Association between blood glucose levels and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

Background Blood glucose levels that are too high or too low after traumatic brain injury (TBI) negatively affect patient prognosis. This study aimed to demonstrate the relationship between blood glucose levels and the Glasgow Outcome Score (GOS) in TBI patients. Methods This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. Information on the disease, laboratory examination, insulin therapy, and surgery for patients with TBI was collected as candidate variables according to clinical importance. Additionally, data on 5-year and 6-month GOS were collected as primary and secondary outcomes, respectively. For multivariate analysis, a generalized additive model (GAM) was used to investigate relationships between blood glucose levels and GOS. The results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). We further applied a two- piecewise linear regression model to examine the threshold effect of blood glucose level and GOS. Results A total of 182 patients were included in the final analysis. Multivariate GAM analysis revealed that a bell-shaped relationship existed between average blood glucose level and 5-year GOS score or 6-month GOS score. The inflection points of the average blood glucose level were 8.81 (95% CI: 7.43–9.48) mmol/L considering 5-year GOS as the outcome and were 8.88 (95% CI 7.43−9.74) mmol/L considering 6-month GOS score as the outcome. The same analysis revealed that there was also a bell relationship between average blood glucose levels and the favorable outcome group (GOS score ≥ 4) at 5 years or 6 months. Conclusion In a population of patients with traumatic brain injury, blood glucose levels were associated with the GOS. There was also a threshold effect between blood glucose levels and the GOS. A blood glucose level that is either too high or too low conveys a poor prognosis. Trial registration ClinicalTrials.gov NCT02161055. Registered on 11 June 2014.

Isolated traumatic acute subdural haematoma: outcome in relation to age, Glasgow Coma Scale, and haematoma thickness

Background Traumatic acute subdural haematoma occurs in about 10–20% of patients with severe head injuries. This study aims to investigate the relation between outcome and the age, Glasgow Coma Scale on admission as well as haematoma thickness upon admission CAT scan. This is a prospective observational clinical trial study of 39 patients with isolated traumatic acute subdural haematomas treated with conservative or surgical procedures during a one-year study period. Results There was a statistically significant relation between Glasgow Outcome Score and both age of the patients and Glasgow Coma Scale upon admission. However, there was a non-statistically significant relationship between Glasgow Outcome Score and haematoma thickness upon admission CAT scan. Conclusions Age of the patients with traumatic acute subdural haematoma as well as Glasgow Coma Scale upon admission are essential predictors of the outcome. Clinical trial registration details: Name of the registry: Traumatic Acute Subdural Haematoma: Management and Outcome. Trial registration number: NCT03971240. Date of registration: June 3, 2019. URL of trial registry record: https://clinicaltrials.gov/ct2/show/record/NCT03971240?term=Mohamed+Ahmed+Alghriany&draw=2&rank=1.

Determine the Outcome of Traumatic Extradural Hematoma and to Compare the Outcome of Small and Large Size Extradural Hematoma

Objective: The aim of this study is to determine the outcome of traumatic extradural hematoma and to compare the outcome of small and large size extradural hematoma. Study Design: Descriptive case study Place and Duration: Study was conducted at the department of Neurosurgery, Saidu Teaching Hospital, Saidu Sharif, Swat for duration of two years from January 2016 to December 2017. Methods: Total one hundred and forty patients of both genders with ages 2-70 years were presented. Patients had traumatic extradural hematoma within duration first 24 hours were included and admitted through the emergency department. Detailed demographics of enrolled cases age, sex, GCS on arrival and cause of injury were recorded after taking informed written consent. CT scan of all the patients was done for diagnosis. Glasgow Outcome Score (GOS) was used for determination of outcomes. SPSS 23.0 version was used to analyze the data. Results: There were 110 (78.6%) male patients and 30 (21.4%) patients were females. Mean age of the patients was 32.78±10.43 years. RTA was the most common cause found in 84 (60%) followed by falling 29 (20.7%) and assault in 27 (19.3%). Small size hematoma volume among 100 (71.4%) cases and large size was in 40 (28.6%) patients. According to Glasgow outcome score, 24 (17.1%) cases had 1-3 score and 116 (82.9%) cases had 4-5 score. Mean GOS was 4.01±1.12. We found successful outcomes among 116 (82.9%) cases in which majority of the patients were from small size extradural hematoma. Conclusion: We concluded in this study that a significant relationship exists between the volume of extradural hematoma and both the clinical and functional outcome. Prognosis becomes increasingly worse with rising extradural hematoma size. Keywords: Traumatic Brain Injury, Extradural Hematoma, Glasgow Outcome Score

The Impact of Hyperoxia Treatment on Neurological Outcomes and Mortality in Moderate to Severe Traumatic Brain Injured patients

Background: Traumatic brain injury is a leading cause of morbidity and mortality worldwide. The relationship between hyperoxia and outcomes in patients with TBI remains controversial. We assessed the effect of persistent hyperoxia on the neurological outcomes and survival of critically ill patients with moderate-severe TBI. Method: This was a retrospective cohort study of all adults with moderate-severe TBI admitted to the ICU between 1st January 2016 and 31st December 2019 and who required invasive mechanical ventilation. Arterial blood gas data was recorded within the first 3 hours of intubation and then after 6-12 hours and 24-48 hours. The patients were divided into two categories: Group I had a PaO2 < 120mmHg on at least two ABGs undertaken in the first twelve hours post intubation and Group II had a PaO2 ≥ 120mmHg on at least two ABGs in the same period. Multivariable logistic regression was performed to assess predictors of hospital mortality and good neurologic outcome (Glasgow outcome score ≥ 4). Results: The study included 309 patients: 54.7% (n=169) in Group I and 45.3% (n=140) in Group II. Hyperoxia was not associated with increased mortality in the ICU (20.1% vs. 17.9%, p=0.62) or hospital (20.7% vs. 17.9%, p=0.53), moreover, the hospital discharge mean (SD) Glasgow Coma Scale (11.0(5.1) vs. 11.2(4.9), p=0.70) and mean (SD) Glasgow Outcome Score (3.1(1.3) vs. 3.1(1.2), p=0.47) were similar. In multivariable logistic regression analysis, persistent hyperoxia was not associated with increased mortality (adjusted odds ratio [aOR] 0.71, 95% CI 0.34-1.35, p=0.29). PaO2 within the first 3 hours was also not associated with mortality: 121-200mmHg: aOR 0.58, 95% CI 0.23-1.49, p=0.26; 201-300mmHg: aOR 0.66, 95% CI 0.27-1.59, p=0.35; 301-400mmHg: aOR 0.85, 95% CI 0.31-2.35, p=0.75 and >400mmHg: aOR 0.51, 95% CI 0.18-1.44, p=0.20; reference: PaO2 60-120mmHg within 3 hours. However, hyperoxia >400mmHg was associated with being less likely to have good neurological (GOS ≥4) outcome on hospital discharge (aOR 0.36, 95% CI 0.13-0.98, p=0.046; reference: PaO2 60-120mmHg within 3 hours. Conclusion: In intubated patients with moderate-severe TBI, hyperoxia in the first 48 hours was not independently associated with hospital mortality. However, PaO2 >400mmHg may be associated with a worse neurological outcome on hospital discharge.

Surgical management of tentorial meningiomas: case series

Background There are several surgical strategies involved in the treatment of patients with tentorial meningioma, and choosing the most appropriate one is not straight forward. Our study aims to illustrate our experience in the management of tentorial meningiomata at our center. Results This study included 32 patients with tentorial meningiomas, operated upon, with assessment of the extent of resection and the Glasgow outcome score (GOS). The mean age at the time of surgery for the studied group was 48.4 years ranging from 20 to 70 years. Total removal was considered as Simpson grade I or II and was achieved in 26 cases (81.25%). Subtotal removal was considered as Simpson grade III or IV and was achieved in 6 cases (18.75%). The final Glasgow outcome score (GOS) for all cases was GOS 1 in 4 cases (12.5%), GOS 4 in 9 cases (28.2%), and GOS 5 in 19 cases (59.3%). Conclusion Tentorial meningiomas can be very challenging during surgery due to their proximity to vital structures. Subtotal resection should be considered when total removal can be hazardous to the patient or result in severe morbidity.

AN ANALYSIS OF TRAUMATIC BRAIN INJURY [TBI] IN TERMS OF 3-MONTH GLASGOW OUTCOME SCORE [GOS] AT A TERTIARY CARE CENTRE

INTRODUCTION - Traumatic brain injury [TBI] most affects the working population and their earning capacity. The various sub categories of TBI in terms of clinical features,Glasgow coma scale [GCS] and radiology are well defined.We have attempted an analysis in terms of long term Glasgow outcome score [GOS] and tried to correlate with the various factors of TBI. MATERIALS AND METHODS – All patients of TBI over 12 years and below 60 years and those without other major trauma were included over a period of about two years. The clinical features, presentation GCS, treatment given, and outcomes were assessed.The three month GOS was scored for all patients and was used to analyse the the initial data in its light. RESULTS – A total of 200 patients were eligible for the study and were included. Of these 159 were males and 41 were females.The average age was 37.16 years.There was a relatively higher proportion of mild TBI and greater prevalence of fractures and EDH [extradural hematoma].On analyzing with three month GOS we found that 90.4 % of the patients with mild TBI had a three month GOS of 5 whereas only 31.9% of patients with moderate or severe TBI had a three month GOS of 5. CONCLUSION – The long term GOS is most representative of the extent to which the patient has been able to return to their pre TBI lives. In our study the three month GOS co related well with the initial GCS. Further prospective data can elaborate more on the effect of other clinical features and radiology on long term GOS

Comparison of Mean Glasgow Outcome Score in Patients with Traumatic Brain Injury after Magnesium Sulphate Therapy and Placebo. A Prospective Study of Shaikh Zayed Hospital Lahore

Objective: We evaluated the effectiveness of magnesium sulphate treatment for the management and outcome of TBI. Material and Methods: The prospective cases (n = 112) of TBI were included from Department of Neurosurgery, Shaikh Zayed Hospital, Lahore. Patients were split into two groups. Magnesium sulphate treatment group (n = 56) and placebo group (n = 56). Detailed history of patients was taken along with comprehensive examinations with CT scans.56 TBI patients were given standard treatment plus magnesium sulphate and remaining 56 patients received just standard treatment. Results: Mean age of the magnesium supplement therapy group was 36.83 ± 13.45 years while in the placebo group was 33.64 ± 12.88 years). Majority 28 (67.9%) were male in the magnesium sulphate group while 37 (66.1%) were in the placebo group. Mean duration passed between hospital presentation and traumatic brain injury was 4.98 ± 2.32 hours in the magnesium sulphate group while it was 5.05 ± 2.48 in the placebo group. Mean Glasgow outcome score was 3.57 ± 1.33 in the magnesium sulphate group while 2.78 ± 1.23 in the placebo group and this difference was statistically significant. Conclusion: There is significant improvement in GOS after magnesium sulphate therapy in patients with traumatic brain injury versus placebo group as noted in the results.