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Acesso restrito: Texto completo. p. 979-984. Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2012-02-07T17:28:00Z No. of bitstreams: 1 __www.springerlink.com_c...9528175g70847735_fulltext.pdf: 126147 bytes, checksum: 95f54f456f6ba24c19fadb609d612295 (MD5) Made available in DSpace on 2012-02-07T17:28:00Z (GMT). No. of bitstreams: 1 __www.springerlink.com_c...9528175g70847735_fulltext.pdf: 126147 bytes, checksum: 95f54f456f6ba24c19fadb609d612295 (MD5) Previous issue date: 2011 Purpose The purpose of this study is to evaluate the accuracy of emergency Transcranial Doppler (TCD) to predict intracranial hypertension and abnormal cerebral perfusion pressure in children with severe traumatic brain injury (TBI). Patients and methods A descriptive and retrospective cross-sectional study was designed through data collected from medical records of children with severe TBI (Glasgow coma scale 8), admitted to a level I pediatric trauma center,between January 2000 and December 2005. Early TCD examination was performed upon admission, and TCD profiles were considered as altered using previously validated threshold values for diastolic velocity (1.31) or when no-flow/backflow was detected. Invasive intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring were considered as the gold standard to measure intracranial hypertension (ICH). Statistical analyses compared TCD profiles to increased ICP( 20 mmHg) and abnormal cerebral perfusion pressure (

Texto completo: acesso restrito. p.1542-1547 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-07-03T15:18:20Z No. of bitstreams: 1 00006123-201012000-00020.pdf: 117205 bytes, checksum: ae370d1b7718181f8a8367ac41a62dd2 (MD5) Approved for entry into archive by Flávia Ferreira(flaviaccf@yahoo.com.br) on 2013-08-05T15:53:21Z (GMT) No. of bitstreams: 1 00006123-201012000-00020.pdf: 117205 bytes, checksum: ae370d1b7718181f8a8367ac41a62dd2 (MD5) Made available in DSpace on 2013-08-05T15:53:21Z (GMT). No. of bitstreams: 1 00006123-201012000-00020.pdf: 117205 bytes, checksum: ae370d1b7718181f8a8367ac41a62dd2 (MD5) Previous issue date: 2010-12 BACKGROUND: Traumatic brain injury is a public health problem around the world, and recognition of systemic sources of secondary brain lesions is crucial to improve outcome. OBJECTIVE: To identify the main predictors of mortality and to propose a grading scale to measure the risk of death. METHODS: This retrospective study was based on medical records of children with severe traumatic brain injury who were hospitalized at a level I pediatric trauma center between January 2000 and December 2005. Multiple logistic regression analysis was done to identify independent factors related to mortality. A receiver-operating characteristics curve was performed to verify the accuracy of the multiple logistic regression, and associations that increased mortality were verified. RESULTS: We identified 315 children with severe head injury. Median Glasgow Coma Scale score was 6, and median Pediatric Trauma Score was 4. Global mortality rate was 30%, and deaths occurred despite adequate medical management within the first 48 hours in 79% of the patients. Age < 2 years (P = .02), Glasgow Coma Scale ≤ 5 (P < 10), accidental hypothermia (P = .0002), hyperglycemia (P = .0003), and coagulation disorders (P = .02) were all independent factors predicting mortality. A prognostic scale ranging from 0 to 6 that included these independent factors was then calculated for each patient and resulted in mortality rates ranging from 1% with a score of 6 to 100% with a score of 0. CONCLUSION: Independent and modifiable mortality predictors could be identified and used for a new grading scale correlated with the risk of mortality in pediatric traumatic brain injury.

Acesso restrito: Texto completo. p.1559-1565 Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2012-04-19T12:18:00Z No. of bitstreams: 1 __www.springerlink.com_c...463441020qg64w37_fulltext.pdf: 130599 bytes, checksum: e8f6267c14ea1a5ffa2adaff05811afc (MD5) Made available in DSpace on 2012-04-19T12:18:00Z (GMT). No. of bitstreams: 1 __www.springerlink.com_c...463441020qg64w37_fulltext.pdf: 130599 bytes, checksum: e8f6267c14ea1a5ffa2adaff05811afc (MD5) Previous issue date: 2010 Purpose Hyperglycemia in the acute phase after trauma could adversely affect outcome in children with severe traumatic brain injury (TBI). The goal of this study was to identify the relationship between acute spontaneous hyperglycemia and outcome in children with severe TBI at hospital discharge and 6 months later. Methods A retrospective analysis of blood glucose levels in children with severe TBI at a Pediatric level I Trauma Center, between January 2000 and December 2005. Hyperglycemia was considered for a cut-off value of 11.1 mmol/l (200 mg/dl). Outcome was measured with Glasgow Outcome Scale (GOS) at hospital discharge and at 6 months. A multiple logistic regression analysis, the Student's t test and the χ2 test were done. Results Hyperglycemia was noted within the first 48 h in 34% of the patients. Mortality (70% vs 14%, p

Trabalho completo: acesso restrito, p.1077–1083 Submitted by Bruna Lessa (lessbruna@gmail.com) on 2012-07-04T19:23:11Z No. of bitstreams: 1 (103)fulltext.pdf: 152533 bytes, checksum: 63ca3d18473a20c22ef3f09a07a51931 (MD5) Made available in DSpace on 2012-07-04T19:23:11Z (GMT). No. of bitstreams: 1 (103)fulltext.pdf: 152533 bytes, checksum: 63ca3d18473a20c22ef3f09a07a51931 (MD5) Previous issue date: 2009 Purpose This study aims to describe the characteristics of severe head injuries in children less than 6 years old, victims of falls from windows, and identify the main predictive factors of mortality in this population. Patients and methods A cross-sectional study was designed through data derived from medical records of less than 6- year-old children victims of falls from windows presenting with a severe head injury defined by an initial Glasgow coma scale (GCS) ≤8, hospitalized at a Pediatric Trauma center level III, between January 2000 and December 2005. Statistical analysis used univariate analysis and multiple logistic regressions.Results We identified 58 severe head injuries in children victims of falls from windows. The mean age was 2.8± 1.4 years, with a male prevalence (64%); 48% of patients had a GCS ≤5; 62.1% had a Pediatric Trauma Score(PTS) ≤3 at hospital admission. The mortality rate was 41% (24/58) and most of them (88%; 21/24) died within 48 h. An increased death rate was noted in children admitted with hypoxemia (p=0.001), low systolic blood pressure (p=0.002), hypothermia (p=0.0001), GCS ≤5 (p=10−5), PTS ≤3 (p=0.008), hyperglycemia (p=0.023), coagulation disorders (p=0.02), and initial intracranial pressure ≥20 mmHg (p=0.03). Initial hypothermia, hyperglycemia, and coagulation disorders were the only independent predictive factors of mortality. Conclusion Severe head injuries resulting from falls from windows carry a high risk of mortality in less than 6-yearold children. Hypothermia, hyperglycemia, and coagulation’s disorders are independent predictive factors of mortality. Early deaths could be considered as direct consequences of uncontrollable brain lesions.