Prophylactic antibiotic for prevention of posttraumatic meningitis after traumatic pneumocephalus: design and rationale of a placebo-controlled randomized multicenter trial [ISRCTN71132784]

BACKGROUND: The purpose of this study is to compare the efficacy of prophylactic antibiotic for prevention of meningitis in acute traumatic pneumocephalus patients. METHODS: In this prospective, randomized controlled clinical trial, 200 selected head injury patients with traumatic pneumocephalus are randomly assigned to receive intravenous antibiotics (2 grams Ceftriaxone twice a day), oral antibiotics (Azithromycin) or placebo for at least 7 days after trauma. The patients will be followed for one month posttrauma. CONCLUSION: The authors hope that this study helps clarifying the effectiveness and indications of antibiotics in prevention of meningitis in traumatic pneumocephalus after head injury and in specific subgroup of these patients

Late and Early Comparing Effects of Sensory Stimulation on the Level of Consciousness in Comatose Patients

Objective: Disorder of consciousness is the common problem of severe traumatic brain injury. There is controversy about the effects of sensory stimulation on the level of consciousness in comatose patients. The aim of this study was to compare the effect of early (7th days post injury) and late (15th DPI) onset sensory stimulation on the level of consciousness of the comatose patients. Materials & Methods: In this experimental and interventional study twenty – one patients with Glasgow Coma Scale (GCS) £ 8 at least be stable for 3 days post injury (DPI), Normal ICP in CT- scan, no sedation, no previous neurological disorder, aged 18-59 suffering from sever traumatic brain injury were selected and divided in to 3 groups. First group (early onset) was received intervention (tactile, acoustic, visual, R.O.M and smell as stimulation) from 7th DPI to 15th DPI. The second (late onset) was received the intervention as same as early group but from 15th DPI to 21th DPI. The last one (control group) had no intervention. Level of consciousness evaluated by GCS and CRS-R in all of them every other day during the first month after injury. Data were analyzed by use of paired T test, Pearsonian correlation and repeated measurement analysis. Results: Repeated measurement analysis showed significant increase of GCS and CRS-R scores over the time (P<0.001). Significant changes were identified in CRS-R score between early and control group by post hoc test (P<0.05). Nevertheless, the increase of GCS score was different between groups, but this increase wasn’t statically significant (P=0/15). Conclusion: One week intervention of sensory stimulation on the 7-15 DPI can accelerate the trend of improvement in these patients. One thing many experts agree on is that starting rehabilitation early is of paramount importance to increase level of consciousness