Korean Journal of Neurotrauma最新文献

Objective: The regional trauma center (RTC) in our hospital was established in November 2015. The Korean Trauma Data Bank (KTDB) was established in 2013 and maintains a prospective database. In this study, based on KTDB data, we investigated the characteristics of traumatic brain injury (TBI) in patients who visited our RTC.

Methods: Between 2017 and 2021, we analyzed the data of 1,939 patients with TBI. Demographic characteristics of patients were recorded, and variables such as transfer information, mechanism of injury, severity, occupational relevance, multiple trauma, and surgery were analyzed. Hospital length of stay (LOS), fatality, and Glasgow outcome scale (GOS) were analyzed to confirm treatment outcomes.

Results: This study enrolled 1,939 patients with a median age of 58 years and male predominance (75.5%). The transfer time decreased (from 1.95 hours to 1.1 hours) following an increase in the frequency of direct transfers to our hospital each year. Motor vehicle-related accidents (48.4%) were implicated as the most common cause, and the severity of TBI showed an increasing trend each year. The outcomes confirmed that the fatality rate and GOS scores deteriorated. The mean LOS in the hospital was 26.92 days, with a fatality rate of 23.6% (458 patients).

Conclusion: In this study, we investigated characteristics and treatment outcomes associated with TBI. Our research confirms that patients with TBI are currently well triaged at the accident site and rapidly transferred to our RTC. Follow-up studies are necessary to establish strategies for improved treatment outcomes.

Objectives: Traumatic brain injury (TBI) is preventable and expensive. The medical costs of TBI can be too high for some households and might lead to poverty, malnutrition, and loss of assets, which are called catastrophic expenditures. In this study, we investigated the incidence of catastrophic costs associated with TBI caused by road accidents in a province in northern Iran.

Methods: This prospective study involved a 1-year follow-up after the accident. Data of 220 patients were collected from the medical records of the Poursina Hospital, Rasht, Iran from March 2018 to February 2020. Direct and indirect costs faced by the households of patients with TBI and catastrophic costs related to TBI were calculated. Regression models were obtained and sensitivity analyses were performed at the end of the study.

Results: In total, the prevalence of households TBI-related catastrophic costs (TBICC) was 45.5% . Households of female patients (odds ratio [OR]: 0.289, p=0.042), households of retired patients (OR: 0.053, p=0.005), and households falling in the fifth quintile of wealth (OR: 0.370, p=0.050) faced lower TBICC compared to other groups. The Activities of Daily Living scores had a significant negative relationship with TBICC.

Conclusions: Political interventions such as implementation of insurance schemes, exemptions from payment for certain groups, identification of poor households, and coverage of assistance services can protect households from catastrophic health expenditures.

Penetrating intracranial foreign bodies are rare and have a high potential for death or serious morbidity. Their surgical management is complicated and challenging. Herein, we present the case of a 30-years-old man who was a victim of aggression from a rake blow to the head. The rake's teeth were embedded in his cranium, crossing the midline. The surgery was delicate and had to be well studied because two of the rake's teeth plunged into the superior sagittal sinus (SSS). The patient recovered a perfect state of consciousness and was discharged with squealer right upper limb monoparesia. Penetrating intracranial foreign bodies are rare. Few studies have reported on the removal of such foreign bodies, particularly in cases where the foreign body is close to or penetrates the SSS. They cause spectacular cranial trauma and a greater volume of the object. The aim of surgery is to remove the object without worsening the parenchymal and vascular cerebral lesions. This maneuver was delicate. A craniectomy is recommended around the penetrating object before it is carefully extracted with or without opening the dura mater.

Objective: Patients with a contralateral intracranial hemorrhage after decompressive craniectomy have a worse prognosis than those whose recovery is uneventful. Therefore, the objective of this study was to identify risk factors for postoperative contralateral hemorrhage (PCH) in patients who underwent unilateral craniectomy or craniotomy due to a traumatic brain injury (TBI).

Methods: Data were obtained from the Korean Neuro-Trauma Data Bank System and retrospectively reviewed. Patients who had a unilateral craniectomy or craniotomy for acute TBI were included in this study. Clinical outcomes of a PCH group and an uneventful group were compared and the risk factors for PCH were identified using regression analysis.

Results: A total of 326 patients were included in this study. PCH was observed in 25 (7.7%) patients. The Glasgow coma scale (GCS) and Glasgow outcome scale extended (GOSE) scores at discharge were significantly lower in the PCH group than those in the uneventful group (GCS: 3.6 vs. 6.2, p=0.043; GOSE: 2.1 vs. 3.2, p=0.032). In the multivariable regression analysis, when the time from injury to surgery was shorter than 150 minutes, the risk of PCH was increased by 4.481 times (p=0.005). When the intraoperative transfusion volume was more than 1.5 L, the risk of PCH was increased by 4.843 times (p=0.003).

Conclusion: The risk of PCH is increased when the time from injury to surgery is shorter than 150 minutes and when the intraoperative transfusion volume is greater than 1.5 L. Neurosurgeons must predict and be prepared for the development of PCH in high-risk patients.

Objective: Since traumatic brain injury is more common in young people, who are the main workforce and builders of society, it is important to consider the effects caused by brain injury on them. In this study, we investigated the clinical manifestations, complications, and prognosis of patients with basilar skull fractures.

Methods: This cross-sectional study was conducted from March 2021 to March 2022 at the Kashani Hospital, Esfahan, Iran. Patients with basilar skull fractures were included in this study by census for one year. Recorded patient information was divided into two parts: demographic information, including age and sex, and disease information including loss of consciousness, signs of meningitis, need for surgery, and neurologic examination.

Results: In this study, 100 patients were included, of whom 89 were men. The most common complication was pain at the site of the trauma, followed by bruising and bleeding from the site of the trauma. Raccoon eyes and cerebrospinal fluid leakage were observed in 19% and 32% of the patients, respectively.

Conclusion: As the occurrence of trauma has an economic burden on the country's health system, we must identify its consequences and problems and prevent its occurrence as much as possible by implementing educational measures.