Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury

Fifty-one patients with mild(n = 14),moderate(n = 10) and severe traumatic brain injury(n = 27) received early rehabilitation.Level of consciousness was evaluated using the Glasgow Coma Score.Functional level was determined using the Glasgow Outcome Score,whilst mobility was evaluated using the Mobility Scale for Acute Stroke.Activities of daily living were assessed using the Barthel Index.Following Bobath neurodevelopmental therapy,the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury,but was not greatly influenced in patients with mild traumatic brain injury.Mobility and functional level were significantly improved in patients with mild,moderate and severe traumatic brain injury.Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury.Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury.Nevertheless,complete recovery was not acquired at discharge.Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.     

Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke

BACKGROUND: Randomized trials of thrombolytic stroke treatment have either excluded patients with posterior circulation ischemia or used inclusion criteria making enrollment of these patients less likely. Consequently, there is less published information on thrombolytic therapy for posterior circulation stroke. OBJECTIVE: To determine effective thrombolytic treatment times for posterior circulation stroke and factors that might help predict clinical outcome. DESIGN: We describe our experience treating 21 consecutive patients with either intravenous or intra-arterial thrombolytic therapy for posterior circulation ischemic stroke between October 9, 1993, and February 19, 2001. MAIN OUTCOME MEASURES: National Institutes of Health Stroke Scale, Glasgow Coma Scale, and modified Rankin Scale scores were evaluated at baseline, and the modified Rankin Scale was measured 3 months after stroke, with a good outcome being a modified Rankin Scale score of 2 or less. RESULTS: Nine patients received intravenous therapy; 12 patients received intra-arterial therapy. The median National Institutes of Health Stroke Scale score at onset was 20 (range, 2-39), and the median Glasgow Coma Scale score was 9 (range, 3-15). Twelve patients were treated within 8 hours of symptom onset (range, 1 1/2 hours to 16 days). Nine patients (43%) had a modified Rankin Scale score of 2 or less at 3 months. The initial Glasgow Coma Scale score and treatment within 8 hours of symptom onset were each associated with good outcome, but the initial National Institutes of Health Stroke Scale score was not predictive. CONCLUSIONS: Thrombolytic therapy for posterior circulation stroke may be beneficial even when initiated 8 hours after symptom onset. Level of consciousness, as measured by Glasgow Coma Scale score, seems to be a more important predictor of outcome than the initial National Institutes of Health Stroke Scale score.     

Glasgow Coma Scale on admission is correlated with postoperative Glasgow Outcome Scale in chronic subdural hematoma

OBJECTIVE: To evaluate the correlation between admission Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) in chronic subdural hematoma (CSDH). METHODS: 128 consecutive patients (107 men and 21 women) with CSDH were studied and the correlation between GCS on admission and postoperative GOS was determined. RESULTS: GCS and GOS were correlated with a Spearman rank correlation coefficient of 0.557 (p<0.01). CONCLUSION: GCS and GOS are well-correlated in CSDH.     

Correlation of brain stem evoked response audiometry (BERA) with Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS)

The diagnostic value of electric responses from the brain stem (BERA) in neurosurgical patients is still a matter for debate in the literature. Therefore in the study an attempt was made to determine the relationship between GCS scores and BERA recordings. Participants in the study were 64 patients with various types of brain damage. Evoked potentials from the brain stem were registered using the Hortmann BERAmodul apparatus. To facilitate the interpretation of results a special scale was developed for quantitative measurement of changes in BERA recordings. Abnormalities in BERA recordings were reflected in changes in GCS scores, and correlation between the two dimensions was found to be statistically significant. The relationship between BERA recordings and GOS scores was also significant: pathological changes in BERA recordings assessed as severe were associated with an unfavorable therapeutic outcome in the GOS. The presented findings indicate auditory evoked brain stem response (BERA) usefulness for objective evaluation of brain-damaged patients' clinical state.     

Epidemiology and outcomes of pediatric traumatic brain injury

Traumatic brain injury is a leading cause of death and disability in the pediatric age group. Causes of injury vary with child developmental age, with more inflicted injuries in infants, fall-related injuries among toddlers, sports-related injuries among middle-school-aged children and motor vehicle crashes in older children. Prevention strategies exist for some pediatric traumatic brain injury; however, all suffer from lack of compliance and enforcement. Neuropsychological and behavioral outcomes for injured children vary with the severity of injury, child age at injury, premorbid child characteristics, family factors and the families' socioeconomic status. Each of these factors needs to be taken into account when designing rehabilitation strategies and assessing factors related to outcome.     

DIC评分在颅脑损伤中的临床应用研究

目的分析弥散性血管内凝血（DIC）评分与颅脑损伤病人病情及预后的关系,探讨其在颅脑损伤中的临床应用价值。方法采用前瞻性研究设计方法,测定并记录110例颅脑损伤病人伤后DIC评分、GCS评分及随访6个月时的GOS评分。采用SPSS15.0软件包进行统计分析。结果至随访结束,本组死亡19例。D-二聚体升高是颅脑损伤后最常见的凝血异常指标（56例,占50.9%）。DIC评分0、1、2、3、≥4分者分别为32、26、15、20、17例,病死率分别为0、0、0、20%、88.2%。GCS评分、GOS评分与DIC评分之间存在高度相关关系。结论DIC评分是评估颅脑损伤病人病情及预后的可靠指标;DIC分值越高,病人病情越重,预后越差。     

简易运动评分与GCS对颅脑损伤伤情评价的比较

目的探讨简易运动评分(SMS)对颅脑损伤伤病情评价的可靠性。方法对72例颅脑损伤患者,分别行SMS和GCS评价并比较其伤情和不同伤情患者的预后。结果两种评价均为颅脑损伤轻型者57例,均为中重型者12例;有3例GCS评为中重型,而SMS评为轻型;SMS与GCS对伤情的评价无明显差异(P>0.05)。两种方法均评为重型者4例,3例恢复差(GOS1～3分),1例恢复良好(GOS4～5分);8例均为中型者,2例恢复差,6例良好;57例均为轻型者均恢复良好;3例GCS评为中型,而SMS评为轻型者均恢复良好。SMS与GCS分别评为颅脑损伤轻型或中型或轻型者中,预后无明显差异(P>0.05)。结论与GCS相比,SMS可作为脑损伤病情的评价方法之一,简便易行,结果可靠。     

Multimodality comparison of neuroimaging in pediatric traumatic brain injury

Traumatic brain injury is a common cause of death and disability in children; early neuroimaging has assumed an increasingly important role in evaluating the extent and severity of injury. Several imaging methods were assessed in a study of 40 children with traumatic brain injury: computed tomography (CT), T(2)-weighted magnetic resonance imaging (MRI), fluid-attenuated inversion recovery (FLAIR) MRI, and susceptibility-weighted imaging (SWI) MRI to determine which were most valuable in predicting 6-12 month outcomes as classified by the Pediatric Cerebral Performance Category Scale score. Patients were subdivided into three groups: (1) normal, (2) mild disability, and (3) moderate/severe disability/persistent vegetative state. T(2), FLAIR, and SWI showed no significant difference in lesion volume between normal and mild outcome groups, but did indicate significant differences between normal and poor and between mild and poor outcome groups. Computed tomography revealed no significant differences in lesion volume between any groups. The findings suggest that T(2), FLAIR, and SWI MRI sequences provide a more accurate assessment of injury severity and detection of outcome-influencing lesions than does CT in pediatric traumatic brain injury patients. Although CT was inconsistent at lesion detection/outcome prediction, it remains an essential part of the acute traumatic brain injury work-up to assess the need for neurosurgic intervention.     

Heart rate variability for assessing comatose patients with different Glasgow Coma Scale scores

ObjectiveTo assess the autonomic nervous system (ANS) in coma by heart rate variability (HRV).MethodsSixteen comatose patients and 22 normal subjects with comparable ages and genders were studied. Patients were classified in two subgroups according to the Glasgow Coma Scale (GCS). Time, frequency, and informational HRV domain indices were calculated.ResultsA notable reduction of HRV was found in patients. Regarding the time domain indices, the triangular index, and the Delta_RRs, were significantly reduced in the subgroup with GCS = 3. Absolute power for the whole frequency spectrum decreased whenever GCS scores were lower. A significant decrement was found for absolute power of the VLF and LF bands in the subgroup of GCS = 3, and although it was lower for the HF band in these patients, those changes were not statistically significantly different. The LF/HF ratio and the Shannon´s entropy indices were significantly reduced in the subgroup with GCS = 3. Our results are discussed regarding the progressive dysfunction the ANS networks when coma deepens.ConclusionsThe HRV procedure is a powerful tool to assess the ANS in comatose patients.SignificanceHRV is a minimally invasive, low-cost methodology, suitable for assessing the ANS in coma.     

Clinical applications of biomarkers in pediatric traumatic brain injury

Introduction  

The diagnosis, treatment, and prediction of outcome in pediatric traumatic brain injury (TBI) present significant challenges to the treating clinician. Clinical and radiological tools for assessing injury severity and predicting outcome, in particular, lack sensitivity and specificity. In patients with mild TBI, often there is uncertainty about which patients should undergo radiological imaging and who is at risk for long term neurological sequelae. In severe TBI, often there is uncertainty about which patients will experience secondary insults and what the outcome for individual patients will be. In several other clinical specialties, biomarkers are used to diagnose disease, direct treatment, and prognosticate. However, an ideal biomarker for brain injury has not been found.     

Impact of pediatric traumatic brain injury on hippocampal neurogenesis

Traumatic brain injury(TBI) is a major cause of mortality and morbidity in the pediatric population. With advances in medical care, the mortality rate of pediatric TBI has declined. However, more children and adolescents are living with TBI-related cognitive and emotional impairments, which negatively affects the quality of their life. Adult hippocampal neurogenesis plays an important role in cognition and mood regulation. Alterations in adult hippocampal neurogenesis are associated with a variety of neurological and neurodegenerative diseases, including TBI. Promoting endogenous hippocampal neurogenesis after TBI merits significant attention. However, TBI affects the function of neural stem/progenitor cells in the dentate gyrus of hippocampus, which results in aberrant migration and impaired dendrite development of adult-born neurons. Therefore, a better understanding of adult hippocampal neurogenesis after TBI can facilitate a more successful neuro-restoration of damage in immature brains. Secondary injuries, such as neuroinflammation and oxidative stress, exert a significant impact on hippocampal neurogenesis. Currently, a variety of therapeutic approaches have been proposed for ameliorating secondary TBI injuries. In this review, we discuss the uniqueness of pediatric TBI, adult hippocampal neurogenesis after pediatric TBI, and current efforts that promote neuroprotection to the developing brains, which can be leveraged to facilitate neuroregeneration.     

Predicting premorbid neuropsychological functioning following pediatric traumatic brain injury

Abstract

This study examined the prediction of premorbid neuropsychological functioning using data from an ongoing prospective study of traumatic brain injuries (TBI) in children ages 6 to 12 years. Prediction equations were derived based on 80 children with orthopedic injuries (OI), who served as a comparison group for the children with TBI. Collectively, parent ratings of premorbid school performance, maternal ethnicity, family socioeconomic status, and children's word recognition skill predicted from 13% to 45% of the variance in three measures of neuropsychological functioning. The regression equations were used to compute predicted scores among 109 children with TBI. Actual scores fell significantly below predicted scores among children with TBI, and the magnitude of the deficits was correlated with injury severity. Premorbid neuropsychological functioning can be predicted in children with TBI, but with less precision than would be desirable for clinical purposes.     

Comparison of the Full Outline of UnResponsiveness and Glasgow Liege Scale/Glasgow Coma Scale in an Intensive Care Unit Population

Background  

The Full Outline of UnResponsiveness (FOUR) has been proposed as an alternative for the Glasgow Coma Scale (GCS)/Glasgow Liège Scale (GLS) in the evaluation of consciousness in severely brain-damaged patients. We compared the FOUR and GLS/GCS in intensive care unit patients who were admitted in a comatose state.     

Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years

BACKGROUND: Age and the Glasgow Coma Scale (GCS) score on admission are considered important predictors of outcome after traumatic brain injury. We investigated the predictive value of the GCS in a large group of patients whose computerised multimodal bedside monitoring data had been collected over the previous 10 years. METHODS: Data from 358 subjects with head injury, collected between 1992 and 2001, were analysed retrospectively. Patients were grouped according to year of admission. Glasgow Outcome Scores (GOS) were determined at six months. Spearman's correlation coefficients between GCS and GOS scores were calculated for each year. RESULTS: On average 34 (SD: 7) patients were monitored every year. We found a significant correlation between the GCS and GOS for the first five years (overall 1992-1996: r = 0.41; p<0.00001; n = 183) and consistent lack of correlations from 1997 onwards (overall 1997-2001: r = 0.091; p = 0.226; n = 175). In contrast, correlations between age and GOS were in both time periods significant and similar (r = -0.24 v r = -0.24; p<0.002). CONCLUSIONS: The admission GCS lost its predictive value for outcome in this group of patients from 1997 onwards. The predictive value of the GCS should be carefully reconsidered when building prognostic models incorporating multimodality monitoring after head injury.     

The potential role of mitochondria in pediatric traumatic brain injury

Mitochondria play a central role in cerebral energy metabolism, intracellular calcium homeostasis and reactive oxygen species generation and detoxification. Following traumatic brain injury (TBI), the degree of mitochondrial injury or dysfunction can be an important determinant of cell survival or death. Literature would suggest that brain mitochondria from the developing brain are very different from those from mature animals. Therefore, aspects of developmental differences in the mitochondrial response to TBI can make the immature brain more vulnerable to traumatic injury. This review will focus on four main areas of secondary injury after pediatric TBI, including excitotoxicity, oxidative stress, alterations in energy metabolism and cell death pathways. Specifically, we will describe what is known about developmental differences in mitochondrial function in these areas, in both the normal, physiologic state and the pathologic state after pediatric TBI. The ability to identify and target aspects of mitochondrial dysfunction could lead to novel neuroprotective therapies for infants and children after severe TBI.