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Management of Severe Head Injury

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10681. Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury. Full Text available with Trip Pro

Critical thresholds of intracranial pressure and cerebral perfusion pressure related to age in paediatric head injury. The principal strategy for managing head injury is to reduce the frequency and severity of secondary brain insults from intracranial pressure (ICP) and cerebral perfusion pressure (CPP), and hence improve outcome. Precise critical threshold levels have not been determined in head injured children.To create a novel pressure-time index (PTI) measuring both duration and amplitude (...) thresholds generated are identical to age related physiological values. Management guidelines for paediatric head injuries should take account of these CPP thresholds to titrate appropriate pressor therapy.

2006 Neurosurgery and Psychiatry

10682. The impacts and outcomes of implementing head injury guidelines: clinical experience in Thailand. Full Text available with Trip Pro

of "talk and deteriorate" patients and a "poor" outcome for patients with severe head injury. Changes to clinical practice were observed where the guidelines were implemented.1000 patients with head injury were enrolled from 1st August 2005 to 15th January 2006. The incidence of "talk and deteriorate" patients was 10.5% and a poor outcome was noted in 35.5% of patients with severe head injury, similar to the results of a previous study in Songklanagarind Hospital (p>0.05). Following implementation (...) The impacts and outcomes of implementing head injury guidelines: clinical experience in Thailand. To describe the impact of implementing clinical practice guidelines (CPG) for head injury in a trauma referral system in Songkla province, Thailand.The CPG was developed by a local multidisciplinary team and implemented using multi-faceted methods. The outcome of patients with head injury from three community hospitals and a university hospital (Songklanagarind Hospital) was reported in terms

2007 Emergency Medicine Journal

10683. A Study to Evaluate the Efficacy of Somatropin in Adults With Growth Hormone Deficiency Caused by Trauma and/or Head Injury

A Study to Evaluate the Efficacy of Somatropin in Adults With Growth Hormone Deficiency Caused by Trauma and/or Head Injury A Study to Evaluate the Efficacy of Somatropin in Adults With Growth Hormone Deficiency Caused by Trauma and/or Head Injury - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached (...) . Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: 18 Years and older (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Documented GHD Documented mild, moderate, and severe head injury (e.g

2008 Clinical Trials

10684. Internal decapitation: survival after head to neck dissociation injuries. Full Text available with Trip Pro

patients had upper neck and head dissociation injuries. The pattern of injury in all of these cases included a distraction type mechanism. All cases demonstrated soft tissue disruption in the zone of injury, which was consistent and apparent on all imaging studies. In these patients, the extent and severity of injury was more apparent on magnetic resonance imaging (MRI) than on radiograph or computed tomography scan. Management of these injuries included immobilization followed by surgery (...) Internal decapitation: survival after head to neck dissociation injuries. Case series.To describe survival and outcomes after occipitocervical dissociation injuries.Historically, occipitocervical dissociation injuries have a high rate of associated neurologic deficit with a relatively high incidence of mortality.Six patients with occipitocervical dissociation injuries are reported and their management and imaging findings reviewed. Possible contributory factors for survival are discussed.All

2008 Spine

10685. Missile injuries in head — neck and maxillo-facial region — an experience in eastern nepal Full Text available with Trip Pro

Missile injuries in head — neck and maxillo-facial region — an experience in eastern nepal Ballistic injuries to head-neck and maxillofacial region is quite common problem nowadays. Most of the time the injuries seem to be dreadful but the mechanism of the injuries caused by ballistics and the anatomical conditions of maxillofacial and head-neck region mitigate the severity of the injuries. Proper primary management followed by reconstruction and management of associated injuries decreases (...) the mortality and morbidity of missile injuries in head-neck and maxillofacial region. Eleven cases of missile injuries in head-neck and maxillofacial region are included in the present study. The mechanism of the injury and the ideal management strategy for the ballistics injuries in the region has been discussed in the article.

2008 Indian Journal of Otolaryngology and Head & Neck Surgery

10686. Head Injury Retrieval Trial

Party): Alan Garner, CareFlight Study Details Study Description Go to Brief Summary: The study hypothesis is that advanced interventions as provided by a physician at an accident scene will decrease the death rate and the rate of severe disability in survivors of severe head injury. Extended interventions by advanced level prehospital providers may include rapid sequence intubation (RSI) airway management, blood transfusions, surgical procedures, etc. Condition or disease Intervention/treatment (...) Phase Head Injuries, Closed Procedure: Extended interventions by advanced level prehospital providers Not Applicable Detailed Description: A randomised, controlled trial examining prehospital management of persons with severe blunt head injury, in the Sydney region. Treatments examined will be the current system consisting principally of paramedic management (standard care) compared with management by a retrieval team lead by a consultant anaesthetist, emergency physician or intensive care

2005 Clinical Trials

10687. Warfighter Head Injury Study

Warfighter Head Injury Study Warfighter Head Injury Study - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Warfighter Head Injury Study The safety and scientific validity of this study is the responsibility (...) and the published results of those studies have changed the management and evaluation of head-injured warfighters, and contributed to knowledge of brain function and the long-term effects of head injury. Furthermore, based on the knowledge acquired in our previous research with Vietnam warfighters and our current interests in the functions of the human PFC, cognitive neuroplasticity in the young brain, posttraumatic stress disorder (PTSD), posttraumatic epilepsy (PTE), caregiver stress, and genetic-plasticity

2008 Clinical Trials

10688. Vietnam Head Injury Study

Vietnam Head Injury Study Vietnam Head Injury Study - Phase III - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Vietnam Head Injury Study - Phase III The safety and scientific validity of this study (...) heart dysfunction, etc...) A history of severe head injury, stroke, loss of consciousness, or other significant neurological, psychiatric or medical condition that would render the subject unsuitable for the VHIS testing battery. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov

2005 Clinical Trials

10689. Immunemodulation in Patients With Minor Head Injury

Immunemodulation in Patients With Minor Head Injury Immunemodulation in Patients With Minor Head Injury - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Immunemodulation in Patients With Minor Head Injury (...) Population Patients from daily practice Criteria Inclusion Criteria: minor head injury Exclusion Criteria: severe head injury Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00622778 Locations Layout table for location information Austria Medical

2008 Clinical Trials

10690. Observational Endothelin and Markers of Cellular Apoptosis In CSF Head Injury

Observational Endothelin and Markers of Cellular Apoptosis In CSF Head Injury Observational Endothelin and Markers of Cellular Apoptosis In CSF Head Injury - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more (...) Neurohormones Cellular Apoptosis Endothelin System Detailed Description: Severe traumatic brain injury (TBI) remains a critical problem in the United States and throughout the world. Advances in critical care of the TBI patient has resulted in improved outcome. However, despite these efforts, half of the patients with severe brain injury die or are left with severe disability. Thus, the need for a pharmaceutical agent to blunt the cascade of neurotoxins released with mechanical head trauma and improve

2007 Clinical Trials

10691. Transcranial Doppler Measurement and Prognosis in Moderate Head Injury

Transcranial Doppler Measurement and Prognosis in Moderate Head Injury Transcranial Doppler Measurement and Prognosis in Moderate Head Injury - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Transcranial (...) which could produce ischemia. The measurement of CPP generally is gotten by invasión with ICP determination. In severe head injury has been demonstrated correlation between ICP and PI, strongest for CPP and PI. Other parameters are oligaemia and vasospasm in the first 24 hours correlate poor outcome. Because of the non invasive characteristic and good correlation with physiologic and prognosis, we think it is important evaluate if there are a kind of correlation between amnesia and orientation

2006 Clinical Trials

10692. Cholinomimetic agents and neurocognitive impairment following head injury: a systematic review. Full Text available with Trip Pro

Cholinomimetic agents and neurocognitive impairment following head injury: a systematic review. There has been increasing interest in the role of cholinomimetic agents in the long-term management of cognitive impairment following traumatic brain injury. This paper aims to assess the evidence accumulated thus far.Studies are identified by searching MEDLINE, EMBASE and PsychINFO, contacting experts and pharmaceutical companies and hand searching bibliographies. All study designs are included.This (...) study identified 25 papers that studied cholinesterase inhibitors, physostigmine and choline in mild-to-severe traumatic brain injury. The outcome with cholinesterase inhibitors and choline is suggestive but not conclusive while physostigmine appears of little benefit. A lack of rigorous studies and a plethora of outcome measures preclude drawing definitive conclusions. Further randomized controlled trials are urgently required.

2008 Brain injury : [BI]

10693. Hypothermia pediatric head injury trial: the value of a pretrial clinical evaluation phase. (Abstract)

Hypothermia pediatric head injury trial: the value of a pretrial clinical evaluation phase. The utility of a pretrial clinical evaluation or run-in phase prior to conducting trials of complex interventions such as hypothermia therapy following severe traumatic brain injury in children and adolescents has not been established.The primary objective of this study was to prospectively evaluate the ability of investigators to adhere to the clinical protocols of care including the cooling (...) and rewarming procedures as well as management guidelines in patients with severe traumatic brain injury (Glasgow Coma Scale

2006 Developmental neuroscience Controlled trial quality: uncertain

10694. Hemodynamic and oxygen transport patterns after head trauma and brain death: implications for management of the organ donor. (Abstract)

Hemodynamic and oxygen transport patterns after head trauma and brain death: implications for management of the organ donor. The aims of the present study were to describe the temporal hemodynamic and oxygen transport patterns of patients with head injuries as well as the patterns of those who became brain dead to better understand the role of underlying central regulatory hemodynamic mechanisms and ultimately to improve rates of organ donation.We studied 388 consecutive noninvasively monitored (...) patients with severe head trauma; 79 of these became brain dead. Monitoring was started shortly after admission to the emergency department and was designed to describe the sequence of cardiac, pulmonary, and tissue perfusion functions by cardiac index (CI), mean arterial pressure, heart rate, arterial saturation by pulse oximetry (Sapo2), and transcutaneous oxygen and carbon dioxide (Ptco2/Fio2 and Ptcco2) patterns. The latter were used as markers of tissue perfusion or oxygenation.Patients with head

2007 Journal of Trauma

10695. The value of computed tomographic scanning in the diagnosis and management of orbital fractures associated with head trauma: a prospective, consecutive study at a level I trauma center. (Abstract)

period, 600 consecutive patients admitted with head trauma were examined clinically; these patients then underwent cranial helical CT scanning, irrespective of severity of head injuries and presence or absence of fracture-related symptoms.Orbital fractures were diagnosed on CT scan in 118 cases (19.7%). All patients with symptoms directly related to an orbital fracture had radiologically diagnosed fractures, compared with 58.3% of patients with isolated blepharohematoma and 3.8% of asymptomatic (...) The value of computed tomographic scanning in the diagnosis and management of orbital fractures associated with head trauma: a prospective, consecutive study at a level I trauma center. Orbital fractures associated with head trauma are not always easy to diagnose. The real incidence of such fractures is unknown. The aim of this study was to evaluate the usefulness of routine primary computed tomographic (CT) scanning for diagnosis of orbital fractures in head trauma patients.Over a 3-year

2005 Journal of Trauma

10696. Clinical algorithm and resource use in the management of children with minor head trauma. (Abstract)

for a skull fracture, which led to an admission in half of these patients. The other half was mainly discharged from ER after being observed. Several patients underwent a skull x-ray that we feel was not necessary in the management of their minor head injury. For those who had a head CT scan, only one revealed additional information and none of them had an impact on the final management. Observation in the ER could have been reasonable for most cases. (...) Clinical algorithm and resource use in the management of children with minor head trauma. There are no clear guidelines for the management of minor head injury, including the use of skull x-rays and computed tomography (CT) scans of the head. This is reflected in clinical practice by a wide variability in imaging study use and by the fact that some patients are discharged home from the emergency room (ER), whereas others are admitted to the hospital with or without a period of observation

2007 Journal of Pediatric Surgery

10697. Management and hospital outcomes of blunt renal artery injuries: analysis of 517 patients from the National Trauma Data Bank. (Abstract)

and the effect of various therapeutic modalities on hospital outcomes.This was a National Trauma Data Bank study including all blunt trauma admissions with renal artery injuries. Demographics, mechanism of injury, Injury Severity Score, Abbreviated Injury Score for each body area (head, chest, abdomen, extremities) injuries, type of management (nephrectomy, arterial reconstruction, or observation), time from admission to definitive treatment, and hospital outcomes (mortality, ICU, and hospital stay) were (...) Management and hospital outcomes of blunt renal artery injuries: analysis of 517 patients from the National Trauma Data Bank. Blunt renal artery injuries are rare and no single trauma center can accumulate substantial experience for meaningful conclusions about optimal therapeutic strategies. The purpose of this study was to assess the incidence of renal artery injuries after different types of blunt trauma, and evaluate the current therapeutic approaches practiced by American trauma surgeons

2006 Journal of the American College of Surgeons

10698. Emergency department management of mild traumatic brain injury in the USA. Full Text available with Trip Pro

Emergency department management of mild traumatic brain injury in the USA. To describe the emergency department (ED) management of isolated mild traumatic brain injury (TBI) in the USA and to examine variation in care across age and insurance types.A secondary analysis of ED visits for isolated mild TBI in the National Hospital Ambulatory Medical Care Survey 1998-2000 was performed. Mild TBI was defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 (...) ) codes for skull fracture, concussion, intracranial injury (unspecified), and head injury (unspecified). Available ED care variables were analysed by patient age and insurance categories using multivariate logistic regression.The incidence of isolated mild TBI cases attending ED was 153,296 per year, or 56.4/100,000 people. Of the patients with isolated mild TBI, 44.3% underwent computed tomography, 23.9% underwent other non-extremity, non-chest x rays, 17.1% received wound care and 14.1% received

2005 Emergency Medicine Journal

10699. Examination of the management of traumatic brain injury in the developing and developed world: focus on resource utilization, protocols, and practices that alter outcome. (Abstract)

, 2003, and September 30, 2004.Complete data were available for 1607 patients. Grady Memorial Hospital had a higher proportion of females (p = 0.003), and patients were older at GMH (p = 0.0009) compared with patients at KPH and UHWI. The most common mode of injury was a motor vehicle accident at KPH and GMH (42 and 66%, respectively) and assaults at UHWI (37%). Grady Memorial Hospital admitted more patients with severe head injuries (25.5%) than KPH (18.5%) and UHWI (14.4%). More CT scans were (...) Examination of the management of traumatic brain injury in the developing and developed world: focus on resource utilization, protocols, and practices that alter outcome. We evaluated management and outcome of traumatic brain injury (TBI) in a developed country (US) and a developing country (Jamaica).Data were collected prospectively at Grady Memorial Hospital (GMH) in the US and at University Hospital of the West Indies (UHWI) and Kingston Public Hospital (KPH) in Jamaica between September 1

2008 Journal of Neurosurgery

10700. The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience. (Abstract)

The failure of nonoperative management in pediatric solid organ injury: a multi-institutional experience. Nonoperative management (NOM) is the accepted treatment of most pediatric solid organ injuries (SOI) and, is typically successful. We sought to elucidate predictors of, and the time course to, failure in the subset of children suffering SOI who required operative intervention.A retrospective analysis was performed from January 1997 through December 2002 of all pediatric patients (age 0-20 (...) years) with a SOI (liver, spleen, kidney, pancreas) from the trauma registries of seven designated, level I pediatric trauma centers. Failure of NOM was defined as the need for intra-abdominal operative intervention. Data reviewed included demographics, injury mechanism, injury severity (ISS, AIS, SOI grade, and GCS), and outcome. For the failures of NOM, time to operation and relevant clinical variables were also abstracted. A summary AIS (sAIS) was calculated for each patient by summing the AIS

2005 Journal of Trauma

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