Effect of trauma center designation in severe traumatic brain injury outcome

Effect of trauma center designation in severe traumatic brain injury outcome

Trauma center designation is significantly associated with functional independence (FI) and independent expression (IE) (defined as a functional independence measure component of 4) after severe traumatic brain injury, but not moderate traumatic brain injuryProspective study is warranted to verify and explore factors contributing to this discrepancy 1).

Patients with severe traumatic brain injury treated in American College of Surgeons (ACS)-designated level 1 trauma centers have better survival rates and outcomes than those treated in ACS-designated level 2 trauma center2).

In 2019 a study showed superior functional outcomes and lower mortality rates in patients undergoing a neurosurgical procedurefor severe traumatic brain injury in level 1 trauma center3).

References

1)

Brown JB, Stassen NA, Cheng JD, Sangosanya AT, Bankey PE, Gestring ML. Trauma center designation correlates with functional independence after severe but not moderate traumatic brain injury. J Trauma. 2010 Aug;69(2):263-9. doi: 10.1097/TA.0b013e3181e5d72e. PubMed PMID: 20699734.
2)

DuBose JJ, Browder T, Inaba K, Teixeira PG, Chan LS, Demetriades D. Effect of trauma center designation on outcome in patients with severe traumatic brain injury. Arch Surg. 2008 Dec;143(12):1213-7; discussion 1217. doi: 10.1001/archsurg.143.12.1213. PubMed PMID: 19075174.
3)

Chalouhi N, Mouchtouris N, Saiegh FA, Starke RM, Theofanis T, Das SO, Jallo J. Comparison of Outcomes in Level I vs Level II Trauma Centers in Patients Undergoing Craniotomy or Craniectomy for Severe Traumatic Brain Injury. Neurosurgery. 2019 Jan 24. doi: 10.1093/neuros/nyy634. [Epub ahead of print] PubMed PMID: 30690608.

Percutaneous balloon compression trigeminal rhizotomy for multiple sclerosis related trigeminal neuralgia

Percutaneous balloon compression trigeminal rhizotomy for multiple sclerosis related trigeminal neuralgia

Many patients with multiple sclerosis related trigeminal neuralgia have pain that is centrally mediated, reducing the effectiveness of procedures performed on the trigeminal roottrigeminal ganglion, or divisions 1).

Balloon compression had the highest rate of initial pain-free response (IPFR) and duration of pain-free intervals (PFIs), compared with other modalities in the initial treatment of MS-related TN 2). It could be considered a useful technique for patients whose pain recurs after other procedures 3).

Percutaneous balloon compression PBC is a treatment that can be effective for many patients with MS-TN 4).

Compared with that in non-MS patients, symptom recurrence is higher and requires multiple procedures 5).

Repeated previous surgeries is a risk factor for an unsatisfactory outcome. However, the patients with multiple surgeries had less satisfactory results already at the first procedure, indicating that a therapy resistant disease can be predicted after the first two PBCs. Postoperative sensory deficits were common but not lasting 6).


One hundred eleven procedures with Percutaneous balloon compression (PBC) performed in 66 cases of Multiple sclerosis related trigeminal neuralgia (MS-TN) were analyzed. Therapeutic effect was measured as postoperative time to pain recurrence without medication. All complications were compiled and the sensory function was evaluated in a subgroup of cases.

The initial pain free rate was 67% and the median time to pain recurrence was 8 mo. Thirty-six patients were treated with PBC only, and among them, the results were worse if treated 3 to 4 times before, compared to first treatment (P = .009-.034). Patients who had several PBCs had worse results already after the first surgery (P < .001). A significant number of patients had impaired sensation to light touch directly after surgery, which was normalized at the late follow-up. Sensimetric testing showed raised thresholds for perception and pain directly after surgery (P = .004-.03), but these were also normalized at the late follow-up.

PBC is a treatment that can be effective for many patients with MS-TN. Repeated previous surgeries is a risk factor for an unsatisfactory outcome. However, the patients with multiple surgeries had less satisfactory results already at the first procedure, indicating that a therapy resistant disease can be predicted after the first two PBCs. Postoperative sensory deficits were common but not lasting 7).


Retrospectively collected clinical data on 80 consecutive patients who underwent 144 procedures and who received PBC for TN treatment between January 2000 and January 2010 were analyzed. The cohort included 17 MS and 63 non-MS patients.

The mean age at first operation was significantly younger in the MS group compared with the non-MS group (59 years vs 72 years, respectively, p < 0.0001). After a mean follow-up of 43 months (MS group) and 25 months (non-MS group), the symptom recurrence rate following the first operation was higher in the MS group compared with that in the non-MS group (86% vs 47%, respectively, p < 0.01). During long-term follow-up, more than 70% of MS patients required multiple procedures compared with only 44% of non-MS patients. Excellent or satisfactory outcomes were not significantly different between the MS and non-MS cohorts, respectively, at 1 day postoperatively (82% vs 91%, p = 0.35), 3 months postoperatively (65% vs 81%, p = 0.16), and at last follow-up (65% vs 76%, p = 0.34). A similar incidence of postoperative complications was observed in the 2 groups.

PBC is effective in the treatment of trigeminal neuralgia in patients with MS, but, compared with that in non-MS patients, symptom recurrence is higher and requires multiple procedures 8).


During the period 2000-2012, 10 patients with medically refractory TN and ipsilateral brainstem T2 hyperintensity underwent MVD. In 5 patients, additional clinical features suspicious for MS were present, including prior optic neuritis (n = 2), multiple disseminated lesions (n = 3), and elevated immunoglobulin G index (n = 2). One patient had failed prior percutaneous surgery; 1 patient had Burchiel type 2 TN. Follow-up (median, 14 months) was censored at the time of additional surgery (n = 6) or last clinic visit (n = 4).

Neurovascular compression was confirmed at surgery from the superior cerebellar artery (SCA) plus adjacent vein (n = 4), vein alone (n = 3), SCA alone (n = 2), and SCA plus anterior inferior cerebellar artery (n = 1). Initially after MVD, 8 patients (80%) were pain-free and subsequently tapered off medications for their facial pain. Pain recurred in 6 patients at a median of 4 months (range, 1-23 months). Actuarial rates of being pain-free off medications were 50% at 3 months and 15% at 2 years. In 6 patients, additional treatments were performed, including glycerol rhizotomy (n = 4), radiosurgery (n = 2), balloon compression (n = 2), and repeat MVD (n = 1). At last contact, 5 of the 6 patients who were retreated were pain-free.

Facial pain outcomes after MVD in patients with suspected MS-related TN are poor compared with outcomes for patients with idiopathic TN. This study provides further support that many patients with MS-related TN have pain that is centrally mediated, reducing the effectiveness of procedures performed on the trigeminal root, ganglion, or divisions 9).


Seven patients had TN related to multiple sclerosis (MS). Mean follow-up was 51.81 ± 26.63 months. 81.81 % of patients reported an acute pain relief. No major complication was observed after PBC. Eight patients (36.36 %) experienced pain recurrence and underwent one (five patients) or more (three patients) PBC. At the last follow-up, we obtained an excellent outcome (BNI I-II) in 16 patients out of 22 (72.72 %) and a good outcome (BNI III) in the remaining six. No patients had an uncontrolled pain. The lack of history of MS (p = 0.0174), the pear-like shape of the balloon at the operation (p = 0.0234) and a compression time <5 min (p < 0.05) were associated to higher pain-free survival. Considering these results PBC could be considered a useful technique for patients whose pain recurs after other procedures 10).


Balloon compression had the highest rate of initial pain-free response (IPFR) and duration of pain-free intervals (PFIs), compared with other modalities in the initial treatment of MS-related TN 11).

References

1) , 9)

Ariai MS, Mallory GW, Pollock BE. Outcomes after microvascular decompression for patients with trigeminal neuralgia and suspected multiple sclerosis. World Neurosurg. 2014 Mar-Apr;81(3-4):599-603. doi: 10.1016/j.wneu.2013.09.027. Epub 2013 Sep 19. PubMed PMID: 24056218.
2) , 11)

Mohammad-Mohammadi A, Recinos PF, Lee JH, Elson P, Barnett GH. Surgical outcomes of trigeminal neuralgia in patients with multiple sclerosis. Neurosurgery. 2013 Dec;73(6):941-50; discussion 950. doi: 10.1227/NEU.0000000000000128. PubMed PMID: 23921703.
3) , 10)

Montano N, Papacci F, Cioni B, Di Bonaventura R, Meglio M. The role of percutaneous balloon compression in the treatment of trigeminal neuralgia recurring after other surgical procedures. Acta Neurol Belg. 2014 Mar;114(1):59-64. doi: 10.1007/s13760-013-0263-x. Epub 2013 Dec 12. PubMed PMID: 24338759.
4) , 6) , 7)

Asplund P, Linderoth B, Lind G, Winter J, Bergenheim AT. One hundred eleven Percutaneous Balloon Compressions for Trigeminal Neuralgia in a Cohort of 66 Patients with Multiple Sclerosis. Oper Neurosurg (Hagerstown). 2019 Jan 23. doi: 10.1093/ons/opy402. [Epub ahead of print] PubMed PMID: 30690631.
5) , 8)

Martin S, Teo M, Suttner N. The effectiveness of percutaneous balloon compression in the treatment of trigeminal neuralgia in patients with multiple sclerosis. J Neurosurg. 2015 Dec;123(6):1507-11. doi: 10.3171/2014.11.JNS14736. Epub 2015 Jun 12. PubMed PMID: 26067615.

Social media

Social media

see also WhatsApp

Social media are interactive computer-mediated technologies that facilitate the creation and sharing of information, ideas, career interests and other forms of expression via virtual communities and networks.

The variety of stand-alone and built-in social media services currently available introduces challenges of definition.

Social media, web based applications, and internet has revolutionized communication process. Similarly, learning and teaching process in the field of medicine had transformed slowly and progressively to suit the changes according to the geographical and economic constraints.


Electronic media has irrupted physician’s clinical practice. Patients increasingly use Internet and social media to obtain enormous amounts of unsupervised data about cancer. Blogs, social networking sites, online support groups and forums are useful channels for medical education and experience sharing but also perfect environments for misinformation, quackery, violation of privacy and lack of professionalism. The widespread availability of such electronic resources allows some followers of the alternative oncology to spread useless irrational and controversial remedies for cancer, like false medicaments, miraculous diets, electronic devices, and even psychic therapies, as did charlatans in the past, providing false expectations about cancer treatments. Moreover, so-called predatory journals have introduced confusion and malpractice within the academic biomedical publishing system. This is a rising editorial phenomenon affecting all fields of biomedicine, including oncology that jeopardizes the quality of scientific contribution and damages the image of open access publication 1).


Brainbook is a multi-platform, social media-based resource that was created specifically to enhance public engagement in neurosurgery.

Results from one of its case discussions was reported in collaboration with the NIHR Global Health Research Group on Neurotrauma and presented over 3 days (23-25 February 2018). YouTube videos were created depicting the management of an acute subdural hematoma using patient interviews, medical illustration, consultant-led discussion and operative footage. Content was shared across all Brainbook social media platforms and analytics were gathered through social media applications.

Over a 72-hour time period, and across multiple social media accounts, 101,418 impressions were achieved (defined as penetrance onto individual media feeds and total views of the content), with active discussion on social media.

Neurosurgical content published across multiple social media outlets represents an encouraging and exciting potential for global engagement across multiple audiences. Social media can be an effective method of not only disseminating neurosurgical knowledge, but activating and engaging the public, allied healthcare professionals, medical students and neurosurgeons 2).


The purpose of a study was to assess the impact of certain demographics, social media usage, and physician review website variables for spine surgeons across Healthgrades.com (Healthgrades), Vitals.com (Vitals), and Google.com (Google).

Through a directory of registered North American Spine Society (NASS) physicians, they identified spine surgeons practicing in Texas (107 neurosurgery trained, 192 orthopedic trained). Three physician rating websites (Healthgrades, Vitals, Google) were accessed to obtain surgeon demographics, training history, practice setting, number of ratings/reviews, and overall score (January 2, 2018-January 16, 2018). Using only the first 10 search results from Google.com, we then identified whether the surgeon had a website presence or an accessible social media account on Facebook, Twitter, and/or Instagram.

Physicians with either a personal or institutional website had a higher overall rating on Healthgrades compared to those who did not have a website (p < 0.01). Nearly all spine surgeons had a personal or institutional website (90.3%), and at least 1 accessible social media account was recorded for 43.5% of the spine surgeons in our study cohort (39.5% Facebook, 10.4% Twitter, 2.7% Instagram). Social media presence was not significantly associated with overall ratings across all 3 sites, but it did significantly correlate with more comments on Healthgrades. In multivariable analysis, increasing surgeon age was significantly associated with a lower overall rating across all 3 review sites (p < 0.05). Neurosurgeons had higher overall ratings on Vitals (p = 0.04). Longer wait times were significantly associated with a lower overall rating on Healthgrades (p < 0.0001). Overall ratings from all 3 websites correlated significantly with each other, indicating agreement between physician ratings across different platforms.CONCLUSIONSLonger wait times, increasing physician age, and the absence of a website are indicative of lower online review scores for spine surgeons. Neurosurgery training correlated with a higher overall review score on Vitals. Having an accessible social media account does not appear to influence scores, but it is correlated with increased patient feedback on Healthgrades. Identification of ways to optimize patients’ perception of care are important in the future of performance-based medicine 3).


Mata-Gómez et al. made an observational transversal study between February and March 2017, with a systematic search of the Facebook, Twitter and Youtube accounts from public and private neurosurgical units, scientific societies, peer-reviewed publications and patients groups in relation with Neurosurgical pathologies. We rank them according their popularity.

Only 5 public neurosurgical services have social media accounts, being their popularity inferior to the private units accounts. In relation with the scientific societies and neurosurgical publications their presence in social media is marginal, even more in comparison to the accounts of other medical specialities. The popularity of associations of patients and supporting groups is high, especially among patients, finding there more information about their disease.

The use in Spain of Social Media about Neurosurgery is low in comparison to other medical specialities. There is a huge field to improve the popularity of the accounts, making in them promotion of health and extend the diffusion of the scientific society and the peer-reviewed publication Neurocirugía 4).

Metrics

When you click on the Page you want to analyze, you will be taken to that Page’s insights. Here, you will find an overview of your most important metrics, followed by detailed sections on your Likes, reach, visits, posts, and people. The overview starts with your Page’s main metrics, including the following.

Page Likes: Total Pages Likes is number of unique people who like your Page. New Page Likes shows the number of new Likes your Page received during the last seven days, compared with the previous seven-day period.

Post Reach: Total Reach is the number of unique people who have seen any content associated with your Page, including ads, during the last seven days. Post Reach shows the number of unique people who have seen your Page posts.

Engagement: People Engaged is the number of unique people who have clicked, Liked, commented on or shared your posts during the last seven days. Likes, Comments, Shares and Post Clicks show the totals for these actions during the last week.

A study shows different uses of social media platforms and numbers of users of the online neurosurgical community. Content optimization, advanced metrics of user engagement, and their subsequent effects on academic impact remain unanswered queries and require further prospective study 5).


A survey has shown that caregivers of children with shunt-treated hydrocephalus frequently use social media networks for support and information gathering.

The objective of a study is to describe and assess social media utilization among users interested in hydrocephalus.

Publicly accessible accounts and videos dedicated to the topic of hydrocephalus were comprehensively searched across 3 social media platforms (Facebook, Twitter, and YouTube) throughout March 2016. Summary statistics were calculated on standard metrics of social media popularity. A categorization framework to describe the purpose of pages, groups, accounts, channels, and videos was developed following the screening of 100 titles. Categorized data were analyzed using nonparametric tests for statistical significance. RESULTS The authors’ search identified 30 Facebook pages, 213 Facebook groups, 17 Twitter accounts, and 253 YouTube videos. These platforms were run by patients, caregivers, nonprofit foundations, and patient support groups. Most accounts were from the United States (n = 196), followed by the United Kingdom (n = 31), Canada (n = 17), India (n = 15), and Germany (n = 12). The earliest accounts were created in 2007, and a peak of 65 new accounts were created in 2011. The total number of users in Facebook pages exceeded those in Facebook groups (p < 0.001). The majority of users in Facebook groups were in private groups, in contrast to public groups (p < 0.001). The YouTube videos with the highest median number of views were for surgical products and treatment procedures. CONCLUSIONS This study presents novel observations into the characteristics of social media use in the topic of hydrocephalus. Users interested in hydrocephalus seek privacy for support communications and are attracted to treatment procedure and surgical products videos. These findings provide insight into potential avenues of hydrocephalus outreach, support, or advocacy in social media 6).


In 2017 three social media platforms (Facebook, Twitter, and YouTube) were assessed for public content pertaining to brain aneurysms in March 2016. We conducted a mixed-method analysis that includes a descriptive examination of cross-sectional data and a qualitative evaluation of online communications for thematic analysis. We assessed categorized data using nonparametric tests for statistical significance.

The analyses showed that Facebook was the most highly used social media platform, with 11 relevant pages and 83 groups. Facebook accounts were all nonprofit foundations or patient support groups. Most users in Facebook groups were joining private support groups as opposed to public (P < 0.05). The most frequently viewed category of YouTube videos was on treatment procedures (P < 0.001). Six prominent themes emerged from the coded data of posts and comments: inspiration and motivation (27.7%), providing and sharing information (26.3%), requesting information (14.4%), seeking emotional support (12.1%), admiration (8.3%), and loss and grief (8.3%).

This study was the first to provide insight into characteristics and patterns of social media communications regarding brain aneurysms. These findings should serve to inform the treating physicians of the needs and expectations of individuals affected by brain aneurysms 7).

References

1)

Delgado-López PD, Corrales-García EM. Influence of Internet and Social Media in the Promotion of Alternative Oncology, Cancer Quackery, and the Predatory Publishing Phenomenon. Cureus. 2018 May 13;10(5):e2617. doi: 10.7759/cureus.2617. Review. PubMed PMID: 30027009; PubMed Central PMCID: PMC6044480.
2)

Alamri A, Rogers P, Kearns C, Doke T, Al-Habib A, Servadei F, Hutchinson PJ, Kolias AG, Uff C. Social media for dissemination and public engagement in neurosurgery-the example of Brainbook. Acta Neurochir (Wien). 2019 Jan;161(1):5-9. doi: 10.1007/s00701-018-3757-8. Epub 2018 Dec 10. PubMed PMID: 30535760.
3)

Donnally CJ, McCormick JR, Li DJ, Maguire JA, Barker GP, Rush AJ, Wang MY. How do physician demographics, training, social media usage, online presence, and wait times influence online physician review scores for spine surgeons? J Neurosurg Spine. 2018 Nov 1:1-10. doi: 10.3171/2018.8.SPINE18553. [Epub ahead of print] PubMed PMID: 30497169.
4)

Mata-Gómez J, Gilete-Tejero IJ, Rico-Cotelo M, Royano-Sánchez M, Ortega-Martínez M. Current use of Social Media in Neurosurgery in Spain. Neurocirugia (Astur). 2018 May – Jun;29(3):109-115. doi: 10.1016/j.neucir.2018.01.001. Epub 2018 Feb 24. English, Spanish. PubMed PMID: 29486985.
5)

Alotaibi NM, Badhiwala JH, Nassiri F, Guha D, Ibrahim GM, Shamji MF, Lozano AM. The Current Use of Social Media in Neurosurgery. World Neurosurg. 2015 Nov 14. pii: S1878-8750(15)01528-4. doi: 10.1016/j.wneu.2015.11.011. [Epub ahead of print] PubMed PMID: 26585734.
6)

Elkarim GA, Alotaibi NM, Samuel N, Wang S, Ibrahim GM, Fallah A, Weil AG, Kulkarni AV. Social media networking in pediatric hydrocephalus: a point-prevalence analysis of utilization. J Neurosurg Pediatr. 2017 May 26:1-6. doi: 10.3171/2017.3.PEDS16552. [Epub ahead of print] PubMed PMID: 28548615.
7)

Alotaibi NM, Samuel N, Wang J, Ahuja CS, Guha D, Ibrahim GM, Schweizer TA, Saposnik G, Macdonald RL. The Use of Social Media Communications in Brain Aneurysms and Subarachnoid Hemorrhage: A Mixed-Method Analysis. World Neurosurg. 2017 Feb;98:456-462. doi: 10.1016/j.wneu.2016.11.085. Epub 2016 Nov 24. PubMed PMID: 27890750.
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