PURPOSE: Despite advances in modern medicine, traumatic brain injuries (TBIs) are still a major medical problem. Early diagnosis of TBI is crucial for clinical decision-making and prognosis. This study aims to compare the predictive value of Helsinki, Rotterdam, and Stockholm CT scores in predicting the 6-month outcomes in blunt TBI patients. METHODS: This cohort study was conducted on blunt TBI patients of 15 years or older. All of them were admitted to the surgical emergency department of Shahid Beheshti Hospital in Kashan, Iran from 2020 to 2021 and had abnormal trauma-related findings on brain CT images. The patients' demographic data such as age, gender, history of comorbid conditions, mechanism of trauma, Glasgow coma scale, CT images, length of hospital stay, and surgical procedures were recorded. The Helsinki, Rotterdam, and Stockholm CT scores were simultaneously determined according to the existing guidelines. The included patients' 6-month outcome was determined using the Glasgow outcome scale extended. M Data were analyzed by SPSS software version 16.0. Sensitivity, specificity, negative/positive predictive value and the area under the receiver operating characteristic curve were calculated for each test. The Kappa agreement coefficient and Kuder Richardson-20 were used to compare the scoring systems. RESULTS: Altogether 171 TBI patients met the inclusion and exclusion criteria, with the mean age of (44.9 ± 20.2) years. Most patients were male (80.7%), had traffic related injuries (83.1%) and mild TBIs (64.3%). Patients with lower Glasgow coma scale had higher Helsinki, Rotterdam, and Stockholm CT scores and lower Glasgow outcome scale extended scores. Among all the scoring systems, the Helsinki and Stockholm scores showed the highest agreement in predicting patients' outcomes (kappa = 0.657, p < 0.001). The Rotterdam scoring system had the highest sensitivity (90.1%) in predicting death of TBI patients, whereas the Helsinki scoring system had the highest sensitivity (89.8%) in predicting the 6-month outcome in TBI patients. CONCLUSION The Rotterdam scoring system was superior in predicting death in TBI patients, whereas the Helsinki scoring system was more sensitive in predicting the 6-month outcome.
Humans ; Male ; Young Adult ; Adult ; Middle Aged ; Aged ; Female ; Cohort Studies ; Tomography, X-Ray Computed/methods* ; Brain Injuries, Traumatic/diagnosis* ; Brain Injuries ; Prognosis ; Glasgow Coma Scale ; Wounds, Nonpenetrating/diagnostic imaging* ; Brain

In subarachnoid hemorrhage following traumatic brain injury (TBI), the high intracisternal pressure drives the cerebrospinal fluid into the brain parenchyma, causing cerebral edema. Basal cisternostomy involves opening the basal cisterns to atmospheric pressure and draining cerebrospinal fluid in an attempt to reverse the edema. We describe a case of basal cisternostomy combined with decompressive craniectomy. A 35-year-old man with severe TBI following a road vehicle accident presented with acute subdural hematoma, Glasgow coma scale score of 6, fixed pupils and no corneal response. Opening of the basal cisterns and placement of a temporary cisternal drain led to immediate relaxation of the brain. The patient had a Glasgow coma scale score of 15 on postoperative day 6 and was discharged on day 10. We think basal cisternostomy is a feasible and effective procedure that should be considered in the management of TBI.
Adult ; Brain ; Brain Edema ; Brain Injuries, Traumatic/surgery* ; Decompressive Craniectomy/methods* ; Glasgow Coma Scale ; Humans ; Male ; Treatment Outcome

PURPOSE: Traumatic brain injury (TBI) generally causes mortality and disability, particularly in children. Machine learning (ML) is a computer algorithm, applied as a clinical prediction tool. The present study aims to assess the predictability of ML for the functional outcomes of pediatric TBI. METHODS: A retrospective cohort study was performed targeting children with TBI who were admitted to the trauma center of southern Thailand between January 2009 and July 2020. The patient was excluded if he/she (1) did not undergo a CT scan of the brain, (2) died within the first 24 h, (3) had unavailable complete medical records during admission, or (4) was unable to provide updated outcomes. Clinical and radiologic characteristics were collected such as vital signs, Glasgow coma scale score, and characteristics of intracranial injuries. The functional outcome was assessed using the King's Outcome Scale for Childhood Head Injury, which was thus dichotomized into favourable outcomes and unfavourable outcomes: good recovery and moderate disability were categorized as the former, whereas death, vegetative state, and severe disability were categorized as the latter. The prognostic factors were estimated using traditional binary logistic regression. By data splitting, 70% of data were used for training the ML models and the remaining 30% were used for testing the ML models. The supervised algorithms including support vector machines, neural networks, random forest, logistic regression, naive Bayes and k-nearest neighbor were performed for training of the ML models. Therefore, the ML models were tested for the predictive performances by the testing datasets. RESULTS: There were 828 patients in the cohort. The median age was 72 months (interquartile range 104.7 months, range 2-179 months). Road traffic accident was the most common mechanism of injury, accounting for 68.7%. At hospital discharge, favourable outcomes were achieved in 97.0% of patients, while the mortality rate was 2.2%. Glasgow coma scale score, hypotension, pupillary light reflex, and subarachnoid haemorrhage were associated with TBI outcomes following traditional binary logistic regression; hence, the 4 prognostic factors were used for building ML models and testing performance. The support vector machine model had the best performance for predicting pediatric TBI outcomes: sensitivity 0.95, specificity 0.60, positive predicted value 0.99, negative predictive value 1.0; accuracy 0.94, and area under the receiver operating characteristic curve 0.78. CONCLUSION The ML algorithms of the present study have a high sensitivity; therefore they have the potential to be screening tools for predicting functional outcomes and counselling prognosis in general practice of pediatric TBIs.
Bayes Theorem ; Brain Injuries, Traumatic/therapy* ; Child ; Female ; Glasgow Coma Scale ; Humans ; Machine Learning ; Prognosis ; Retrospective Studies

PURPOSE: Patients' gender, which can be one of the most important determinants of traumatic brain injury (TBI) outcomes, is also likely to interact with many other outcome variables of TBI. This multicenter descriptive study investigated gender differences in epidemiological, clinical, treatment, mortality, and variable characteristics in adult TBI patients. METHODS: The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1, 2016 and December 31, 2018. A total of 4468 adult TBI patients were enrolled at eight University Hospitals. Based on the list of enrolled patients, the medical records of the patients were reviewed and they were registered online at each hospital. The registered patients were classified into three groups according to the Glasgow coma scale (GCS) score: mild (13-15), moderate (9-12), and severe (3-8), and the differences between men and women in each group were investigated. The risk factors of moderated and severe TBI compared to mild TBI were also investigated. RESULTS: The study included 3075 men and 1393 women and the proportion of total males was 68.8%. Among all the TBI patients, there were significant differences between men and women in age, past history, and GCS score. While the mild and severe TBI groups showed significant differences in age, past history, and clinical symptoms, the moderate TBI group showed significant differences in age, past history, cause of justice, and diagnosis. CONCLUSION To the best of our knowledge, this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea. This study shows significant differences between men and women in many aspects of adult TBI. Therefore, gender differences should be strongly considered in TBI studies.
Adult ; Brain Injuries ; Brain Injuries, Traumatic/epidemiology* ; Female ; Glasgow Coma Scale ; Humans ; Male ; Prospective Studies ; Sex Factors

OBJECTIVE: To study the value of amplitude-integrated EEG (aEEG), Full Outline of Unresponsiveness (FOUR), and Glasgow Coma Scale (GCS) in evaluating the prognosis of children with disturbance of consciousness in the pediatric intensive care unit (PICU). METHODS: A total of 164 children with disturbance of consciousness who were admitted to the PICU of Children's Hospital Affiliated to Soochow University were enrolled as subjects. According to prognosis, they were divided into a poor prognosis group with 111 children and a good prognosis group with 53 children. The results of aEEG monitoring, FOUR score, and GCS score on days 1 and 5 of admission were collected. The association between evaluation methods and prognosis was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the value of aEEG, FOUR, and GCS in predicting prognosis. RESULTS: The children with no improvement or abnormal aggravation of aEEG on day 5 tended to have a poor prognosis. The results of aEEG was positively correlated with prognosis (r=0.689, P<0.001), and FOUR and GCS were negatively correlated with prognosis (r=-0.655 and -0.554 respectively, P<0.001). The areas under the ROC curve (AUC) of aEEG, FOUR, and GCS were 0.894, 0.903, and 0.840 respectively, and there was no significant difference in the AUC between the three indices (P>0.05), while aEEG combined with FOUR had an AUC of 0.945, which was significantly larger than that of each index alone (P<0.05). CONCLUSIONS Both aEEG and FOUR can be used as effective tools to predict the prognosis of children with disturbance of consciousness, and a combination of aEEG and FOUR can improve the predictive value.
Child ; Consciousness ; Electroencephalography ; Glasgow Coma Scale ; Humans ; Prognosis ; ROC Curve

PURPOSE: Owing to the increased agricultural use of the herbicide glufosinate ammonium (GLA), the incidence of GLA poisoning has recently increased. Therefore, we investigated the possible predictive factors associated with severe complications following GLA poisoning. METHODS: A retrospective analysis of medical records was conducted based on 76 patients who had visited our regional emergency medical center with GLA poisoning from 2006 to 2017. Severe complications were defined as respiratory failure requiring intubation, systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (GCS) less than 8, and presence of seizure. RESULTS: Age, ingested amount and ingested amount per weight were significantly greater in the severe group (p<0.001). PSS grade 2 or higher was more common in the severe group (p<0.001), and In addition, the APACHE II score was significantly higher in the severe group (p<0.001), as were the SOFA scores (p=0.002). Serum ammonia levels were significantly higher in the severe group (p=0.007), while MDRD-GFR was smaller in the severe group (p=0.002). The spot urine protein levels were significantly higher in the severe group (p=0.005), as was the urine protein to creatinine ratio (p=0.001). Upon multivariate analysis, the amount ingested per weight and PSS grade 2 or higher were identified as significant predictors. CONCLUSION: Our study showed that MDRD-GFR was significantly lower in the severe group after GLA poisoning. PSS grade 2 or higher and ingested amount per weight may be useful to evaluate the severity of complications after GLA poisoning.
Ammonia ; Ammonium Compounds ; APACHE ; Blood Pressure ; Creatinine ; Emergencies ; Glasgow Coma Scale ; Humans ; Incidence ; Intubation ; Medical Records ; Multivariate Analysis ; Poisoning ; Respiratory Insufficiency ; Retrospective Studies ; Seizures

OBJECTIVE: We investigated the opinions of experts to identify problems and prepare an improvement plan when applying the Korean Triage and Acuity Scale (KTAS) to pediatric patients in the emergency department. METHODS: The experts comprised 15 researchers at a pediatric emergency center designated by the Ministry of Health and Welfare and research team members of the Korean Society of Pediatric Emergency Medicine. The first survey was an open-ended question about the problems, application results, and remedies of applying KTAS to children through e-mail. The problems were categorized by topic, and degree of agreement was presented using a 9-point Likert scale. RESULTS: In the first survey, 67% of experts participated and 18 problems were identified. In the second survey, 73% of experts participated and eight problems were identified in four categories, validity, reliability, feasibility and other opinions. All experts pointed out that resources were not considered during pediatric triage in the KTAS. Ninety-one percent of experts said that peak expiratory flow rate measurement and Glasgow Coma Scale evaluation were unlikely to be feasible. Moreover, 91% experts were concerned that the triage level could be distorted if KTAS was interlocked with medical costs. Eighty-two percent of the respondents pointed to the high triage result of febrile children and the difference in pain score between the evaluators, etc. CONCLUSION: Based on the problems pointed out by experts and the reality of Korea's emergency departments, it is necessary to consider revision of KTAS for children.
Child ; Delphi Technique ; Electronic Mail ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Glasgow Coma Scale ; Humans ; Peak Expiratory Flow Rate ; Surveys and Questionnaires ; Triage

Susceptibility-weighted imaging (SWI) is a magnetic resonance imaging (MRI) sequence used for evaluating traumatic brain injury (TBI). Although SWI is being increasingly used in veterinary medicine, there are no systematic studies regarding its use. We aimed to evaluate TBI lesions by using conventional MRI and SWI in 11 dogs and determine the correlation between clinical status and conventional MRI or SWI findings. The modified Glasgow coma scale (MGCS) at presentation and a previously used MRI grading system (MRGr; grades 1–6) were used to evaluate the brain lesions, and correlations between MGCS score and each MRGr were assessed. Conventional MRI revealed 23 lesions in 11 dogs with variable MGCS scores (range: 11–17). SWI showed comparable findings for all of the lesions except for subdural hemorrhage, and it revealed additional lesions in four dogs. The median MRGr was 2 on both conventional MRI and SWI. The MRGr of the conventional MRI assessments and the MGCS scores showed a significant negative correlation (r = −0.685). In conclusion, SWI had better TBI lesion-detection ability, but conventional MRI had a better correlation with early clinical status and subdural hemorrhage. Thus, a combination of conventional MRI and SWI examinations can improve TBI diagnosis in dogs.
Animals ; Brain ; Brain Injuries ; Diagnosis ; Dogs ; Glasgow Coma Scale ; Hematoma, Subdural ; Magnetic Resonance Imaging ; Veterinary Medicine

The goal of the present study was to test the reliability and validity of the Japanese version of the Quality of Life after Brain Injury (QOLIBRI) scale. Correlations between the QOLIBRI and Glasgow Coma Scale scores, anxiety, depression, general quality of life (QOL), and demographic characteristics were examined to assess scale validity. The structure of the QOLIBRI was investigated with exploratory and confirmatory factor analyses, as well as the Partial Credit Model. Test–retest reliability was assessed over a 2-week interval. Participants were 129 patients with traumatic brain injury (TBI) recruited from rehabilitation centers in Japan. The QOLIBRI showed good-to-excellent internal consistency (Cronbach's α: 0.82–0.96), test–retest reliability, and validity (r = 0.77–0.90). Factor analyses revealed a 6-factor structure. Compared to an international sample (IS), Japanese patients had lower QOLIBRI scores and lower satisfaction in several domains. There were positive correlations between the QOLIBRI scales and the Short Form 36 Health Survey (r = 0.22–0.41). The Japanese version of the QOLIBRI showed good-to-excellent psychometric properties. Differences between JS and IS may reflect sampling bias and cultural norms regarding self-evaluation. The QOLIBRI could be a useful tool for assessing health-related QOL in individuals with TBI.
Anxiety ; Asian Continental Ancestry Group ; Brain Injuries ; Brain ; Depression ; Diagnostic Self Evaluation ; Glasgow Coma Scale ; Health Surveys ; Humans ; Japan ; Psychometrics ; Quality of Life ; Rehabilitation Centers ; Reproducibility of Results ; Selection Bias ; Weights and Measures

OBJECTIVE: To investigate the causes and clinical features of children with traumatic brain injury (TBI) who need hospitalization or emergency observation. METHODS: A retrospective analysis was performed for the clinical data of 126 children with TBI who were admitted to the emergency department from January 1, 2014 to August 31, 2016, including causes of injury and clinical features. RESULTS: Of the 126 children, there were 95 boys and 31 girls, with a mean age of 2.8 years (range 0.8-5.5 years). The children aged <1 year accounted for 38.1% (48/126), and 26 children died. The two most common types of TBI were epidural hematoma (54.0%) and subarachnoid hemorrhage (50.8%). Of the 126 children, 83 (65.9%) had a Glasgow Coma Scale score of ≤8 within 24 hours after admission. There were different causes of TBI and places where TBI occurred in different age groups. The two leading causes of TBI were falls (51.6%) and road traffic injuries (42.9%). Compared with those in the other age groups, the children in the age <1 year group were most likely to experience injury due to falls (46%; P=0.023). Thirty-five percent of all TBI due to road traffic injuries occurred in the children aged 3-6 years (P<0.001). Most TBI cases occurred at home (47.6%) or on roads/streets (45.2%). Among those who experienced TBI at home, the children aged <1 year accounted for the highest proportion of 48% (P=0.002), and 53% of the patients aged 3-6 years experienced TBI on roads/streets. The most common cause of death in children with TBI was road traffic injury, which accounted for 69%. Among those who died, the children aged <1 year accounted for the highest proportion (62%). CONCLUSIONS There are different causes of TBI and places where TBI occurs in different age groups. Among children with TBI, the children aged <1 year account for the highest proportion and have the highest number of deaths, with falls at home as the most common cause of TBI. Children aged 3-6 years tend to suffer TBI due to road traffic injury. Road traffic injury is the leading cause of death.
Brain Injuries, Traumatic ; Child ; Child, Preschool ; Female ; Glasgow Coma Scale ; Hospitalization ; Humans ; Male ; Retrospective Studies