Traumatic Brain Injury: Assessment and Management

Traumatic Brain Injury: Assessment and Management

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Traumatic brain injury (TBI), also referred to as intracranial injury, occurs due to trauma to the brain. It can cause a range of physical, cognitive, behavioral, social and emotional symptoms. Its outcome can vary from complete recovery to permanent disability or death. TBI can occur due to an accident, physical violence or a fall. Its diagnosis involves the use of techniques like magnetic resonance imaging (MRI) and computed tomography. Depending on the extent of the injury, confirmed through a diagnosis, treatment can be minimal or extensive involving medications, surgery and rehabilitation therapies. This book discusses the fundamental as well as modern approaches in the assessment and management of traumatic brain injury. The topics included in this book are of utmost significance and bound to provide incredible insights to readers. It will prove to be immensely beneficial to students and researchers in this domain.

Pediatric Severe Traumatic Brain Injury

Pediatric Severe Traumatic Brain Injury

see Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition.

New level II and level III evidence-based recommendations and an algorithm provide additional guidance for the development of local protocols to treat pediatric patients with severe traumatic brain injury. The intention is to identify and institute a sustainable process to update these Guidelines as new evidence becomes available 1).

Greenan et al., used database research to evaluate admission clinical and CT scan characteristics for use as a decision tool to help clinicians caring for children with very severe traumatic brain injury. It may help clinicians identify children who can benefit the most from aggressive medical and surgical intervention 2).


Sarnaik et al., failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury-unrelated to AHT-that may lead to testable hypotheses in the future 3).

References

1)

Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, Davis-O’Reilly C, Hart EL, Bell MJ, Bratton SL, Grant GA, Kissoon N, Reuter-Rice KE, Vavilala MS, Wainwright MS. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines, Executive Summary. Pediatr Crit Care Med. 2019 Mar;20(3):280-289. doi: 10.1097/PCC.0000000000001736. PubMed PMID: 30830016.
2)

Greenan K, Taylor SL, Fulkerson D, Shahlaie K, Gerndt C, Krueger EM, Zwienenberg M. Selection of children with ultra-severe traumatic brain injury for neurosurgical intervention. J Neurosurg Pediatr. 2019 Apr 5:1-10. doi: 10.3171/2019.1.PEDS18293. [Epub ahead of print] PubMed PMID: 30952132.
3)

Sarnaik A, Ferguson NM, O’Meara AMI, Agrawal S, Deep A, Buttram S, Bell MJ, Wisniewski SR, Luther JF, Hartman AL, Vavilala MS; Investigators of the ADAPT Trial. Age and Mortality in Pediatric Severe Traumatic Brain Injury: Results from an International Study. Neurocrit Care. 2018 Jun;28(3):302-313. doi: 10.1007/s12028-017-0480-x. PubMed PMID: 29476389.

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.
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