Report on the meeting of the W.F.N.S. neuro-traumatology committee, Brussels, 19–23 September 1976

Brihaye, J; Frowein, R. A.; Lindgren, S.; Loew, F.; Stroobandt, G

doi:10.1007/bf01773126

Cited by 70 publications

(17 citation statements)

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“…Other neurological severity scales include the Brussells Coma Grades, Grady Coma Grades, Innsbruck Coma Scale, and the FOUR score scale (Brihaye et al, 1978; Fleischer et al, 1976; Gerstenbrand et al, 1970; Wijdicks et al, 2005). A number of scales are also available to assess extracranial injury and physiologic instability which can influence outcome, including the Abbreviated Injury Scale (AIS) (Medicine AftAoA., 1976; Medicine AftAoA., 1990) and the Injury Severity Score (ISS) (Baker et al, 1974).…”

Section: Overview Of Current Classification Systems For Traumatic Bramentioning

confidence: 99%

Classification of Traumatic Brain Injury for Targeted Therapies

Saatman

Duhaime

Bullock

et al. 2008

Journal of Neurotrauma

939

684

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The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials.

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Section: Overview Of Current Classification Systems For Traumatic Bramentioning

confidence: 99%

Classification of Traumatic Brain Injury for Targeted Therapies

Saatman

Duhaime

Bullock

et al. 2008

Journal of Neurotrauma

939

684

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“…Clinical assessment and correct diagnosis of AS presupposes additional, qualified education and some years of personal expertise in AS management in order to prevent misdiagnoses and maltreatment [4, 9, 23, 26, 27, 50, 51, 60, 67-69, 109, 116, 118, 120-129, 158]. Coma is defined as the pathological status of a patient who cannot be aroused to a wakeful state and whose eyes are continuously closed and do not open on command or on receipt of nociceptive stimuli [119]. Unfortunately, misleading either the phenotype (for example, posttraumatic catatonia, coma prolongé , and prolonged coma) or a single sign and symptom describing historical terminology (for example, hypersomnie, akinetischer Mutismus, Wachkoma, Coma vigile, postcomatose unawareness, Decerebrations syndrome), is still in use confusing the correct diagnosis and management of AS patients [2, 17, 30, 32-34, 36, 43, 52, 53, 55, 100, 102-104, 106-107, 109, 120].…”

Section: Introductionmentioning

confidence: 99%

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Wild

Gerstenbrand²,

Dolce

et al. 2007

Eur J Trauma Emerg Surg

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Management of AS aims at the social reintegration of patients or has to guarantee humanistic active nursing if treatment fails. Outcome depends on the cause and duration of AS/VS as well as patient's age. There is no single AS/VS specific laboratory investigation, no specific regimen or stimulating intervention to be recommended for improving higher cerebral functioning. Quality management requires at least 3 years of advanced training and permanent education to gain approval of qualification for AS/VS treatment and expertise. Sine qua non areas covering AS/VS institutions for early and long-term rehabilitation are required on a population base (prevalence of 2/100.000/year) to quicken functional restoration and to prevent or treat complications. Caring homes are needed for respectful humane nursing including basal sensor-motor stimulating techniques. Passive euthanasia is considered an act of mercy by physicians in terms of withholding treatment; however, ethical and legal issues with regard to withdrawal of nutrition and hydration and end of life discussions raise deep concerns. The aim of the guideline is to provide management guidance (on the best medical evidence class II and III or task force expertise) for neurologists, neurosurgeons, other physicians working with AS/VS patients, neurorehabilitation personnel, patients, next-of-kin, and health authorities.

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“…Of course the clinical signs that supposedly indicated this state of mind had to be defined arbitrarily, since there is no direct way of knowing the state of mind of anybody. A consensus by a number of neurosurgeons had been published in 1978 [3]: the clinical signs of coma are: ªThe patient does not open the eyes, neither after stimuli nor spontaneously and he does not follow commands. Movements after painful stimuli or spontaneous movements are possible.º Obviously a patient in such a condition needs special attention.…”

Section: Introductionmentioning

confidence: 99%

“…Movements after painful stimuli or spontaneous movements are possible.º Obviously a patient in such a condition needs special attention. A classification of the clinical findings of coma was first proposed as the Glasgow Coma Scale [21], which has been widely accepted, but does not provide a precise definition of coma as later proposals [3,12].…”

Section: Introductionmentioning

confidence: 99%

Monitoring of the comatose patient

Firsching¹

2002

Zentralbl Neurochir

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Monitoring of comatose patients involves a close followup of clinical findings and a number of various techniques. These techniques may be differentiated in invasive and non invasive techniques. The benefit of these techniques is controversial as to their effect on the actual therapy of the comatose patient. The benefit of sedation beyond the point of what is required for adequate sedation is questioned, as it makes clinical observation useless. Since there is no evidence that any technical monitoring is as sensitive and reliable as clinical monitoring, the reliance on only technical monitoring needs to be discussed.

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Report on the meeting of the W.F.N.S. neuro-traumatology committee, Brussels, 19–23 September 1976

Cited by 70 publications

References 0 publications

Classification of Traumatic Brain Injury for Targeted Therapies

Classification of Traumatic Brain Injury for Targeted Therapies

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

Monitoring of the comatose patient

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