Journal ArticleDOI
Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury.
Thomas G. Saul,Thomas B. Ducker +1 more
TLDR
This study reconfirms the high mortality rate if ICP is 25 mm Hg or greater; however, the data also document that early aggressive treatment based on ICP monitoring significantly lessens the incidence of ICP of 25mm HG or greater and reduces the overall mortality rate of severe head injury.Abstract:
✓ During 1977–1978, 127 patients with severe head injury were admitted and underwent intracranial pressure (ICP) monitoring. All patients had Glasgow Coma Scale (GCS) scores of 7 or less. All received identical initial treatment according to a standardized protocol. The patients' average age was 29 years; 60% had multiple trauma, and 35% needed emergency intracranial operations. Treatment for elevations of ICP was begun when ICP rose to 20 to 25 mm Hg, and included mannitol therapy and drainage of cerebrospinal fluid (CSF) when possible. Forty-three patients (34%) had ICP greater than or equal to 25 mm Hg; of these, 36 (84%) died. The mortality rate of the entire group was 46%. During 1979–1980, 106 patients with severe head injury were admitted and underwent ICP monitoring. Their average age was 29 years; 51% had multiple trauma, and 31% underwent emergency intracranial surgery. All patients received the same standardized protocol as the previous series, with the exception of the treatment of ICP. In thi...read more
Citations
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Journal ArticleDOI
Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition
Nancy Carney,Annette M Totten,Cindy O’Reilly,Jamie S. Ullman,Gregory W.J. Hawryluk,Michael J. Bell,Susan L. Bratton,Randall M. Chesnut,Odette A. Harris,Niranjan Kissoon,Andres M. Rubiano,Lori Shutter,Robert C. Tasker,Monica S. Vavilala,Jack Wilberger,David W. Wright,Jamshid Ghajar +16 more
TL;DR: The scope and purpose of this work is to synthesize the available evidence and to translate it into recommendations, so that these recommendations be used by others to develop treatment protocols, which necessarily need to incorporate consensus and clinical judgment in areas where current evidence is lacking or insufficient.
Journal ArticleDOI
Traumatic brain injury.
TL;DR: Quantification of cerebral perfusion by monitoring of intracranial pressure and treatment of cerebral hypoperfusion decrease secondary injury and an organised trauma system that allows rapid resuscitation and transport directly to an experienced trauma centre significantly lowers mortality and morbidity.
Journal ArticleDOI
Guidelines for the management of severe traumatic brain injury. Editor's Commentary.
Journal ArticleDOI
Pathophysiology of polytrauma.
Marius Keel,Otmar Trentz +1 more
TL;DR: Whereas most clinical trials with anti-inflammatory, anti-coagulant, or antioxidant strategies failed, the implementation of pre- and in-hospital trauma protocols and the principle of damage control procedures have reduced post-traumatic complications, the development of immunomonitoring will help in the selection of patients at risk of post- traumatic complications and the choice of the most appropriate treatment protocols for severely injured patients.
Journal ArticleDOI
Impact of ICP instability and hypotension on outcome in patients with severe head trauma
Anthony Marmarou,Randy L. Anderson,John D. Ward,Sung C. Choi,Harold F. Young,Howard M. Eisenberg,Mary A. Foulkes,Lawrence F. Marshall,John A. Jane +8 more
TL;DR: The relationship between raised intracranial pressure (ICP), hypotension, and outcome from severe head injury is described and a stepwise ordinal logistic regression was used to determine outcome.
References
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Journal ArticleDOI
ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE: A Practical Scale
Bryan Jennett,Michael R. Bond +1 more
TL;DR: In this article, a five-point scale is described, which includes death, persistent vegetative state, severe disability, moderate disability, and good recovery, and duration as well as intensity of disability should be included in an index of ill-health.
Journal Article
Continuous recording and control of ventricular fluid pressure in neurosurgical practice.
Journal ArticleDOI
The outcome from severe head injury with early diagnosis and intensive management
TL;DR: It is proposed that vigorous surgical and medical therapy, by preventing or reversing secondary cerebral insults, enables some patients who would have died to make a good recovery without increasing the proportion of severely disabled patients.
Journal ArticleDOI
Significance of intracranial hypertension in severe head injury.
TL;DR: Of the 48 patients who died, severe intracranial hypertension was the primary cause of death in nearly half and even moderately increased ICP (greater than 20 mm Hg) was associated with higher morbidity in patients with mass lesions and those with diffuse brain injury.
Journal ArticleDOI
Further experience in the management of severe head injury.
J D Miller,J.F. Butterworth,Steven K. Gudeman,J E Faulkner,Sung C. Choi,John B. Selhorst,John W. Harbison,H. A. Lutz,H. F. Young,D. P. Becker +9 more
TL;DR: A prospective and consecutive series of 225 patients with severe head injuries who were managed in a uniform way was analyzed to relate outcome to several clinical variables, and predictive correlations were equally strong in the entire series and in the subset of 158 patients with coma.