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INTRODUCTION Traumatic brain injuries are typically characterized as disruptions in brain function or evidence of brain pathology resulting from external forces. Given the significant mortality associated with traumatic brain injury,this study aimed to evaluate the applicability of the Glasgow Coma Scale-Pupil score in outcome of severe head injury patients. MATERIAL AND METHODS A prospective observational study was conducted at Neurosurgery Department at UCMS, Bhairahawa, Nepal from October, 2021 to March, 2023 (18 months). All the patients presenting in the emergency department with severe traumatic brain injury i.e., Glasgow Coma Scale score 3 to 8 were enrolled in the study after obtaining written consent from parents. RESULTS Out of 92 patients, 79 were males and 13 were females. The average age was 37.88 ± 16.06 years with most of the patients being from the age groups 31-40 years (25%). The results showed that about 83.8% mortality was found in both pupils non-reactive followed by 66.7% mortality in groups with one pupil unreactive and 61.8% mortality in both reactive pupils.The results showed an overall mortality of 71.7%. Among 28.3% of surviving patients, 57.69% patients had unfavorable outcomes and 42.31% patients had favorable outcomes. The receiver operating characteristic curve showed that the Glasgow Coma Scale-Pupil score is better than the Glasgow Coma Scale in predicting unfavorable outcomes of patients with an area under the curve of 0.807 to 0.689. CONCLUSION The decline in the Glasgow Coma Scale-pupil score was associated with increased mortality and the additional two points in the Glasgow Coma Scale-pupil score gives more idea about the prognosis. Glasgow Coma Scale- pupil score is comparable to Glasgow Coma Scale for predicting mortality but better for predicting unfavorable outcomes in severe head injury [ABSTRACT FROM AUTHOR]

Early operative intervention, craniotomy, and/or craniectomy are occasionally warranted in severe traumatic brain injury (TBI). Persistent increased intracranial pressure or accumulation of intracranial hematoma postsurgery can result in higher mortality and morbidity. There is a gap in information regarding the outcome of repeat surgery (RS) in pediatric patients with severe TBI. An observational cohort study titled Approaches and Decisions in Acute Pediatric TBI Trial data was obtained from the Federal Interagency Traumatic Brain Injury Research Informatics System. All pediatric patients who underwent craniotomy or decompressive craniectomy, survived more than 44 hours and were found to have persistent elevated intracranial pressure >20 mmHg for 2 consecutive hours were included in the study. The purpose of the study was to find the outcomes of RS in pediatric severe TBI. Propensity based matching was used to find the outcomes. The primary outcome was 60-day mortality. Out of 1000 total patients enrolled in the Approaches and Decisions in Acute Pediatric Trial, 160 patients qualified for this study. Propensity score matching created 13 pairs of patients. There were no significant differences found between the groups who had RS versus those who did not have repeat surgery on baseline characteristics. There were no significant differences found between the groups regarding 60-day mortality, median hospital days, median intensive care unit days, and 6-month favorable outcome on Glasgow Outcome Scale Extended score. There was no difference in mortality between patients who underwent a second surgery and patients who did not have to undergo a second surgery. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Unintentional falls from height are a major cause of pediatric traumatic injury. This retrospective study investigated the characteristics, clinic-radiological features, and associated outcomes in a tertiary referral neurosurgical center. Materials and Methods: This study is a retrospective review of children below 16 years who presented to our neurosurgery referral center from January 2018 to 2019 with a history of fall from height. The demographic data, clinical parameters at presentation, imaging findings, clinical status at discharge, and outcome at the follow-up period were analyzed. Results: Of the 1,310 children with a history of neurotrauma, 520 (39.7%) of them had a history of fall from height, among which 67% were falls from short height. The mean age was 5.99 ± 4.9 years. Of these 82.8% of children had mild, 13.8% moderate, and 3.2% had severe head injury. The imaging findings were normal in 59%, subgaleal hematoma in 18.6%, extradural hematoma in 9.9%, and spinal injuries in 1.4%. The regression analysis showed age, gender, the height of the fall, loss of consciousness, and seizure as predictors of the severity of the head injury. The Median Glasgow Outcome Scale-Extended at the follow-up period was one. About 2.3% of children had mortality within 1 week after the injury. The midline shift and associated injury had a significant impact on the outcome. Conclusion: In our retrospective study age, gender, height of fall, loss of consciousness, and seizures were associated with the severity of head injury. The presence of midline shift and other associated injuries was associated with the outcome at follow-up. [ABSTRACT FROM AUTHOR]

Introduction: It is yet unclear what kind of long-term effects such widespread brain damage would have. Apart from the etiology of subdural hematomas and coup injuries, which are characteristic of outer focal head trauma, widespread degeneration of cerebral white matter is linked to sagittal and lateral acceleration with centroaxial trauma. Diffuse axonal injury has a higher mortality rate than outer cerebral injury, with over 50% of sufferers passing away within two weeks. Methods: Between February 2022 to January 2023, at Department of Neurosurgery, Gandhi Medical College, Secunderabad, Hyderabad, Telangana, India, conducted a prospective cross-sectional research of 30 patients. Results: Pathognomonic lesions were found at autopsy in this investigation, even though CT brain scans were normal in most patients. Hypoxic changes including cellular swelling, Microhemorrages, white matter degeneration, and axonal swelling were observed on microscopic examination. The most frequent of these was hypoxic changes accompanied by cell enlargement. Conclusion: Our research shows that the results of a CT of the brain do not reliably predict how severe a patient's head injury would be. Studies performed after death have determined that hypoxia and free radicals were major contributors to death, specifically edema in the brain stem and corpus callosum. The researcher plans to tackle these issues in future studies by doing biochemical analytical studies and studies with larger samples. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical features, diagnosis and treatment of paroxysmal sympathetic hyperexcitability (PSH) after severe head injury. Methods The clinical characteristics, diagnosis and treatment process of 2 patients with PSH were analyzed retrospectively. Results Both patients were young males, both of whom were diagnosed with severe head injury. Symptoms of PSH appeared more than 20 days after the injury. Initially, the treatment of epilepsy or bacteremia was not relieved. After that, propranolol and diazepam were used for treatment and prevention during and between seizures. The patient’s PSH symptoms gradually alleviated and the frequency of seizures gradually decreased. Finally, the symptoms disappeared. There was no recurrence during the hospital. Conclusion Propranolol combined with diazepam can be used as the main treatment method for PSH to prevent the symptoms from persisting or producing bad prognosis. Objective To explore the clinical features, diagnosis and treatment of paroxysmal sympathetic hyperexcitability (PSH) after severe head injury. Methods The clinical characteristics, diagnosis and treatment process of 2 patients with PSH were analyzed retrospectively. Results Both patients were young males, both of whom were diagnosed with severe head injury. Symptoms of PSH appeared more than 20 days after the injury. Initially, the treatment of epilepsy or bacteremia was not relieved. After that, propranolol and diazepam were used for treatment and prevention during and between seizures. The patient’s PSH symptoms gradually alleviated and the frequency of seizures gradually decreased. Finally, the symptoms disappeared. There was no recurrence during the hospital. Conclusion Propranolol combined with diazepam can be used as the main treatment method for PSH to prevent the symptoms from persisting or producing bad prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Early tracheostomy needs to be considered if a ventilator is expected to be used for an extended period of time. Early tracheostomy is recommended since it improves respiratory function, reduces the risk of ventilator-associated pneumonia (VAP), improves patients’ comfort level, cleanses secretions in the throat, reduces laryngeal ulceration, improves mobilization, and speech efforts, and allows treatment outside the intensive care unit (ICU). Case Report: Four cases of severe head injury with an early tracheostomy, which illustrate the prevention of VAP, were reported. In these four cases, early tracheostomy was performed (£ 4 days) considering the initial critical GCS, the location of the lesion, and that mechanical ventilation was expected to be used for an extended period of time. During treatment, no VAP signs were detected, evidenced by Clinical Pulmonary Infection Score (CPIS), Rontgen thorax, and sputum culture examinations. Based on a meta-analysis study, early tracheostomy reduces mortality due to VAP by up to 50% and reduces the length of stay in ICU compared to delayed/late tracheostomy (> 10 days) or prolonged intubation (> 14 days). Conclusion: In the study cases, early tracheostomy (

Background: The optimal tracheostomy time is considered a debatable issue for patients with severe Head injury in intensive care units [ICUs], which require mechanical ventilation [MV] for long period.The aim of the work: The current study aimed to investigate the effect of tracheostomy operation in early few days of admission on the length of mechanical ventilation [MV]. In addition, to determine outcomes and associated mortality rate.Patients and Methods: a prospective randomized Comparative clinical study included 200 patients admitted to ICU units of Al-Azhar university hospitals and El Haram hospital who had the following criteria: severe head injury, Cerebral trauma on and Glasgow Coma Scale [GCS] score 8 or less on the fourth day viewed by brain CT scan done without given any sedation. Divided into 2 groups on the fourth day of admission each group includes 100 patients, one group submitted to early Tracheostomy [ET] [group A] and the other group submitted to extended endotracheal intubation [EEI] [Group B].Results: There was shorter in the main period of the mechanical ventilatory support for group A than group B with statistically significant relationship p value=0.02.Their no remarkable difference in the occurrence of Nosocomial pneumonia between group A and group B. p value of Nosocomial pneumonia = 0.62.Conclusion: In severe head injury, ET significantly decreases the mechanical ventilation time.

Objective To observe the changes in the serum macrophage migration inhibitory factor (MIF)level and Rotterdam CT score in patients with severe head injury (SHI)and to investigate their significance. Methods A total of 121 SHI were selected. According to the prognosis after 6 months, they were divided into the poor prognosis group (n=48) and good prognosis group (n=73). Basic data were compared. When the patients were admitted to the hospital, the serum MIF was detected by enzyme-linked immunosorbent assay and the Rotterdam CT score was conducted. Multivariate Logistic regression analysis was used to analyze the factors affecting the prognosis of patients with SHI, and the predictive value of serum MIF and Rotterdam CT scores in poor prognosis of SHI patients was analyzed by ROC curve. Results The proportion of SHI combined with brain herniation, white blood cell count (WBC), C-reactive protein (CRP), MIF, and Rotterdam CT score were significantly higher in the poor grognosis group than in the good prognosis group (all P<0. 05). SHI combined with cerebral hernia, high MIF, high Rotterdam CT score were independent risk factors for poor prognosis of patients with SCI, and high GCS score was an independent protective factor (all P<0. 05). The area under curve (AUC) of MIF+Rotterdam CT score in predicting poor prognosis of SHI patients was 0. 882 (0. 811-0. 933), the sensitivity was 68. 75%, and the specificity was 98. 63%；the AUC of MIF+Rotterdam CT score in predicting the poor prognosis of SHI patients was greater than that of MIF and Rotterdam CT score alone (both P<0. 05). Conclusion Serum MIF level and Rotterdam CT score increase in SHI patients. The serum MIF level and Rotterdam CT score are independent risk factors for poor prognosis of SHI patients, and the combined detection can improve the predictive value of poor prognosis. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical significance of individualized nutritional formulas on inflammatory factors, immune status and gastrointestinal tolerance in patients with severe head injury. Methods: A total of 80 patients with severe head injury who were hospitalized in Baoding No.1 Central Hospital from March 2017 to March 2020 were randomly divided into two groups with 40 cases in each group. Patients in both groups were given enteral nutrition (EN), the control group was given conventional enteral nutrition formula through nasointestinal tube, and the experimental group was given individualized nutrition formula. All patients were tested for tumor necrosis factor(TNF-a), C-reactive protein(CRP), interleukin 6(IL-6), IgA, IgM, IgG, serum intestinal fatty acid binding protein(I-FABP) and D-lactic acid concentration before and after enteral nutrition treatment. The incidence of adverse reactions such as abdominal distension, diarrhea, constipation, and gastric retention within seven days after treatment of two groups were compared and analyzed. Results: There was no significant difference in inflammatory factors such as TNF-a, CRP, IL-6, immunoglobulin levels, I-FABP and D-lactic acid concentration between the two groups before treatment (p>0.05). After treatment, the above indicators of the two groups of patients were better than before treatment, the difference was statistically significant (p<0.05), and the experimental group was significantly better than the control group (p<0.05). The experimental group had a gastrointestinal adverse reaction rate of 10%, and the control group had 27.5%, the difference was statistically significant (p=0.04). Conclusions: Individualized nutritional formula has more significant advantages than conventional nutritional formula for patients with severe head injury, which can reduce inflammatory response, increase the patient's immune level, improve the intestinal mucosal barrier function, have good gastrointestinal tolerance, and have a low incidence of adverse reactions. [ABSTRACT FROM AUTHOR]

The case report presents the case of a five-year-old boy who fell off a scooter and sustained a blow to the left temporal region of his head. During a CT examination in the district hospital he suddenly showed a deterioration in the level of consciousness. Subsequent treatment along with transport to a specialized department were aimed at preventing secondary pathological changes and maintaining pressure-volume homeostasis of the brain. High-quality controlled ventilation with effective pharmacotherapy and gentle transport were essential. At the target specialized department, cerebral oedema in the left temporal region and aspiration in the right upper lung lobe were identified. The boy was extubated after 6 hours of controlled ventilation and discharged to an intermediate care bed two days later without any serious consequences. [ABSTRACT FROM AUTHOR]

Objective: To explore the application values of L-alanylglutamine-based parenteral nutrition in the Intensive Care Unit (ICU) of severe head injury. Methods: A total of 540 patients with severe head injury, who were diagnosed and treated in the ICU of First Affiliated Hospital of Xinjiang Medical University from June 2018 to June 2020, were selected and were randomly divided into study group(n=270) and control group(n=270). The control group was given standard parenteral nutrition support, and the study group was given L-alanylglutamine adjuvant therapy based on the treatment of the control group. Both groups were treated and observed for 14 days. Results: The incidence(4.8 % and 6.7 %) of undernutrition on the 7th and 14th day of treatment in the study group was significantly lower than that (13.0 % and 17.0 %) in the control group (P<0.05). The serum total protein and albumin content of the two groups after treatment were higher than that before treatment, and the study group was higher than that of the control group, and the differences were statistically significant (P<0.05). The incidence of complications such as lung infection, urinary tract infection, digestive tract reaction, pressure ulcers, etc. during treatment in the study group was 4.8 %, which were significantly lower than that (15.6 %) in the control group (P<0.05). The serum procalcitonin (PCT) value of the two groups after treatment was lower than that before treatment, and the study group was lower than that of the control group, the difference was statistically significant (P<0.05). Conclusion: The application of parenteral nutrition based on L-alanylglutamine in ICU with severe head injury can reduce the incidence of undernutrition and complications, promote the restoration of the body's nutritional status, and inhibit the release of PCT. [ABSTRACT FROM AUTHOR]

Adverse outcomes after severe head injury (SHI) can be difficult to detect in primary care and other settings where there is not specialist expertise for interpretation. Walking and counting dual-task (DT) measures are strongly associated with cognitive impairment and dementia and this preliminary study investigates whether performance on DT walking and counting tasks are associated with cognitive function and disability in 125 participants who sustained a SHI on average 26 years before. Single Task (ST) walking (speed over 6 metres) and ST counting (Serial 3s) and DT performance of concurrent walking and Serial 3s were compared with neuropsychological, wellbeing and disability tests for strength of association. The strongest correlations were between ST Correct Cognitive Responses (CCRs) and MMSE (rho = 0.435), DT CCRs and Short-term Memory Binding Tests (STMBT) binding accuracy (rho = 0,409) and DT CCRs and STROOP (rho = 0.420), but associations were less strong with disability. Developing this test, as a cost-efficient screening tool for triage to onward referral for neuropsychological assessment, holds promise, but requires further research. [ABSTRACT FROM AUTHOR]

Objective: To observe the changes in immune function, intestinal mucosal barrier function and nutritional status of patients with severe head injury after the intervention of dietary fiber enteral nutrition combined with probiotics. Methods: A total of 136 patients with severe head injury admitted to our hospital from June 2016 to May 2020 were selected. According to the odd-even method of admission order, they were divided into 68 cases in the control group and 68 cases in the study group. The control group was given dietary fiber enteral nutrition intervention, and the study group was combined with probiotic intervention on the basis of the control group. The two groups were compared with the Glasgow Coma Scale (GCS). ) Score, nutritional status, immune function, intestinal mucosal barrier function and complications. Results: The albumin (ALB), hemoglobin (Hb), and transferrin (TR) of the two groups were higher than before the intervention for 14 days, and the study group was higher than the control group (P<0.05). After 14 days of intervention, the levels of immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) were higher in the two groups than before the intervention, and the study group was higher than the control group (P<0.05). After 14 days of intervention, the total superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-PX) of the two groups were higher than before the intervention, and the study group was higher than the control group (P<0.05), Malondialdehyde (MDA) was lower than before the intervention, and the study group was lower than the control group (P<0.05). The GCS scores of the two groups increased after 14 days of intervention, and the study group was higher than the control group (P<0.05). The incidence of complications in the study group was lower than that in the control group (P<0.05). Conclusion: The enteral nutrition intervention of probiotics combined with dietary fiber can effectively improve the nutritional status, immune function and intestinal mucosal barrier function of patients with severe head injury after surgery. At the same time, it can also reduce the incidence of complications and improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Background: Gold standard for determining intracranial pressure (ICP), intraventricular catheter, is invasive with associated risks. Non-invasive investigations like magnetic resonance imaging and ultrasonography have demonstrated correlation between optic nerve sheath diameter (ONSD) and raised ICP. However, computed tomography (CT) is accessible and less operator-dependent. Literature shows variable results regarding correlations between ICP and ONSD on CT. The study aimed to investigate correlations between raised ICP and ONSD, eyeball transverse diameter (ETD), and ONSD/ETD ratios on CT scan(s) of severe head injuries., Methods: A retrospective review of a three-year prospectively-maintained database of severe traumatic head injuries in patients who had ICP measurements and CT scans was conducted. Glasgow Coma Score (GCS), ICP, ONSD 3 mm and 9 mm behind the globe, ETD, ONSD/ETD ratios, CT Marshall Grade, and Glasgow Outcome Score (GOS) were recorded. Statistical analysis assessed correlations between ICP and CT measurements., Results: Seventy-four patients were assessed; mortality rate: 36.5 %. Assault (48.6 %) and pedestrian-vehicle collisions (21.6 %) were the most common mechanisms. CT Marshall Grade correlated significantly with 3 mm and 9 mm ONSD, ONSD/ETD ratios, GCS, and GCS motor score, which correlated significantly with GOS. No significant correlation was found between ICP and ONSD, ETD or ONSD/ETD ratios. Marshall Grade was not significantly associated with ICP measurements but correlated with injury severity., Conclusions: Unlike previous studies, our study not only investigated the correlation between ICP and single variables (ONSD and ETD) but also the ONSD/ETD ratios. No correlations were observed between raised ICP and ONSD, ETD or ONSD/ETD ratio on CT in neurotrauma patients., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Severe head injury (SHI) is associated with a high mortality and morbidity rate and is one of the leading causes of death in intensive care units. The aim of this study was to identify predictors of hospital outcome and mortality in ICU admitted SHI patients and to estimate their impact. Methods: A retrospective analysis was carried on patients (n=321) with a severe head injury, defined as Glasgow Coma Scale (GCS) ? 8 who were admitted to the ICU neurosurgical department of National Trauma Center from 2017 to 2018. Both clinical and radiological predictors of hospitalized patients were identified. Results: Total mortality rate was 5.9%. 243 (75.7%) of the patients were male and 78 (24.3%) were female. 55 % of cases were due to traffic accidents. Patients Middle Ages group was 60%. Coexisting injuries, found in 25% of the patients aggravated the prognosis. Blood grouping pattern in SHI were B+, A+ and O+ 36.1, 28 and 24.3% respectively.45% of the patients had Tattoo which was aggravating factors. The outcome is highly correlated with GCS’ values. CT scan findings revealed that patients with subdural hygroma after few days of admission CT scan which was very important prognostic factors in SHI. Conclusions: SHI has high mortality and morbidity in today world as it has a high negative impact on young people, especially men with blood group B+. The age of the patient, presence of Tattoo, GCS at admission, the CT scanning at admission and CT scanning after a week of admission were significant predictors of outcome.

Abstract Background Most of the studies that examined the prognosis of acute subdural hematoma (ASDH) in severe head injury patients stated their overall prognosis as one group. The aim of the present study was to assess the prognosis of ASDH of > 10 mm in thickness in head injury patients with an extension or no motor response to pain after resuscitation. Material and methods This retrospective study reviewed the severe head injury patients admitted to our university hospitals from January 2014 to August 2017. The inclusion criteria were the patients with an extension or no motor response to pain after resuscitation with an ASDH > 10 mm in thickness and a midline shift > 5 mm in the initial head computed tomography (CT) scan. Two hundred six patients met the inclusion criteria of this study. Their mean age was 42.3 years. One hundred forty-two patients (68.9%) were males. Results The mean duration between trauma and admission was 41 min. Sixty-two patients (30%), including 38 anonymous patients, were surgically managed and the remainder were managed conservatively. All patients (100%) died in the intensive care unit within 1 month after trauma. Conclusion This study emphasized that both surgical and conservative management of ASDH had similar dismal results and that there was no additional benefit from surgical intervention in the studied group of head injury patients. Randomized controlled trials are needed to set a standard of care for the management of ASDH in this subgroup of the severe head injury patients.

Cedera otak traumatika (COT) merupakan penyebab kematian dan kecacatan terbesar di Amerika dan negara industri lainnya di dunia. Anak dari usia balita hingga remaja yang mengalami cedera otak berat biasanya akan dapat menghadapi kecacatan yang signifikan selama beberapa dekade. Seorang anak laki-laki berumur 3 tahun dengan diagnosa cedera kepala berat akibat perdarahan subdural di temporo occipital kiri dan fraktur terdepresi yang disebabkan karena jatuh dari ketinggian tiga meter, direncanakan dilakukan kraniektomi dekompresi karena terjadi penurunan kesadaran signifikan. Berbagai komplikasi dan permasalahan terjadi yakni perdarahan masif intraoperatif, edema otak kongestif disertai demam pascaoperasi di ruang perawatan intensif, hingga akhirnya pasien dapat pindah ke ruang perawatan biasa dan dilakukan rawat jalan. Penanganan COT berat memerlukan kemampuan seorang ahli anestesi dalam melakukan resusitasi otak dengan ABCDE neuroanestesi, kontrol terhadap hipertensi intrakranial, neuroproteksi dan neurorestorasi. Perioperative Treatment Pediatric Patients with Head Injuries Traumatic brain injury (TBI) is the largest cause of death and disability in the United States and other industrialized countries in the world. Young age patient who suffered severe TBI typically face significant disability for decades. A 3 years old boy with diagnosis of severe TBI as a result of subdural hemorrhage in the left temporo occipital and fracture depressed due to fall from a height of three meters, was planed to perform decompresive craniectomy because decreased conciouseness significantly.Various complications and problems occur, intraoperative masive bleeding, postoperative diffuse brain edema with persistent hyperthermia on the intensive care unit, until the patient can be moved to a regular ward and can be done outpatient. The management of severe head injury requires the ability of an anesthesiologist in performing brain resuscitation with ABCDE neuroanesthesia, control of intracranial hypertension and neurorestoration.

Cedera kepala trauma masih merupakan masalah di seluruh dunia karena masih merupakan salah satu penyebab utama kematian dan kecacatan pada anak-anak dan dewasa. Akibat cedera primer bisa terjadi cedera sekunder yang akan mempengaruhi hasil luaran. Kejang merupakan salah satu komplikasi dari cedera kepala trauma berat. Kejadian kejang, demam, infeksi paru merupakan cedera sekunder yang akan mempengaruhi hasil luaran. Seorang laki-laki, 24 tahun, 50 kg dirujuk dari RSUD dengan penurunan kesadaran GCS E1M2V1, dari hasil scan kepala didapatkan perdarahan intraserebral di frontal kanan/kiri dan parietal kanan, perdurahan subdural, perdarahan subarachnoid dan oedema serebri. Pasien segera diintubasi di UGD dan direncanakan evakuasi perdarahan dan dekompresi craniektomi. Setelah perawatan ke-2 pasien mengalami kejang yang cukup sering dan durasi lama sehingga proses penyapihan dari ventilator terhambat. Dan salah satu komplikasi pemakaian ventilator 48-72 jam adalah ventilator-associated pneumonia (VAP). Diberikan terapi antibiotik sesuai kultur dan penanganan bagi pemulihan paru. Pasien bisa lepas dari ventilator walaupun masih terpasang dengan tracheostomy. Prolonged of Mechanical Ventilation at Intensive Care Unit (ICU) in Patients with Severe Traumatic Head Injury with Post Traumatic Seizures Traumatic head injury is still a worldwide problem as it is still one of the leading causes of death and disability in children and adults. As a result of a primary injury, a secondary injury will affect the outcome. Seizures are one of the complications of severe trauma head injury. Occurrence of seizures, fever, lung infections is a secondary injury that will affect the outcome. A man, 24 years old, 50 kg was referred from the RSUD with decreased awareness of GCS E1M2V1, from head scans obtained intracerebral hemorrhage on the right and left frontal and right parietal, subdural suburural, subarachnoid hemorrhage and cerebral edema. Patients are immediately intubated in the ER and planned evacuation of bleeding and craniectomy decompression. After the 2nd treatment the patient experienced frequent seizures and long duration so that the weaning process of the ventilator is inhibited. And one of the complications of ventilator use 48-72 hours is VAP (ventilator-associated pneumonia). Given appropriate antibiotic therapy for culture and treatment for lung recovery. Patients can escape from the ventilator although still attached with tracheostomy.

Background Head injury is a major health hazard throughout the world. Overall, the mortality/morbidity has not changed much in the last few decades. In developing nations, the situation is worse. Methods The study was conducted for a period of 1 year. The data collected include demographic profile, mode, circumstances and timing of the injury, neurological assessment using Glasgow Coma Scale (GCS) scoring, computed tomography (CT) scan findings, type of management, and outcome. Results Transport-related injuries and falls were the common cause of head injury, with more severe injuries seen in patients without wearing helmets and seat belts. The youth is at high risk of receiving head injuries. The summer season showed a maximum incidence of head injuries. The most common lesions on CT scan were linear fracture of the skull and brain contusion. Mortality rate was 26% and it correlated with the GCS at presentation. Conclusion Head injury mostly affects young people and males outnumber females. Road traffic accident is the major cause. People not abiding by the traffic rules, such as wearing helmets and seat belts, were at high risk of developing head injury and poor outcome. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effectiveness of various head injury criteria and associated risk functions in prediction of vulnerable road users (VRUs) severe head injuries caused by ground impact during vehicle collisions. Ten VRU accidents with video information were reconstructed by using Chalmers Pedestrian Model, vehicle multi-body system models and the THUMS (Ver. 4.0.2) finite element model. The head kinematics were used to calculate injury risks for seven head kinematics-based criteria: head angular velocity and acceleration, linear acceleration, head injury criterion (HIC), head impact power (HIP) and two versions of brain injury criterion (i.e., BRIC and BrIC). In addition, the intracranial responses were used to estimate seven tissue injury criteria, Von Mises stress, shear stress, coup pressure (C.P.) and countercoup pressure (CC.P.), maximum principal strain (MPS), cumulative strain damage measure (CSDM), and dilatation damage measure (DDM). A review of the medical reports for all cases indicated that each individual suffered severe head injuries and died. The injury risks predicted through simulations were compared to the head injuries recorded in the medical or forensic reports. The results indicated that 75–100% of the reconstructed ground impact accidents injuries were correctly predicted by angular acceleration, linear acceleration, HIC, C.P., MPS and CSDM0.15. Shear stress, CC.P. and CSDM0.25 correctly predicted 50–75% of the reconstructed accidents injuries. For angular velocity, HIP, BRIC and BrIC, the injuries were correctly predicted for less than 50% of the reconstructed accidents. The Von Mises stress and DDM did not correctly predict any reconstructed accidents injuries. The results could help to understand the effectiveness of the brain injury criteria for future head injury evaluation. [ABSTRACT FROM AUTHOR]

Introduction: Severe head injury (SHI) is associated with a high mortality and morbidity rate and is one of the leading causes of death in intensive care units. The aim of this study was to identify predictors of hospital outcome and mortality in ICU admitted SHI patients and to estimate their impact. Methods: A retrospective analysis was carried on patients (n=321) with a severe head injury, defined as Glasgow Coma Scale (GCS) ≤ 8 who were admitted to the ICU neurosurgical department of National Trauma Center from 2017 to 2018. Both clinical and radiological predictors of hospitalized patients were identified. Results: Total mortality rate was 5.9%. 243 (75.7%) of the patients were male and 78 (24.3%) were female. 55 % of cases were due to traffic accidents. Patients Middle Ages group was 60%. Coexisting injuries, found in 25% of the patients aggravated the prognosis. Blood grouping pattern in SHI were B+, A+ and O+ 36.1, 28 and 24.3% respectively.45% of the patients had Tattoo which was aggravating factors. The outcome is highly correlated with GCS' values. CT scan findings revealed that patients with subdural hygroma after few days of admission CT scan which was very important prognostic factors in SHI. Conclusions: SHI has high mortality and morbidity in today world as it has a high negative impact on young people, especially men with blood group B+. The age of the patient, presence of Tattoo, GCS at admission, the CT scanning at admission and CT scanning after a week of admission were significant predictors of outcome. [ABSTRACT FROM AUTHOR]

Penanganan cedera kepala berat selalu bertujuan untuk mempertahankan tekanan perfusi otak (TPO) dan mencegah peningkatan tekanan intrakranial yang dapat menyebabkan cedera otak sekunder. Pada pasien dengan kehamilan, janin juga harus dipantau. Hiperventilasi harus dihindari karena berefek buruk terhadap perfusi otak dan aliran darah plasenta. Seorang wanita, 25 tahun, 60 kg, 160 cm datang ke rumah sakit akibat trauma kepala karena kecelakaan lalu lintas yang dialami kurang dari 1 jam sebelum masuk rumah sakit dengan GCS E4M6V4. Pasien dalam keadaan hamil G1P0A0 dengan usia kehamilan 28–30 minggu. Di unit gawat darurat terjadi penurunan kesadaran mendadak hingga GCS E1M5V1 sehingga dilakukan intubasi endotrakhea disusul dengan pemeriksaan CT Scan dengan hasil hematoma epidural dekstra dan hematoma subarachnoid disertai midline shift. Pasien kemudian menjalani operasi evakuasi hematoma epidural dengan anestesi umum kemudian di rawat di unit perawatan intensif dengan pipa endotrakhea masih dipertahankan. Denyut jantung janin (DJJ) masih terdengar dan dilakukan observasi ketat DJJ selama perawatan di ICU. Namun setelah beberapa hari di ICU, janin dinyatakan meninggal. Ringkasan: Pasien cedera kepala berat dengan hematoma epidural dan subarachnoid disertai kehamilan telah menjalani operasi anestesi umum dengan tetap memperhatikan pemeliharaan tekanan perfusi otak (TPO) dan mempertahankan kondisi janin dalam batas normal. Meskipun pada akhirnya janin tidak bisa diselamatkan akibat lamanya perawatan ibu dengan ventilator. Anesthesia Management for Patients in Pregnancy with Severe Head Injury Due to Acute Epidural Hematoma Management of severe head injury cases, in any given situation, is targeted to maintain cerebral perfusion pressure (CPP), and preventing increase of intracranial pressure that possibly cause secondary brain injury. In a case of pregnancy, besides considering the maternal status, fetus condition is equally important to observe. Hyperventilation should be avoided due to its possible detrimental effect to both the brain perfusion and placental blood flow. A 25 year old female, 60 kg, 160 cm, was taken to the hospital due to head trauma caused by a traffic accident, roughly about an hour prior to hospitalization. GCS was E4M6V4. The patient was in her 28 – 30 week of pregnancy (G1P0A0). Sudden decrease in consciousness occurred and GCS lowered to E1M5V1. Endotracheal intubation was then prompted. Epidural haematoma subarachnoid haematoma with midline shift revealed in CT scan. The patient underwent epidural hematoma evacuation with general anesthesia then transferred to Intensive Care Unit (ICU) with ETT maintained. Fetal heart rate remains heard, followed with close monitoring of the fetal heart rate during treatment in the ICU. After 3 days in ICU, fetus died. Summary: A pregnant patient with severe head injury of epidural and subarachnoid bleeding, has undergone an operation with general anesthesia. The fetus was unfortunately cannot be saved due to the patient long ventilator treatment.

Objective: We aimed to evaluate the most common causes of moderate and severe head injury at age 3 and younger.Material and Methods: This is a retrospective study that included 157 children (105 males and 52 females) at 3 years of age or younger who were admitted to our emergency unit for moderate or severe head injury between June 2001 and December 2008. Data on patient age, gender, cause of trauma, clinical signs and symptoms, length of hospitalization, radiological findings, surgery, additional injuries, postoperative and late complications, and mortality were examined.Results: The mean age of the patients was 21.05 months. The most common presentation was deterioration in consciousness. The most common cause of moderate head injury was a fall from 1–2 m at 7–12 months of age, and for severe head injury it was a motor vehicle accident at 19–24 months of age. The most common radiological finding in all groups was a linear fracture. In the moderate head injury group, 16 epidural hematomas (EDH), four subdural hematomas (SDH), two dura-brain lacerations, and two depressed fractures required surgery. In the severe head injury group, 6 SDHs and 5 EDHs required surgery. The major postoperative complications were meningitis, rhinorrhea, epileptic seizures, and subdural fluid collection. The overall mortality rate was 3.18% (5 of 157 patients).Conclusions:In our series of moderate and severe head trauma in patients younger than 3 years, the most common cause of trauma was falling from 1–2 m. For prevention, family caregivers must watch crawlers and toddlers closely.

Latar Belakang dan Tujuan: Cedera kepala berat merupakan salah satu penyebab mortalitas dan morbiditas bagi pasien pasca trauma. Sirkulasi sitokin interleukin-6 (IL-6) pada cedera kepala berat dan proteksi otak dalam pengaturan suhu berhubungan dengan hasil luaran berupa morbiditas dan mortalitas. Tujuan dari penelitian ini mengkaji efek proteksi otak metamizol intravena sebagai farmakologik hipotermi terhadap suhu inti dan kadar interleukin pada cedera otak traumatik. Subjek dan Metode: Penelitian merupakan penelitian tersamar acak ganda yang dilakukan pada 30 pasien dewasa dengan cedera kepala berat yang dikelompokkan menjadi dua kelompok yaitu kelompok kontrol dan kelompok metamizol (M). Kelompok M diberikan metamizol intravena 15 mg/kgbb setiap 8 jam selama 72 jam. Data yang dicatat adalah suhu membran timpani setiap 8 jam dan kadar IL-6 setiap 24 jam selama 72 jam. Penelitian dilakukan selama bulan Juli sampai Agustus 2016 dan hasil penelitian diuji statistik menggunakan uji t berpasangan, uji Mann-Whitney, Uji Chi-square dan uji Fisher's Exact. Hasil: Penelitian menunjukkan bahwa nilai IL-6 pada kelompok M 244,20±93,07, lebih rendah dari kelompok K 375,20±152,62 dengan nilai p=0,006 pada jam ke-48 dan pada jam ke-72 dengan kadar IL-6 197,20±76,03 dan nilai p=0,008 sehingga bermakna secara statistik (p0,05). Subjek pada kelompok M juga menunjukkan suhu tubuh yang lebih rendah secara keseluruhan dan bermakna secara statistik (p0,01). Simpulan: Metamizole mempunyai efek proteksi otak dan mempunyai kegunaan sebagai farmakologik hipotermi pada cedera kepala traumatik. Effect Brain Protection Metamizol Intravenous as Pharmacalogic Hypothermia to Core Temperature and Interleukin-6 Level in Severe Traumatic Brain Injury Background and Objective: Severe traumatic brain injury (TBI) is one of the major cause of morbidity and mortality in trauma. Circulating interleukin-6 (IL-6) and neuroprotection from temperature has a strong relation with improve outcome. The aim of this study is to evaluate the brain protection properties of intravenous metamizole as a hypothermic pharmacologic in reducting IL-6 and core temperature regulation on severe TBI. Subject and Method: This is a randomized controlled trial to 30 adult pasien with severe TBI which was distributed into two groups which was control group (K) and metamizole group(M). The M grup was given 15 mg/kgbw of intravenous metamizole every 8 hours for 72 hours. Core temperature from the tympnic membrane every 8 hours and IL-6 every 24 hours was noted for 72 hours. This studi was conducted from July to August 2016 and the data was then analyzed statistically using the paire t test, Mann-Whitney test, Chi-Square test and Fishers’s Exact test. Result: Shows that IL-6 on the M group was 244.20±93.07 which was lower than the K group at 375.20±152.62 with p=0.006 on the 48th hour and on the 72nd hour with IL-6 at 197.20±76.03 with p=0.008 which is statistically significant (p0.005) and also shows lower temperature at every recording with p0.01. Conclusion: Metamizole has brain protecting properties in reducing circulating IL-6 and has uses as a hypothermic agent in severe TBI.

Background The management of severe traumatic brain injury is directed at avoidance of secondary brain injuries. The intensive care unit (ICU) provides the ideal environment to achieving improved survival and functional outcome. The study sets out to identify the factors that determine the access of patients with severe head injury presenting at our hospital, to the ICU and their impact on outcome. Materials and Methods his was a longitudinal study at the University College Hospital, Ibadan. Data of all consecutive severe head injury patients over a 9-month period, presenting to the accident and emergency department, was collected and analyzed using descriptive statistics and chi-squared test. The level of significance was p < 0.05. Result There were 36 males (80.0%) in our study, with road crashes (25; 79.5%) as the most common mechanism of injury. Most patients (33; 73.3%) were transferred to our center after initial care in another hospital. Though 31(68.9%) patients had access to the ICU, they were all delayed, with the most common reason for the delay being lack of ICU space. More patients who got admitted into ICU (14; 45.2%) were alive at 28 days into admission (p = 0.04). The females (6; 13.3%) significantly survived till 28 days on admission compared with males (p = 0.03), but there was no difference in the survival rates between children and adults. Conclusion Our study underscores the need for ICU admission in these patients to optimize outcome and identify the nonavailability of beds, as the most important cause of delayed access, as well as the need for increased manpower capacity and organized resource utilization. [ABSTRACT FROM AUTHOR]

Background. Epidural hematoma is intracranial hemorrhage, due to skull fracture caused by head injury which there is a blood accumulation between the layers of duramater and the skull. Objective. To determine the corellation of epidural hematoma trepanation respond time with outcome. Methods. This study is a retrospective observational analytic studies (cross sectional) with 30 samples taken in Saiful Anwar Hospital Malang from June to August 2012. The independent variable in this study is trepanation respond time that divided into trepanation respond time less than 6 hours, between 6-12 hours, between 12-18 hours, between 18-24 hours, and more than 24 hours while the dependent variable in this study is the outcome of the patient. Secondary data were taken using medical records. The data were analyzed using independent T-test, spearman correlation test, kruskall walis test, and ROC test with confidence level 95% (α=0.005). Results. The analysis shows a significant corelation between severe head injury epidural hematoma trepanation respond time with the outcome. Faster trepanation respond time will have better outcome. Conclusion. There is significant corelation between severe head injury epidural hematoma trepanation respond time with the outcome.

Aim Nutritional demand after traumatic brain injury is increased due to hypermetabolic response. The present study was undertaken to assess nutritional status with anthropometric indices, factors associated, and their prognostic role following severe head injury (SHI). Method A total of 114 patients in age group 20 to 60 years, admitted within 24 hours of SHI, with Glasgow Coma Scale of 4 to 8, and with no serious systemic disorder were enrolled for the study. Of these, 67 were prospectively assessed weekly till 21 days for changes in mid arm circumference (MAC), mid arm muscle circumference (MAMC), and triceps skin fold thickness (TSF). They were studied in relation to other factors and outcome was assessed at 3 months. Results The percentage fall at 3 weeks for MAC, MAMC, and TSF were 14, 10, and 37%, respectively. The percentage of fall in MAMC was the earliest, and was significantly greater in patients with surgical intervention, tracheostomy, prolonged fever, delayed enteral feeding, and greater caloric deficit. Admission MAMC < 90% of standard was significantly associated with unfavorable outcome (odds ratio 5.9 [95% confidence interval 1.3–27.8], p = 0.01). Unfavorable outcome was significantly more frequent in patients who had at least 15% fall in MAC (85.7 vs. 41.9%, p = 0.03), or 10% fall in MAMC (68.8 vs. 38.2%, p = 0.04) at 2 weeks, compared with others. Fall in TSF had no significant association with outcome at 3 months. In multivariate analysis, MAMC fall had significant independent association with unfavorable outcome. Conclusion Bedside anthropometry (especially MAMC) is efficient in identifying patients with nutrition depletion with significant influence on outcome at 3 months. [ABSTRACT FROM AUTHOR]

Management of the patient with moderate to severe brain injury in any environment can be time consuming and resource intensive. In the austere or hostile environment, the challenges to deliver care to this patient population are magnified. These guidelines have been developed by acknowledging commonly recognized recommendations for neurosurgical and neuro-critical care patients and augmenting those evaluations and interventions based on the experience of neurosurgeons, trauma surgeons, and intensivists who have delivered care during recent coalition conflicts. [ABSTRACT FROM AUTHOR]

Background: Use of ICP monitoring is considered to be part of “standard of care” in management of severe traumatic brain injury, but it is rarely used in developing countries. The authors present a study which evaluates the efficacy and outcomes of ICP monitoring at a high-volume trauma center in India.Methods: Data on management and outcomes for 126 patients who were admitted with diffuse traumatic brain injury (GCS 3-8) were studied prospectively over an 18-month period. These patients were treated by one of the two specific protocols: ICP monitoring-based or non-ICP monitoring-based. The primary outcome was measured based on 2 weeks mortality and GOS-E at 1, 3, and 6 months. Secondary outcome was measured based on need for brain-specific treatment, length of ICU stay, and radiation exposure.Results: Mortality in a subset of patients who underwent surgical intervention later due to increased ICP values, drop in GCS, or radiological deterioration was noted to be significantly lower in the ICP monitoring group (p = 0.03), in spite of statistically insignificant difference in overall mortality rates between groups. GOS-E scores at 1 month were significantly better (p = 0.033) in ICP monitoring group, even though they equalized at 3 and 6 months. The need for brain-specific treatment (p < 0.001), radiation exposure (p < 0.001), and length of ICU stay (p = 0.013) was significantly lower in the ICP monitoring group.Conclusions: ICP monitoring-based treatment protocol helps in achieving faster recovery; lowers mortality rates in operated patients; and reduces ICU stay, radiation exposure, and the need for brain-specific treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Severe head injury is a major public health threat that is the main cause of morbidity and mortality in all age groups of the world's populations including Ethiopia. In view of this, this study was assessed the severity of head injury and its contributing factors. METHODS: A Two-year retrospective study was conducted at Dilla University Referral Hospital, from December 2014 to November 2016. All head injury patients admitted to the surgical ward were included. Bivariate and multivariate regression analyses were used to identify factors associated with severity of head injury. RESULTS: A total of 106 eligible head injury patient charts were reviewed. The magnitude of severe head injury was 32.1%. Young populations, mainly males, were the highest risk groups, and road traffic accident was the main cause of severe head injury. In adjusted analysis, age interval greater than 45 years (aOR, 5.41; 95% CI:1.05-29.09), alcohol consumption before the trauma (aOR, 4.16, 95%CI: 1.18, 14.61), delayed presentation (beyond 24 hours) after injury (aOR, 4.717; 95% CI: 1.02-21.81), and respiratory rate greater than 30 breaths per minute (aOR, 7.34; 95% CI: 1.88-28.73) were significantly associated with severe head injury. CONCLUSIONS: Severe head injury remains an important public health problem. Young adults were the highest risk groups of populations. Prevention of road traffic accidents, continuous awareness creation about the consequences of road traffic accident and close neurological monitoring offered by neuro-intensive care unit are recommended. [ABSTRACT FROM AUTHOR]