Outcome Prediction in Patients of Traumatic Brain Injury Based on Midline Shift on CT Scan of Brain

Palekar, Shrikant Govindrao; Jaiswal, Manish; Patil, M.; Malpathak, Vijay

doi:10.1055/s-0040-1716990

Cited by 4 publications

(13 citation statements)

References 34 publications

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“…15 In another study by Palekar SG et al, the male: female ratio was 4:1 with males more commonly being affected by head trauma. 16 Similarly in our study males were more commonly affected with male to female ratio of 2.6:1.…”

Section: Discussionsupporting

confidence: 72%

“…25 In a study by Palekar et al, the abnormal pupillary response came out to be statistically significant in relation to outcome. 16 In our study, patients having satisfactory outcomes, 68 (64.8%) patients had equally reacting pupils, while only 37 (35.2%) patients had abnormal pupillary reactivities. This association was shown to be statistically significant in our study (p-value = 0.046).…”

Section: Discussionsupporting

confidence: 43%

“…17 The reason for this might lie in the fact that old aged patients already have different comorbidities apart from the already injured brain, this in addition to senile changes like decreased elasticity and atrophic changes in the brain parenchyma can cause increased mortality in the elderly group. 16 However, Fabbri et al found no evidence that age was significantly related to the prognosis of the patients with head trauma. 18 Slewa-Younan et al, stated that the severity of TBI in males was greater than that of females.…”

Section: Discussionmentioning

confidence: 98%

“…Lower admission GCS scores are associated with worse outcomes. 16 According to a study by Selladurai et al, more than 95% of patients are likely to suffer a worse outcome if their score is 4 or lower in comparison to individuals with a score of 8 or more. 22 According to a study by Chiewvit et al, out of 46 patients with a GCS of 15, 2 cases (13.3%) and 33 patients with a GCS of 13 -14, 1 case (3.0%), respectively, had poor outcomes, while out of 136 patients with a GCS score of 12, 46 cases (33.8%) had poor outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, its use is limited in patients who are under the influence of sedation, psychoactive drugs, or alcohol, or are intubated. 16 Classifying TBI according to morphology based on radiological findings is an alternative in such patients. Computed tomography (CT) continues to be the gold standard for diagnosing, treating, and determining the prognosis of traumatic brain injury despite recent advancements in imaging techniques.…”

Section: Introductionmentioning

confidence: 99%

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Midline Shift as a Predictor of Outcome in Head Trauma Patients managed Conservatively

Qasim¹,

Rehman²,

Javeed³

et al. 2022

Pak J Neurol Surg

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Objective: To evaluate the role of the degree of midline shift on CT scans in predicting clinical outcomes in traumatic brain injury (TBI). Materials and Methods: A prospective observational study was conducted at the Department of Neurosurgery of a tertiary care hospital. We included 148 patients. After fulfilling the inclusion criteria, the patient’s baseline data, including the patient's age, gender, and CT scan findings with the degree of midline shift, was noted. The patients were monitored for three months to evaluate the outcome. The collected data was analyzed using SPSS version 22.0. Results: Our study showed that 105 (70.9%) patients showed satisfactory outcomes while 43 (29.1%) showed unsatisfactory outcomes. Patients with no midline shift were 70, out of which 55 (78.6%) showed satisfactory outcomes. Similarly, patients with 1-2 mm midline shifts showed satisfactory outcomes in 39 (69.6%) while 3-5 mm midline shifts showed 11 (50%) satisfactory outcomes. In our study, the degree of brain midline shift on CT scan was a statistically significant outcome factor (p = 0.035). Conclusion: Patients with TBI who had an increasing degree of midline shift on brain CT scans had considerably worse clinical outcomes. Keywords: Midline shift, CT scan, Glasgow Coma Score, Head Injury.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Midline Shift as a Predictor of Outcome in Head Trauma Patients managed Conservatively

Qasim¹,

Rehman²,

Javeed³

et al. 2022

Pak J Neurol Surg

View full text Add to dashboard Cite

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Predictors of outcomes 3 to 12 months after traumatic brain injury: a systematic review and meta-analysis

Iderdar,

Arraji,

Wachami

et al. 2024

PHRP

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The exact factors predicting outcomes following traumatic brain injury (TBI) remain elusive. In this systematic review and meta-analysis, we examined factors influencing outcomes in adult patients with TBI, from 3 months to 1 year after injury. A search of four electronic databases—PubMed, Scopus, Web of Science, and ScienceDirect—yielded 29 studies for review and 16 for meta-analysis, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. In patients with TBI of any severity, mean differences were observed in age (8.72 years; 95% confidence interval [CI], 4.77–12.66 years), lymphocyte count (−0.15 109/L; 95% CI, −0.18 to −0.11), glucose levels (1.20 mmol/L; 95% CI, 0.73–1.68), and haemoglobin levels (−0.91 g/dL; 95% CI, −1.49 to −0.33) between those with favourable and unfavourable outcomes. The prevalence rates of unfavourable outcomes were as follows: abnormal cisterns, 65.7%; intracranial pressure above 20 mmHg, 52.9%; midline shift of 5 mm or more, 63%; hypotension, 71%; hypoxia, 86.8%; blood transfusion, 70.3%; and mechanical ventilation, 90%. Several predictors were strongly associated with outcome. Specifically, age, lymphocyte count, glucose level, haemoglobin level, severity of TBI, pupillary reaction, and type of injury were identified as potential predictors of long-term outcomes.

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Fecal microbial transplantation limits neural injury severity and functional deficits in a pediatric piglet traumatic brain injury model

Fagan,

Welch,

Scheulin

et al. 2023

Front. Neurosci.

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Pediatric traumatic brain injury (TBI) is a leading cause of death and disability in children. Due to bidirectional communication between the brain and gut microbial population, introduction of key gut bacteria may mitigate critical TBI-induced secondary injury cascades, thus lessening neural damage and improving functional outcomes. The objective of this study was to determine the efficacy of a daily fecal microbial transplant (FMT) to alleviate neural injury severity, prevent gut dysbiosis, and improve functional recovery post TBI in a translational pediatric piglet model. Male piglets at 4-weeks of age were randomly assigned to Sham + saline, TBI + saline, or TBI + FMT treatment groups. A moderate/severe TBI was induced by controlled cortical impact and Sham pigs underwent craniectomy surgery only. FMT or saline were administered by oral gavage daily for 7 days. MRI was performed 1 day (1D) and 7 days (7D) post TBI. Fecal and cecal samples were collected for 16S rRNA gene sequencing. Ipsilateral brain and ileum tissue samples were collected for histological assessment. Gait and behavior testing were conducted at multiple timepoints. MRI showed that FMT treated animals demonstrated decreased lesion volume and hemorrhage volume at 7D post TBI as compared to 1D post TBI. Histological analysis revealed improved neuron and oligodendrocyte survival and restored ileum tissue morphology at 7D post TBI in FMT treated animals. Microbiome analysis indicated decreased dysbiosis in FMT treated animals with an increase in multiple probiotic Lactobacilli species, associated with anti-inflammatory therapeutic effects, in the cecum of the FMT treated animals, while non-treated TBI animals showed an increase in pathogenic bacteria, associated with inflammation and disease such in feces. FMT mediated enhanced cellular and tissue recovery resulted in improved motor function including stride and step length and voluntary motor activity in FMT treated animals. Here we report for the first time in a highly translatable pediatric piglet TBI model, the potential of FMT treatment to significantly limit cellular and tissue damage leading to improved functional outcomes following a TBI.

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Outcome Prediction in Patients of Traumatic Brain Injury Based on Midline Shift on CT Scan of Brain

Cited by 4 publications

References 34 publications

Midline Shift as a Predictor of Outcome in Head Trauma Patients managed Conservatively

Midline Shift as a Predictor of Outcome in Head Trauma Patients managed Conservatively

Predictors of outcomes 3 to 12 months after traumatic brain injury: a systematic review and meta-analysis

Fecal microbial transplantation limits neural injury severity and functional deficits in a pediatric piglet traumatic brain injury model

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