Displaying publications 1 - 20 of 90 in total

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  1. Abdul Halim Mansar, Muhammad Aadeel T., Khairul Osman, Sharin Iskandar, A.W.
    MyJurnal
    The abdominal pelvic cavity has always been regarded as one of the most vulnerable regions of the body. Injuries to this part have been known to be very serious. Based on this a retrospective study was performed on postmortem cases with abdominal and pelvic trauma from 1 October 2002 to 31 January 2003 at the Forensic Institute, Hospital Kuala Lumpur to determine the common pattern of abdomino-pelvic injuries, the injury’s relationship to epidemiological and socio-economic factors, risk organ within the abdominopelvic region and relationship between injuries and survival period. A total of 122 cases abdomino-pelvic were obtained stemming from medico legal postmortems procedures. Results indicated that those aged between 21 to 30 years (38.5%) had the highest incidence of this type of injury. Categorization based on gender showed that males (90.2%) dominated most of the cases. Prevalence based on socio-economic status showed that lower socioeconomy class (52.5%) had the highest incident. This was followed by the middle income (39.3%) and finally the higher income group. The most numerous type of trauma was non-penetrating trauma (94.3%). It was also found that victims with low injury severity score (ISS) had a longer survival period as compared to those with high ISS. It was also noted that victims with two or more region injuries either were spot dead or brought dead. The most common combination of injuries was abdomen, pelvic, chest and limb. In most blunt trauma cases majority of victims had one or two organ involvement while penetrating injuries were difficult to asses. The most common organ involved in this type of trauma was liver (72.1%), pelvic bone (47.5%) and spleen (43.4%). In conclusion, abdomino-pelvic injury is a serious condition and should not be overlooked. Proper attention towards their diagnosis and management is important and so any patient of head injury with coma must be considered as having intra-abdominal injury until proven otherwise.
    Matched MeSH terms: Coma
  2. Abdullah JM, Husin A
    Acta Neurochir. Suppl., 2011;111:421-4.
    PMID: 21725794 DOI: 10.1007/978-3-7091-0693-8_72
    The use of intravascular hypothermia in the treatment of hemorrhagic stroke is currently still being researched. The exact therapeutic properties and effect of hypothermia on the natural progression of the disease are not known, and a only small number of papers has been published with results from these studies. Mild hypothermia at 34°C was induced in six patients with hemorrhagic stroke in the first 48 h after presentation, using an intravascular catheter placed in the inferior vena cava. The hypothermia was induced and maintained for 24 h followed by gradual rewarming. Another 18 patients with hemorrhagic stroke but not receiving hypothermia were then taken as the control group, and all patients were treated with standard stroke management. The patients were then followed up using the modified Rankin Scale (mRS) for 6 months and 1 year. There was a statistically significant improvement at 6 months and 1 year follow-up using the mRS score in the hypothermia group, indicating a possible beneficial effect of early therapeutic hypothermia in the management of acute hemorrhagic stroke. However, a larger study is needed in order to confirm our finding.
    Matched MeSH terms: Glasgow Coma Scale
  3. Abdullah JM, Kumaraswamy N, Awang N, Ghazali MM, Abdullah MR
    Asian J Surg, 2005 Jul;28(3):163-7.
    PMID: 16024307
    To use data from a prospective, longitudinal study to determine whether psychomotor functions improve spontaneously during the first year following paediatric traumatic brain injury without modern rehabilitation facilities in a rural area of Malaysia.
    Matched MeSH terms: Glasgow Coma Scale
  4. Abdullah MI, Ahmad A, Syed Saadun Tarek Wafa SWW, Abdul Latif AZ, Mohd Yusoff NA, Jasmiad MK, et al.
    Chin J Traumatol, 2020 Oct;23(5):290-294.
    PMID: 32423779 DOI: 10.1016/j.cjtee.2020.04.004
    PURPOSE: Malnutrition is a common problem among hospitalized patients, especially among traumatic brain injury (TBI) patients. It is developed from hypermetabolism and the condition may worsen under the circumstance of underfeeding or incompatible dietary management. However, the data of nutrient intake especially calorie and protein among TBI patients were scarce. Hence, this study aimed to determine the calorie and protein intake among acute and sub-acute TBI patients receiving medical nutrition therapy in hospital Sultanah Nur Zahirah, Terengganu.

    METHODS: This observational study involved 50 patients recruited from the neurosurgical ward. Method of 24 h dietary recall was utilized and combined with self-administered food diaries for 2-8 days. Food consumptions including calorie intake and protein intake were analyzed using Nutritionist PRO™ (Woodinville, USA) and manual calculation based on the Malaysian food composition database (2015).

    RESULTS: Patients consisted of 56% males and 44% females with the median age of 28.0 (IQR = 22.8-36.5) years, of which 92% were diagnosed as mild TBI and the remaining (8%) as moderate TBI. The Glasgow coma scale (GCS) was adopted to classify TBI severity with the score 13-15 being mild and 9-12 being moderate. The median length of hospital stay was 2 (IQR = 2.0-3.3) days. Calorie and protein intake improved significantly from day 1 to discharge day. However, the intake during discharge day was still considered as suboptimal, i.e. 75% of calorie requirement, whilst the median protein intake was only 61.3% relative to protein requirement. Moreover, the average percentages of calorie and protein intakes throughout hospitalization were remarkably lower, i.e. 52.2% and 41.0%, respectively.

    CONCLUSION: Although the calorie and protein intakes had increased from baseline, hospitalized TBI patients were still at a risk to develop malnutrition as the average intakes were considerably low as compared to their requirements. Optimum nutrient intakes especially calorie and protein are crucial to ensure optimum recovery process as well as to minimize risks of infection and complications.

    Matched MeSH terms: Glasgow Coma Scale
  5. Abosadegh MM, Rahman SA, Saddki N
    Dent Traumatol, 2017 Oct;33(5):369-374.
    PMID: 28504848 DOI: 10.1111/edt.12349
    BACKGROUND/AIMS: The association of traumatic head injury (THI) with maxillofacial fractures (MFF) is a major health concern worldwide. In spite of the close anatomical proximity of maxillofacial bones to the cranium, the association of THI with MFF is controversial. The aim of this study was to assess the association between THI and MFF. Other factors associated with THI in patients with MFF were also investigated.

    MATERIALS AND METHODS: A hospital-based retrospective study was conducted at the OMFS Unit, Hospital USM, Kelantan, Malaysia. From 12 June 2013 to 31 December 2015, 473 patient records with MFF were reviewed to evaluate the association of THI and MFF.

    RESULTS: A total of 331 patients (69.98%) presented with concomitant THI. The most common associated THI were cranial bone fractures (68.6%) followed by intracranial injuries and concussion. A significant association existed between the Glasgow coma scale (GCS) score and the presence of THI concomitant MFF with P-value

    Matched MeSH terms: Glasgow Coma Scale
  6. Alcamo AM, Weiss SL, Fitzgerald JC, Kirschen MP, Loftis LL, Tang SF, et al.
    Pediatr Crit Care Med, 2022 Aug 01;23(8):593-605.
    PMID: 36165937 DOI: 10.1097/PCC.0000000000002979
    OBJECTIVES: To compare outcomes associated with timing-early versus late-of any neurologic dysfunction during pediatric sepsis.

    DESIGN: Secondary analysis of a cross-sectional point prevalence study.

    SETTING: A total of 128 PICUs in 26 countries.

    PATIENTS: Less than 18 years with severe sepsis on 5 separate days (2013-2014).

    INTERVENTIONS: None.

    MEASUREMENTS AND MAIN RESULTS: Patients were categorized as having either no neurologic dysfunction or neurologic dysfunction (i.e., present at or after sepsis recognition), which was defined as Glasgow Coma Scale score less than 5 and/or fixed dilated pupils. Our primary outcome was death or new moderate disability (i.e., Pediatric Overall [or Cerebral] Performance Category score ≥3 and change ≥1 from baseline) at hospital discharge, and 87 of 567 severe sepsis patients (15%) had neurologic dysfunction within 7 days of sepsis recognition (61 at sepsis recognition and 26 after sepsis recognition). Primary site of infection varied based on presence of neurologic dysfunction. Death or new moderate disability occurred in 161 of 480 (34%) without neurologic dysfunction, 45 of 61 (74%) with neurologic dysfunction at sepsis recognition, and 21 of 26 (81%) with neurologic dysfunction after sepsis recognition (p < 0.001 across all groups). On multivariable analysis, in comparison with those without neurologic dysfunction, neurologic dysfunction whether at sepsis recognition or after was associated with increased odds of death or new moderate disability (adjusted odds ratio, 4.9 [95% CI, 2.3-10.1] and 10.7 [95% CI, 3.8-30.5], respectively). We failed to identify a difference between these adjusted odds ratios of death or new moderate disability that would indicate a differential risk of outcome based on timing of neurologic dysfunction (p = 0.20).

    CONCLUSIONS: In this severe sepsis international cohort, the presence of neurologic dysfunction during sepsis is associated with worse outcomes at hospital discharge. The impact of early versus late onset of neurologic dysfunction in sepsis on outcome remains unknown, and further work is needed to better understand timing of neurologic dysfunction onset in pediatric sepsis.

    Matched MeSH terms: Glasgow Coma Scale
  7. Amirudin, S., Ismail, M.S.
    Medicine & Health, 2020;15(2):290-296.
    MyJurnal
    Leptospirosis adalah salah satu penyakit yang endemik di Malaysia. Ia mempunyai pelbagai manifestasi klinikal bermula daripada yang ringan sehingga yang boleh membawa maut. Kami melaporkan sebuah kes tentang seorang lelaki berumur 56 tahun dengan pelbagai masalah kesihatan terdahulu, dengan sejarah tidak sihat kerana demam, batuk dan sakit perut selama dua hari. Pesakit datang ke Jabatan Kecemasan dalam keadaan tidak sedarkan diri dengan Pulseless Electrical Activity (PEA) cardiac arrest. Pesakit telah diresusitasi dan berjaya dipulihkan dengan mencapai peredaran darah spontan (return of spontaneous circulation) tidak berapa lama selepas itu. Keadaan pesakit dirumitkan lagi dengan keadaan Hyperosmolar Hyperglycemic State (HHS), oliguric acute kidney injury, dan non- ST elevation myocardial infarction (NSTEMI). Pesakit kemudian dimasukkan ke unit rawatan rapi dan dirawat dengan IV Ceftriaxone 2 g sekali sehari selama empat hari, dan kemudian ditukar kepada IV Ceftazidime 2 g dua kali sehari untuk seminggu disebabkan ventilator acquired pneumonia (VAP). Keadaan pesakit bertambah baik dan akhirnya di benarkan pulang ke rumah pada hari yang ke 18.

    Matched MeSH terms: Hyperglycemic Hyperosmolar Nonketotic Coma
  8. Anada RP, Wong KT, Jayapalan JJ, Hashim OH, Ganesan D
    Electrophoresis, 2018 09;39(18):2308-2315.
    PMID: 29570807 DOI: 10.1002/elps.201700407
    The Glasgow Coma Scale (GCS), which classifies patients into mild, moderate or severe traumatic brain injury (TBI), is a system used to prioritize treatment and prognosticate the severity of head injury. In this study, sera of patients with various stages of TBI, as well as control subjects, were analyzed to screen for proteins that may be used to complement the GCS system. By subjecting pooled serum samples to iTRAQ analysis for quantitative comparison of protein abundance, and attesting their altered levels using ELISA, we have detected increased levels of serum amyloid A, C-reactive protein, leucine-rich alpha-2-glycoprotein, lipopolysaccharide-binding protein, fibronectin, vitronectin and alpha-1-antichymotrypsin in patients across all strata of TBI relative to the controls. However, kininogen was decreased only in moderate and severe TBI, whereas apolipoprotein E and zinc-alpha-2-glycoprotein were only increased in severe TBI. Hence, we propose a panel of serum biomarkers, which if analyzed within 24 h of the injury, can be used to diagnose patients with TBI into mild, moderate or severe stratification objectively, thus complementing the traditional GCS.
    Matched MeSH terms: Glasgow Coma Scale
  9. Arumugasamy N, Siqueira EB
    Med J Malaya, 1970 Dec;25(2):155-60.
    PMID: 4251137
    Matched MeSH terms: Diabetic Coma/complications; Diabetic Coma/etiology*
  10. Azian AA, Nurulazman AA, Shuaib L, Mahayidin M, Ariff AR, Naing NN, et al.
    Acta Neurochir (Wien), 2001;143(7):711-20.
    PMID: 11534693
    Head injury is a significant economic, social and medical problem all over the world. Road accidents are the most frequent cause of head injury in Malaysia with highest risk in the young (15 to 24 years old). The associated outcomes include good recovery, possibility of death for the severely injured, which may cause disruption of the lives of their family members. It is important to predict the outcome as it will provide sound information to assist clinicians in Malaysia in providing prognostic information to patients and their families, to assess the effectiveness of different modes of treatment in promoting recovery and to document the significance of head injury as a public health problem.

    RESULTS: A total of 103 cases with intracranial haemorrhage i.e. intracerebral haemorrhage, extradural haemorrhage, subdural haemorrhage, intraventricular haemorrhage, haemorrhagic contusion and subarachnoid haemorrhage, following motor vehicle accidents was undertaken to study factors contributing to either good or poor outcome according to the Glasgow Outcome Scale. Patients below 12 years of age were excluded. The end point of the study was taken at 24 months post injury. The selected variables were incorporated into models generated by logistic regression techniques of multivariate analysis to see the significant predictors of outcome as well as the correlation between the CT findings with GCS.

    CONCLUSION: Significant predictors of outcome were GCS on arrival in the accident emergency department, pupillary reflex and the CT scan findings. The CT predictors of outcome include ICH, EDH, IVH, present of SAH, site of ICH, volumes of EDH and SDH as well as midline shift.

    Matched MeSH terms: Glasgow Coma Scale
  11. BROWNE J
    Med J Malaya, 1954 Dec;9(2):99-114.
    PMID: 14355274
    Matched MeSH terms: Insulin Coma*
  12. Chai FY, Farizal F, Jegan T
    Turk Neurosurg, 2013;23(4):561-3.
    PMID: 24101284 DOI: 10.5137/1019-5149.JTN.5724-12.1
    Ventriculostomy or external ventricular drain (EVD) placement by free-hand technique has a high malplacement rate. It is a blind procedure that often requires multiple attempts and revisions. To date, no neurological complication due to EVD malplacement has been reported in the literature. In this report, we present the first case of coma induced by a malplaced EVD and the patient regained consciousness after the drain was adjusted. Our discussion focused on various techniques that can improve the accuracy of EVD insertion. EVD insertion under image guidance provides better accuracy with limited disadvantages. We hypothesized that the patient's coma was due to the mass effect and irritation of the malplaced EVD exerted onto the ventral periaqueductal grey matter and the ascending neurons from upper brainstem.
    Matched MeSH terms: Coma/etiology*; Glasgow Coma Scale
  13. Chan HC, Adnan WA, Jaalam K, Abdullah MR, Abdullah J
    PMID: 16295557
    Mild head injury (MHI) is a common presentation to many hospitals in both rural and urban settings in Southeast Asia, but it is not well studied. We studied 330 patients that presented to Hospital Universiti Sains Malaysia Emergency Department with possible MHI, with the intentions to identify prognostic factors that may improve the diagnosis of MHI in the emergency setting as well as to determine which patients would need follow-up. Patients' one-year outcomes were classified as discharged well (DW) for patients without post-traumatic signs and symptoms and discharged with long term follow-up (DFU) for patients with such signs and symptoms. Four patients died and 82 were DFU. An abnormal skull X ray was associated with mode of accident and type of transportation, older age, presence of vomiting, confusion, bleeding from ear, nose or throat, abnormal pupil size on the right side associated with orbital trauma, unequal pupillary reflexes, absence of loss of consciousness (LOC), a lower Glasgow Coma Scale (GCS) score, multiple clinical presentations, and DFU. An abnormal CT scan was associated with older age, multiple clinical presentation, skull X-ray findings, and DFU. A similar analysis on outcomes revealed that mode of accident, older age, vomiting, confusion, headache, bleeding from ear, nose and throat, neurological deficits, absence of LOC, pupil size, multiple presentation, abnormal skull X ray, CT scan of the brain, and a GCS of 13 was associated with DFU. In conclusion, all patients involved in motor vehicle accidents (MVAs), especially motorcycles, aged over 30 years of age, with multiple clinical presentations, including a lower GCS, and with abnormal radiological findings should have a longer follow-up due to persistent post-traumatic symptomatology.
    Matched MeSH terms: Glasgow Coma Scale
  14. Chan YF
    Med J Malaya, 1972 Mar;26(3):211-4.
    PMID: 5031019
    Matched MeSH terms: Diabetic Coma/drug therapy; Diabetic Coma/etiology*
  15. Chee CP, Ali A
    Aust N Z J Surg, 1991 Aug;61(8):597-602.
    PMID: 1867613
    A prospective study of 100 consecutive patients with basal skull fracture admitted to the University Hospital, Kuala Lumpur between July 1986 and October 1988 was carried out to study its epidemiological pattern, clinical and radiological presentations, mechanisms of injury, time interval between accidents and neurosurgical referrals, complications and outcomes. Two-thirds of the patients were between 20 and 50 years old and 79% were male. Half of the injured were motorcyclists and 22% were pedestrians. Three-quarters of the patients were seen within an hour after injury. Thirty-two patients had intracranial haematomas: 14 subdural, 9 extradural and 9 intracerebral. Three patients developed meningitis (two after operations) and six developed epilepsy. Eighteen patients died, but good recovery resulted in 70 patients at follow-up of 1 to 28 months. A small subgroup of 15 patients with severe ear and nose bleeding as a result of basal venous sinus tear died within a few hours despite aggressive resuscitation, probably due to underlying severe brain stem injury. The implication of the high incidence of basal skull fractures in motorcyclists, despite the enforcement of crash helmets is discussed, with possible mechanisms proposed.
    Matched MeSH terms: Glasgow Coma Scale
  16. Chee LC, Siregar JA, Ghani ARI, Idris Z, Rahman Mohd NAA
    Malays J Med Sci, 2018 Feb;25(1):32-41.
    PMID: 29599633 MyJurnal DOI: 10.21315/mjms2018.25.1.5
    Background: Ruptured cerebral aneurysm is a life-threatening condition that requires urgent medical attention. In Malaysia, a prospective study by the Umum Sarawak Hospital, Neurosurgical Center, in the year 2000-2002 revealed an average of two cases of intracranial aneurysms per month with an operative mortality of 20% and management mortality of 25%. Failure to diagnose, delay in admission to a neurosurgical centre, and lack of facilities could have led to the poor surgical outcome in these patients. The purpose of this study is to identify the factors that significantly predict the outcome of patients undergoing a surgical clipping of ruptured aneurysm in the local population.

    Material and Method: A single center retrospective study with a review of medical records was performed involving 105 patients, who were surgically treated for ruptured intracranial aneurysms in the Sultanah Aminah Hospital, in Johor Bahru, from July 2011 to January 2016. Information collected was the patient demographic data, Glasgow Coma Scale (GCS) prior to surgery, World Federation of Neurosurgical Societies Scale (WFNS), subarachnoid hemorrhage (SAH) grading system, and timing between SAH ictus and surgery. A good clinical grade was defined as WFNS grade I-III, whereas, WFNS grades IV and V were considered to be poor grades. The outcomes at discharge and six months post surgery were assessed using the modified Rankin's Scale (mRS). The mRS scores of 0 to 2 were grouped into the "favourable" category and mRS scores of 3 to 6 were grouped into the "unfavourable" category. Only cases of proven ruptured aneurysmal SAH involving anterior circulation that underwent surgical clipping were included in the study. The data collected was analysed using the Statistical Package for Social Sciences (SPSS). Univariate and multivariate analyses were performed and aP-value of < 0.05 was considered to be statistically significant.

    Result: A total of 105 patients were included. The group was comprised of 42.9% male and 57.1% female patients. The mean GCS of the patients subjected to surgical clipping was 13, with the majority falling into the good clinical grade (78.1%). The mean timing of the surgery after SAH was 5.3 days and this was further categorised into early (day one to day three, 45.3%), intermediate (day four to day ten, 56.2%), and late (after day ten, 9.5%). The total favourable outcome achieved at discharge was 59.0% as compared to 41.0% of the unfavourable outcome, with an overall mortality rate of 10.5%. At the six-month post surgery review (n= 94), the patients with a favourable outcome constituted 71.3% as compared to 28.7% with an unfavourable outcome. The mortality, six months post surgery was 3.2%. On a univariate analysis of early surgical clipping, patients with a better GCS and good clinical grade had a significantly better outcome at discharge. Based on the univariate study, six months post surgery, the timing of the surgery and the clinical grade remained significant predictors of the outcome. On the basis of the multivariate analysis, male patients of younger age, with a good clinical grade, were associated with favourable outcomes, both at discharge and six months post surgery.

    Conclusion: In this study, we concluded that younger male patients with a good clinical grade were associated with a favourable outcome both at discharge and six months post surgery. We did not find the timing of the surgery, size of the aneurysm or duration of surgery to be associated with a patient's surgical outcome. Increasing age was not associated with the surgical outcome in a longer term of patient's follow up.

    Matched MeSH terms: Glasgow Coma Scale
  17. Chen TH, Wu MY, Do Shin S, Jamaluddin SF, Son DN, Hong KJ, et al.
    Int J Surg, 2023 May 01;109(5):1231-1238.
    PMID: 37222717 DOI: 10.1097/JS9.0000000000000287
    BACKGROUND: The shock index (SI) predicts short-term mortality in trauma patients. Other shock indices have been developed to improve discriminant accuracy. The authors examined the discriminant ability of the SI, modified SI (MSI), and reverse SI multiplied by the Glasgow Coma Scale (rSIG) on short-term mortality and functional outcomes.

    METHODS: The authors evaluated a cohort of adult trauma patients transported to emergency departments. The first vital signs were used to calculate the SI, MSI, and rSIG. The areas under the receiver operating characteristic curves and test results were used to compare the discriminant performance of the indices on short-term mortality and poor functional outcomes. A subgroup analysis of geriatric patients with traumatic brain injury, penetrating injury, and nonpenetrating injury was performed.

    RESULTS: A total of 105 641 patients (49±20 years, 62% male) met the inclusion criteria. The rSIG had the highest areas under the receiver operating characteristic curve for short-term mortality (0.800, CI: 0.791-0.809) and poor functional outcome (0.596, CI: 0.590-0.602). The cutoff for rSIG was 18 for short-term mortality and poor functional outcomes with sensitivities of 0.668 and 0.371 and specificities of 0.805 and 0.813, respectively. The positive predictive values were 9.57% and 22.31%, and the negative predictive values were 98.74% and 89.97%. rSIG also had better discriminant ability in geriatrics, traumatic brain injury, and nonpenetrating injury.

    CONCLUSION: The rSIG with a cutoff of 18 was accurate for short-term mortality in Asian adult trauma patients. Moreover, rSIG discriminates poor functional outcomes better than the commonly used SI and MSI.

    Matched MeSH terms: Glasgow Coma Scale
  18. Chong SL, Ong GY, Zheng CQ, Dang H, Ming M, Mahmood M, et al.
    Neurosurgery, 2021 07 15;89(2):283-290.
    PMID: 33913493 DOI: 10.1093/neuros/nyab157
    BACKGROUND: Although early coagulopathy increases mortality in adults with traumatic brain injury (TBI), less is known about pediatric TBI.

    OBJECTIVE: To describe the prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet levels of children with moderate to severe TBI to identify predictors of early coagulopathy and study the association with clinical outcomes.

    METHODS: Using the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) TBI retrospective cohort, we identified patients <16 yr old with a Glasgow Coma Scale (GCS) ≤13. We compared PT, APTT, platelets, and outcomes between children with isolated TBI and multiple trauma with TBI. We performed logistic regressions to identify predictors of early coagulopathy and study the association with mortality and poor functional outcomes.

    RESULTS: Among 370 children analyzed, 53/370 (14.3%) died and 127/370 (34.3%) had poor functional outcomes. PT was commonly deranged in both isolated TBI (53/173, 30.6%) and multiple trauma (101/197, 51.3%). Predictors for early coagulopathy were young age (adjusted odds ratio [aOR] 0.94, 95% CI 0.88-0.99, P = .023), GCS

    Matched MeSH terms: Glasgow Coma Scale
  19. Chong SL, Dang H, Ming M, Mahmood M, Zheng CQS, Gan CS, et al.
    Pediatr Crit Care Med, 2021 Apr 01;22(4):401-411.
    PMID: 33027240 DOI: 10.1097/PCC.0000000000002575
    OBJECTIVES: Traumatic brain injury remains an important cause of death and disability. We aim to report the epidemiology and management of moderate to severe traumatic brain injury in Asian PICUs and identify risk factors for mortality and poor functional outcomes.

    DESIGN: A retrospective study of the Pediatric Acute and Critical Care Medicine Asian Network moderate to severe traumatic brain injury dataset collected between 2014 and 2017.

    SETTING: Patients were from the participating PICUs of Pediatric Acute and Critical Care Medicine Asian Network.

    PATIENTS: We included children less than 16 years old with a Glasgow Coma Scale less than or equal to 13.

    INTERVENTIONS: None.

    MEASUREMENTS AND MAIN RESULTS: We obtained data on patient demographics, injury circumstances, and PICU management. We performed a multivariate logistic regression predicting for mortality and poor functional outcomes. We analyzed 380 children with moderate to severe traumatic brain injury. Most injuries were a result of road traffic injuries (174 [45.8%]) and falls (160 [42.1%]). There were important differences in temperature control, use of antiepileptic drugs, and hyperosmolar agents between the sites. Fifty-six children died (14.7%), and 104 of 324 survivors (32.1%) had poor functional outcomes. Poor functional outcomes were associated with non-high-income sites (adjusted odds ratio, 1.90; 95% CI, 1.11-3.29), Glasgow Coma Scale less than 8 (adjusted odds ratio, 4.24; 95% CI, 2.44-7.63), involvement in a road traffic collision (adjusted odds ratio, 1.83; 95% CI, 1.04-3.26), and presence of child abuse (adjusted odds ratio, 2.75; 95% CI, 1.01-7.46).

    CONCLUSIONS: Poor functional outcomes are prevalent after pediatric traumatic brain injury in Asia. There is an urgent need for further research in these high-risk groups.

    Matched MeSH terms: Glasgow Coma Scale
  20. Croci DM, Dalolio M, Aghlmandi S, Taub E, Rychen J, Chiappini A, et al.
    Neurol Res, 2021 Jan;43(1):40-53.
    PMID: 33106124 DOI: 10.1080/01616412.2020.1819091
    Objective: Early permanent cerebrospinal fluid (CSF) diversion for hydrocephalus during the first 2 weeks after aneurysmal subarachnoid hemorrhage (aSAH) shortens the duration of external ventricular drainage (EVD) and reduces EVD-associated infections (EVDAI). The objective of this study was to detect any association with symptomatic delayed cerebral vasospasm (DCVS), or delayed cerebral ischemia (DCI) by the time of hospital discharge. Methods: We used a single-center dataset of aSAH patients who had received a permanent CSF diversion. We compared an 'early group' in which the procedure was performed up to 14 days after the ictus, to a 'late group' in which it was performed from the 15th day onward. Results: Among 274 consecutive aSAH patients, 39 (14%) had a permanent CSF diversion procedure with a silver-coated EVD. While the blood clot burden was similarly distributed, patients with early permanent CSF diversion (20 out of 39; 51%) had higher levels of consciousness on admission. Early permanent CSF diversion was associated with less colonized catheter, a shorter duration of extracorporeal CSF diversion (OR 0.73, 95%CI 0.58-0.92 per EVD day), and a lower rate of EVDAI (OR 0.08, 95%CI 0.01-0.80). The occurrence of CSF diversion device obstruction, the rate of symptomatic DCVS or detected DCI on computed tomography and the likelihood of a poor outcome at discharge did not differ between the two groups. Discussion: Early permanent CSF diversion lowers the occurrence of catheter colonization and infectious complication without affecting DCVS-related morbidity in good-grade aSAH patients. These findings need confirmation in larger prospective multicenter cohorts. Abbreviations: aSAH: aneurysmal subarachnoid hemorrhage; BNI: Barrow Neurological Institute Scale; CSF: Cerebrospinal fluid; DCVS: Delayed Cerebral Vasospasm; DCI: Delayed Cortical Ischemia; EKNZ: Ethik-Kommission Nordwest Schweiz; EVD: External ventricular drain; EVDAI: External ventricular drain-associated infections; GCS: Glasgow Coma Scale; IRB: Institutional Review Board; IVH: Inraventricular hemorrhage; mRS: Modified Rankin Scale; SOS: Swiss Study of Subarachnoid Hemorrhage Registry; WFNS: World Federation Neurological-Surgeon Scale.
    Matched MeSH terms: Glasgow Coma Scale
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