Coma After Acute Head Injury

Firsching, Raimund

doi:10.3238/arztebl.2017.0313

Cited by 15 publications

(14 citation statements)

References 40 publications

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“…Figure 1a in the article (or the corresponding clinical course: epidural hematoma, operated 3 hours after the crash) shows that even here, the primarily presumed herniation of brainstem and cerebellar tonsils has not led to lasting injury even 3 hours after the event, such as was documented in the other case (Figure 1c), where the hematoma had obviously been drained much later (3). It always should be borne in mind, however, that epidural hemorrhages can develop slowly and gradually.…”

Section: Tissue Pressure and Perfusionmentioning

confidence: 96%

“…It suggests that acute head injury often affects young motorcyclists who are willing to take risks. Newer studies have found, however, that patients' age has risen continuously over recent years, and that, meanwhile, falls have taken over from traffic accidents as the most common causes of acute head injury (2,3). Although claims have been made to the contrary, over the past two decades no reduction in mortality due to acute head injury has been observed, and neither have outcomes improved to any significant degree (2).…”

Section: Falls Are More Common Than Traffic Crashesmentioning

confidence: 99%

“…I was interested to read Firsching's excellent article on the treatment and prognosis of acute head injury (1). Unfortunately, however, he mentions only by implication age specific aspects and therefore differences in the topics addressed in the article.…”

Section: Falls Are More Common Than Traffic Crashesmentioning

confidence: 99%

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Firsching¹

2017

Deutsches Ärzteblatt International

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Section: Tissue Pressure and Perfusionmentioning

confidence: 96%

Section: Falls Are More Common Than Traffic Crashesmentioning

confidence: 99%

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Firsching¹

2017

Deutsches Ärzteblatt International

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“…Die Prognose nach einem SHT korreliert signifikant mit den Faktoren ▪ Alter, ▪ Dauer der Bewusstlosigkeit, ▪ neurologische Begleitsymptomen und ▪ Lokalisation der Hirnschädigung [1].…”

Section: Prognoseunclassified

“…Bei Patienten unter 15 Jahren mit einem schweren SHT wird ein besseres Outcome erreicht als bei Erwachsenen [1].…”

Section: Prognoseunclassified

Prähospitale Versorgung des Schädel-Hirn-Traumas

Freude¹,

Mauer²,

Gäßler³

et al. 2017

Notarzt

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ZusammenfassungNach einem Schädel-Hirn-Trauma (SHT) soll zügig eine Computertomografie des Schädels (CCT) durchgeführt werden, um das Ausmaß einer intrakraniellen Verletzung zu beurteilen. Bei Vorliegen einer posttraumatischen Bewusstlosigkeit ist der direkte Transport in ein Traumazentrum mit neurochirurgischer Versorgungsmöglichkeit zu empfehlen. Kritische Blutungen am Kopf müssen gestillt werden. Bei einem Wert unter 9 auf der Glasgow Coma Scale (GCS) soll intubiert und beatmet werden.

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Predictors of mortality and rehabilitation location in adults with prolonged coma following traumatic brain injury

Cassinat,

Nygaard,

Hoggard

et al. 2024

PM&R

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IntroductionTraumatic brain injury (TBI) is a leading cause of death and disability, often resulting in prolonged coma and disordered consciousness. There are currently gaps in understanding the factors affecting rehabilitation location and outcome after TBI.ObjectiveTo identify the impact of demographics, comorbidities, and complications on discharge disposition in adults with prolonged coma following TBI.DesignRetrospective cohort study.SettingTertiary care hospitals and trauma centers in the United States.ParticipantsPatients 18 years of age or older with TBI and prolonged coma during the years 2008 to 2015.InterventionNot applicable.Main Outcome MeasuresDemographics, clinical injury data, comorbidities, and complications were collected, and odds ratios (ORs) and descriptive analysis were calculated for mortality, long‐term rehabilitation, and home discharge without services.ResultsA total of 6929 patients with TBI and prolonged coma were included in the final analysis; 3318 (47.9%) were discharged to rehabilitation facilities, 1859 (26.8%) died, and 1752 (25.3%) were discharged home. Older patients and those with higher injury severity scores had significantly higher ORs for mortality and rehab discharge. A total of 58.3% of patients presented with at least one comorbidity. Non‐White ethnicities and self‐pay/uninsured patients were significantly less likely to be discharged to a rehab facility. Furthermore, comorbidities including congestive heart failure (CHF) and diabetes were associated with a significantly increased OR for mortality and rehab discharge compared to home discharge without services.ConclusionsComorbidities, age, and injury severity were the most significant risk factors for increased mortality and acute rehab discharge. Maximizing the treatment of comorbidities including CHF and diabetes has the potential to decrease mortality and adverse outcomes following TBI with prolonged coma.

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Coma After Acute Head Injury

Abstract: Brain tissue can tolerate ischemia and elevated pressure only for a very limited time. Comatose head-injured patients must therefore be evaluated urgently to determine whether they can be helped by the surgical removal of a hematoma or by a decompressive hemicraniectomy.

Cited by 15 publications

References 40 publications

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Prähospitale Versorgung des Schädel-Hirn-Traumas

Predictors of mortality and rehabilitation location in adults with prolonged coma following traumatic brain injury

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