The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables

Fearnside, Michael R.; Cook, Raymond; McDougall, Patricia; McNeil, R. J.

doi:10.3109/02688699309023809

Cited by 335 publications

(173 citation statements)

References 27 publications

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“…Studies of adults have linked early hypotension following TBI with poor outcome (2,(16)(17)(18). Hypotension occurring at any point from the time of injury through resuscitation has been shown to double the mortality rate (2).…”

Section: Discussionmentioning

confidence: 99%

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Coates¹,

Vavilala²,

Mack³

et al. 2005

Critical Care Medicine

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Objective-To examine the influence of definition and location (field, emergency department [ED] or Pediatric Intensive Care Unit [PICU]) of hypotension on outcome following severe pediatric Traumatic Brain Injury (TBI). Participants-93 children < 14 years of age with TBI following injury, head abbreviated injury score (AIS) ≥ 3, and PICU admission Glasgow Coma Sale (GCS) score < 9 formed the analytic sample. Data sources included the Harborview Trauma Registry and Hospital Records. Design-Retrospective Cohort study. Setting-HarborviewOutcome Measures-The relationship between hypotension and outcome was examined comparing two definitions of hypotension: 1) systolic blood pressure (SBP) < 5 th percentile for age and 2) SBP < 90 mmHg. Hospital discharge Glasgow Outcome score (GOS) < 4, or disposition of either death or discharge to a skilled nursing facility were considered poor outcomes. PICU and hospital length of stay (LOS) were also examined.Results-SBP < 5 th percentile for age was more highly associated with poor hospital discharge GOS (p = 0.001), poor disposition (p = 0.02), PICU LOS (RR 9.5; 95% CI 6.7-12.3) and hospital LOS (RR 18.8;) than SBP < 90mmHg. Hypotension occurring in either the field or ED, but not in the PICU, was associated with poor GOS (p = 0.008), poor disposition (p= 0.03) and hospital LOS (RR 18.7; 95% CI 13.1-24.2).Conclusions-Early hypotension, defined as SBP < 5 th percentile for age in the field and/or ED, was a better predictor of poor outcome than delayed hypotension or the use of SBP < 90 mmHg.

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Section: Discussionmentioning

confidence: 99%

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Coates¹,

Vavilala²,

Mack³

et al. 2005

Critical Care Medicine

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“…1 Prior studies have demonstrated that secondary brain insults (SBIs), such as fever, hypotension, or hypoxia, worsen outcome in patients with traumatic brain injury (TBI). [2][3][4][5][6][7][8] A retrospective study utilizing the Traumatic Coma Data Bank convincingly showed that hypotension or hypoxia at the time of hospital admission had a significant negative effect on six-month functional outcome as measured by the Glasgow Outcome Scale (GOS). 9 These events are common, as hypotension (defined in these settings as a systolic blood pressure ,90 mm Hg) is seen in up to 35% of patients with head injury.…”

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confidence: 99%

A Novel Method of Evaluating the Impact of Secondary Brain Insults on Functional Outcomes in Traumatic Brain-injured Patients

et al. 2005

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Objectives: Prior studies suggest that the emergency department (ED) occurrence of secondary brain insults (SBIs), such as systemic hypotension and hypoxia, worsens outcome in patients with traumatic brain injury. However, previous methods of assessing SBIs have been relatively crude, generally only determining the incidence and duration of events. The authors hypothesized that a new method that accounts for the cumulative depth and duration of SBIs would provide a more informative measure that better correlates with outcome. Methods: The authors developed a computer algorithm to calculate the total ''dose'' of an SBI (in this case, hypotension and hypoxia) as the area under the curve between a cut-point value and a measured vital sign over time. To test this method, the authors used an existing data set of head trauma patients for whom occurrence in the ED of any hypotension had been shown to be associated with in-hospital mortality. The authors applied the algorithm using the cut-point values from the prior study (systolic blood pressure #90 mm Hg and oxygen saturation #92%). The effects of SBIs on inhospital mortality and three-month Glasgow Outcome Scale score were evaluated. Results: Of 107 patients overall, 26 had hypotension (dose range 0.2-898 mm Hg Á min) and 40 had hypoxia (dose range 0.005-6.7% Á min). Moderate and high doses of hypotension were more strongly associated with outcome than the measures from the initial study (any hypotension and number of hypotensive episodes). Hypoxia had no effect. Conclusions: New methods of measuring SBIs that take into account depth and duration of episodes may more accurately reflect the influence of these events on outcome after head trauma.

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“…A study of Fearnside et al reported that 65% of patients with 3 GCS score and 10% of patients with 7-13 GCS score ended with mortality (12). In our study, while GCS levels of patients in admission decreased, the rate of surgical operations (severe: 6.1%, modarate: 25%, mild: 25%) and the rate of recovery with sequelae increased (mild: 6.1%, moderate: 0% and severe: 50%).…”

Section: Discussionmentioning

confidence: 48%

Travmatik Beyin Hasarlı Çocuk Hastalarda Tekrarlayan Bilgisayarlı Tomografinin Değerliliği ve Radyasyon Hasarı

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Ayvaci

et al. 2014

HSP

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25'i (%32,9) kız ve yaş ortalamaları 5,82 ± 3,66 bulundu. Araştırmaya alınan 76 hastaya toplamda 317 kez BT çekilmişti. Hastaların %42,10'una üç BT çekilirken geri kalanına üçten fazla BT çekilmişti. Hastaların %78,94'ünün sekelsiz taburcu olduğu, %7,9'unun opere edildiği görüldü. Hastaların ikinci BT'lerinde birinci BT'lerine göre sadece 2 hastada değişiklik saptandığı, yeni gelişen lezyon olarak bir hastada epidural hematom ve bir hastada subdural hematomun ortaya çıktığı belirlendi. Birinci BT sonuçlarına göre hastaların %7.9'una cerrahi tedavi uyulandı. Hastaların %92.1'i herhangi bir cerrahi tedavi uygulanmadan hastaneden taburcu oldu. Hastaların %6.6'sı sekelli iyileşirken, mortalite oranı %1.3 olarak bulundu. Tekrarlayan BT'ler ile çocuklara ek radyasyon dozu verilirken, tedavilerinde herhangi bir değişiklik oluşmadı. Sonuç: Kafa travmalı çocuklarda tekrarlayan BT'lerin hastanın prognozuna, acil cerrahi girişim ve tahmini yaşam beklentisine bir katkısı olmadığı tespit edilmiştir. Tekrarlayan BT çekimi uygulanan çocuklar, gelecekte radyasyon ile ilişkili gelişebilecek hastalıklar yönünden izlenmelidir. -diagnosis. Forty two point one percent of patients had CT three times, the rest had more than three times; total CT number was 317. Two patients showed changes in second CT (one epidural and one subdural hemorrhage) according to first CT whereas there was no change in third CT. The decision of operation in all operated patients treated surgically (7.9%) was given according to the result of first CT. While 92.1% of patients were discharged from the hospital by complete recovery, 6.6% of patients were with sequelae and mortality ratio was 1.3%. The changes in repeated CT did not change the treatment while every child was exposed to additional radiation. Conclusion: Repeated CT in children with head trauma did not contribute to the prognosis of patients, the choice of treatment and survival. The children applied serial CT should be followed for the diseases which can be progressed due to radiation in future.Key words: Head trauma in children, repeated brain CT, radiation exposure, traumatic brain injury Introduction Traumatic Brain Injury (TBI) is one of the most important diseases of 21. century which causes mortality and disablement (1,2). Different procedures about the indication, dosage of Head CT and repeated CT used common in pediatric TBI have been performed in different centers (3-4).The rates of CT used in the USA and other countries have increased rapidly particularly in the past 10 years (5). The use of CT procedures has expanded to more than 70 million in the United States per year, with nearly 10% of procedures performed on children (6).Although CT scans are very useful clinically, recent reports have raised concerns about the potential for malignancy following CT scanning, especially in pediatric patients (5) In a case-control study (part of the UK Childhood Cancer Study) by Rajaraman et al. was showed further evidence of possible excess risk of cancer, even at doses lower than those associated...

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The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables

Cited by 335 publications

References 27 publications

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury*

A Novel Method of Evaluating the Impact of Secondary Brain Insults on Functional Outcomes in Traumatic Brain-injured Patients

Travmatik Beyin Hasarlı Çocuk Hastalarda Tekrarlayan Bilgisayarlı Tomografinin Değerliliği ve Radyasyon Hasarı

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