Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT
Background Traumatic brain injury (TBI) patients with unconsciousness and normal initial head computed tomography (CT) present a clinical dilemma for physicians and neurosurgeons in the emergency department (ED). We recorded how long it took for patients to regain consciousness and evaluated the pat...
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| Veröffentlicht in: | World journal of surgery 2022-12, Vol.46 (12), p.2882-2889 |
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| container_title | World journal of surgery |
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| creator | Li, Cheng-Yu Chuang, Chi-Cheng Chen, Ching-Chang Tu, Po-Hsun Hsu, Ting-An Kuo, Yu-Chi Liao, Chien-Hung Hsieh, Chi-Hsun Fu, Chih-Yuan |
| description | Background
Traumatic brain injury (TBI) patients with unconsciousness and normal initial head computed tomography (CT) present a clinical dilemma for physicians and neurosurgeons in the emergency department (ED). We recorded how long it took for patients to regain consciousness and evaluated the patients’ characteristics.
Methods
From 2018 to 2020, TBI patients with unconsciousness and normal initial head CT [Glasgow coma scale (GCS) score |
| doi_str_mv | 10.1007/s00268-022-06747-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2716935685</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2731920677</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4264-bf0caa14a66f02e285856494d5eeeeb1e3e9396768f16f54fe747b47b2b14a8f3</originalsourceid><addsrcrecordid>eNqNkc1u1DAUhS0EokPhBVggS2zYBPwXJ2GD2qilRRVUYiqWlpO5YTxy7MFOqOYxeGMupIDEAmFZ8o--c3x9DyFPOXvJGateZcaErgsmRMF0paricI-suJKiEFLI-2TFpFa45_KIPMp5xxivNNMPyZHUXHJeyxX5toZxH5NNBxoTvYY02gBhekNPaOtdcL31tN1a7yF8BuoCnbZAz75aP9vJxUDjQNfJziOeenqaLBKXYTej3TVeoVOmt27a0pvQx5B7F-ccIGdqw4a-j_iaR95NDtcLsBvarh-TB4P1GZ7crcfk5vxs3V4UVx_eXrYnV0WvBH6rG1hvLVdW64EJEHVZl1o1alMCjo6DhEY2utL1wPVQqgGwQx1O0aGoHuQxebH47lP8MkOezOhyD95jA7BKIyquG1nqukT0-V_oLs4pYHVISd4IbH-FlFioPsWcEwxmn9yInTWcmR-BmSUwg4GZn4GZA4qe3VnP3Qib35JfCSHwegFunYfDf1iaT-8-np5j1FKhWC7ijDoMMP0p_B81fQd7irNp</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2731920677</pqid></control><display><type>article</type><title>Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><source>SpringerLink Journals - AutoHoldings</source><creator>Li, Cheng-Yu ; Chuang, Chi-Cheng ; Chen, Ching-Chang ; Tu, Po-Hsun ; Hsu, Ting-An ; Kuo, Yu-Chi ; Liao, Chien-Hung ; Hsieh, Chi-Hsun ; Fu, Chih-Yuan</creator><creatorcontrib>Li, Cheng-Yu ; Chuang, Chi-Cheng ; Chen, Ching-Chang ; Tu, Po-Hsun ; Hsu, Ting-An ; Kuo, Yu-Chi ; Liao, Chien-Hung ; Hsieh, Chi-Hsun ; Fu, Chih-Yuan</creatorcontrib><description>Background
Traumatic brain injury (TBI) patients with unconsciousness and normal initial head computed tomography (CT) present a clinical dilemma for physicians and neurosurgeons in the emergency department (ED). We recorded how long it took for patients to regain consciousness and evaluated the patients’ characteristics.
Methods
From 2018 to 2020, TBI patients with unconsciousness and normal initial head CT [Glasgow coma scale (GCS) score < 13, negative CT scan and normal laboratory test results] were evaluated. Patients who regained consciousness were analyzed. Multivariate logistic regression (MLR) analyses were used to evaluate independent factors for regaining consciousness.
Results
A total of 77 patients were included in this study. Fifty-eight (75.3%) patients regained consciousness, most within one day (43.1%). Nineteen (24.7%) patients never regained consciousness. MLR analysis showed that initial GCS score (odds 1.85,
p
= 0.017), early airway protection in ED (odds 25.02,
p
= 0.018) and 72-h GCS score improvement by two points (odds 0.02,
p
= 0.001) were independent factors for regaining consciousness. Overall, 94.1% of patients who received early airway protection and improved 2 points in 72-h GCS score regained consciousness. The association between days to
M
5 status and days to
M
6 status (consciousness) was highly significant. Fewer days to
M
5 status were highly associated with needing fewer days to regain consciousness.
Conclusions
For TBI patients with unconsciousness and normal initial head CT, a higher probability of regaining consciousness was observed in those who underwent early airway protection and who improved 2 points in 72-h GCS score. Regaining consciousness within a short period could be expected in patients with
M
5 status.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-022-06747-y</identifier><identifier>PMID: 36131183</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Brain ; Brain Injuries, Traumatic - complications ; Brain Injuries, Traumatic - diagnostic imaging ; Cardiac Surgery ; Computed tomography ; Consciousness ; Emergency medical care ; Emergency medical services ; Emergency Service, Hospital ; General Surgery ; Glasgow Coma Scale ; Head injuries ; Humans ; Laboratory tests ; Medicine ; Medicine & Public Health ; Original Scientific Report ; Patients ; Respiratory tract ; Statistical analysis ; Surgery ; Thoracic Surgery ; Tomography, X-Ray Computed ; Traumatic brain injury ; Unconsciousness ; Unconsciousness - diagnostic imaging ; Unconsciousness - etiology ; Vascular Surgery</subject><ispartof>World journal of surgery, 2022-12, Vol.46 (12), p.2882-2889</ispartof><rights>The Author(s) under exclusive licence to Société Internationale de Chirurgie 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4264-bf0caa14a66f02e285856494d5eeeeb1e3e9396768f16f54fe747b47b2b14a8f3</citedby><cites>FETCH-LOGICAL-c4264-bf0caa14a66f02e285856494d5eeeeb1e3e9396768f16f54fe747b47b2b14a8f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-022-06747-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-022-06747-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,41488,42557,45574,45575,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36131183$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Cheng-Yu</creatorcontrib><creatorcontrib>Chuang, Chi-Cheng</creatorcontrib><creatorcontrib>Chen, Ching-Chang</creatorcontrib><creatorcontrib>Tu, Po-Hsun</creatorcontrib><creatorcontrib>Hsu, Ting-An</creatorcontrib><creatorcontrib>Kuo, Yu-Chi</creatorcontrib><creatorcontrib>Liao, Chien-Hung</creatorcontrib><creatorcontrib>Hsieh, Chi-Hsun</creatorcontrib><creatorcontrib>Fu, Chih-Yuan</creatorcontrib><title>Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Traumatic brain injury (TBI) patients with unconsciousness and normal initial head computed tomography (CT) present a clinical dilemma for physicians and neurosurgeons in the emergency department (ED). We recorded how long it took for patients to regain consciousness and evaluated the patients’ characteristics.
Methods
From 2018 to 2020, TBI patients with unconsciousness and normal initial head CT [Glasgow coma scale (GCS) score < 13, negative CT scan and normal laboratory test results] were evaluated. Patients who regained consciousness were analyzed. Multivariate logistic regression (MLR) analyses were used to evaluate independent factors for regaining consciousness.
Results
A total of 77 patients were included in this study. Fifty-eight (75.3%) patients regained consciousness, most within one day (43.1%). Nineteen (24.7%) patients never regained consciousness. MLR analysis showed that initial GCS score (odds 1.85,
p
= 0.017), early airway protection in ED (odds 25.02,
p
= 0.018) and 72-h GCS score improvement by two points (odds 0.02,
p
= 0.001) were independent factors for regaining consciousness. Overall, 94.1% of patients who received early airway protection and improved 2 points in 72-h GCS score regained consciousness. The association between days to
M
5 status and days to
M
6 status (consciousness) was highly significant. Fewer days to
M
5 status were highly associated with needing fewer days to regain consciousness.
Conclusions
For TBI patients with unconsciousness and normal initial head CT, a higher probability of regaining consciousness was observed in those who underwent early airway protection and who improved 2 points in 72-h GCS score. Regaining consciousness within a short period could be expected in patients with
M
5 status.</description><subject>Abdominal Surgery</subject><subject>Brain</subject><subject>Brain Injuries, Traumatic - complications</subject><subject>Brain Injuries, Traumatic - diagnostic imaging</subject><subject>Cardiac Surgery</subject><subject>Computed tomography</subject><subject>Consciousness</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency Service, Hospital</subject><subject>General Surgery</subject><subject>Glasgow Coma Scale</subject><subject>Head injuries</subject><subject>Humans</subject><subject>Laboratory tests</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Scientific Report</subject><subject>Patients</subject><subject>Respiratory tract</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Tomography, X-Ray Computed</subject><subject>Traumatic brain injury</subject><subject>Unconsciousness</subject><subject>Unconsciousness - diagnostic imaging</subject><subject>Unconsciousness - etiology</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkc1u1DAUhS0EokPhBVggS2zYBPwXJ2GD2qilRRVUYiqWlpO5YTxy7MFOqOYxeGMupIDEAmFZ8o--c3x9DyFPOXvJGateZcaErgsmRMF0paricI-suJKiEFLI-2TFpFa45_KIPMp5xxivNNMPyZHUXHJeyxX5toZxH5NNBxoTvYY02gBhekNPaOtdcL31tN1a7yF8BuoCnbZAz75aP9vJxUDjQNfJziOeenqaLBKXYTej3TVeoVOmt27a0pvQx5B7F-ccIGdqw4a-j_iaR95NDtcLsBvarh-TB4P1GZ7crcfk5vxs3V4UVx_eXrYnV0WvBH6rG1hvLVdW64EJEHVZl1o1alMCjo6DhEY2utL1wPVQqgGwQx1O0aGoHuQxebH47lP8MkOezOhyD95jA7BKIyquG1nqukT0-V_oLs4pYHVISd4IbH-FlFioPsWcEwxmn9yInTWcmR-BmSUwg4GZn4GZA4qe3VnP3Qib35JfCSHwegFunYfDf1iaT-8-np5j1FKhWC7ijDoMMP0p_B81fQd7irNp</recordid><startdate>202212</startdate><enddate>202212</enddate><creator>Li, Cheng-Yu</creator><creator>Chuang, Chi-Cheng</creator><creator>Chen, Ching-Chang</creator><creator>Tu, Po-Hsun</creator><creator>Hsu, Ting-An</creator><creator>Kuo, Yu-Chi</creator><creator>Liao, Chien-Hung</creator><creator>Hsieh, Chi-Hsun</creator><creator>Fu, Chih-Yuan</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>202212</creationdate><title>Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT</title><author>Li, Cheng-Yu ; Chuang, Chi-Cheng ; Chen, Ching-Chang ; Tu, Po-Hsun ; Hsu, Ting-An ; Kuo, Yu-Chi ; Liao, Chien-Hung ; Hsieh, Chi-Hsun ; Fu, Chih-Yuan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4264-bf0caa14a66f02e285856494d5eeeeb1e3e9396768f16f54fe747b47b2b14a8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Abdominal Surgery</topic><topic>Brain</topic><topic>Brain Injuries, Traumatic - complications</topic><topic>Brain Injuries, Traumatic - diagnostic imaging</topic><topic>Cardiac Surgery</topic><topic>Computed tomography</topic><topic>Consciousness</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Emergency Service, Hospital</topic><topic>General Surgery</topic><topic>Glasgow Coma Scale</topic><topic>Head injuries</topic><topic>Humans</topic><topic>Laboratory tests</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Scientific Report</topic><topic>Patients</topic><topic>Respiratory tract</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Tomography, X-Ray Computed</topic><topic>Traumatic brain injury</topic><topic>Unconsciousness</topic><topic>Unconsciousness - diagnostic imaging</topic><topic>Unconsciousness - etiology</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Cheng-Yu</creatorcontrib><creatorcontrib>Chuang, Chi-Cheng</creatorcontrib><creatorcontrib>Chen, Ching-Chang</creatorcontrib><creatorcontrib>Tu, Po-Hsun</creatorcontrib><creatorcontrib>Hsu, Ting-An</creatorcontrib><creatorcontrib>Kuo, Yu-Chi</creatorcontrib><creatorcontrib>Liao, Chien-Hung</creatorcontrib><creatorcontrib>Hsieh, Chi-Hsun</creatorcontrib><creatorcontrib>Fu, Chih-Yuan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Cheng-Yu</au><au>Chuang, Chi-Cheng</au><au>Chen, Ching-Chang</au><au>Tu, Po-Hsun</au><au>Hsu, Ting-An</au><au>Kuo, Yu-Chi</au><au>Liao, Chien-Hung</au><au>Hsieh, Chi-Hsun</au><au>Fu, Chih-Yuan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2022-12</date><risdate>2022</risdate><volume>46</volume><issue>12</issue><spage>2882</spage><epage>2889</epage><pages>2882-2889</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
Traumatic brain injury (TBI) patients with unconsciousness and normal initial head computed tomography (CT) present a clinical dilemma for physicians and neurosurgeons in the emergency department (ED). We recorded how long it took for patients to regain consciousness and evaluated the patients’ characteristics.
Methods
From 2018 to 2020, TBI patients with unconsciousness and normal initial head CT [Glasgow coma scale (GCS) score < 13, negative CT scan and normal laboratory test results] were evaluated. Patients who regained consciousness were analyzed. Multivariate logistic regression (MLR) analyses were used to evaluate independent factors for regaining consciousness.
Results
A total of 77 patients were included in this study. Fifty-eight (75.3%) patients regained consciousness, most within one day (43.1%). Nineteen (24.7%) patients never regained consciousness. MLR analysis showed that initial GCS score (odds 1.85,
p
= 0.017), early airway protection in ED (odds 25.02,
p
= 0.018) and 72-h GCS score improvement by two points (odds 0.02,
p
= 0.001) were independent factors for regaining consciousness. Overall, 94.1% of patients who received early airway protection and improved 2 points in 72-h GCS score regained consciousness. The association between days to
M
5 status and days to
M
6 status (consciousness) was highly significant. Fewer days to
M
5 status were highly associated with needing fewer days to regain consciousness.
Conclusions
For TBI patients with unconsciousness and normal initial head CT, a higher probability of regaining consciousness was observed in those who underwent early airway protection and who improved 2 points in 72-h GCS score. Regaining consciousness within a short period could be expected in patients with
M
5 status.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36131183</pmid><doi>10.1007/s00268-022-06747-y</doi><tpages>8</tpages></addata></record> |
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| ispartof | World journal of surgery, 2022-12, Vol.46 (12), p.2882-2889 |
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| language | eng |
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| source | MEDLINE; Wiley Online Library All Journals; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Brain Brain Injuries, Traumatic - complications Brain Injuries, Traumatic - diagnostic imaging Cardiac Surgery Computed tomography Consciousness Emergency medical care Emergency medical services Emergency Service, Hospital General Surgery Glasgow Coma Scale Head injuries Humans Laboratory tests Medicine Medicine & Public Health Original Scientific Report Patients Respiratory tract Statistical analysis Surgery Thoracic Surgery Tomography, X-Ray Computed Traumatic brain injury Unconsciousness Unconsciousness - diagnostic imaging Unconsciousness - etiology Vascular Surgery |
| title | Temporary or Permanent? A Clinical Challenge in the Evaluation of Traumatic Brain Injury Patients with Unconsciousness and Normal Initial Head CT |
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