Articles: traumatic-brain-injuries.
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Multicenter Study Observational Study
Transcranial Doppler to Predict Neurologic Outcome after Mild to Moderate Traumatic Brain Injury.
To assess the performance of transcranial Doppler (TCD) in predicting neurologic worsening after mild to moderate traumatic brain injury. ⋯ TCD measurements upon admission may provide additional information about neurologic outcome after mild to moderate traumatic brain injury. This technique could be useful for in-hospital triage in this context. (Anesthesiology 2016; 125:346-54).
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To investigate the associated factors and change trajectories of quality of life (QoL), global outcome, and post-concussion symptoms (PCS) over the first year following mild traumatic brain injury (mTBI). ⋯ Employment status was the most crucial associated factor for QoL in individuals with mTBI at the 1-year follow-up. Future studies should explore the benefits of employment on QoL of individuals with mTBI.
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No evidence-based guidelines are available for the definitive diagnosis or directed treatment of most blast-associated traumatic brain injuries, partly because the underlying pathology is unknown. Moreover, few neuropathological studies have addressed whether blast exposure produces unique lesions in the human brain, and if those lesions are comparable with impact-induced traumatic brain injury. We aimed to test the hypothesis that blast exposure produces unique patterns of damage, differing from that associated with impact-induced, non-blast traumatic brain injuries. ⋯ Defense Health Program of the United States Department of Defense.
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OBJECTIVE Concerns about mild traumatic brain injury (mTBI) have increased in recent years, and neurosurgical consultation is often requested for patients with radiographic abnormalities or clinical findings suspicious for mTBI. However, to the authors' knowledge, no study has used the Acute Concussion Evaluation (ACE) tool to systematically evaluate the evolution of symptoms in patients with mTBI during neurosurgical follow-up. The goal in this study was to evaluate symptom progression in pediatric patients referred for neurosurgical consultation by using the ACE, as endorsed by the Centers for Disease Control and Prevention. ⋯ Patients with positive head CT findings required longer follow-up: these patients needed 14.59 weeks, versus 7.87 weeks of follow-up in patients with negative findings on head CT scans (p < 0.05). CONCLUSIONS The data suggest that patients with mTBI, particularly those with developmental and/or psychiatric comorbidities and concurrent cerebral or extracranial injury, often report symptoms for several weeks after their initial injury. Serial ACE assessment permits systematic identification of patients who are experiencing continued symptoms, leading to appropriate patient management and referral.
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Journal of critical care · Aug 2016
Safety of peripheral administration of phenylephrine in a neurologic intensive care unit: A pilot study.
Integral to the management of the neurocritically injured patient are the prevention and treatment of hypotension, maintenance of cerebral perfusion pressure, and occasionally blood pressure augmentation. When adequate volume resuscitation fails to meet perfusion needs, vasopressors are often used to restore end-organ perfusion. This has historically necessitated central venous access given well-documented incidence of extravasation injuries associated with peripheral administration of vasopressors. ⋯ We were able to administer peripheral phenylephrine, up to a dose of 2 μg/(kg min), for an average of 14.29hours (1-54.3) in 20 patients with only 1 possible minor complication and no major complications. This was achieved by adding additional safety measures in our computerized physician order entry system and additional nurse-driven safety protocols. Thus, with careful monitoring and safety precautions, peripheral administration of phenylephrine at an optimized concentration appears to have an acceptable safety profile for use in the neurocritical care unit up to a mean infusion time of 14hours.