Incidence and Associated Factors of Anemia in Patients with Acute Moderate and Severe Traumatic Brain Injury

Background Anemia might contribute to the development of secondary injury in patients with acute traumatic brain injury (TBI). Potential determinants of anemia are still poorly acknowledged, and reported incidence of declined hemoglobin concentration varies widely between different studies. The aim of this study was to investigate the incidence of severe anemia among patients with moderate to severe TBI and to evaluate patient- and trauma-related factors that might be associated with the development of anemia. Methods This retrospective cohort study involved all adult patients admitted to Tampere University Hospital's emergency department for moderate to severe TBI (August 2010 to July 2012). Detailed information on patient demographics and trauma characteristics were obtained, including data on posttraumatic care, data on neurosurgical procedures, and all measured in-hospital hemoglobin values. Severe anemia was defined as a hemoglobin level less than 100 g/L. Both univariate and multivariable analyses were performed, and hemoglobin trajectories were created. Results The study included 145 patients with moderate to severe TBI (male 83.4%, mean age 55.0 years). Severe anemia, with a hemoglobin level less than 100 g/L, was detected in 66 patients (45.5%) and developed during the first 48 h after the trauma. In the univariate analysis, anemia was more common among women (odds ratio [OR] 2.84; 95% confidence interval [CI] 1.13-7.15), patients with antithrombotic medication prior to trauma (OR 3.33; 95% CI 1.34-8.27), patients with cardiovascular comorbidities (OR 3.12; 95% CI 1.56-6.25), patients with diabetes (OR 4.56; 95% CI 1.69-12.32), patients with extracranial injuries (OR 3.14; 95% CI 1.69-12.32), and patients with midline shift on primary head computed tomography (OR 2.03; 95% CI 1.03-4.01). In the multivariable analysis, midline shift and extracranial traumas were associated with the development of severe anemia (OR 2.26 [95% CI 1.05-4.48] and OR 4.71 [95% CI 1.74-12.73], respectively). Conclusions Severe anemia is common after acute moderate to severe TBI, developing during the first 48 h after the trauma. Possible anemia-associated factors include extracranial traumas and midline shift on initial head computed tomography.Peer reviewe

Ureemisen enkefalopatian aiheuttama aivojen reversiibeli kuvantamislöydös

publishedVersio

Incidence of surgically treated post-traumatic hydrocephalus 6 months following head injury in patients undergoing acute head computed tomography

Background Post-traumatic hydrocephalus (PTH) is a well-known complication of head injury. The percentage of patients experiencing PTH in trauma cohorts (0.7-51.4%) varies greatly in the prior literature depending on the study population and applied diagnostic criteria. The objective was to determine the incidence of surgically treated PTH in a consecutive series of patients undergoing acute head computed tomography (CT) following injury. Methods All patients (N=2908) with head injuries who underwent head CT and were treated at the Tampere University Hospital's Emergency Department (August 2010-July 2012) were retrospectively evaluated from patient medical records. This study focused on adults (18 years or older) who were residents of the Pirkanmaa region at the time of injury and were clinically evaluated and scanned with head CT at the Tampere University Hospital's emergency department within 48 h after injury (n = 1941). A thorough review of records for neurological signs and symptoms of hydrocephalus was conducted for all patients having a radiological suspicion of hydrocephalus. The diagnosis of PTH was based on clinical and radiological signs of the condition within 6 months following injury. The main outcome was surgical treatment for PTH. Clinical evidence of shunt responsiveness was required to confirm the diagnosis of PTH. Results The incidence of surgically treated PTH was 0.15% (n = 3). Incidence was 0.08% among patients with mild traumatic brain injury (TBI) and 1.1% among those with moderate to severe TBI. All the patients who developed PTH underwent neurosurgery during the initial hospitalization due to the head injury. The incidence of PTH among patients who underwent neurosurgery for acute traumatic intracranial lesions was 2.7%. Conclusion The overall incidence of surgically treated PTH was extremely low (0.15%) in our cohort. Analyses of risk factors and the evaluation of temporal profiles could not be undertaken due to the extremely small number of cases.Peer reviewe

HYVÄNLAATUISEN ASENTOHUIMAUKSEN HOIDON VAIKUTUS LUKIHÄIRIÖISTEN LASTEN TEKNISEEN LUKUTAITOON – SATUNNAISTETTU HOITOKOKEILU

Tutkimuksen tavoitteena oli arvioida hyvänlaatuisen asentohoidon vaikutustaalakouluikäisten lukihäiriöisten lasten teknisen lukutaidon sujuvuuteen.Koeryhmä koostui 36 hoidetusta lukihäiriöisestä lapsesta. Lisäksitutkimuksessa oli kaksi vertailuryhmää: 18 lukihäiriöistä oppilasta, jotkasaivat laaja-alaista erityisopetusta, ja 18 normaalisti lukevaa lasta. Oppilaatlukivat ääneen ennen ja jälkeen hoidon saman tekstin, ja lukemiseen kulunutaika mitattiin.Tulosten mukaan kaikkien lasten lukeminen nopeutui tilastollisestimerkitsevästi. Asentohoitoa saanut lukihäiriöisten ryhmä ei eronnutvertailuryhmänä toimineesta lukihäiriöisten lasten ryhmästä. Lukihäiriöistenlasten ryhmästä erottui kuitenkin kuusi lasta, joiden lukemisen nopeusoli parantunut huomattavan paljon (vähintään 30 sekuntia). Kaikki nämälapset olivat saaneet asentohoidon. Tulosten perusteella näyttäisi, ettähyvänlaatuinen asentohoito voi auttaa niitä lapsia, joilla etenkin tekninenlukeminen on vaikeutunut. Lisätutkimuksia kuitenkin tarvitaan, jottatutkimusasetelmasta johtuvat virhetekijät saadaan eliminoitua.Asiasanat: Lukihäiriö, tekninen lukutaito, hyvänlaatuinen asentohuimaus, OCI, hoitokokeilu, satunnaistaminenKeywords: Dyslexia, technical reading, bening position vertigo, OCI, clinical trial, randomizatio

Preexisting conditions in older adults with mild traumatic brain injuries

Objective: This study examined the prevalence of preexisting conditions that could affect premorbid brain health, cognition, and functional independence among older adults with mild traumatic brain injury (MTBI), and the relationship between preexisting conditions, injury characteristics, and emergency department (ED) discharge location (home versus continued care). Methods: Older adults (N = 1,427; 55–104 years-old; 47.4% men) who underwent head computed tomography (CT) after acute head trauma were recruited from the ED. Researchers documented preexisting medical conditions retrospectively from hospital records. Results: Multiple preexisting conditions increased in frequency with greater age, including circulatory and nervous system diseases and preexisting abnormalities on head CT. Psychiatric and substance use disorders (SUDs) decreased in frequency with greater age. Among participants with uncomplicated MTBI and GCS = 15, preexisting nervous system diseases and preexisting CT abnormalities were associated with higher odds of continued care for all participants, whereas psychiatric disorders and SUDs were only associated with higher odds of continued care among participants <70 years-old. Preexisting circulatory diseases, loss of consciousness, and amnesia were unassociated with discharge location. Conclusions: Preexisting medical conditions that could affect brain and cognitive health occur commonly among older adults who sustain MTBIs. These conditions can confound research examining post-injury outcomes within this age group.acceptedVersionPeer reviewe

Incidence of surgically treated chronic subdural hematoma after head injury with normal initial computed tomography

Purpose: The objective was to determine the incidence of surgically treated chronic subdural hematoma (cSDH) within six months after head trauma in a consecutive series of head injury patients with a normal initial computed tomography (CT). Methods: A total of 1941 adult patients with head injuries who underwent head CT within 48 h after injury and were treated at the Tampere University Hospital’s emergency department were retrospectively evaluated from medical records (median age = 59 years, IQR = 39–79 years, males = 58%, patients using antithrombotic medication = 26%). Patients with no signs of acute traumatic intracranial pathology or any type of subdural collection on initial head CT were regarded as CT negative (n = 1573, 81%). Results: Two (n = 2) of the 1573 CT negative patients received surgical treatment for cSDH. Consequently, the incidence of surgically treated cSDH after a normal initial head CT during a six-month follow-up was 0.13%. Both patients sustained mild traumatic brain injuries initially. One of the two patients was on antithrombotic medication (warfarin) at the time of trauma, hence incidence of surgically treated cSDH among patients with antithrombotic medication in CT negative patients (n = 376, 23.9%) was 0.27%. Additionally, within CT negative patients, one subdural hygroma was operated shortly after trauma. Conclusion: The extremely low incidence of surgically treated cSDH after a normal initial head CT, even in patients on antithrombotic medication, supports the notion that routine follow-up imaging after an initial normal head CT is not indicated to exclude the development of cSDH. Additionally, our findings support the concept of cSDH not being a purely head trauma-related disease.Peer reviewe

Serotonergic Antidepressants and Risk for Traumatic Intracranial Bleeding

Background:Serotonergic antidepressants may predispose to bleeding but the effect on traumatic intracranial bleeding is unknown.Methods:The rate of intracranial bleeding in patients with antidepressant medication was compared to patients not antidepressants in a cohort of patients with acute head injury. This association was examined by using a consecutive cohort of head trauma patients from a Finnish tertiary center emergency department (Tampere University Hospital, Tampere, Finland). All consecutive (2010–2012) adult patients (n = 2,890; median age = 58; male = 56%, CT-positive = 22%, antithrombotic medication users = 25%, antidepressant users = 10%) who underwent head CT due to head trauma in the emergency department were included.Results:Male gender, GCS Conclusions:Serotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage.</p