Progress in the management of head injury

Miller, Jay D.; Jones, Patricia A.; Dearden, N. M.; Tocher, J. L.

doi:10.1002/bjs.1800790122

Cited by 42 publications

(9 citation statements)

References 26 publications

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“…Alexander [2] reports a figure of 27/100 000, comparable to Parkinson's disease (20/100 000) and significantly more than multiple sclerosis (3/100 000). In the UK, estimates suggest that between 85-90% of the total number of head injuries seen at hospital have a Glasgow Coma score of 13-15 and can, therefore, be graded as mild [3,[18][19][20][21]. Adopting the '15% rule', 40 000 cases with persisting post-concussional symptoms can be expected annually in the UK, although the data by Thornhill et al [3] suggest the numbers could be much higher.…”

Section: Introductionmentioning

confidence: 93%

Understanding the ‘miserable minority’: a diasthesis-stress paradigm for post-concussional syndrome

2004

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Opinions about persisting post-concussional symptoms after minor traumatic brain injury still reflect a polarization of views around the sterile debate concerning the psychological vs organic origins of symptoms. Reviews of the experimental literature do not always integrate the often diverse perspectives that explain persisting symptoms of concussion. As a result, the disorder is still poorly understood. In this review, a diasthesis-stress paradigm examines the interaction between physiological and psychological factors that generate and maintain post-concussional symptoms. Motivational factors and different coping strategies are considered to explain why some people are at risk of developing a post-concussional syndrome. The early iatrogenic potential of GPs and hospital doctors who may create insecurity or reinforce illness perceptions is considered. Finally, the rationale and effectiveness of interventions that ameliorate the impact of early post-concussional symptoms is reviewed to see if prevention of the post-concussional syndrome is more effective than cure.

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Section: Introductionmentioning

confidence: 93%

Understanding the ‘miserable minority’: a diasthesis-stress paradigm for post-concussional syndrome

2004

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“…Nearly one-third of hospitalized TBI patients die from injuries that are secondary to the initial trauma, including increased neuroinflammation, disruption of the BBB, neuronal excitotoxicity, brain edema, and intracranial hypertension [67] . In addition to displaying protective and reparative functions, reactive astrocytes may also exert detrimental roles to exacerbate secondary brain injury.…”

Section: Potential Damaging Roles For Astrocytes Following Tbimentioning

confidence: 99%

Opposing Roles for Reactive Astrocytes following Traumatic Brain Injury

2008

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Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Current medical therapies exhibit limited efficacy in reducing neurological injury and the prognosis for patients remains poor. While most research is focused on the direct protection of neuronal cells, non-neuronal cells, such as astrocytes, may exert an active role in the pathogenesis of TBI. Astrocytes, the predominant cell type in the human brain, are traditionally associated with providing only structural support within the CNS. However, recent work suggests astrocytes may regulate brain homeostasis and limit brain injury. In contrast, reactive astrocytes may also contribute to increased neuroinflammation, the development of cerebral edema, and elevated intracranial pressure, suggesting possible roles in exacerbating secondary brain injury following neurotrauma. The multiple, opposing roles for astrocytes following neurotrauma may have important implications for the design of directed therapeutics to limit neurological injury. As such, a primary focus of this review is to summarize the emerging evidence suggesting reactive astrocytes influence the response of the brain to TBI.

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“…Subsets were created to ascertain whether any particular patient group was having a disproportionate effect on survival. When sorted by age, survival decreased in the under 16 year olds, and in the 21 to 45 year olds. However, in the over 75 age group, survival increased significantly from just over 0% to 21% but this group only accounts for 5.7% of the total population.…”

Section: Discussionmentioning

confidence: 95%

Head injuries in Leeds: changes in epidemiology and survival over 12 years

Wittenberg

2004

Emergency Medicine Journal

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Objectives: To map the pattern of survival and epidemiology of patients admitted to accident and emergency, at a regional neurosciences unit with an isolated head injury, over a 12 year period. Methods: The TARN database of a regional neuroscience referral centre was analysed to identify patients who where admitted after a significant, isolated head injury between January 1990 and December 2001. Demographic data about the patient and nature and cause of the injury were extracted and survival was mapped over the time period. Statistical analysis was performed to identify change in survival. Results: There were 810 eligible patients. The most common cause of injury was road traffic accident (47%) with an average of 42.6% patients transferred from other hospitals. The most common disposal of patients was to an intensive care unit (35%). There was an overall increase in the number of patients but survival did not increase over the time period. Mean survival was 81.8% and overall survival decreased from 95.0% in 1990 to 81.6% in 2001, although this did not represent significant change (p = 0.990). Conclusions: Short term survival after significant head injury has not changed significantly over the 12 year period studied. No subset of patients is having a disproportionate effect on survival but in patients aged over 75, survival increased significantly. Further multicentre work is indicated to map a more accurate clinical picture of head injury survival.

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Progress in the management of head injury

Cited by 42 publications

References 26 publications

Understanding the ‘miserable minority’: a diasthesis-stress paradigm for post-concussional syndrome

Understanding the ‘miserable minority’: a diasthesis-stress paradigm for post-concussional syndrome

Opposing Roles for Reactive Astrocytes following Traumatic Brain Injury

Head injuries in Leeds: changes in epidemiology and survival over 12 years

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