Articles: brain-injuries.
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Comparative Study
Incidence, costs, and DRG-based reimbursement for traumatic brain injured patients: a 3-year experience.
A 3-year prospective study was conducted to establish the incidence of traumatic brain injury (TBI) and related characteristics of age, sex, length of stay (LOS), intensive care unit LOS (ICU/LOS), direct hospital charges, and reimbursement using a prospective DRG-based reimbursement system. The study identified TBI patients using ICD-9-Codes. The mean LOS for the two groups of patients with intracranial injury differed (p less than 0.05). ⋯ Of the 71 DRGs assigned to the study population, 15 reimbursed more than the actual charges. The severity of TBI victims and the complexity of caring for them in a Level I trauma center generates hospital charges of which only half are reimbursed through an all-payor DRG system. Strategies to correct what could be a financial disincentive are: documenting the uniqueness of this population to justify additional reimbursement, calculating a more precise mean LOS for TBI-related DRGs to more accurately identify outliers, and calculating DRG rates for TBI diagnoses derived from a representative sample at varying severity levels and hospitalized in facilities with and without rehabilitation services.
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Vestn. Khir. Im. I. I. Grek. · May 1989
[Surgical treatment of patients with cranio-cerebral trauma and the role of neurological symptoms in the prognosis of its outcomes].
Under examination there were 411 patients with cranio-cerebral traumas. A unified method was used at different medical institutions in order to study questions of prognosis of the outcomes. ⋯ The investigations have shown that the state of trance-coma both before operation and in the postoperative period is absolutely unfavourable prognostically. The state of trance-coma and the value of 15 scores and less should be taken into consideration as a contraindication for the solution of the question of operation in patients with cranio-cerebral traumas.
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There has recently been an increased interest in the use of hypertonic solutions for fluid resuscitation of trauma victims. In this study, we examined the acute cerebral effects of a hypertonic lactated Ringer's solution (measured osmolality = 469 mOsm/kg) in an animal model of traumatic brain injury. Following the production of a cerebral cryogenic lesion, eight New Zealand white rabbits were randomized to undergo hemodilution with either lactated Ringer's (measured osmolality = 254 mOsm/kg) or hypertonic lactated Ringer's. ⋯ Brain water content was significantly increased in the region of the lesion as assayed by both the wet/dry weight method and cortical specific gravity determinations, but there was no difference between the two treatment groups. Water content of the nonlesioned hemisphere was significantly less in the hypertonic group. This study suggests that hypertonic saline solutions may be useful for the resuscitation of hypovolemic patients with localized brain injury.
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The policy of patient selection for prophylactic anticonvulsant treatment has been evaluated retrospectively in 124 head-injured patients admitted consecutively for rehabilitation after primary neurosurgical treatment. Prophylaxis had been instituted in about 60% (51/83) of high risk patients and in about 30% (12/41) of the patients who did not belong to the high risk categories. The use of existing risk data as guidelines for decisions about anticonvulsant prophylaxis is discussed.
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Despite of the use of all the current intensive care measures, some patients develop dangerously high intracranial pressures (ICP) after head injury. We have studied the use of THAM for the rapid control of dangerously high ICP in these patients. PATIENT AND METHODS. ⋯ DISCUSSION. Our study indicates that THAM not only decreases an elevated ICP, but also improves CPP. These results are of note because only patients with otherwise unresponsive increases in ICP were included.