Secondary insults during intrahospital transport of head-injured patients

Andrews, Pjd; Piper, Ian; Dearden, N. M.; Miller, Jay D.

doi:10.1016/0140-6736(90)90614-b

Cited by 259 publications

(127 citation statements)

References 16 publications

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“…On the contrary, inter-facility transfers are not without risks from the process itself or from the lack of a controlled environment, increasing TBI patient's susceptibility to hypotension, hypoxemia, and intracranial hypertension. 21 The impact of non-medical factors in the decision to transfer TBI patients remains an issue of debate.…”

Section: Discussionmentioning

confidence: 99%

The Association of Insurance Status and Race With Transfers of Patients With Traumatic Brain Injury Initially Evaluated at Level III and IV Trauma Centers

2015

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Objective-To investigate the association of lack of insurance and African-American race with the probability of transfer to level I/II trauma centers, after evaluation in the ED of level III/IV trauma centers for TBI.Summary Background Data-The influence of non-medical factors on the disposition of TBI patients initially seen in less specialized institutions is debated.Methods-We performed a retrospective cohort study involving TBI patients, who were registered in the National Trauma Data Bank between 2009 and 2011. Regression methods were used to investigate the association of insurance status and race with the disposition of TBI patients evaluated in less specialized trauma centers.Results-During the study period, there were 26,031 TBI patients, who were registered in NTDB and met inclusion criteria. Of these, 10,572 (35.9%) were transferred to a higher level of care institution. Multivariable logistic regression after coarsened exact matching demonstrated an association of uninsured patients with increased possibility of transfer (OR, 1.22; 95% CI, 1.05-1.42). On the contrary, there was no association of African-Americans with transfers (OR, 1.27; 95% CI, 0.99-1.62). Those with GCS above 8 (OR, 1.22; 95% CI, 1.08-1.39), or ISS below 16 (OR, 1.33; 95% CI, 1.13-1.56) had a higher possibility of transfer.Conclusions-In TBI patients, lack of insurance was associated with increased possibility of transfer to higher level of care institutions, after evaluation in a level III or IV trauma center ED.

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Section: Discussionmentioning

confidence: 99%

The Association of Insurance Status and Race With Transfers of Patients With Traumatic Brain Injury Initially Evaluated at Level III and IV Trauma Centers

2015

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“…Numerous studies highlight the adverse effects of failing to adequately resuscitate and monitor head injury patients during inter-and intrahospital transport [2,9]. Minimal monitoring requirements for transport include ECG, pulse oximetry to measure oxygen saturation and blood pressure.…”

Section: Transportationmentioning

confidence: 99%

EBIC-Guidelines for management of severe head injury in adults

et al. 1997

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SummaryGuidelines for the management of severe head injury in adults as evolved by the European Brain Injury Consortium are presented and discussed. The importance of preventing and treating secondary insults is emphasized and the principles on which treatment is based are reviewed. Guidelines presented are of a pragmatic nature, based on consensus and expert opinion, covering the treatment from accident site to intensive care unit. Specific aspects pertaining to the conduct of clinical trials in head injury are highlighted. The adopted approach is further discussed in relation to other approaches to the development of guidelines, such as evidence based analysis.

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“…Studies have reported a relationship between ADHD and childhood TBI (7)(8)(9)(10). Unlike other diseases resulting from various pathogenic mechanisms, TBI is caused by a complex interplay among damages occurring in the neuroanatomy, neurochemistry, and neurophysiology because of primary and secondary processes (11). A meta-analytic review showed that neurocognitive outcomes after pediatric TBI have a dose-response relationship with injury severity.…”

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confidence: 99%

Association of traumatic brain injury in childhood and attention-deficit/hyperactivity disorder: a population-based study

et al. 2016

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Background:We evaluated the risk of attention-deficit hyperactivity disorder (ADHD) following childhood traumatic brain injury (TBI). Methods: Using Taiwan's National Health Insurance Research Database, we included 10,416 newly diagnosed TBI children (aged ≤12 y) between 2001 and 2002 and 41,664 children without TBI, who were frequency matched by sex, age, and year of the index medical service with each TBI child, as controls. Children who had been diagnosed with ADHD prior to their medical service index were excluded. Each individual was followed for 9 y to identify ADHD diagnosis. We also compared the ADHD risk in children who were treated for fractures but not TBI as sensitivity analysis. results: During the 9-y follow-up period, children with TBI had a higher ADHD risk (adjusted hazard ratio (AHR) = 1.32, 95% confidence interval (CI) = 1.19, 1.45) than did those without TBI. Furthermore, children with mild and severe TBI had higher AHRs for ADHD than did those without TBI (AHR = 1.30; 95% CI = 1.10, 1.53; and AHR = 1.37; 95% CI = 1.22, 1.55). However, no significant association was observed between fractures and ADHD. conclusion: TBI in childhood is associated with a greater likelihood of developing ADHD. t raumatic brain injury (TBI) is the leading cause of death and disability in children and often results in persistent behavioral disturbances and neurocognitive deficits in attention, learning, and memory (1-3). Children with cognitive impairment following TBI impose a great economic and social burden on their families and communities. In addition, these children are more likely to have slower psychosocial development and exhibit poor academic achievement. Therefore, the relationship between TBI and neuropsychiatric consequences has become a crucial research topic.Attention-deficit-hyperactivity disorder (ADHD), a neurodevelopmental disorder, is associated with impulsivity, excessive talking, difficulty in sustaining attention, being easily distracted, and injuries (4-6). Studies have reported a relationship between ADHD and childhood TBI (7-10). Unlike other diseases resulting from various pathogenic mechanisms, TBI is caused by a complex interplay among damages occurring in the neuroanatomy, neurochemistry, and neurophysiology because of primary and secondary processes (11). A meta-analytic review showed that neurocognitive outcomes after pediatric TBI have a dose-response relationship with injury severity. Babikian and colleagues found that patients with severe TBI exhibited poorer performance in intelligence quotient tests, executive functioning, processing speed, attention maintenance, verbal immediate memory, and delayed memory, whereas patients with mild TBI exhibited no change (12). In addition, several studies have suggested that children with moderate to severe TBI are significantly more likely to develop ADHD symptoms than are those with mild TBI (8,(13)(14)(15)(16)(17). A longitudinal birth cohort study reported no association between preschool mild TBI and ADHD after adjusting for potential co...

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Secondary insults during intrahospital transport of head-injured patients

Cited by 259 publications

References 16 publications

The Association of Insurance Status and Race With Transfers of Patients With Traumatic Brain Injury Initially Evaluated at Level III and IV Trauma Centers

The Association of Insurance Status and Race With Transfers of Patients With Traumatic Brain Injury Initially Evaluated at Level III and IV Trauma Centers

EBIC-Guidelines for management of severe head injury in adults

Association of traumatic brain injury in childhood and attention-deficit/hyperactivity disorder: a population-based study

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