Following a motor vehicle collision, a 60-year-old woman is brought in by emergency medical transport. She was a restrained driver in a vehicle that went out of control, hit a tree, and ended up in a ditch. There was a prolonged extrication time (, 30 minutes) due to extensive damage to the front of the vehicle. On arrival, the patient is awake and alert, complaining primarily of pain in her left hip and right foot. Her medical history is unremarkable. She has an initial Glasgow Coma Scale score of 15. Her vital signs are: blood pressure, 154/100 mm Hg; pulse, 108 beats/min; respiratory rate, 16 breaths/min; and O2 saturation, 100% on room air. Primary survey is otherwise unremarkable. A series of radiographs are ordered; that of the right foot is shown. What is your impression?. ...
Concussion represents a distinct subset of traumatic brain injury (TBI) at the milder end of severity, which falls outside the expected clinical presentation seen with moderate-severe TBI. The term concussion may be used interchangeably with mild TBI (mTBI) and is defined by The American Congress of Rehabilitation Medicine as a traumatically induced physiological disruption of brain function, as manifested by at least of the following: (1) any period of loss of consciousness; (2) any loss of memory for events immediately before or after the accident; (3) any alteration in mental state at the time of injury such as feeling dazed, disoriented or confused and (4) focal neurological deficit(s) which may or may not be transient.1 The severity of the injury may not exceed the following: (1) loss of consciousness of approximately 30 min or less; (2) after 30 min, an initial Glasgow Coma Scale (GCS) of 13-15 and (3) post-traumatic amnesia not greater than 24 hours. Both the International Collaboration ...
OBJECTIVES: Prehospital triage of trauma patients is of paramount importance because adequate trauma center referral improves survival. We developed a simple score that is easy to calculate in the prehospital phase.. DESIGN: Multicenter prospective observational study.. SETTING: Prehospital physician-staffed emergency system in university and nonuniversity hospitals.. INTERVENTIONS: We evaluated 1360 trauma patients receiving care from a prehospital mobile intensive care unit in 22 centers in France during 2002. The association of prehospital variables with in-hospital death was tested using logistic regression, and a simple score (the Mechanism, Glasgow coma scale, Age, and Arterial Pressure [MGAP] score) was created and compared with the triage Revised Trauma Score, Revised Trauma Score, and Trauma Related Injury Severity Score. The model was validated in 1003 patients from 2003 through 2005.. MEASUREMENTS AND MAIN RESULTS: Four independent variables were identified, and each was assigned a ...
Care guide for Glasgow Coma Scale. Includes: possible causes, signs and symptoms, standard treatment options and means of care and support.
With the Glasgow Coma Scale, a LNC will help your legal team determine a cases merit and efficiently pinpoint factors that will affect how you proceed.
Patients sustaining severe head injury require use of standardized treatment protocols, most of them focused on the maintenance of cerebral perfusion pressure. Among other goals, neurologic recovery can be expected if a satisfactory...
Free, official coding info for 2020 ICD-10-CM R40.2433 - includes detailed rules, notes, synonyms, ICD-9-CM conversion, index and annotation crosswalks, DRG grouping and more.
The present report of 10 years data on head injured patients shows a loss in correlation between admission GCS and GOS from 1997 onwards, suggesting a reduction in power of the GCS score as predictor of outcome after brain trauma. In the same group of patients, age remains an important factor in prognostic modelling after head injury.. In this study we have considered only patients included in our multimodal monitoring programme whose data were promptly available. These patients do not represent the entire group of severely head injured patients admitted to our NCCU during the same period of time. They required ICP and ABP monitoring for a comparatively long period, and either their level of consciousness was severely impaired at the time of admission or they showed a progressive deterioration during the following days. Patients who died or who recovered consciousness shortly after admission were not included in the analysis.. As different authors have suggested,8 the "motor component" of the ...
116 SDH patients (18 acute, 56 mixed acute/subacute/chronic, 42 subacute/chronic) were included. At 3 months, 61 (53 %) patients had good outcomes (mRS 0-3) while 55 (47 %) were severely disabled or dead (mRS 4-6). Of those who underwent surgical evacuation, 54/94 (57 %) had good outcomes compared to 7/22 (32 %) who did not (p = 0.030). Patients with mixed acuity or subacute/chronic SDH had significantly better 3-month mRS with surgery (median mRS 1 versus 5 without surgery, p = 0.002) compared to those with only acute SDH (p = 0.494). In multivariable analysis, premorbid mRS, age, admission Glasgow Coma Score, history of smoking, and fever were independent predictors of poor 3-month outcome (all p , 0.05; area under the curve 0.90), while SDH evacuation tended to improve outcomes (adjusted OR 3.90, 95 % CI 0.96-18.9, p = 0.057). Nearly 50 % of SDH patients were dead or moderate-severely disabled at 3 months. Older age, poor baseline, poor admission neurological status, history of smoking, and ...
OBJECT: The authors prospectively studied the occurrence of clinical and nonclinical electroencephalographically verified seizures during treatment with an intracranial pressure (ICP)-targeted protocol in patients with traumatic brain injury (TBI). METHODS: All patients treated for TBI at the Department of Neurosurgery, University Hospital Umeå, Sweden, were eligible for the study. The inclusion was consecutive and based on the availability of the electroencephalographic (EEG) monitoring equipment. Patients were included irrespective of pupil size, pupil reaction, or level of consciousness as long as their first measured cerebral perfusion pressure was , 10 mm Hg. The patients were treated in a protocol-guided manner with an ICP-targeted treatment based on the Lund concept. The patients were continuously sedated with midazolam, fentanyl, propofol, or thiopental, or combinations thereof. Five-lead continuous EEG monitoring was performed with the electrodes at F3, F4, P3, P4, and a midline ...
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Decerebrate posturing is also called decerebrate response, decerebrate rigidity, or extensor posturing. It describes the involuntary extension of the upper extremities in response to external stimuli. In decerebrate posturing, the head is arched back, the arms are extended by the sides, and the legs are extended.[6] A hallmark of decerebrate posturing is extended elbows.[13] The arms and legs are extended and rotated internally.[14] The patient is rigid, with the teeth clenched.[14] The signs can be on just one side of the body or on both sides, and it may be just in the arms and may be intermittent.[14]. A person displaying decerebrate posturing in response to pain gets a score of two in the motor section of the Glasgow Coma Scale (for adults) and the Pediatric Glasgow Coma Scale (for infants), due to his or her muscles extending because of the neuro-muscular response to the trauma.[12]. Decerebrate posturing indicates brain stem damage, specifically damage below the level of the red nucleus ...
Results 560 cases were identified; 77% were male and 32% were children ,18 years of age. Rollovers (45%) were most common, followed by striking an object (22%) and ejection/fall (13%). Collisions with a motorised vehicle occurred in 8% of patients. Speeds ,20 mph were associated with higher Max Head Abbreviated Injury Scale (AIS) scores than those ≤20 mph (p = 0.05). Crashes with speeds ,30 mph had higher Max Head AIS scores than those ≤30 mph (p = 0.014). Higher speeds were also associated with a trend towards lower patient Glasgow Coma Scale (GCS) scores. Only about 20% of victims overall were wearing a helmet. Competitive racers, although helmeted, had more severe head injuries than all other victims. Competitive racers had lower GCS scores than their helmeted non-racing peers (p , 0.05). Non-racers without helmets had lower GCS scores than their helmeted peers (p = 0.003). ...
Seventy-three primary ICH patients (51%) had IVH. Median admission IVH, Graeb, and LeRoux scores were 13, 6, and 8, respectively. Median IVH, Graeb and LeRoux scores decreased to 9 (p = 0.005), 4 (p = 0.002), and 4 (p = 0.003), respectively, within 6 days of ictus. Poor outcome was noted in 55 patients (75%). Areas under the receiver operating characteristic curve were similar among the IVH, Graeb, and LeRoux scores (0.745, 0.743, and 0.744, respectively) and within 6 days postictus (0.765, 0.722, 0.723, respectively). Moreover, the IVH, Graeb, and LeRoux scores had similar maximum Youden Indices both at admission (0.515 vs 0.477 vs 0.440, respectively) and within 6 days postictus (0.515 vs 0.339 vs 0.365, respectively). Patients who received EVDs had higher mean IVH volumes (23 ± 26 ml vs 9 ± 11 ml, p = 0.003) and increased incidence of Glasgow Coma Scale scores , 8 (67% vs 38%, p = 0.015) and hydrocephalus (82% vs 50%, p = 0.004) at admission but had similar outcome as those who did not ...
A 73-year-old man presents to the emergency department with a 3-day history of mild headache and somnolence. His wife notes that he has periods when he seems "off," that he has been napping frequently, and that he has had a poor appetite. They deny any history of trauma, seizures, or focal neurologic deficits. Symptomatic review of the cardiopulmonary, gastrointestinal, and genitourinary systems is unremarkable. The patient drinks 5-6 ounces of hard liquor per day, but he does not smoke or use illicit drugs. He has not travelled recently, and there have been no changes in his daily routine. He takes a baby aspirin daily for unknown reasons but no other medications. He denies allergies or any other medical conditions. He has never had major surgery.. On physical examination, the patient appears well. Despite the fact that the patient is slightly vague and tangential in answering questions, his Glasgow Coma Scale score is 15. His blood pressure is 180/90 mm Hg, and his heart rate is 80 bpm and ...
We performed a retrospective data base and patient chart review at an urban tertiary care academic hospital and included adult patients (18 years of age or older) with a discharge diagnosis of HIE. All patients had been admitted to our intensive care unit between September 2012 and January 2014 with a Glasgow Coma Scale score of ,8. All patients underwent routine brain MR imaging on a 3T scanner (Tim Trio; Siemens, Erlangen, Germany) as part of standard clinical care. Acquired sequences varied slightly depending on the specific imaging protocol used but always included axial diffusion, T1- and T2-weighted, fluid-attenuated inversion recovery, and susceptibility-weighted imaging or gradient recalled-echo sequences.. Cerebrovascular perfusion was evaluated by using a commercially available pulsed ASL sequence that incorporates quantitative imaging of perfusion by using a single subtraction (QUIPSS), second version (QUIPSS II), with thin-section TI, periodic saturation (Q2TIPS), and proximal ...
The application works as a calculator for Glasgow Coma Scale. The GCS is a neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment ...
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I got to meet Dr. Baticulon whose blog (Ronibats.ph) I religiously follow. Do yourself a favor and read his posts. He has a gift for teaching, making abstact concepts more understandable. I had never truly understood Glasgow Coma Scale completely until he demonstrated its implications to us. Before our rotation had even started he gave a brief lecture on the common neurosurgical cases encountered in our setting, and I was amazed at how he was able to cover so many topics in so short a time. The end-of-the-rotation exam he crafted was a teaching tool in itself, revealing the fact that I need to brush up on neuroanatomy ...
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Thoughts on this patient and the treatment plan if you would. 26 yr old male fell through attic. Initial gcs was 13 in ed. He became less responsive and was agitated so subsequently intubated.
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Study evaluates associations between fresh frozen plasma (FFP) and platelet transfusions with long-term functional outcome and survival in patients with traumatic brain injury (TBI) and moderate hemostatic laboratory abnormalities. Data examined included patient demographics, several initial injury severity metrics, daily laboratory values, Glasgow Outcome Score- Extended (GOSE) scores, Functional Status Examination (FSE) scores, and survival to 6 months. Correlations were evaluated between these variables and transfusion of FFP, platelets, packed red blood cells (RBCs), cryoprecipitate, recombinant factor VIIa, and albumin. Analyses showed significant correlations between poor outcome scores and FFP, platelet, or packed RBC transfusion; the volume of FFP or packed RBCs transfused also correlated with poor outcome. Several measures of initial injury and laboratory abnormalities also correlated with poor outcome. Patient age, initial Glasgow Coma Scale score, and highest recorded serum sodium ...
TY - JOUR. T1 - Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma. AU - Borgialli, Dominic A.. AU - Mahajan, Prashant. AU - Hoyle, John D.. AU - Powell, Elizabeth C.. AU - Nadel, Frances M.. AU - Tunik, Michael G.. AU - Foerster, Adele. AU - Dong, Lydia. AU - Miskin, Michelle. AU - Dayan, Peter S.. AU - Holmes, James F.. AU - Kuppermann, Nathan. AU - Walthall, Jennifer. AU - Gerardi, M.. AU - Tunik, M.. AU - Tsung, J.. AU - Melville, K.. AU - Lee, L.. AU - Mahajan, P.. AU - Dayan, P.. AU - Nadel, F.. AU - Powell, E.. AU - Atabaki, S.. AU - Brown, K.. AU - Glass, T.. AU - Hoyle, J.. AU - Cooper, A.. AU - Jacobs, E.. AU - Foerster, A.. AU - Monroe, D.. AU - Borgialli, D.. AU - Gorelick, M.. AU - Bandyopadhyay, S.. AU - Bachman, M.. AU - Schamban, N.. AU - Callahan, J.. AU - Kuppermann, N.. AU - Holmes, J.. AU - Lichenstein, R.. AU - Stanley, R.. AU - Badawy, M.. AU - Babcock-Cimpello, L.. AU - Schunk, J.. AU - Quayle, K.. AU - Jaffe, ...
Introduction: Research within the European Union has shown international visitors to have a higher injury mortality than residents. Traffic accidents are the leading cause of injury-related death among overseas visitors and evidence suggests overseas visitors are at a greater risk of being involved in road traffic accidents than the resident population. Little information looks specifically at pedestrian injuries to overseas visitors. Pedestrian deaths account for 21% of all UK road deaths.. Methods: A retrospective database review of London helicopter emergency medical service (HEMS) missions was undertaken to examine the number and type of missions to overseas visitors, specifically examining pedestrian incidents.. Results: Of 121 missions to overseas visitors, 74 (61%) involved the visitor as a pedestrian struck by a vehicle. Thirty-five pedestrians (47%) were struck by a bus and 20 by a car (27%). Fourteen patients (19%) had an initial Glasgow coma scale score of 3-8, suggesting severe head ...
TY - JOUR. T1 - Increased adenosine in cerebrospinal fluid after severe traumatic brain injury in infants and children. T2 - Association with severity of injury and excitotoxicity. AU - Robertson, Courtney. AU - Bell, M. J.. AU - Kochanek, P. M.. AU - Adelson, P. D.. AU - Ruppel, R. A.. AU - Carcillo, J. A.. AU - Wisniewski, S. R.. AU - Mi, Z.. AU - Janesko, K. L.. AU - Clark, R. S B. AU - Marion, D. W.. AU - Graham, S. H.. AU - Jackson, E. K.. PY - 2001. Y1 - 2001. N2 - Objectives: To measure adenosine concentration in the cerebrospinal fluid of infants and children after severe traumatic brain injury and to evaluate the contribution of patient age, Glasgow Coma Scale score, mechanism of injury, Glasgow Outcome Score, and time after injury to cerebrospinal fluid adenosine concentrations. To evaluate the relationship between cerebrospinal fluid adenosine and glutamate concentrations in this population. Design: Prospective survey. Setting: Pediatric intensive care unit in a university-based ...
Glasgow Coma Scale Score A Frequent method used to Assess the severity of a Traumatic brain injury is the Glasgow Coma Scale (GCS) score.) The GCS score ranges from 3 to 15. Its founded on the individuals best verbal response, ability to follow orders, and eye opening. A rating of 3 means that a individual doesnt have any eye opening, isnt creating a noises or speaking, and isnt responding even to annoyance (and so isnt following orders). This reflects an extremely severe TBI. Someone with a rating of 15 has their eyes open, is after orders, and is speaking (even to the extent of being oriented). By definition of a GCS score of 8 or under reflects a serious TBI, a score of 9-12 a moderate TBI, along with a score of 13-15 a moderate TBI. The very first GCS score is usually done in the roadside from the EMTs. In several cases, moderately to seriously injured men and women are intubated (a tube is put down the throat and to the air passage to the lungs) in the scene of the harm to guarantee ...
If films and TV were anything to go by then unconsciousness is pretty much an on/off state. James Bond bonks you on the head, off go the lights. Bang your head on a low ceiling, off go the lights. Now this is all very well for drama and Im certainly not one of these people who sit through films pointing out every single slight deviation from reality (what is their problem?) but in real life consciousness is a wee bit more complicated than a light switch. The mind can exist in a wide neurological space between fully alert and comatose, anyone with teenagers can tell you that for sure. As such it becomes necessary to have a scale with which the wakefulness of a patient can be reliably and repeatedly measured against.. Enter the Glasgow Coma Scale. No prizes for guessing where it was developed. The GCS measures wakefulness along three axes; ocular, verbal and motor. Each of these has a series of criteria that correspond to a score out of 4, 5, and 6 respectively. This means that the lowest score ...
The Brain Trauma Foundation is presenting a free webinar on Assessment & Prognosis in Severe Traumatic Brain Injury on Wednesday, April 25, 2012, 12-1 Eastern Time. This webinar is open to all. Survivors of severe traumatic brain injury face a wide range of possible prognoses, from nearly complete recovery to permanent unconsciousness. The ability to predict prognosis at an early point is limited, but the time until return of consciousness (e.g., command following) and orientation (e.g., duration of post-traumatic amnesia) are useful predictors in the early days and weeks. More specialized assessment techniques exist of those with persistent disorders of...
Abstract Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children worldwide. This study was conducted to report the presentation, management, outcomes and prognostic indicators in a large series of patients from a tertiary care centre in a developing country. It is a review of prospectively collected data of paediatric patients with TBI admitted at our centre between July 2010 and December 2013. A total of 291 patients with a mean age of 7.2±5.0 years were dichotomised into survivors and non-survivors, and variables were compared between the two groups. The mean post-resuscitation Glasgow coma scale (GCS) score was 11.6±3.9, mean Marshall Score was 2.26±0.95 and the mean revised trauma score at presentation was 10.58±1.7. Younger age, lower GCS score after resuscitation, lower revised trauma score, absent cisterns on imaging, associated subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) and a lower Marshall score were associated with higher
Results: Among 220 patients, 53.2%, 30.9% and15.9% suffered mild, moderate and severe head injury. 50% patients developed secondary systemic insults (SSIs). Neurosurgical procedures were needed in 25% cases. Mortality was 20%, brain herniation being the leading cause. Univariate analysis showed need for mechanical ventilation, anisocoria, SSIs, and low Glasgow Coma Scale scores to be the strongest predictors of mortality (p values,0.0001). Multivariate analysis showed that moderate [RR 1.7 (95% CI 1.3-2.1), p,0.0001] and severe head injury [RR 2.0 (95% CI 1.6-2.5), p,0.0001], hyponatremia [RR 1.4 (95% CI 1.2-1.8), p=0.005], nosocomial infections [RR 1.5 (95% CI 1.3-1.9), p=0.002] and presence of midline shift in CT brain [RR 1.7 (95% CI 1.3-2.1), p=0.004] were the independent risk factors for development of poor outcome. 49% had good outcome with low disability (Glasgow outcome score 5) and 7.2% had post-traumatic seizure disorder ...
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From the age of five through adulthood, trauma is the leading cause of death, and many traumatic injuries involve brain injury. Fortunately, the majority of traumatic brain injuries are mild, but nevertheless, some children will experience a severe traumatic brain injury.
The overall aim of the research presented here was to expand the knowledge on metabolic course and nutritional outcome in patients with severe traumatic brain injury and to analyze the use and accuracy of different methods of assessment.. Study I, a systematic review of 30 articles demonstrated consistent data on increased metabolic rate, of catabolism and of upper gastrointestinal intolerance in the majority of the patients during early post injury period. Data also indicated a tendency of less morbidity and mortality in early fed patients.. Study II, a retrospective survey, based on medical records of 64 patients from three regions in Sweden, showed that the majority of patients regained their independence in eating within six months post injury. However, energy intake was set at a low level and 68 % of the patients developed malnutrition with 10 to 29 % loss of initial body mass during the first and second month post injury.. Study III, a questionnaire based study addressed to 74 care units ...
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Emotive, Cognitive and Motor Rehabilitation Post Severe Traumatic Brain Injury A New Convergent Approach Grigore Burdea, Bryan Rabin, Aurélien Chaperon Tele-Rehabilitation Institute Rutgers University
Evidence-based analgosedation in severe pediatric traumatic brain injury (pTBI) management is lacking, and improved pharmacological understanding is needed. This starts with increased knowledge of factors controlling the pharmacokinetics (PK) of unbound drug at the target site (brain) and related drug effect(s). This prospective, descriptive study tested a pediatric physiology-based pharmacokinetic software model by comparing actual plasma and brain extracellular fluid (brainECF) morphine concentrations with predicted concentration-time profiles in severe pTBI patients (Glasgow Coma Scale [GCS], ≤8). Plasma and brainECF samples were obtained after legal guardian written consent and were collected from 8 pTBI patients (75% male; median age, 96 months [34.0-155.5]; median weight, 24 kg [14.5-55.0]) with a need for intracranial pressure monitoring (GCS, ≤8) and receiving continuous morphine infusion (10-40 μg/kg/h). BrainECF samples were obtained by microdialysis. BrainECF samples were taken ...
OBJECTIVE: This study was conducted to assess the clinical significance of traumatic brain stem injury (TBSI) reflected on Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS) by various clinical variables. METHODS: A total of 136 TBSI patients were selected out of 2695 head-injured patients. All initial computerized tomography and/or magnetic resonance imaging studies were retrospectively analyzed according to demographic- and injury variables which result in GCS and GOS. RESULTS: In univariate analysis, mode of injury showed a significant effect on combined injury ( ...
Background: Traumatic Brain Injury (TBI) in children has been poorly studied, and the literature is limited. We evaluated 146 children with severe TBI (coma score less than 8) in an attempt to establish the prognostic factors of severe TBI in children.. Methods: The severity of TBI was assessed via modified Glasgow Coma Score for those more than 3 years old and via Children Coma Score for those under 3 years old. Clinical presentations, laboratory parameters and features of Computerised Tomography brain scans were analyzed. Outcomes were assessed at 6 months with the Pediatric Cerebral Performance Categories Scale; the outcomes were categorised as good or poor outcomes. Correlations with outcome were evaluated using univariate and multivariate logistic models.. Results: A low coma score upon admission was independently associated with poor outcome. The presence of diabetes insipidus within 3 days post-TBI (OR: 1.9), hyperglycaemia (OR: 1.2), prolonged PT ratio (OR: 2.3) and leukocytosis (OR: ...