Focus on traumatic brain injury

Rickels, E.

doi:10.1007/s00068-017-0866-7

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…Despite regional differences in incidence and severity across different areas of the world, TBI and its consequences result in a significant overall burden of disease [ 2 ]. Regional differences include patient characteristics, etiology and case management strategies [ 3 , 4 ]. Severe TBI seems to occur with two incidence peaks in high-income countries.…”

Section: Introductionmentioning

confidence: 99%

The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: experiences from a state under lockdown

Pinggera

Klein

Thomé

et al. 2020

Eur J Trauma Emerg Surg

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Purpose In February 2020, the federal state of Tyrol in Austria has become one of the epicenters of the COVID-19 pandemic. Tyrol is known for numerous skiing areas. Thus, winter sport resorts became a starting point for COVID-19 infections spreading towards the rest of the state, Austria and other countries, leading to a mandatory quarantine for almost a million people, who were placed under a curfew and restrictions in daily life. Additionally, all ski resorts and hotels were closed. We aimed to analyze the influence of the COVID-19 quarantine on traumatic brain injury (TBI) cases in Tyrol. Methods We retrospectively compared demographical and injury characteristics from all TBI patients within the 2020 strict quarantine period with the respective time periods from 2016 to 2019. As our department is the only neurosurgical unit in Tyrol, all patients with moderate or severe TBI are transferred to our hospital. Results During 3 weeks of the full quarantine period, the weekly TBI cases load decreased significantly in comparison to the same time periods in the years 2016-2019. Furthermore, concomitant skull fractures decreased significantly (p < 0.016), probably reflecting different causative mechanisms. The other demographical and injury characteristics and particularly falls at home stayed relatively unchanged. Conclusion TBI remained an important contributor to the neurosurgical workflow during the COVID-19 pandemic. Strategies to ensure neurosurgical care also under pandemic-induced lockdown are important.

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Section: Introductionmentioning

confidence: 99%

The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: experiences from a state under lockdown

Pinggera

Klein

Thomé

et al. 2020

Eur J Trauma Emerg Surg

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“…Traumatic shock was the leading cause of death in this group. Interestingly, the interdisciplinary clinical selection of patients for SSRF successfully excluded those patients that deceased due to secondary traumatic brain injuries [ 17 , 28 , 29 ]. The discriminator for polytrauma patients with concomitant traumatic brain injury benefitting from SSRF was a GCS of about 8 in our study.…”

Section: Discussionmentioning

confidence: 99%

“…SSRF to preserve or repair respiratory mechanics in polytrauma patients may, therefore, be a way to breach this vicious circle. But TBI treatment in polytrauma patients is a particular challenge for trauma surgeons and emergency physicians alike due to the imminent multifactorial risk of secondary brain injury and the tight time frame to avert additional brain injury and to improve patient prognosis [17][18][19]. Therefore, precipitative SSRF in polytrauma management may represent a preventable 'second hit' that aggravates patient recovery and prognosis [20,21].…”

Section: Introductionmentioning

confidence: 99%

Surgical stabilization of serial rib fractures is advantageous in patients with relevant traumatic brain injury

Freitag

Bechmann

Eden³

et al. 2022

Eur J Trauma Emerg Surg

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Purpose To evaluate the clinical benefit of surgical stabilization of rib fractures (SSRF) in polytrauma patients with serial rib fractures. Methods Retrospective single-center cohort analysis in trauma patients. Serial rib fracture was defined as three consecutive ribs confirmed by chest computer tomography (CT). Study cohort includes 243 patients that were treated conservatively and 34 patients that underwent SSRF. Demographic patient data, trauma mechanism, injury pattern, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) and hospital course were analyzed. Two matched pair analyses stratified for ISS (32 pairs) and GCS (25 pairs) were performed. Results The majority of patients was male (74%) and aged 55 ± 20 years. Serial rib fractures were associated with more than 6 broken ribs in average (6.3 ± 3.7). Other thoracic bone injury included sternum (18%), scapula (16%) and clavicula (13%). Visceral injury consisted of pneumothorax (51%), lung contusion (33%) and diaphragmatic rupture (2%). Average ISS was 22 ± 7.3. Overall hospital stay was 15.9 and ICU stay 7.4 days. In hospital, mortality was 13%. SSRF did not improve hospital course or postoperative complications in the complete study cohort. However, patients with a significantly reduced GCS (7.6 ± 5.3 vs 11.22 ± 4.8; p = 0.006) benefitted from SSRF. Matched pair analysis stratified for GCS showed shorter ICU stays (9 vs 15 days; p = 0.005) including shorter respirator time (143 vs 305 h; p = 0.003). Conclusion Patients with serial rib fractures and simultaneous moderate or severe traumatic brain injury benefit from surgical stabilization of rib fractures.

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“…In the presence of neurological symptoms and/or risk factors, native cranial computed tomography (cCT) is considered the gold standard in the primary diagnosis of TBI with respect to the assessment of intracranial damage. In addition to its high sensitivity and specificity, cCT has short examination times and is ubiquitously available (11,12). A disadvantage of cCT is the radiation exposure to the patient with an average effective dose of 2.6 mSv.…”

Section: Introductionmentioning

confidence: 99%

Cranial CT is a mandatory tool to exclude asymptomatic cerebral hemorrhage in elderly patients on anticoagulation

Schindler

Best²,

Woschek³

et al. 2023

Front. Med.

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BackgroundTraumatic brain injury (TBI) after falls causes death and disability with immense socioeconomic impact through medical and rehabilitation costs in geriatric patients. Diagnosing TBI can be challenging due to the absence of initial clinical symptoms. Misdiagnosis is particularly dangerous in patients on permanent anticoagulation because minimal trauma might result in severe intracranial hemorrhage. The aim of this study is to evaluate the diagnostic necessity of cranial computed tomography (cCT) to rule out intracranial hemorrhage, particularly in the absence of neurologic symptoms in elderly patients on permanent anticoagulation in their premedication.Patients and methodsRetrospective cohort analysis of elderly trauma patients (≥ 65 years) admitted to the emergency department (ED) of the level-1-trauma center of the University Hospital Frankfurt from 01/2017 to 12/2019. The study included patients who suffered a ground-level fall with suspected TBI and subsequently underwent CT because of preexisting anticoagulation.ResultsA total of 227 patients met the inclusion criteria. In 17 of these patients, cCT showed intracranial hemorrhage, of which 14 were subdural hematomas (SDH). In 8 of the patients with bleeding showed no clinical symptoms, representing 5% (n = 160) of all symptom-free patients. Men and women were equally to suffer a post-traumatic hemorrhage. Patients with intracranial bleeding were hospitalized for 14.5 (±10.4) days. Acetylsalicylic acid (ASA) was the most prescribed anticoagulant in both patient cohorts—with or without intracerebral bleeding (70.6 vs. 77.1%, p = 0.539). Similarly, patients taking new oral anticoagulant (NOAC) (p = 0.748), coumarins, or other platelet inhibitors (p > 0.1) did not show an increased bleeding incidence.ConclusionAcetylsalicylic acid and NOAC use are not associated with increased bleeding risk in geriatric trauma patients (≥ 65 years) after fall-related TBI. Even in asymptomatic elderly patients on anticoagulation, intracranial hemorrhage occurs in a relevant proportion after minor trauma to the head. Therefore, cCT is an obligatory tool to rule out cerebral hemorrhage in elderly patients under anticoagulation.

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Focus on traumatic brain injury

Cited by 5 publications

References 8 publications

The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: experiences from a state under lockdown

The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: experiences from a state under lockdown

Surgical stabilization of serial rib fractures is advantageous in patients with relevant traumatic brain injury

Cranial CT is a mandatory tool to exclude asymptomatic cerebral hemorrhage in elderly patients on anticoagulation

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