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Original Articles
Alcohol Intoxication and Glasgow Coma Scale Scores in Patients with Head Trauma
Jisoo Park, Taejin Park, Jung-In Ko, Woonhyung Yeo
J Trauma Inj. 2020;33(4):227-235.   Published online December 31, 2020
DOI: https://doi.org/10.20408/jti.2020.0041
  • 8,649 View
  • 166 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Alcohol intoxication is commonly associated with traumatic brain injury (TBI), but the influence of alcohol on the Glasgow Coma Scale (GCS) score remains unclear. This study investigates the effects of blood alcohol concentration (BAC) on the GCS score in head trauma patients with alcohol intoxication.

Methods

In total, 369 head trauma patients with alcohol intoxication in a 1-year period were retrospectively analyzed. The patients underwent head computed tomography and had a BAC ≥80 mg/dL. Patients were divided into TBI and non-TBI groups. Brain injury severity was further classified using the head Abbreviated Injury Score (AIS). The effects according to 5 BAC groups were examined.

Results

The TBI group consisted of 64 patients (16.2%). The mean BAC was significantly higher in the non-TBI group (293.4±87.3 mg/dL) than in the TBI group (242.8±89.9 mg/dL). The mean GCS score was significantly lower in the TBI group (10.3±4.6) than in the non-TBI group (13.0±2.5). A higher BAC showed a significant association with a lower mean GCS score in the TBI group, but not in the non-TBI group. Above ≥150 mg/dL, higher BACs showed significant odds ratios for a lower GCS score.

Conclusions

The influence of alcohol in patients with head trauma depended on the presence of a brain injury. An association between a higher BAC and a lower GCS score was only observed in patients with TBI. Therefore, if a severe brain injury is suspected based on a GCS evaluation in patients with alcohol intoxication, prompt diagnosis and intensive care should be performed without delay.

Summary

Citations

Citations to this article as recorded by  
  • Intoxication and Glasgow coma scale scores in patients with head trauma
    Callie Pina, Catherine A. Marco
    The American Journal of Emergency Medicine.2024; 80: 8.     CrossRef
Clinical Outcomes of Diffuse Axonal Injury According to Radiological Grade
Hak-Jae Lee, Hyun-Woo Sun, Jae-Seok Lee, Nak-Joon Choi, Yoon-Joong Jung, Suk-Kyung Hong
J Trauma Inj. 2018;31(2):51-57.   Published online August 31, 2018
DOI: https://doi.org/10.20408/jti.2018.31.2.51
  • 17,180 View
  • 278 Download
  • 5 Citations
AbstractAbstract PDF
Purpose

Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients.

Methods

From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient’s MRI findings.

Results

For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness.

Conclusions

This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.

Summary

Citations

Citations to this article as recorded by  
  • Prediction for the prognosis of diffuse axonal injury using automated pupillometry
    Makoto Murase, Shinichi Yasuda, Makoto Sawano
    Clinical Neurology and Neurosurgery.2024; 240: 108244.     CrossRef
  • Head CT for the intensivist: 10 tips and pearls
    Sajeev A. MAHENDRAN, Oliver FLOWER, J. Claude HEMPHILL III rd
    Minerva Anestesiologica.2022;[Epub]     CrossRef
  • Evaluation of Laboratory Variables Related to Diffuse Axonal Injury: A Cross-sectional Study
    Masoud Hatefi, Khalil Komlakh
    Archives of Neuroscience.2022;[Epub]     CrossRef
  • Clinical outcomes of diffuse axonal injury after traumatic brain injury according to magnetic resonance grading
    Insu Lee, Kawngwoo Park, Tae Seok Jeong, Woo-Seok Kim, Woo Kyung Kim, Do Yeon Rhee, Cheol Wan Park
    Journal of Korean Society of Geriatric Neurosurger.2021; 16(2): 71.     CrossRef
  • Use of Magnetic Resonance Imaging in Acute Traumatic Brain Injury Patients is Associated with Lower Inpatient Mortality
    Hwan Lee, Yifeng Yang, Jiehui Xu, Jeffrey B. Ware, Baogiong Liu
    Journal of Clinical Imaging Science.2021; 11: 53.     CrossRef
Correlation between Optic Nerve Sheath Diameter Measured by Computed Tomography and Elevated Intracranial Pressure in Patients with Traumatic Brain Injury
Tae Kyoo Lim, Byug Chul Yu, Dae Sung Ma, Gil Jae Lee, Min A Lee, Sung Yeol Hyun, Yang Bin Jeon, Kang Kook Choi
J Trauma Inj. 2017;30(4):140-144.   Published online December 30, 2017
DOI: https://doi.org/10.20408/jti.2017.30.4.140
  • 5,134 View
  • 122 Download
  • 6 Citations
AbstractAbstract PDF
Purpose

The optic nerve sheath diameter (ONSD) measured by ultrasonography is among the indicators of intracranial pressure (ICP) elevation. However, whether ONSD measurement is useful for initial treatment remains controversial. Thus, this study aimed to investigate the relationship between ONSD measured by computed tomography (CT) and ICP in patients with traumatic brain injury (TBI).

Methods

A total of 246 patients with severe trauma from January 1, 2015 until December 31, 2015 were included in the study. A total of 179 patients with brain damage with potential for ICP elevation were included in the TBI group. The remaining 67 patients comprised the non-TBI group. A comparison was made between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of ONSD when used as a screening test for the TBI group including those with TBI with midline shift (with elevated ICP).

Results

The mean injury severity score (ISS) and glasgow coma scale (GCS) of all patients were 24.2±6.1 and 5.4±0.8, respectively. The mean ONSD of the TBI group (5.5±1.0 mm) was higher than that of the non-TBI group (4.7±0.6 mm). Some significant differences in age (55.3±18.1 vs. 49.0±14.8, p<0.001), GCS (11.7±4.1 versus 13.3±3.0, p<0.001), and ONSD (5.5±1.0 vs. 4.7±0.6, p<0.001) were observed between the TBI and the non-TBI group. An ROC analysis was used to assess the correlation between TBI and ONSD. Results showed an area under the ROC curve (AUC) value of 0.752. The same analysis was used in the TBI with midline shift group, which showed an AUC of 0.912.

Conclusions

An ONSD of >5.5 mm, measured on CT, is a good indicator of ICP elevation. However, since an ONSD is not sensitive enough to detect an increased ICP, it should only be used as one of the parameters in detecting ICP along with other screening tests.

Summary

Citations

Citations to this article as recorded by  
  • Correlation Between Optic Nerve Sheath Diameter at Initial Head CT and the Rotterdam CT Score
    Aletor O Amakhian, Elohor B Obi-Egbedi-Ejakpovi, Eghosa Morgan, Ademola A Adeyekun, Munir M Abubakar
    Cureus.2023;[Epub]     CrossRef
  • Sono-clinical decision rule for repeat head computed tomography scan in traumatic brain injury in emergency settings
    Priyanka Modi, Sanjeev Bhoi, Savan Pandey
    WFUMB Ultrasound Open.2023; 1(2): 100026.     CrossRef
  • Sonographic Measurement of the Optic Nerve Sheath Diameter to Improve Detection of Elevated Intracranial Pressure
    Faten Farid Awdallah, Islam Hassan Abulnaga, Suzy Fawzy Michael, Hassan Khaled Nagi, Mohamed Hosny Abdallah
    Biomedical and Pharmacology Journal.2022; 15(3): 1677.     CrossRef
  • Serial Optic Nerve Sheath Diameter via Radiographic Imaging
    Diane McLaughlin, Lisa Anderson, Jinhong Guo, Molly McNett
    Neurology Clinical Practice.2021;[Epub]     CrossRef
  • The association between intracranial pressure and optic nerve sheath diameter on patients with head trauma
    Kaan Çelik, Bekir Enes Demiryurek
    Arquivos de Neuro-Psiquiatria.2021; 79(10): 879.     CrossRef
  • MRI measurement of optic nerve sheath diameter using 3D driven equilibrium sequence as a non-invasive tool for the diagnosis of idiopathic intracranial hypertension
    Ahmed S. Abdelrahman, Mai M. K. Barakat
    Egyptian Journal of Radiology and Nuclear Medicine.2020;[Epub]     CrossRef
Value of Repeat Brain Computed Tomography in Children with Traumatic Brain Injury
Ho Jun Jo, Yong Su Lim, Jin Joo Kim, Jin Seong Cho, Sung Youl Hyun, Hyuk Jun Yang, Gun Lee
J Trauma Inj. 2015;28(3):149-157.   Published online September 30, 2015
DOI: https://doi.org/10.20408/jti.2015.28.3.149
  • 1,965 View
  • 8 Download
  • 1 Citations
AbstractAbstract PDF
PURPOSE
Traumatic brain injury (TBI) is the most common cause of pediatric trauma patients came to the emergency department. Without guidelines, many of these children underwent repeat brain computed tomography (CT). The purpose of this study was to evaluate the value of repeat brain CT in children with TBI.
METHODS
We conducted a retrospective study of TBI in children younger than 19 years of age who visited the emergency department (ED) from January 2011 to December 2012. According to the Glasgow Coma Scale (GCS) and Pediatric Glasgow Coma Scale score of the patients, study population divided in three groups. Clinical data collected included age, mechanism of injury, type of TBI, and outcome.
RESULTS
A Total 83 children with TBI received repeat brain CT. There were no need for neurosurgical intervention in mild TBI (GCS score 13-15) group who underwent routine repeat CT. 4 patients of mild TBI group, received repeat brain CT due to neurological deterioration, and one patient underwent neurosurgical intervention. Routine repeat CT identified 12 patients with radiographic progression. One patient underwent neurosurgical intervention based on the second brain CT finding, who belonged to the moderate TBI (GCS score 9-12) group.
CONCLUSION
Our study showed that children with mild TBI can be observed without repeat brain CT when there is no evidence of neurologic deterioration. Further study is needed for establish indication for repetition of CT scan in order to avoid unnecessary radiation exposure of children.
Summary

Citations

Citations to this article as recorded by  
  • Mortality and Epidemiology in 256 Cases of Pediatric Traumatic Brain Injury : Korean Neuro-Trauma Data Bank System (KNTDBS) 2010–2014
    Hee-Won Jeong, Seung-Won Choi, Jin-Young Youm, Jeong-Wook Lim, Hyon-Jo Kwon, Shi-Hun Song
    Journal of Korean Neurosurgical Society.2017; 60(6): 710.     CrossRef
Validation of the Simplified Motor Score for the Triage after Traumatic Brain Injury
Sang Kyong Lee, Hyun Wook Ryoo, Jung Bae Park, Kang Suk Seo, Jae Myung Chung
J Korean Soc Traumatol. 2008;21(2):71-77.
  • 1,401 View
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AbstractAbstract PDF
PURPOSE
The Glasgow Coma Scale (GCS), though it is widely used for triage, has been criticized as being unnecessarily complex. Recently, a 3-point Simplified Motor Score (SMS, defined as obeys commands=2; localizes pain=1; withdrawals to pain or worse=0) was developed from the motor component of the GCS and was found to have a similar test performance for triage after traumatic brain injury when compared with the GCS as the criterion standard. The purpose of this study was to validate the SMS.
METHODS
We analyzed the patients who visited Kyungpook National University Hospital emergency center after traumatic brain injury from 2006 January to 2006 June. The test performance of the GCS, its motor component, and SMS relative to three clinically relevant traumatic brain injury outcomes (abnormal brain CT scans, Abbreviated Injury Scale (AIS)> or =4, and mortality) were evaluated with areas under the receiver operating characteristic curves (AUCs).
RESULTS
Of 504 patients included in the analysis, 25.6% had an abnormal brain CT scans, 13.1% had AIS> or = 4, and 5.0% died. The AUCs for the GCS, its motor component, and SMS with respect to the abnormal CT scans were 0.776, 0.715, and 0.716, and respectively, those for AIS> or =4 and mortality, were 0.969, 0.973, and 0.968, and 0.931, 0.909, and 0.909, respectively.
CONCLUSION
The 3-point SMS demonstrated similar test performance when compared with the 15-point GCS score and its motor component for triage after traumatic brain injury in our populations.
Summary
Relation between Serum S100beta and Severity and Prognosis in Traumatic Brain Injury
Oh Hyun Kim, Kang Hyun Lee, Kap Jun Yoon, Kyung Hye Park, Yong Su Jang, Hyun Kim, Sung Oh Hwang
J Korean Soc Traumatol. 2007;20(2):138-143.
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AbstractAbstract PDF
PURPOSE
S100beta, a marker of traumatic brain injury (TBI), has been increasingly focused upon during recent years. S100beta, is easily measured not only in cerebrospinal fluid (CSF) but also in serum. After TBI, serum S100beta, has been found to be increased at an early stage. The purpose of this study was to evaluate the clinical correlations between serum S100beta, and neurologic outcome, and severity in traumatic brain injury.
METHODS
From August 2006 to October 2006, we made a protocol and studied prospectively 42 patients who visited the emergency room with TBI. Venous blood samples for S100beta, protein were taken within six hours after TBI and vital signs, as well as the Glasgow Coma Scale (GCS), were recorded. The final diagnosis and the severity were evaluated using the Abbreviated Injury Score (AIS), and the prognosis of the patients was evaluated using the Glasgow Outcome Score (GOS).
RESULTS
Thirty-eight patients showed a favorable prognosis (discharge, recovery, transfer), and four showed an unfavorable prognosis. Serum S100beta, was higher in patients with an unfavorable prognosis than in patients with a favorable prognosis, and a significant difference existed between the two groups (0.74+/-50 microgram/L vs 7.62+/-6.53 microgram/L P=0.002). A negative correlation existed between serum S100beta, and the Revised Traumatic Score (R2=-0.34, P=0.03), and a positive correlation existed between serum S100beta, and the Injury Severity Score (R2=0.33, P=0.03). Furthermore, the correlations between serum S100beta, and the initial GCS and the GCS 24 hours after admission to the ER were negative (R2=-0.62, P<0.001; R2=-0.47, P=0.005). Regarding the GOS, the mean serum concentration of S100beta. was 7.62 beta partial differential/L (SD=+/-6.53) in the expired patients, 1.15 microgram/L in the mildly disable patient, and 0.727 microgram/L (SD=+/-0.73) in the recovered patients. These differences are statistically significant (p<0.001).
CONCLUSION
In traumatic brain injury, a higher level of serum concentration of S100beta, has a poor prognosis for neurologic outcome.
Summary
The Relationship Between Type and Size of Scalp Injury and Intracranial Injury Among Patients who Visited the Emergency room due to head Trauma
Yong Sung Kim, Hoon Lim, Young Soon Cho, Ho Jung Kim
J Korean Soc Traumatol. 2006;19(1):8-13.
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AbstractAbstract PDF
PURPOSE
Traumatic head injury is very common in the emergency room. Early diagnosis and treatment can significantly reduce mortality and morbidity. When diagnosis is delayed, however, it could be critical to the patients. In reality, it is difficult to take a brain CT for all patients with head trauma, so this study examined the relationship between type and size of scalp injury and intracranial injury.
METHODS
This prospective study was conducted from May 2005 to July 2005. The participants were 193 patients who had had a brain CT. Head trauma included obvious external injury or was based on reports of witnesses to the accident. Children under three years of age were also included if there was a witness to the accident. The size of the injury was measured based on the maximum diameter.
RESULTS
Out of the total of 193 patients, patients with scalp bleeding totaled 126 (65.2%), and patients without scalp bleeding totaled 67 (34.8%). Among patients with scalp bleeding, patients with intracranial injuries numbered nine, and among patients without scalp bleeding, patients with intracranial injuries numbered 17 (P=0.001). Among patients who showed evidence of scalp swelling with no scalp bleeding, the relationship between the size of the scalp swelling and intracranial injury was statistically significant when the size of the scalp swelling was between 2 cm and 5 cm.
CONCLUSION
Among patients who visit an emergency medical center due to traumatic head injury, patients with no scalp bleeding, but with scalp swelling between 2 cm and 5 cm, should undergone more accurate and careful examination, as well as as a brain CT.
Summary
The Utility of Routine Serial Brain Computed Tomography for Referred Traumatic Brain Injury Patients According to the Severity of Traumatic Brain Injury
Jeong In Hwang, Jin Seong Cho, Seung Chul Lee, Jeong Hun Lee
J Korean Soc Traumatol. 2009;22(2):134-141.
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AbstractAbstract PDF
PURPOSE
Patients with traumatic brain injury (TBI) were referred from other hospitals for further management. In addition, patients routinely underwent computed tomography examinations of the head (HCT) in the referral hospitals. The purpose of this study was to evaluate retrospectively the utility of routine HCT scans according to the severity of TBI.
METHODS
Patients with TBI referred to our hospital between December 2005 and July 2008 were included in this study. We investigated HCT findings, indications for repeat HCT examinations (routine versus a neurological change), and neurosurgical interventions. The head injury severity was divided into three categories according to the Glasgow Coma Scale (GCS) score, including mild, moderate, and severe TBI. The use of neurosurgical interventions between patients who underwent routine HCT scans and patients who underwent HCT scans for a neurological change were compared according to the severity of TBI.
RESULTS
A total of 81 patients met the entry criteria for this study. Among these patients, 67%(n=54) of the patients underwent HCT scans on a routine basis, whereas 33%(n=27) of the patients underwent HCT scans for a neurological change. A total of 21 patients showed signs of a worsening condition on the HCT scans. Neurosurgical intervention was required for 23(28.4%) patients. For patients who underwent routine HCT examinations, no patient with mild TBI underwent a neurosurgical intervention. However, one patient with moderate TBI and three(13%) patients with severe TBI underwent neurosurgical interventions. The kappa index, the level of agreement for HCT indications of intervention and referral reasons for intervention, was 0.65 for high hierarchy hospitals and 0.06 for low hierarchy hospitals.
CONCLUSION
Routine serial HCT examinations in the referred hospitals would be useful for patients with severe head injury and for patients from low hierarchy hospitals where no emergency physicians or neurosurgeons are available.
Summary
The Relationship between Facial Fractures and Radiologically-proven Cranial Injuries
Jin Woo Song, Ik Joon Jo, Sang Kook Han, Yeon Kwon Jeong
J Korean Soc Traumatol. 2009;22(1):18-23.
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AbstractAbstract PDF
PURPOSE
In this study, we retrospectively investigated the medical records of patients with facial fractures and suspected cranial injuries in order to determine if there was any relationship between various facial fracture patterns and cranial injuries.
METHODS
Medical records were reviewed to identify patients diagnosed with facial fractures who underwent cranial computed tomography (CT) scans. Records were reviewed for gender, age, injury mechanism, facial fracture pattern, and presence or absence of cranial injuries. Facial fracture patterns were classified as isolated fractures (tripod, zygomatic arch, maxilla, orbit, and mandible), combined fractures, or total fractures. Cranial injuries included skull fractures, traumatic subarachnoid hemorrhages, subdural hemorrhages, epidural hemorrhages, and contusional hemorrhages. All cranial injuries were established by using cranial CT scans, and these kinds of cranial injuries were defined radiologically-proven cranial injuries (RPCIs). We evaluated the relationship between each pattern of facial fractures and the incidence of RPCIs.
RESULTS
Of 132 eligible patients with facial fractures who underwent cranial CT scans, a total of 27 (20.5%) patients had RPCIs associated with facial fractures. Falls and slips were the most common causes of the fractures (31.8%), followed by assaults and motor vehicle accidents (MVAs). One hundred one (76.5%) patients had isolated facial fractures, and 31 (23.5%) patients had combined facial fractures. Fractures were found most commonly in the orbital and maxillary bones. Patients with isolated maxillary fractures had a lower incidence of RPCIs than those with total mandibular fractures. RPCIs frequently accompanied combined facial fractures.
CONCLUSION
Combined facial fractures had a significant positive correlation with RPCIs. This means that facial fractures caused by stronger or multidirectional external force are likely to be accompanied by cranial injuries.
Summary
The Use of Brain Computer Tomography Examination with Mild Traumatic Brain Injury in Pediatrics
Ha Kyung Kim, Jin Joo Kim, Jin Seong Cho, Jae Ho Jang, Hyuk Jun Yang, Gun Lee
J Trauma Inj. 2014;27(3):63-70.
  • 1,108 View
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AbstractAbstract PDF
PURPOSE
In children, mild traumatic brain injuries (TBI) account for 70~90% of head injuries. Without guidelines, many of these children may be exposed to excess radiation due to unnecessary imaging. The purpose of this study was to evaluate the impact of a mild TBI guideline in imaging of pediatric patients.
METHODS
The medical records of all children who had head computed tomography and were admitted to our hospital with a TBI with Pediatric Glasgow Coma Scale and Glasgow Coma Scale of 14 to 15 were retrospectively reviewed and compared with PECARN Rule.
RESULTS
A total of 1260 children were included and all children checked with head computed tomography. 61 pediatrics had CT positive and presented skull fracture 40, hemorrhage 8, hemorrhagic contusion 7, and diffuse axonal injury 1. Also, 4 patients diagnosed both skull fracture and brain haemorrhage and 1 patient diagnosed both haemorrhage and haemorrhagic contusion.
CONCLUSION
There are many pediatric traumatic patients who exposed to radiation due to CT. But, the most of results were negative. So, consider to follow the CT guideline for children and many do not require brain CT.
Summary
Serologic Markers of Excessive Callus formation in Traumatic Brain Injury Patient
Hee Gon Park, Yeon Jun Kim
J Trauma Inj. 2013;26(3):81-88.
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AbstractAbstract PDF
PURPOSE
Among patients with multiple traumatic fractures, a tendency to form more callus exists in groups with multiple fractures combined with traumatic brain injury. This retrospective study evaluated the hematologic factors that might be useful to predict callus formation by comparing serologic tests and clinical and radiologic results in two groups.
METHODS
From January 2000 to December 2010, patients with femur shaft fractures were divided in two groups: one without traumatic brain injury (control group: 32 cases), and the other with traumatic brain injury (study group: 44 cases). We evaluated routine serologic exams and the amount of callus formation during the follow-up period.
RESULTS
Only the alkaline phosphatase level was statistically different between the two groups, not the White blood cell count, C-reactive protein, total calcium, and lactate dehydrogenase level. The amount of callus formation on the antero-posterior radiograph at the last follow up period was 74.9% in the study group and 42.1% in the control group. Then lateral radiograph showed 73.2% callus formation rate in the study group and 31.8% in the control group.
CONCLUSION
In routine serologic exams, the two groups had no significant differences, except for the alkaline phosphatase level. The group with traumatic brain injury had much more callus formation, but there was no reliable factor to predict callus formation on the routine serologic exam.
Summary

J Trauma Inj : Journal of Trauma and Injury