Traumatic brain injury assessment

Moppeth I.K., 2007. Traumatic brain injury assessment, resuscitation and early management. Br. J. Anaesth 99,18-31. 

CS415 Payne, H. C. Traumatic brain injury, depression and cannabis use—assessing their effects on a cognitive performance. Brain Inj 2000 14(5) CS426... 

The incidence of hypotension with the use of midazolam for pre-hospital rapid-sequence intubation of the trachea has been assessed in a retrospective chart review of two aeromedical crews (19). The rapid-sequence protocols were identical, except for the dose of midazolam. Both crews used 0.1 mg/kg, but one crew had a maximum dose of 5 mg imposed. This meant that patients over 50 kg received lower doses of midazolam they also had a higher incidence of hypotension. This relation was also present in patients with traumatic brain injury, implying that cerebral perfusion could be compromised at a critical time in those without dosage restriction. 

The philosophy of evidence-based practice is widely accepted, although operational and implementation issues represent major barriers. One of the significant barriers is a shortage of evidence reports on topics of critical interest, and the lack of a national infrastructure to prepare such reports. In response to this need, AHRQ has funded 12 Evidence-based Practice Centers to conduct systematic, comprehensive analyses and syntheses of the scientific literature to develop evidence reports and technology assessments on clinical topics that are common, expensive, and present challenges to decision makers. Since December 1998, 11 evidence reports have been released on topics that include sleep apnea, traumatic brain injury, alcohol dependence, cervical cytology, urinary tract infection, depression, dysphasia, sinusitis, stable angina, testosterone suppression, and attention deficit hyperactivity disorder. 

Calabrese, E. J. (2008g). Drug therapies for stroke and traumatic brain injury often displays U-shaped dose responses Occurrence, mechanisms, and chnical implications. Crit Rev Toxicol 38, 557—577. Calabrese, E. J. (2008h). An assessment of anxiolytic drug screening tests Hormetic dose responses predominate. Crit Rev Toxicol 38, 489-542. 

Chun KA, Manley GT, Stiver SI, Aiken AH, Phan N, Wang V, Meeker M, Cheng SC, Getm AD, Wintermark M (2009) Interobserver Variability in the Assessment of CT Imaging Features of Traumatic Brain Injury. J Neurotrauma 2009 Nov 6 [Epub ahead of print]... 

Newman, J., Beusenberg, M., Fournier, E. et al. 1999. A new biomechanical assessment of mild traumatic brain injury — part Iimethodology. In Proceedings of the 1999 International IRCOBI Conference on... 

There are also many examples of patients being assessed repeatedly on tracking tasks for periods up to 12 or more months. This has been done to quantify recovery following stroke (Lynn et al., 1977 De Souza et al., 1980 Jones and Donaldson, 1981 Jones et al., 1989, 1990) and traumatic brain injury (Jones and Donaldson, 1981 Heitger et al., 2004,2007). Tracking tasks have also been used to quantify... 

Nervous system The depressant effects of alcohol on level of consciousness in patients with head injuries have been assessed in a retrospective study of changes in the Glasgow Coma Scale (GCS) in 269 patients with traumatic brain injury, of whom 81 were excluded because of incomplete data [1 ]. The other 188 were divided into those who were intoxicated and those who were not. The blood alcohol concentration was significantly related to the changes in Glasgow Coma Scale scores in those who were intoxicated but not in the others. 

Bayir, H., Kagan, V.E., Tyurina, Y.Y., et al, 2002. Assessment of antioxidant reserves and oxidative stress in cerebrospinal fluid after severe traumatic brain injury in infants and children. Pediatr. Res. 51, 571-578. 

Additional experiments have been conducted in severely head-injured cats to assess the effects of U-74006F on brain energy metabolites [61]. A 1 mg/kg i.v. dose administered at 30 minutes post-injury, plus a second 0.5 mg/kg dose 2 hours later, resulted in an improved metabolic profile within the injured hemisphere measured at 4 hours. Most notably, U-74006F significantly reduced post-traumatic accumulation of lactic acid in both the cerebral cortex and the sub-cortical white matter. This biochemical effect suggests an improved maintenance of cerebral blood flow in the injured brain. As noted above, U-74006F does very effectively reduce progressive development of post-traumatic ischemia in experimental cat spinal-cord injury [24,27] which may also provide the explanation for the reduction of post-traumatic lactate levels in the injured brain. 

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