoura University

Pattern and Outcome of Traumatic Brain Injury in Geriatric Population in Emergency Hospital Mansoura University

Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda

Clinical Impact of Hemorrhagic Lesion Progression Following Moderate-to-Severe Traumatic Brain Injury: An Observational Cohort Study

Contact Info

Product

Resources

About