Articles: brain-injuries.
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The Journal of pediatrics · Feb 1992
Limitations of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury.
To study the hypothesis that, in the absence of an ischemic-hypoxic state, children with severe traumatic brain injury and with unfavorable Glasgow Coma Scale scores may have good recovery. ⋯ A low Glasgow Coma Scale score does not always accurately predict the outcome of severe traumatic brain injury; in the absence of hypoxic-ischemic injury, children with traumatic brain injury and Glasgow Coma Scale scores of 3 to 5 can recover independent function.
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We reviewed the records of 253 patients with head injury who required serial computed tomographic (CT) scans; 123 (48.6%) developed delayed brain injury as evidenced by new or progressive lesions after a CT scan. An abnormality in the prothrombin time, partial thromboplastin time, or platelet count at admission was present in 55% of the patients who showed evidence of delayed injury, and only 9% of those whose subsequent CT scans were unchanged or improved from the time of admission (P less than 0.001). Among patients developing delayed injury, mean prothrombin time at admission was significantly longer (14.6 vs. 12.6 s, P less than 0.001) and partial thromboplastin time was significantly longer (36.9 vs. 29.2 s, P less than 0.001) than patients who did not have delayed injury. ⋯ This risk rose to almost 85% if at least one clotting test at admission was abnormal (P less than 0.001). We conclude that clotting studies at admission are of value in predicting the occurrence of delayed injury. If coagulopathy is discovered in the patient with head injury early follow-up CT scanning is advocated to discover progressive and new intracranial lesions that are likely to occur.
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Acute management involves triage, well directed investigation and timely surgical intervention when necessary. All are discussed in this review. Cerebral blood flow (CBF) and flow velocity assessment are among the other investigations mentioned. Other topics include paediatric head injury, cerebrospinal fluid (CSF) fistulae, stab wounds and post-traumatic epilepsy.
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Craniocerebral missile injuries are a relatively rare type of head injury during peacetime. In the Department of Neurosurgery of the Landesnervenklinik Salzburg 72 patients were operated on for gunshot wounds of the brain in the period 1970-1990, and 31 survived. In the same period 6763 patients were treated for other head injuries. As shown by the clinical courses and the operative results, the velocity and thus the extent of the primary brain damage determine the prospects of success in the treatment of cerebral missile injuries.
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Traumatic brain injury affects approximately 500,000 persons each year. For those patients who survive until they reach the hospital, the major goal of the health care team is to prevent secondary injuries or insults that may follow the initial event and worsen the brain injury. ⋯ Early recognition of these factors and prompt intervention can improve the neurologic outcome of the patient with severe head injury. An understanding of the causes and effects of these secondary insults is critical to the appropriate medical and nursing management of these patients.