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4 results

  • 48 - Severe Traumatic Brain Injury

  • from Section 11 - Trauma
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 516-527

  • Summary

    • Severe traumatic brain injury (TBI) is usually defined as a Glasgow Coma Scale (GCS) score < 9. The goals of early resuscitation should focus on identifying and treating the primary injuries and limiting the negative cascade of secondary injuries such as hypotension and hypoxia. All patients with suspected severe TBI need an emergent computed tomography (CT) scan of the brain to identify hemorrhage immediately following initial stabilization. Ten percent of severe TBI patients have concomitant c-spine injury.

  • Chapter 5 - Coma, Delirium, and Dementia

  • from Section 2 - Common Neurologic Presentations: A Symptom-Based Approach
  • Edited by Thomas P. Campbell, Allegheny Health Network, Pittsburgh, Kevin M. Kelly, Allegheny Health Network, Pittsburgh
  • Book:
    Handbook of Emergency Neurology
    Published online:
    10 January 2024
    Print publication:
    17 August 2023, pp 51-69

  • Summary

    Alterations in mental status are a frequently encountered chief complaint that the emergency physician is asked to evaluate. These changes vary from marked depression of mental status to extreme over-activation. The differential diagnosis of altered mental status (AMS) is perhaps one of the broadest encountered in medicine. Here we will discuss alterations in mental status, and a diagnostic approach to these types of patients.

  • An Analysis of the Distribution of Glasgow Coma Scale Scores across Pan-Asian Trauma Outcomes Study (PATOS) Regions

  • Benjamin Capuano, David C. Cone
  • Journal:
    Prehospital and Disaster Medicine / Volume 37 / Issue 2 / April 2022
    Published online by Cambridge University Press:
    14 February 2022, pp. 157-163
    Print publication:
    April 2022
  • Background:

    The Glasgow Coma Scale (GCS) was devised in 1974 as a way of tracking the progress of neurosurgical coma patients. It is comprised of three components: eye movement, response to verbal commands, and motor function. Since then, it has become the primary tool in Emergency Medical Services (EMS) and emergency departments for assessing cognitive function and triaging patients in the setting of acute trauma. However, the GCS was never intended to be used in such a way. It has been demonstrated that there is a high degree of inter-rater variability when assigning GCS scores for trauma patients. Potential differences in GCS score assignments between different countries were examined. It was hypothesized there would be differences in mean total and component scores.

    Methods:

    Using de-identified data from the Pan-Asian Trauma Outcomes Study (PATOS), the distributions of GCS scores from six countries were assessed: Japan, Korea, Malaysia, Taiwan, Thailand, and Vietnam. Using SPSS data analysis, a one-way ANOVA and Bonferroni post-hoc tests were performed to compare the means of the three GCS components and the total GCS scores reported by EMS personnel caring for trauma patients.

    Results:

    Data from 15,173 cases showed significant differences in mean total GCS score between countries (P <.001) as well as in mean component GCS scores (P <.001 for each of eye, verbal, and motor). Post-hoc tests showed that EMS personnel in Korea assigned significantly lower scores compared to all other countries in both component and total GCS scores. Field personnel in Japan, Malaysia, and Vietnam assigned the highest scores and significantly differed from the other three countries on component and total scores; Thailand and Taiwan had similar scores but significantly differed from the other four countries on component and total scores. Visual inspection of mean component and total GCS score histograms revealed differences in score assignment patterns among countries.

    Conclusions:

    There are a number of significant differences in the mean total and component GCS scores assigned by EMS personnel in the six Asian countries studied. More investigation is necessary to determine if there is clinical significance to these differences in GCS score assignments, as well as the reasons for the differences.

  • Dietary acid load and mortality from all causes, CVD and cancer: results from the Golestan Cohort Study

  • Ehsan Hejazi, Hadi Emamat, Maryam Sharafkhah, Atoosa Saidpour, Hossein Poustchi, Sadaf Sepanlou, Masoud Sotoudeh, Sanford Dawsey, Paolo Boffetta, Christian C Abnet, Farin Kamangar, Arash Etemadi, Akram Pourshams, Akbar Fazeltabar Malekshah, Paul Berennan, Reza Malekzadeh, Azita Hekmatdoost
  • Journal:
    British Journal of Nutrition / Volume 128 / Issue 2 / 28 July 2022
    Published online by Cambridge University Press:
    16 August 2021, pp. 237-243
    Print publication:
    28 July 2022
    • Article
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  • Given the limited studies and controversial results on association between dietary acid load and mortality from CVD and cancers, we aimed to investigate this association in a large population cohort study in Middle East, with a wide range of dietary acid load. The study was conducted on the platform of the Golestan Cohort Study (GCS), which enrolled 50 045 participants in 2004–2008. Dietary intake was assessed using a validated FFQ. Dietary potential renal acid load (PRAL) score was calculated from nutrient intake. Death and its causes were identified and confirmed by two or three physicians. Cox proportional hazards regression was used to estimate hazard ratio (HR) and 95 % CI for total and cause-specific mortalities. Then, the associations were modelled using restricted cubic splines. PRAL range was −57·36 to +53·81 mEq/d for men and −76·70 to +49·08 for women. During 555 142 person-years of follow-up, we documented 6830 deaths, including 3070 cardiovascular deaths, 1502 cancer deaths and 2258 deaths from other causes. For overall deaths, in final model after adjustment for confounders, participants in the first and fifth quintiles of PRAL had a higher risk of mortality compared with the second quintile of PRAL (HR: 1·08; 95 % CI1·01, 1·16 and HR: 1·07; 95 % CI 1·01, 1·15, respectively); P for trend < 0·05). Participants in the first and fifth quintiles of PRAL had a 12 % higher risk of CVD mortality compared with the Q2 of PRAL (HR: 1·12; 95 % CI 1·01–1·25 and HR: 1·12; 95 % CI 1·01, 1·26, respectively; P for trend < 0·05). We found that all-cause and CVD mortality rates were higher in the lowest and highest PRAL values, in an approximately U-shaped relation (P-values for the overall association and the non-linear association of energy-adjusted PRAL with total mortality were < 0·001 and < 0·001, and with CVD mortality were 0·008 and 0·003, respectively). Our results highlight unfavourable associations of high acidity and alkalinity of diet with the increased total and CVD mortality risk. It may be important to consider a balanced acid–base diet as a protective strategy to prevent pre-mature death, especially from CVD.