A prospective clinical study of routine repeat computed tomography (CT) after traumatic brain injury (TBI)

Ding, Jun; Yuan, Fang; Guo, Yan; Chen, Shiwen; Gao, Wen; Gan, Wang; Cao, Hongyan; Ju, Shiming; Chen, Hao; Zhang, Peng-Qi; Huang, Tian

doi:10.3109/02699052.2012.667591

Cited by 36 publications

(37 citation statements)

References 18 publications

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“…It is also reported that a series of CT scans in non-operative EDH patients should be obtained within 6 to 8 hours after the initial injury for better outcomes with prompt decision of treatment 20). Moreover, Ding et al3) reported that the non-surgical patients with routine repeat CT scans have a better outcome than those with non-routine repeat CT. However, the same authors also mentioned that routine follow-up CT scans 48 hours after trauma may not also be required 316)…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Acute Epidural Hematoma in Korea: Preliminary Report of 285 Cases Registered in the Korean Trauma Data Bank System

Jeong

Cho

2016

Korean J Neurotrauma

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ObjectiveThe aim of this preliminary collaborative study was to assess the clinical characteristics, management, and outcome of epidural hematoma (EDH) based on the data collected and registered in the Korean Trauma Data Bank System (KTDBS).MethodsOf 2,698 patients registered in the KTDBS between September 2010 and March 2014, 285 patients with EDH were analyzed. Twenty-three trauma centers participated in the study voluntarily to collect data. We subcategorized the patients into two groups with good and poor outcomes. Various clinical characteristics and the time intervals with regard to treatment course were investigated to determine the relationship between these parameters and the functional outcome.ResultsOf multiple parameters for this analysis, older age (p=0.0003), higher degree of brain injury (p<0.0001), cases of surgical EDH (p<0.0001), time interval from trauma to hospital before 6 hours, and the decreasing pattern of Glasgow Coma Scale (GCS) between and initial and final GCS were strongly associated with poor outcome. Use of prophylactic anticonvulsant did not affect the functional outcome. There was an interesting difference in the use of mannitol in treating EDH between the urban and rural regions (p<0.0001).ConclusionThis is the first multi-center analysis of etiology of injury, pre-hospital care, treatment, and functional outcome of EDH in Korea. The degree of brain injury and the GCS difference were notable factors that were significant in determining the functional outcome of EDH.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Acute Epidural Hematoma in Korea: Preliminary Report of 285 Cases Registered in the Korean Trauma Data Bank System

Jeong

Cho

2016

Korean J Neurotrauma

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“…As identifying the actual injury time cannot be verified in many trauma cases, we supposed that the time elapsed from the initial CT was more practical. The Ding et al 13 RCT reported that 80% of patients (56 out of 70) complicated with progression of TBI did so within 24h and the remaining 20% were delayed 24-48 h. Epidural hematoma, non-operatively treated in accordance with the guidelines, in a prospective non-controlled study, 11 have shown EDHP in 10% of patients, occurring within 12h in 6 out of 70 patients and 24 h in 1 patient. However, they excluded another patient who developed EDHP after four days.…”

Section: Time Interval For Edhpmentioning

confidence: 98%

“…9,11 Epidural hematoma progression represented 7.9% of all cases of TBI progression in a randomized controlled trial. 13 The risk factors of such progression are still not very obvious and the literature has seldom addressed this issue with specific attention and mostly in studies prior to the publication of the BTF surgical guidelines. We carried out this study to identify which patients, among those candidates with EDH, suitable for an initial non-operative treatment, are at greater risk of EDHP, and to determine when they become surgical candidates.…”

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confidence: 99%

Epidural Hematoma Treated Conservatively: When to Expect the Worst

Basamh

Robert

Lamoureux

et al. 2015

Can. J. Neurol. Sci.

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Background: The Brain Trauma Foundation's 2006 surgical guidelines have objectively defined the epidural hematoma (EDH) patients who can be treated conservatively. Since then, the literature has not provided adequate clues to identify patients who are at higher risk for EDH progression (EDHP) and conversion to surgical therapy. The goal of our study was to identify those patients. Methods: We carried a retrospective review over a 5-year period of all EDH who were initially triaged for conservative management. Demographic data, injury severity and history, neurological status, use of anticoagulants or anti-platelets, radiological parameters, conversion to surgery and its timing, and Glasgow Outcome Scale were analyzed. Bivariate association and further logistic regression were used to point out the significant predictors of EDHP and conversion to surgery. Results: 125 patients (75% of all EDH) were included. The mean age was 39.1 years. The brain injury was mild in 62.4% of our sample and severe in 14.4%. Only 11.2% of the patients required surgery. Statistical comparison showed that younger age (p < 0.0001) and coagulopathy (p = 0.009) were the only significant factors for conversion to surgery. There was no difference in outcomes between patients who had EDHP and those who did not. Conclusions: Most traumatic EDH are not surgical at presentation. The rate of conversion to surgery is low. Significant predictors of EDHP are coagulopathy and younger age. These patients need closer observation because of a higher risk of EDHP. Outcome of surgical conversion was similar to successful conservative management.RÉSUMÉ: Hématome épidural traité de façon conservatrice : quand s'attendre au pire. Contexte : Les lignes directrices chirurgicales de la Brain Trauma Foundation de 2006 ont défini objectivement les patients atteints d'un hématome épidural (HÉD) qui peuvent être traités de façon conservatrice. Depuis lors, il n'existe pas dans la littérature d'indices adéquats pour identifier les patients qui sont à plus haut risque de progression de l'HÉD et chez qui un traitement chirurgical doit être envisagé. Le but de notre étude était d'identifier ces patients. Méthode : Nous avons effectué une revue rétrospective sur une période de 5 ans des dossiers de tous les patients atteints d'un HÉD qui ont été assignés initialement au traitement conservateur. Nous avons analysé les données démographiques, la sévérité de la lésion et son historique, l'état neurologique, la prise d'anticoagulants ou d'antiplaquettaires, les paramètres radiologiques, le recours à un traitement chirurgical et le moment où il a été réalisé ainsi que le score au Glasgow Outcome Scale. L'analyse bivariée ainsi que l'analyse de régression logistique ont été utilisées pour déterminer les facteurs de prédiction significatifs de la progression de l'HÉD et du recours à la chirurgie. Résultats : Cent vingt-cinq patients (75% des patients atteints d'un HÉD) ont été inclus dans l'étude. L'âge moyen des patients était de 39,1 ans. La lésion cérébrale étai...

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“…Cranial CT is the most frequently used imaging modality during the pre-and post-operative periods in EDH. The followup is made with frequent cranial CTs in unoperated patients [8,9]. In our study, the mean number of CT scans for the follow-up of EDH was 3.7.…”

Section: Discussionmentioning

confidence: 64%

Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

Atçı¹,

Yılmaz²,

Yaman³

et al. 2017

Romanian Neurosurgery

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Abstract:Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH) were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS) at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU), length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36%) patients, 9-13 in 23 (46%) patients and 3-8 in 9 (18%) patients. The reasons for emergency department admissions were fall from high in 29 (58%) patients, assault in 11 (22%) patients and motor vehicle accident in 10 (20%) patients. The average cost per ICU stay was 2838 $ (range=343-20571 $). The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients). Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.

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A prospective clinical study of routine repeat computed tomography (CT) after traumatic brain injury (TBI)

Abstract: The routine-repeat CT group fared better than did the non-routine-repeat CT group. Routinely repeated CTs were minimally effective among those with mild TBI, whereas this procedure demonstrated a significant effect on patients with moderate and severe TBI.

Cited by 36 publications

References 18 publications

Clinical Outcome of Acute Epidural Hematoma in Korea: Preliminary Report of 285 Cases Registered in the Korean Trauma Data Bank System

Clinical Outcome of Acute Epidural Hematoma in Korea: Preliminary Report of 285 Cases Registered in the Korean Trauma Data Bank System

Epidural Hematoma Treated Conservatively: When to Expect the Worst

Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

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