Intensive Management and Prognosis of 127 Cases with Traumatic Bilateral Frontal Contusions

Gao, Liang; Wu, Xuehai; Hu, Jin; Jin, Yi; Han, Xi; Wu, Xing; Mao, Ying; Zhou, Lei

doi:10.1016/j.wneu.2013.01.020

Cited by 19 publications

(31 citation statements)

References 6 publications

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“…In this study, a total of 55 patients underwent surgery, 41 decompressive craniectomy, and 14 craniotomy with removal of frontal contusion. 10 The overall mortality was 14.3%, which is much lower than our study. The authors have not mentioned about mortality in relationship to symmetry of contusions, and type of surgical procedure.…”

Section: Discussioncontrasting

confidence: 70%

“…In a recent study of ICP monitoring in patients with bifrontal contusions, the author concluded that ICP is one of the most important intensive types of monitoring for patients with bifrontal contusions. 10 The patients who underwent ICP monitoring had shorter length of stay and shorter length of therapy with mannitol. Though there was no difference in mortality between groups, the average GOS was better in patients who underwent ICP monitoring.…”

Section: Discussionmentioning

confidence: 97%

“…Though there was no difference in mortality between groups, the average GOS was better in patients who underwent ICP monitoring. 10…”

Section: Discussionmentioning

confidence: 99%

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Bifrontal Contusions: What Is the Best Surgical Treatment?

Sarma

Shukla

Devi

2015

IJNT

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Problems Considered?Bifrontal contusions are common and pose surgical dilemma regarding both indication as well as extent of surgery. There is no guideline available for optimal treatment of such lesions. The objective of this study was to determine the best modality of surgical treatment for such patients. Methods?This is a retrospective study of patients who were surgically treated for bifrontal contusions during the last 5 years. Clinical features, computed tomographic scan findings, surgical treatment modality, in-hospital mortality, and follow-up data were recorded. Results?A total of 98 patients (mean age 45 years) were operated for bifrontal contusions. Mean Glasgow coma score was 9 and motor response was M5. Contusions were of the same size on both sides in 22 cases and asymmetric in 76 cases. Patients underwent following surgical procedures: bifrontal decompressive craniectomy without evacuation of contusion (40 cases), bifrontal craniotomy and evacuation of bifrontal contusion (34 cases), and evacuation of unilateral contusion (24 cases). The overall mortality was 36.7%. The mortality was 55, 35.3, and 8.3%, respectively, with the above-mentioned surgical treatments. There was no difference in mortality between patients with symmetric and asymmetric contusions. The mean duration of follow-up was 23 months. Follow-up data were available for 42 (67.7%) survivors. Favorable outcome was seen in 80.9% of the survivors. Frontal lobe dysfunction was seen in 59.5% of the survivors. Conclusion?Patients who underwent bifrontal decompressive craniectomy without evacuation of contusion had worst outcome. Variable removal of contused brain tissue is required for reducing mortality.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 97%

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Bifrontal Contusions: What Is the Best Surgical Treatment?

Sarma

Shukla

Devi

2015

IJNT

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“…Four studies [25, 26, 28, 33] provided available data showing no decreased risk of ICU mortality in the ICP monitor group (RR = 1.01, 95% CI = 0.90–1.13, p>0.05; I 2 = 0%, p for heterogeneity>0.1) (Fig 4). Four studies [15, 25–27] (hospitalized before 2007) with 4088 patients and five studies [13, 32, 34, 37, 38] (hospitalized after 2007) with 14716 patients attached importance to analyzing the link between ICP monitoring and the risk of mortality.…”

Section: Resultsmentioning

confidence: 99%

Effects of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury: A Meta-Analysis

Shen

Wang

et al. 2016

PLoS ONE

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BackgroundThe Brain Trauma Foundation (BTF) guidelines published in 2007 suggest some indications for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). However, some studies had not shown clinical benefit in patients with severe TBI; several studies had even reported that ICP monitoring was associated with an increased mortality rate. The effect of ICP monitoring has remained controversial, regardless of the ICP monitoring guidelines. Here we performed a meta-analysis of published studies to assess the effects of ICP monitoring in patients with severe TBI.MethodsWe searched three comprehensive databases, the Cochrane Library, PUBMED, and EMBASE, for studies without limitations published up to September 2015. Mortality, ICU LOS, and hospital LOS were analyzed with Review Manager software according to data from the included studies.ResultsEighteen eligible studies involving 25229 patients with severe TBI were included in our meta-analysis. The results indicated no significant reduction in the ICP monitored group in mortality (hospitalized before 2007), hospital mortality (hospitalized before 2007), mortality in randomized controlled trials. However, overall mortality, mortality (hospitalized after 2007), hospital mortality (hospitalized after 2007), mortality in observational studies (hospitalized after 2007), 2-week mortality, 6-month mortality, were reduced in ICP monitored group. Patients with an increased ICP were more likely to require ICP monitoring.ConclusionSuperior survival was observed in severe TBI patients with ICP monitoring since the third edition of “Guidelines for the Management of Severe Traumatic Brain Injury,” which included “Indications for intracranial pressure monitoring,” was published in 2007.

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“…All included articles were retrospective studies with a particular focus on TBC patients. Geographical locations included Scotland [12], USA [9], China [4,16,17], and India [11]. Sampling periods ranged from 1 to 14.5 years, with an average of 5.6 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

Demographics, presentation, and clinical outcomes after traumatic bifrontal contusions: a systematic review

et al. 2019

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Traumatic bifrontal contusions (TBC) form a recognised clinical entity among patients with traumatic brain injury (TBI). This study aims to systematically review current literature on demographics, management, and predictors of outcomes of patients with TBC. A multi-database literature search (PubMed, Cochrane, OVID Medline/Embase) was performed using PRISMA as a search strategy. Studies were selected by predefined selection criteria (PROSPERO: CRD42018055390), and risk of bias was assessed using an adapted form of ROBINS-I tool. Of the 275 studies yielded by the literature search, seven articles met the criteria for inclusion, all of which were level III evidence. Total cohort consisted of 468 patients; predominantly male (n = 5; 303/417 patients) with average age 44.3 years (range, 7-81). Falls (44.9%) and road traffic accidents (46.6%) were the commonest mechanisms of injury with an average presentation GCS of 9.2 (n = 3, 119 patients). GCS on admission of ≤ 13.1 and contusion volume at day 2 post-injury of ≥ 62.9cm 3 were associated with increased risk of deterioration needing surgical interventions (n = 1, 7 patients). The majority of patients underwent surgery; the average GOS was 4, at an average follow-up duration of 11.7 months (n = 6, 356 patients). The currently available evidence on the management of TBC is scarce. Larger multicentre well-designed studies are needed to further delineate the factors behind acute deterioration, the effectiveness of management options. Once in place, this can be used to develop and test an algorithmic approach to management of TBC resulting in consistently improved outcomes.

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Intensive Management and Prognosis of 127 Cases with Traumatic Bilateral Frontal Contusions

Cited by 19 publications

References 6 publications

Bifrontal Contusions: What Is the Best Surgical Treatment?

Bifrontal Contusions: What Is the Best Surgical Treatment?

Effects of Intracranial Pressure Monitoring on Mortality in Patients with Severe Traumatic Brain Injury: A Meta-Analysis

Demographics, presentation, and clinical outcomes after traumatic bifrontal contusions: a systematic review

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