Direct Transport Within An Organized State Trauma System Reduces Mortality in Patients With Severe Traumatic Brain Injury

Härtl, Roger; Gerber, Linda M.; Iacono, Laura; Ni, Quanhong; Lyons, Kerry A.; Ghajar, Jamshid

doi:10.1097/01.ta.0000203717.57821.8d

Cited by 224 publications

(149 citation statements)

References 15 publications

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“…Their findings supported the hypothesis that time may indeed be of essence. They showed 50% increase in mortality associated with indirect transfer of TBI patients [6]. These findings were a replica of studies performed a decade earlier [7,8].…”

Section: Managementsupporting

confidence: 76%

“…However, over the past few years, extensive body of evidence endorsing direct transport of injured patients to definitive care center has been studied, established, and well accepted. In a prospective study using compulsory protocol, Hart et al [6] evaluated prospectively whether direct transport to Level I or Level II trauma center would be associated with decreased mortality at 2 weeks following injury when compared to indirect transfers. Their findings supported the hypothesis that time may indeed be of essence.…”

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

Prehospital Triage and Emergency Room Care in TBI

Chmayssani¹

2014

Emergency Medicine

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Section: Managementsupporting

confidence: 76%

Section: Managementmentioning

confidence: 99%

Prehospital Triage and Emergency Room Care in TBI

Chmayssani¹

2014

Emergency Medicine

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“…15 The primary goals of the current study were to analyze 2-week mortality due to severe TBI between 2001 and 2009 in New York State and to examine the trends in adherence to the Guidelines.…”

mentioning

confidence: 99%

Marked reduction in mortality in patients with severe traumatic brain injury

Gerber¹,

Chiu²,

Carney

et al. 2013

JNS

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204

115

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Object In spite of evidence that use of the Brain Trauma Foundation Guidelines for the Management of Severe Traumatic Brain Injury (Guidelines) would dramatically reduce morbidity and mortality, adherence to these Guidelines remains variable across trauma centers. The authors analyzed 2-week mortality due to severe traumatic brain injury (TBI) from 2001 through 2009 in New York State and examined the trends in adherence to the Guidelines. Methods The authors calculated trends in adherence to the Guidelines and age-adjusted 2-week mortality rates between January 1, 2001, and December 31, 2009. Univariate and multivariate logistic regression analyses were performed to evaluate the effect of time period on case-fatality. Intracranial pressure (ICP) monitor insertion was modeled in a 2-level hierarchical model using generalized linear mixed effects to allow for clustering by different centers. Results From 2001 to 2009, the case-fatality rate decreased from 22% to 13% (p < 0.0001), a change that remained significant after adjusting for factors that independently predict mortality (adjusted OR 0.52, 95% CI 0.39–0.70; p < 0.0001). Guidelines adherence increased, with the percentage of patients with ICP monitoring increasing from 56% to 75% (p < 0.0001). Adherence to cerebral perfusion pressure treatment thresholds increased from 15% to 48% (p < 0.0001). The proportion of patients having an ICP elevation greater than 25 mm Hg dropped from 42% to 29% (p = 0.0001). Conclusions There was a significant reduction in TBI mortality between 2001 and 2009 in New York State. Increase in Guidelines adherence occurred at the same time as the pronounced decrease in 2-week mortality and decreased rate of intracranial hypertension, suggesting a causal relationship between Guidelines adherence and improved outcomes. Our findings warrant future investigation to identify methods for increasing and sustaining adherence to evidence-based Guidelines recommendations.

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“…Bu amaçla medikal ve cerrahi teknikler bir arada kullanılmak-tadır. Kafa travması olgularının hızlı cerrahi girişimin yapıla-bileceği, bilgisayarlı tomografinin olduğu, kafa içi basıncının ölçülebildiği travma merkezlerinde tedavi edilmesinin mortaliteyi düşürdüğü gösterilmiştir (29).…”

Section: Sonuçunclassified

Intensive Care Treatment in Traumatic Brain Injury

Dilmen¹,

Akçıl²,

Tunalı³

2015

Turk J Anesth Reanim

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Head injury remains a serious public problem, especially in the young population. The understanding of the mechanism of secondary injury and the development of appropriate monitoring and critical care treatment strategies reduced the mortality of head injury. The pathophysiology, monitoring and treatment principles of head injury are summarised in this article. Kafa Travmasının Fizyopatolojisi Primer ve sekonder beyin hasarıPrimer hasar travmanın olduğu anda oluşan hasardır, sekonder hasar ise primer hasardan sonra hipoksi, hiperkapni, hipotansiyon, kafa içi basıncının artması ve hiperglisemi gibi faktörlerin zaman içinde oluşturduğu hasardır (Tablo 1). Kafa travmalarında tedavi sekonder hasarı önlemeye yönelik olup sekonder beyin hasarının önlenmesi morbidite ve mortaliteyi önemli ölçüde azaltmaktadır.Primer hasar fokal veya difüz olabilir. Kontüzyon, laserasyon ve intrakraniyal kanamalar fokal beyin hasarı örnekleridir. Difüz akson hasarı ve beyin ödemi ise difüz beyin hasarı çeşitleridir (2).Kafa travmasının ilk dönemi travmanın oluşturduğu doğrudan doku hasarı, beyin kan akımı ve beyin metabolizmasında oluşan hasar ile karakterizedir. Bu dönemde anaerobik glikoliz nedeniyle laktik asit birikimi, membran geçirgenliğinde artış ve ödem oluşur. Anaerobik glikoliz yeterli enerji sağlayamayıp var olan ATP depoları da tükenince, ATP'ye bağımlı çalışan iyon pompaları hasar görür. Bu patofizyolojik kaskadın ikinci aşamasında glutamat, aspartat gibi eksitatör nörotransmitter-lerin aşırı salınımı, N-metil-D aspartat, voltaj bağımlı sodyum ve kalsiyum kanallarının aktivasyonuyla terminal membran aktivasyonu oluşur. Sodyum ve kalsiyumun sürekli hücre içine akışı hücrelerin ölümüne neden olan intraselüler süreçleri başlatır. Hücre içi kalsiyum, lipid peroksidaz, proteaz ve fosfolipazları aktive ederek intrasellüler serbest yağ asidi ve serbest radikallerin konsantrasyonunu arttırır. Ayrıca hücre içi translokaz ve endonükleaz gibi maddelerin aktivasyonu hücre membranı ve DNA'ya hasar vererek nekroz ya da apopitozise neden olur. Kafa Travmasının Spesifik Patofizyolojisi Beyin kan akımı Hipoperfüzyon ve hiperperfüzyonNormal şartlarda 100 g beyin dokusuna dakikada 50 mL kan akımı olur. Fakat kafa travması gerçekleştiğinde beyin kan akı-mı otoregülasyonu bozulmakta, beyin oksijen tüketiminin artması nedeniyle 50 mL kg -1 dk -1 düzeyindeki kan akımı yeterli

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Direct Transport Within An Organized State Trauma System Reduces Mortality in Patients With Severe Traumatic Brain Injury

Cited by 224 publications

References 15 publications

Prehospital Triage and Emergency Room Care in TBI

Prehospital Triage and Emergency Room Care in TBI

Marked reduction in mortality in patients with severe traumatic brain injury

Intensive Care Treatment in Traumatic Brain Injury

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