339 Traumatic Intracranial Hemorrhage in Older Patients on Direct Oral Anticoagulants
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We reviewed the medical records of 55 patients who underwent a cranial computed tomographic (CT) scan for acute head trauma. The severity of head trauma was classified according to objective clinical findings as severe in 44 patients, moderate in three, and mild in eight. Thirty-seven patients (84%) with severe head trauma had a brain injury identified on CT scan. Six patients with severe head trauma had a Glasgow Coma Scale score of 12 or greater and an abnormal CT scan. All patients with mild or moderate head trauma had normal CT scans. Severe head trauma, as defined in this study, accurately identified all patients with abnormal CT scan findings. We conclude that a classification based on objective clinical findings accurately identifies the severity of head trauma. This is particularly important in evaluating patients with a Glasgow Coma Scale score of 12 or greater. A prospective study including larger numbers of patients is needed to further evaluate such a classification.
Head trauma
Medical record
Coma (optics)
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A clinical coma scale modified from the Glasgow Coma Scale used for humans has been suggested as a useful predictor of outcome in the head trauma patient. The objective of this study was to correlate the modified Glasgow Coma Scale (MGCS) score of dogs with head trauma with their probability of survival. Thirty-eight dogs with head trauma were selected and retrospectively evaluated. The information retrieved from the medical record of each dog included signalment, body weight, cause of head trauma, MGCS, presence of concurrent neck pain, and outcome (dead or alive) after 48 hours. Logistic regression was used to model survival in the 1st 48 hours as a function of MGCS, gender, weight, and calvarial fractures. The MGCS ranged from 5 to 18. Seven dogs died within 48 hours of the head trauma. The MGCS could predict the probability of survival in the 1st 48 hrs after head trauma with 50% probability in a patient with a score of 8. Gender, weight, and presence of skull fractures did not predict survival. In conclusion, the MGCS is a useful index for prediction of outcome in dogs with head trauma.
Head trauma
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Skull fracture
Glasgow Outcome Scale
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A clinical coma scale modified from the Glasgow Coma Scale used for humans has been suggested as a useful predictor of outcome in the head trauma patient. The objective of this study was to correlate the modified Glasgow Coma Scale (MGCS) score of dogs with head trauma with their probability of survival. Thirty-eight dogs with head trauma were selected and retrospectively evaluated. The information retrieved from the medical record of each dog included signalment, body weight, cause of head trauma, MGCS, presence of concurrent neck pain, and outcome (dead or alive) after 48 hours. Logistic regression was used to model survival in the 1st 48 hours as a function of MGCS, gender, weight, and calvarial fractures. The MGCS ranged from 5 to 18. Seven dogs died within 48 hours of the head trauma. The MGCS could predict the probability of survival in the 1st 48 hrs after head trauma with 50% probability in a patient with a score of 8. Gender, weight, and presence of skull fractures did not predict survival. In conclusion, the MGCS is a useful index for prediction of outcome in dogs with head trauma.
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Mild head trauma had been defined in patients with direct impact or deceleration effect admitted with a Glasgow Coma Scale score of 13-15. It is one of the most frequent causes of morbidity in emergency medicine. Although common, several controversies persist about its clinical management. In this paper, we describe the Brazilian guidelines for mild head trauma, based on a critical review of the relevant literature.
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Craniocerebral trauma
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The decision as to whether to perform a CT examination of the brain in patients with a Glasgow coma score of 15 after injury is often difficult, given the limited CT scanning facilities available in state hospitals. A retrospective evaluation of 100 consecutive head-injury patients presenting with a Glasgow coma score of 15 at Tygerberg Hospital was therefore carried out. In a surprisingly high number of patients (50%) abnormal findings due to the injury were detected. Analysis of the clinical history parameters did not demonstrate a significant association with abnormal CT findings. It is therefore concluded that brain CT examination in patients with a Glasgow coma score of 15 is justified and that the Glasgow coma scale is a poor predictor of intracranial injury.
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Background: The aim of the study is to find out the age and sex distribution, modes of head injury and correlate Glasgow Coma Scale with Computed Tomography in patients with head trauma in our center.Methods: A cross-sectional study was performed among 113 patients of acute head trauma presenting to Emergency department of our hospital for three months. The severity of the head injury was assessed on admission by the Glasgow Coma Scale score and categorized as mild, moderate, or severe head injury. Non contrast head computed tomography was obtained. Results: The mean age of patients studied in this study was 35.53 year in males and 32.1 year in female with male to female ratio being 1.86:1. The most common causes of head injury were road-traffic accident 58 (51%), falls 42 (37%) and physical assault 13 (12%). In our present study, 67 (59.3%) of patients had mild head injury, 27 (23.9%) had moderate head injury and 19(16.8%) had severe head injury. Our study shows presence of multiple lesions with depressed bone fracture of skull bone was associated with lower Glasgow Coma Scale. Significant association between Glasgow Coma Scale and computed tomography finding was seen (p<0.001). Conclusions: Glasgow Coma Scale is strongly associated with computed tomography in patients with head injury. Road traffic accident is the commonest mode of injury. Most present with mild head injury.Keywords: Computed tomography; Glasgow coma scale; head injury
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Background: Intracranial hemorrhage is a complication of head injury. The initial assessment of the consciousness using Glasgow Coma Scale (GCS) shows severity level of head injury since arriving to the hospital. The GCS score is also known to have association with the presence of intracranial bleeding caused by head injury. This finding helps doctor lived in rural area with no facility of computed tomography (CT) scan to predict the intracranial haemorrhage by assessing the level of consciousness correctly using GCS score. Methods: This study is an observational analytic study using a cross-sectional design. The research was conducted in Dr. Moewardi Hospital for 6 months starting from July to October 2020. The population was all patients with head injury and were then examined by CT scan of head. The 61 subjects were established through the inclusion and the exclusion criteria. Results: There were 61 patients in this study. The reliability test of CT-Scan instrument used Kappa-Cohen test which showed the K value of 0.875 with p < 0.001. The finding of moderate-severe head injury (GCS score 3-12) was associated with the increased risk of intracranial bleeding in head CT scan by 20.70 (5.58-76.77) times significantly higher (p < 0.001). Conclusion: There is significant relationship between the patient's level of consciousness represented by Glasgow Coma Scale (GCS) and the intracranial bleeding based on the head CT scan in the patients with head injuries
Glasgow Outcome Scale
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Head trauma
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Background S-100, a protein of astroglial cells, is described as a marker for central nervous system damage. The aim of this study was to evaluate whether the marker could give information about the severity and possibility of functional recovery after minor and severe head injury. Methods Thirty patients after severe head injury (Glasgow Coma Scale score <9) and 11 patients after minor head injury (Glasgow Coma Scale score > 12) were included. In each case, blood samples were drawn within 6 hours after injury. Outcome was estimated at hospital discharge using the Glasgow Outcome Scale. Results All patients who sustained minor head injury had reached a favorable outcome by the time they were discharged from the hospital. Their mean S-100 serum level was 0.35 [micro sign]g/L. Patients who sustained severe head injury and were classified as having an unfavorable outcome (31%) showed a mean serum concentration of 4.9 [micro sign]g/L, whereas patients classified as having a favorable outcome (69%) had a mean S-100 level of 1.2 [micro sign]g/L. All groups differed significantly (p < 0.05) Conclusion S-100 appears to be a promising marker for the severity of head injury and neuronal damage.
Glasgow Outcome Scale
Brain damage
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