An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

Buitendag, J J P; Ras, A; Kong, Victor; Bruce, John; Laing, G L; Clarke, Damian; Brysiewicz, Petra

doi:10.17159/2078-5151/2018/v57n1a2711

Cited by 5 publications

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Buitendag et al . [13] reported a mortality rate of only 1.83% in patients with penetrating TBI, which contrasts sharply with a mortality rate exceeding 50% in our patients, who primarily sustained blunt trauma to the head rather than penetrating injuries. Less than 15% of the patients had made a good recovery by the time they were discharged from hospital.…”

Section: Discussioncontrasting

confidence: 94%

Outcomes of severe traumatic brain injury at time of discharge from tertiary academic hospitals in Bloemfontein

Maasdorp

Swanepoel²,

Gunter³

2020

Afr J Thorac Crit Care Med

View full text Add to dashboard Cite

Traumatic brain injury (TBI) can be defined as 'an alteration in brain function manifest with confusion, altered level of consciousness, seizure, coma, or focal sensory or motor neurologic deficit resulting from blunt or penetrating force to the head. ' [1] It poses a major public health problem, with an estimated annual hospitalisation rate of 90.5 per 100 000 population in the USA, [2] and more than 200 per 100 000 in Europe. [3] Although there is a paucity of epidemiological studies regarding the incidence of TBI in South Africa (SA), an incidence of 316 per 100 000 per year has been reported. [4] TBI is generally graded as mild if the Glasgow Coma Scale (GCS) score is 13 -15, moderate if 9 -12 and severe if 3 -8 after resuscitation. [5] Since the brain is enclosed in a non-deformable skull, any increase in intracerebral volume as a result of haemorrhage or oedema can cause a significant increase in intracranial pressure. Raised intracranial pressure can potentially lead to reduced cerebral perfusion pressure (CPP) associated with cerebral hypoxia and ischaemia, ultimately resulting in permanent neurological impairment. The management of patients with severe TBI therefore mainly entails reducing intracranial pressure by draining any haematomas that exert a pressure effect on the underlying brain parenchyma, but it also aims to prevent secondary brain injury by means of optimising CPP and via oxygenation of brain tissue. [6] This can be achieved by intubating and ventilating the patient, providing isotonic fluid and vasopressor therapy to ensure normotension, maintaining normothermia and preventing either hypo-or hyperglycaemia.In SA, most people suffering TBIs are young and otherwise healthy adults who may survive the initial injury, but are often left with severe cognitive or functional impairment. [7] Furthermore, the reality in resource-constrained countries such as SA is that post-hospital discharge rehabilitation or long-term care facilities for patients with severe neurological disabilities are not readily available in the public healthcare sector. [8] Andrew et al. [9] report alarming information on the admission of patients with TBI to a public rehabilitation centre in the Western Cape Province. According to previously unpublished statistics, only 2.4% (n=16) of 654 patients with TBI treated at Groote Schuur Hospital in 2009 were admitted to a rehabilitation facility. In 2013, a total of 2 851 patients with TBI were treated at Groote Schuur and Tygerberg Hospitals, of whom 2.9% (n=82) were discharged from hospital to a rehabilitation centre. [9] Webster et al. [8] reported that <9% of all patients with TBI were admitted to the Western Cape Rehabilitation Centre for the 5-year period 2008 -2012. No similar information is currently available for the Free State Province.It has been argued that SA patients are not hospitalised for a sufficient period of time after sustaining a TBI. Because of the shortage of specialised rehabilitation facilities, which negatively influences Background. Despite the conditi...

show abstract

Section: Discussioncontrasting

confidence: 94%

Outcomes of severe traumatic brain injury at time of discharge from tertiary academic hospitals in Bloemfontein

Maasdorp

Swanepoel²,

Gunter³

2020

Afr J Thorac Crit Care Med

View full text Add to dashboard Cite

show abstract

“…Motor vehicle accidents represented the prevailing mechanism of the blunt aetiologies (6/11), while penetrating pancreatic injuries were most frequently sustained by self-inflicted stabbings (2/3). Based on published data from American and South African centres, penetrating injuries are more common due to higher prevalence of shootings and stabbings[ 17 - 20 ], occurring in 48%–81% of cases in the US[ 21 ] and 53%-72% in South Africa[ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit

Chui¹,

Kotecha²,

Gall³

et al. 2023

World J Gastrointest Surg

View full text Add to dashboard Cite

BACKGROUND The management of high-grade pancreatic trauma is controversial. AIM To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries. METHODS A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma (AAST) Grade III or greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified. RESULTS Over a twenty-year period, 14 patients underwent pancreatic resection for high-grade injuries. Seven patients sustained AAST Grade III injuries and 7 were classified as Grades IV or V. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy (PD). Overall, there was a predominance of blunt aetiologies (11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases (7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies. CONCLUSION We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.

show abstract

“…Part of such work will be investigating the natural development of the brain injuries in each subgroup so that the earliest time for the safe initiation of chemical thromboprophylaxis can be identified [18,23,24]. This further study will help categorize patients based on the risk of TBI progression and VTE rates, thereby helping with developing clinical guidelines [25][26][27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Early Chemical Thromboprophylaxis in Traumatic Brain Injury Patients Admitted to a Trauma ICU

2022

J Surg

View full text Add to dashboard Cite

Object: Traumatic Brain Injury (TBI) increases the risk of coagulopathy and thromboembolism, and its presence is a poor prognostic factor. There is no clear evidence to support recommendations regarding the preferred drug, dose or the timing of chemical thromboprophylaxis. This study aims to determine the feasibility of initiating early chemical prophylaxis in our clinical setting, given the existing controversies. It further aims to identify the subgroups of TBI patients which may benefit from early chemical thromboprophylaxis based on CT findings.Methodology: This is a retrospective study from 01 January 2017 to 31 December 2018 of TBI cases 18 years and older admitted to a Trauma ICU unit which required a repeat CTB during their stay. Demographic data, mechanisms of injury, timing of chemical Thromboembolic prophylaxis and complication were included. A comparison between those receiving prophylaxis early (24-hrs), intermediate (48hrs) and late (72hrs) was made. Statistical descriptive analysis was done using the STATA Statistics/Data Analysis version 16.0 to summarise our data. A p-value of <0.05 was considered statistically significant. Ethics approval from the Human Research Ethics Committee (HREC) (medical) of the University of the Witwatersrand, clearance number: M200345.Findings: One hundred and thirty-two patients were eligible for the study. Most patients had a repeat CTB before the initiation of chemical thromboprophylaxis. Only 18/132 (13,64%) showed clinical or radiological deterioration of their head injury. There was no difference in the ED physiological characteristics, ISS and need for transfusion between those who deteriorated and those who did not deteriorate. However, the mortality was higher among those who deteriorated. Our mortality at 28-days was 4.55% (n=6). The patients in our study had an overall higher ISS, which the literature associated with a worse outcome (6). In our study, however, even with a high ISS, other related injuries were not associated with a poor outcome or even increased 28-day mortality. Comparing the available literature, a repeat CTB scan seems to be the only parameter we can use to guide the initiation of chemical thromboprophylaxis in our study. Conclusion:The study results do not show any statistically significant difference in the rate of worsening of intracranial bleeding if chemical thromboprophylaxis is initiated at 24 hours, 48-hours vs 72-hours. The deterioration of the bleeds was not further exacerbated by early chemical prophylaxis.

show abstract

An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

Cited by 5 publications

References 14 publications

Outcomes of severe traumatic brain injury at time of discharge from tertiary academic hospitals in Bloemfontein

Outcomes of severe traumatic brain injury at time of discharge from tertiary academic hospitals in Bloemfontein

Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit

The Feasibility of Early Chemical Thromboprophylaxis in Traumatic Brain Injury Patients Admitted to a Trauma ICU

Contact Info

Product

Resources

About