Clinical course and prognosis of acute post-traumatic coma.

Pazzaglia, P; Frank, Guido; Frank, F.; Gaist, G

doi:10.1136/jnnp.38.2.149

Cited by 79 publications

(19 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our outcomes are an improvement on what has been reported with less aggressive therapy [18,19,20] which has generally shown very high morbidity and mortality. The finding of continued neurological improvement, even 6–12 months after injury, reconfirms that the pediatric brain responds to TBI differently than that of adults and expresses the need for pediatric driven protocols.…”

Section: Discussionsupporting

confidence: 63%

See 1 more Smart Citation

Initial Observations of Combination Barbiturate Coma and Decompressive Craniectomy for the Management of Severe Pediatric Traumatic Brain Injury

et al. 2011

View full text Add to dashboard Cite

Objective: In the pediatric population, treatment of severely injured children presenting with low Glasgow Coma Score (GCS) and fixed and dilated pupils is controversial. The combination of barbiturate coma and decompressive craniectomy as an aggressive means of controlling intracranial pressure is limited to few studies. In the present series, we report our experience with aggressive combination therapy resulting in good outcomes in pediatric patients with severe traumatic brain injury (TBI). Patients and Methods: Six TBI patients, aged <18 years, either presented with or deteriorated to a GCS <5 with fixed and dilated pupils and CT evidence of surgical lesions with brain edema. Despite hyperventilation, anesthesia, and mannitol, intracranial pressures remained elevated and all patients underwent decompressive craniectomy and external ventricular drainage and were subsequently placed into barbiturate coma for 72 h. Results: One patient died and 1 patient remained vegetative. Two patients had excellent recoveries (GOS 5/Rankin 1 or 0, no cognitive deficits) and 2 patients had good recoveries (GOS 4/Rankin 1, mild cognitive deficits). Conclusions: Combination of barbiturate coma with decompressive craniectomy and external ventricular drainage led to good outcomes in a small group of pediatric patients with severe TBI. Based on this series we recommend further investigation into aggressive combination management.

show abstract

Section: Discussionsupporting

confidence: 63%

“…Pazzaglia et al [18] reported a 40% mortality and Jennet et al [19], who prospectively studied 199 pediatric patients, found a mortality rate of 37% with a 56% 6-month good recovery. A prospective study by Berger et al [20] looked at outcomes in 37 children with criteria similar to those in our current study, except up to a higher GCS of 8.…”

Section: Discussionmentioning

confidence: 99%

Initial Observations of Combination Barbiturate Coma and Decompressive Craniectomy for the Management of Severe Pediatric Traumatic Brain Injury

et al. 2011

View full text Add to dashboard Cite

show abstract

“…However, previous studies have shown that TBI-related death after hospital discharge is uncommon. [47][48][49] In a population-based cohort study of hospitalized TBI patients who were discharged alive, approximately 92% of those patients were alive at 15 months after discharge. 50 Among post-discharge deaths, only 17% were TBI related.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury: Results from the American College of Surgeons Trauma Quality Improvement Program

Alali

Fowler

Mainprize

et al. 2013

Journal of Neurotrauma

185

145

View full text Add to dashboard Cite

Although existing guidelines support the utilization of intracranial pressure (ICP) monitoring in patients with traumatic brain injury (TBI), the evidence suggesting benefit is limited. To evaluate the impact on outcome, we determined the relationship between ICP monitoring and mortality in centers participating in the American College of Surgeons Trauma Quality Improvement Program (TQIP). Data on 10,628 adults with severe TBI were derived from 155 TQIP centers over 2009-2011. Random-intercept multilevel modeling was used to evaluate the association between ICP monitoring and mortality after adjusting for important confounders. We evaluated this relationship at the patient level and at the institutional level. Overall mortality (n = 3769) was 35%. Only 1874 (17.6%) patients underwent ICP monitoring, with a mortality of 32%. The adjusted odds ratio (OR) for mortality was 0.44 [95% confidence interval (CI), 0.31-0.63], when comparing patients with ICP monitoring to those without. It is plausible that patients receiving ICP monitoring were selected because of an anticipated favorable outcome. To overcome this limitation, we stratified hospitals into quartiles based on ICP monitoring utilization. Hospitals with higher rates of ICP monitoring use were associated with lower mortality: The adjusted OR of death was 0.52 (95% CI, 0.35-0.78) in the quartile of hospitals with highest use, compared to the lowest. ICP monitoring utilization rates explained only 9.9% of variation in mortality across centers. Results were comparable irrespective of the method of case-mix adjustment. In this observational study, ICP monitoring utilization was associated with lower mortality. However, variability in ICP monitoring rates contributed only modestly to variability in institutional mortality rates. Identifying other institutional practices that impact on mortality is an important area for future research.

show abstract

“…In previous studies the clinical assessment of the level of consciousness has afforded good prognostic guidance regardless of the lesions causing the clinical condition 2, 1.9 lv- 19 The time of the clinical assessment is essential 18. An early assessment will include patients dying early, and generally a lower level of consciousness will be registered than in a later assessment 11 In a later assessment some of the most severely affected patients will be dead, and the outcome in patients in the lower levels of consciousness will be poorer owing to the prolonged period of unconsciousness 3, r. The treatment given may also make a late assessment difficult 1, 14…”

Section: Discussionmentioning

confidence: 99%

Computerized tomography (CT) in patients with head injuries. Assessment of outcome based upon initial clinical findings and initial CT scans

Espersen

Petersen

1982

Acta neurochir

View full text Add to dashboard Cite

In this study, which comprises 144 consecutive head injuries, the initial clinical assessment and the findings of the initial CT scan are related to the outcome. The mortality is related to the patient's level of consciousness and pupillary light reflex on admission. The disability rate (= number of disabled/number of survivors) was independent of the level of consciousness but closely related to pupillary light reaction. Diminished and obliterated basal cisterns were bad prognostic signs, with a mortality rate of 66% in the latter group. Both disability and mortality increase with the number of different lesion types.

show abstract

Clinical course and prognosis of acute post-traumatic coma.

Cited by 79 publications

References 7 publications

Initial Observations of Combination Barbiturate Coma and Decompressive Craniectomy for the Management of Severe Pediatric Traumatic Brain Injury

Initial Observations of Combination Barbiturate Coma and Decompressive Craniectomy for the Management of Severe Pediatric Traumatic Brain Injury

Intracranial Pressure Monitoring in Severe Traumatic Brain Injury: Results from the American College of Surgeons Trauma Quality Improvement Program

Computerized tomography (CT) in patients with head injuries. Assessment of outcome based upon initial clinical findings and initial CT scans

Contact Info

Product

Resources

About