The National Traumatic Coma Data Bank

Marshall, Lawrence F.; Becker, Donald P.; Bowers, Sharon A.; Cayard, Carol; Eisenberg, Howard M.; Gross, Cynthia R.; Grossman, Robert G.; Jane, John A.; Kunitz, Selma C.; Rimel, Rebecca W.; Tabaddor, Kamran; Warren, Joseph B.

doi:10.3171/jns.1983.59.2.0276

Cited by 393 publications

(19 citation statements)

References 2 publications

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Section: Pathophysiology Of Traumatic Brain Injurymentioning

confidence: 99%

“…[17] A single episode of hypotension was associated with increased morbidity and mortality. [17] A meta-analysis of 8721 patients (IMPACT study) also suggested that hypotension and hypoxia were significantly associated with unfavorable 6-month outcome. [18] A study on the association between intraoperative hypotension and outcome demonstrated that patients who had intraoperative hypotension had over three times increased mortality than normotensive patients.…”

Section: Pathophysiology Of Traumatic Brain Injurymentioning

confidence: 99%

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Perioperative management of traumatic brain injury

Curry

Viernes

Sharma

2011

Int J Crit Illn Inj Sci

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Traumatic brain injury (TBI) is a major public health problem and the leading cause of death and disability worldwide. Despite the modern diagnosis and treatment, the prognosis for patients with TBI remains poor. While severity of primary injury is the major factor determining the outcomes, the secondary injury caused by physiological insults such as hypotension, hypoxemia, hypercarbia, hypocarbia, hyperglycemia and hypoglycemia, etc. that develop over time after the onset of the initial injury, causes further damage to brain tissue, worsening the outcome in TBI. Perioperative period may be particularly important in the course of TBI management. While surgery and anesthesia may predispose the patients to new onset secondary injuries which may contribute adversely to outcomes, the perioperative period is also an opportunity to detect and correct the undiagnosed pre-existing secondary insults, to prevent against new secondary insults and is a potential window to initiate interventions that may improve outcome of TBI. For this review, extensive Pubmed and Medline search on various aspects of perioperative management of TBI was performed, followed by review of research focusing on intraoperative and perioperative period. While the research focusing specifically on the intraoperative and immediate perioperative TBI management is limited, clinical management continues to be based largely on physiological optimization and recommendations of Brain Trauma Foundation guidelines. This review is focused on the perioperative management of TBI, with particular emphasis on recent developments.

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Section: Pathophysiology Of Traumatic Brain Injurymentioning

confidence: 99%

Section: Pathophysiology Of Traumatic Brain Injurymentioning

confidence: 99%

Perioperative management of traumatic brain injury

Curry

Viernes

Sharma

2011

Int J Crit Illn Inj Sci

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“…Marshall et al [6] have used this strategy. The investigators call it ‘pseudoscoring’ probably because the true verbal score in some of these patients may be more than ‘1’, but aphasia or intubation limits the determination of the true score.…”

Section: Methodsmentioning

confidence: 99%

“…Other reports have also encountered the problem in scoring the verbal subscale [4, 5]. Investigators have employed three different strategies to deal with this problem in patients with untestable verbal subscale: some have used a pseudoscore of ‘1’ for the verbal subscale [6] while others have completely eliminated the verbal subscale and used only the eye and motor subscale (short form) of the GCS [5, 7] or have substituted the verbal score of such patients with the median verbal score of patients with the same eye and motor scores but with lesions of the nondominant hemisphere [8]. There is little discussion in the literature on the relative merits and demerits of the three strategies.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Three Strategies of Verbal Scoring of the Glasgow Coma Scale in Patients with Stroke

Prasad

Menon

1998

Cerebrovasc Dis

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Presence of aphasia in patients with stroke poses a problem in the use of the full form (eye-motor-verbal) Glasgow Coma Scale (GCS). Stroke investigators and clinicians have used three different strategies to deal with the untestable verbal subscale, i.e. eliminating the verbal subscale; pseudoscoring with ‘one’, and median value substitution; but the predictive accuracy of the strategies has not been compared. To compare the predictive accuracy of the three strategies for acute mortality in stroke, we prospectively applied the GCS to 275 consecutive patients with acute stroke and recorded their survival status before discharge from hospital. 95 (33.8%) patients died. 32 (12%) patients had untestable verbal score. Receiver-Operator-Characteristic curves for predicting mortality were constructed with the GCS sum score and with the multivariate logistic models, and areas under the curves were measured to compare the predictive accuracy. They were all found to be similar (0.87–0.88 sq unit). Specifically, the GCS with eye and motor subscale had 87% accuracy compared to 88% for the model with eye, motor and verbal scale. We conclude that the short-form (eye-motor) GCS is as good a predictor of early mortality (within 2 weeks) as the full form (eye-motor-verbal) GCS in patients with stroke.

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“…Cerebral CT scan was carried out at admission and after 48 h. The CT scan findings were evaluated using a modification of the Traumatic Coma Data Bank CT scan classification system [6]. …”

Section: Methodsmentioning

confidence: 99%

S100B Is Not a Reliable Prognostic Index in Paediatric TBI

et al. 2007

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Background: As far as paediatric traumatic brain injury is concerned, it is difficult to quantify the extent of the primary insult, to monitor secondary changes and to predict neurological outcomes by means of the currently used diagnostic tools: physical examination, Glasgow Coma Scale (GCS) score and computed tomography. For this reason, several papers focused on the use of biochemical markers (S100B, neuron-specific enolase) to detect and define the severity of brain damage and predict outcome after traumatic head injury or cardiac arrest. Objective: The aim of this paper is measuring the range of S100B serum concentrations in children affected by traumatic brain injury and describing the possible roles of this protein in the reaction to trauma. Methods: Fifteen children aged 1–15 years were included in the study. Traumatic brain injury severity was defined by paediatric GCS score as mild (9 patients), moderate (2 patients) or severe (4 patients). Blood samples for S100B serum measurement were taken at emergency department admission and after 48 h. Results: The serum S100B concentration was higher in the group of severe trauma patients, who scored the lowest on the GCS at admission, and among them, the highest values were reported by the children with concomitant peripheral lesions. Conclusions: The role of S100B in paediatric traumatic brain injury has not been clarified yet, and the interpretation of its increase when the head trauma is associated with other injuries needs the understanding of the physiopathological mechanisms that rule its release in the systemic circulation. The levels of S100B in serum after a brain injury could be related to the mechanical discharge from a destroyed blood-brain barrier, or they could be due to the active expression by the brain, as a part of its involvement in the systemic inflammatory reaction. Early increase of this protein is not a reliable prognostic index of neurological outcome after pediatric traumatic brain injury, since even very elevated values are compatible with a complete neurological recovery.

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The National Traumatic Coma Data Bank

Cited by 393 publications

References 2 publications

Perioperative management of traumatic brain injury

Perioperative management of traumatic brain injury

Comparison of the Three Strategies of Verbal Scoring of the Glasgow Coma Scale in Patients with Stroke

S100B Is Not a Reliable Prognostic Index in Paediatric TBI

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