Articles: traumatic-brain-injuries.
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Patients suffering traumatic brain and chest wall injuries are often difficult to liberate from the ventilator yet best timing of tracheostomy remains ill-defined. While prior studies have addressed early versus late tracheostomy, they generally suffer from the use of historical controls, which cannot account for variations in management over time. Propensity scoring can be utilized to identify controls from the same patient population, minimizing impact of confounding variables. The purpose of this study was to determine outcomes associated with early versus late tracheostomy by application of propensity scoring. ⋯ In the current era of increased health-care costs, early tracheostomy significantly decreased both pulmonary morbidity and critical care resource utilization. This translates to an appreciable cost savings, at minimum $52,173 per patient and a potential total savings of $2.8million/year for the entire LT cohort. For trauma patients requiring prolonged ventilator support, early tracheostomy should be performed.
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Brain injury : [BI] · Jan 2015
Subdural hygroma following decompressive craniectomy or non-decompressive craniectomy in patients with traumatic brain injury: Clinical features and risk factors.
Subdural hygroma (SDG) is a common complication that can occur after head trauma or secondary to decompressive craniectomy (DC). SDGs can be located not only ipsilateral or contralateral to the side of the DC, but also bilateral or unilateral in patients without DC. This study investigated the incidence and risk factors for different types of SDG in a large cohort of patients with traumatic brain injury (TBI). ⋯ This study suggested that the incidence of SDG in patients who have and have not undergone DC was identical; however, the patients' characteristics and risk factors differed. Therefore, the management and prediction of SDG should be performed according to SDG type.
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Brain injury : [BI] · Jan 2015
Serum ferritin correlates with Glasgow coma scale scores and fatal outcome after severe traumatic brain injury.
Severe traumatic brain injury (TBI) is associated with a 30-70% mortality rate. Nevertheless, in clinical practice there are no effective biomarkers for the prediction of fatal outcome following severe TBI. Therefore, the aim was to determine whether ferritin serum levels are associated with ICU mortality in patients with severe TBI. ⋯ Increased serum ferritin levels were associated with lower hospital admission GCS scores and predicted short-term fatal outcome following severe TBI.
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Permutation entropy is computationally efficient, robust to outliers, and effective to measure complexity of time series. We used this technique to quantify the complexity of continuous vital signs recorded from patients with traumatic brain injury (TBI). Using permutation entropy calculated from early vital signs (initial 10-20% of patient hospital stay time), we built classifiers to predict in-hospital mortality and mobility, measured by 3-month Extended Glasgow Outcome Score (GOSE). ⋯ The overall prediction accuracy achieved 91.67% for mortality, and 76.67% for 3-month GOSE in testing datasets, using the leave-one-out cross validation. We also applied Receiver Operating Characteristic analysis to compare classifiers built from different learning methods. Those results support the applicability of permutation entropy in analyzing the dynamic behavior of TBI vital signs for early prediction of mortality and long-term patient outcomes.
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Brain injury : [BI] · Jan 2015
Prevalence and predictors of affective lability after paediatric traumatic brain injury.
Paediatric severe traumatic brain injury (TBI) is associated with significant post-injury affective and behavioural problems. Few studies have examined the prevalence and characteristics of affective lability after paediatric TBI. ⋯ Affective lability is common after paediatric TBI and frequently manifests as irritability and unpredictable outbursts. Early intervention is needed to improve psychiatric outcomes.