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Management of Severe Head Injury

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10721. 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

10722. 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

10723. 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

10724. 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

10725. Non-Operative Management of High Grade Blunt Hepatic Injury: Clinical Complications and the Role of Collateral Damage

by uncontrolled bleedings from associated intra- and extra-abdominal injuries, and that most late deaths result from collateral head injuries and sepsis with multi-organ-failure (MOF). But no detailed data about the occurrence of extra-abdominal complications after NOMLI has been published so far. Objective: We first hypothesized that NOMLI can be safely achieved also in high-grade liver injured patients, the management of trauma patients with LI mainly consist of the treatment of collateral damages (...) Non-Operative Management of High Grade Blunt Hepatic Injury: Clinical Complications and the Role of Collateral Damage Non-Operative Management of High Grade Blunt Hepatic Injury: Clinical Complications and the Role of Collateral Damage - 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

2008 Clinical Trials

10726. Discrete Hypothermia in the Management of Traumatic Brain Injury

in the Management of Traumatic Brain Injury Study Start Date : July 2006 Actual Primary Completion Date : August 2007 Actual Study Completion Date : October 2008 Resource links provided by the National Library of Medicine related topics: Arms and Interventions Go to Arm Intervention/treatment Experimental: Treatment Device: CoolSystems Discrete Cerebral Hypothermia System The CoolSystems Discrete Cerebral Hypothermia System (DCHS) will be removed from the patients head after 48 hours. Sham Comparator: Control (...) Discrete Hypothermia in the Management of Traumatic Brain Injury Discrete Hypothermia in the Management of Traumatic Brain 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. Discrete Hypothermia

2008 Clinical Trials

10727. 11 March 2004: The terrorist bomb explosions in Madrid, Spain – an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital Full Text available with Trip Pro

of clinical management and patterns of injuries in casualties who were taken to the closest hospital, with an emphasis on the critically ill. A total of 312 patients were taken to the hospital and 91 patients were hospitalized, of whom 89 (28.5%) remained in hospital for longer than 24 hours. Sixty-two patients had only superficial bruises or emotional shock, but the remaining 250 patients had more severe injuries. Data on 243 of these 250 patients form the basis of this report. Tympanic perforation (...) occurred in 41% of 243 victims with moderate-to-severe trauma, chest injuries in 40%, shrapnel wounds in 36%, fractures in 18%, first-degree or second-degree burns in 18%, eye lesions in 18%, head trauma in 12% and abdominal injuries in 5%. Between 08:00 and 17:00, 34 surgical interventions were performed in 32 patients. Twenty-nine casualties (12% of the total, or 32.5% of those hospitalized) were deemed to be in a critical condition, and two of these died within minutes of arrival. The other 27

2004 Critical Care

10728. Management of spleen injuries in the adult trauma population: a ten-year experience Full Text available with Trip Pro

-31.5] d, p < 0.001), respectively. This difference was more likely related to a higher proportion of patients having injury severity scores greater than 25 in the operative group. The rate of nonoperative management of spleen injuries was significantly increased from 48.5% to 63.1% between 1992-1996 and 1997-2001 (p = 0.02).The present study has shown that nonoperative management of blunt spleen trauma has increased over time and has acceptable mortality and complication rates in selected patients (...) . Additional prospective studies are needed to assess the feasibility and safety of nonoperative management in adult spleen injuries. Furthermore, the management of traumatic spleen injuries with respect to associated injuries, such as head injuries or intra-abdominal injuries, needs ongoing evaluation.

2006 Canadian Journal of Surgery

10729. 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

10730. Blunt renal injuries in children can be managed nonoperatively: outcome in a consecutive series of patients. (Abstract)

, for an overall renal salvage rate of 98.9%. In children with isolated renal injuries (n = 48), one child (2.1%) required laparotomy. Seven children required adjunctive urologic procedures (ureteral stenting, n = 5; cystoscopy/cystogram, n = 2). There were seven deaths (7.4% overall; five because of head injury and two because of severe abdominal bleeding at presentation).A nonoperative management strategy was advantageous and successful in pediatric blunt renal injuries (94.7% successful nonoperative rate (...) Blunt renal injuries in children can be managed nonoperatively: outcome in a consecutive series of patients. Nonoperative management of radiographically defined solid organ injuries has proven highly successful in children with blunt splenic and hepatic injuries. The role of nonoperative management protocols is less well defined for blunt renal injuries. The purpose of this study was to review the management and outcome of a consecutive series of children with blunt renal injury.The trauma

2004 Journal of Trauma

10731. 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

10732. The role of early follow-up computed tomography imaging in the management of traumatic brain injury patients with intracranial hemorrhage. (Abstract)

The role of early follow-up computed tomography imaging in the management of traumatic brain injury patients with intracranial hemorrhage. The purpose of this study was to investigate whether routine follow-up computed tomography (CT) for patients with head injury, in the absence of clinical indications, alters patient management.Nonpenetrating head injury patients admitted to San Francisco General Hospital during an 18-month period were reviewed. Patients not surgically treated at presentation (...) = 0.01), and higher Marshall score (p = 0.01) on initial CT imaging.Although PHI is common with head injury, delayed interventions in the absence of clinical indicators are uncommon. Our data suggest that early follow-up CT imaging in the setting of head trauma is not routinely indicated. We suggest that assessment, based on the severity of findings on initial brain imaging and serial clinical examinations, should guide the need for follow-up imaging in the setting of head trauma.

2007 Journal of Trauma

10733. 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

10734. 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

10735. Usefulness of the abbreviated injury score and the injury severity score in comparison to the Glasgow Coma Scale in predicting outcome after traumatic brain injury. (Abstract)

Usefulness of the abbreviated injury score and the injury severity score in comparison to the Glasgow Coma Scale in predicting outcome after traumatic brain injury. Assessment of injury severity is important in the management of patients with brain trauma. We aimed to analyze the usefulness of the head abbreviated injury score (AIS), the injury severity score (ISS), and the Glasgow Coma Scale (GCS) as measures of injury severity and predictors of outcome after traumatic brain injury (TBI).Data (...) score and ISS modestly improved the correlation with GOS-E (R = 0.335, p < 0.001). The combination of GCS score and head AIS had a similar effect (R = 0.275, p < 0.001). Correlations were stronger from patients severe injuries (GCS injuries (GCS >8).GCS score, AIS, and ISS are weakly correlated with 12-month outcome. However, anatomic measures modestly outperform GCS

2007 Journal of Trauma

10736. Survey of intensive care of severely head injured patients in the United Kingdom. Full Text available with Trip Pro

Survey of intensive care of severely head injured patients in the United Kingdom. To study practice in intensive care of patients with severe head injury in neurosurgical referral centres in United Kingdom.Structured telephone interview of senior nursing staff in intensive care unit of adult neurosurgical referral centre.39 intensive care units in hospitals that accepted acute head injuries for specialist neurosurgical management, identified from Medical Directory and information from (...) professional bodies.Details of organisation and administration of intensive care and patterns of monitoring and treatment for patients admitted with severe head injury.Patients were managed in specialist neurosurgical intensive care units in 21 of the centres and in general intensive care units in 18. Their intensive care was coordinated by an anaesthetist in 25 units and by a neurosurgeon in 12. Annual case-load varied between units: 20 received > 100 patients, 12 received 50-100, and seven received 25-49

1996 BMJ : British Medical Journal

10737. Hypothermia to Treat Severe Brain Injury

Hypothermia to Treat Severe Brain Injury Hypothermia to Treat Severe Brain 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. Hypothermia to Treat Severe Brain Injury The safety and scientific validity (...) hospital within 2 hours of injury—and who have not already been evaluated by EMS personnel affiliated with the study—will be evaluated and cooling begun, if applicable, by NABISH study personnel. NABISH-trained EMS personnel who reach a patient with a suspected severe head injury within 2 hours of injury will induce hypothermia to 35˚C at the scene, in transit, or in the ED. NABISH study personnel will induce hypothermia to 35˚C in the ED in patients with suspected severe head injury who reach the ED

2002 Clinical Trials

10738. [Seizure prevention using carbamazepine following severe brain injuries]. (Abstract)

[Seizure prevention using carbamazepine following severe brain injuries]. In this article the efficacy of carbamazepine for seizure prophylaxis in severe head injuries is tested. In addition, conditions with high risk of seizures requiring prophylactic regimen, were defined. One hundred and thirty-nine patients above 15 years of age with severe head injuries were included in the study. They were randomly divided into two groups--carbamazepine versus placebo. Prophylaxis was started immediately (...) after the accident and was continued for one and a half to two years. Carbamazepine dosage was adjusted individually to provide serum levels within therapeutic range. In case of a seizure all the necessary clinical management was initiated. Patients on carbamazepine showed a lower probability of post-traumatic seizures than those on placebo (p less than 0.05). This difference was statistically significant with regard to early seizures within the first week and with regard to the follow-up time

1983 Neurochirurgia Controlled trial quality: uncertain

10739. A phase II study of moderate hypothermia in severe brain injury. (Abstract)

A phase II study of moderate hypothermia in severe brain injury. Forty-six patients with severe nonpenetrating brain injury [Glasgow Coma Scale (GCS) 4-7] were randomized to standard management at 37 degrees C (n = 22) and to standard management with systemic hypothermia to 32 to 33 degrees C (n = 24). The two groups were balanced in terms of age (Wilcoxon's rank sum test, p > 0.95), randomizing GCS (chi-square test, p = 0.54), and primary diagnosis. Cooling was begun within 6 h of injury (...) hypothermia in patients with severe head injury is warranted.

1993 Journal of neurotrauma Controlled trial quality: uncertain

10740. A home program of rehabilitation for moderately severe traumatic brain injury patients. The DVHIP Study Group. (Abstract)

A home program of rehabilitation for moderately severe traumatic brain injury patients. The DVHIP Study Group. We have recently reported the results of a prospective controlled randomized trial comparing home versus inpatient cognitive rehabilitation for patients with moderate to severe head injury. That study showed no overall difference in outcomes between the two groups.(1) In this article, we provide further details of the home program arm of the study. All patients in the home program (...) received medical treatment as needed, a multidisciplinary in-hospital evaluation, and TBI counseling before entering the eight-week home program, which then included guidance on home activities, as well as weekly telephone calls from a psychiatric nurse.

2000 The Journal of head trauma rehabilitation Controlled trial quality: uncertain

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