RESUMO
OBJECTIVES: To identify injury patterns and characteristics associated with severe traumatic brain injury course and outcome, within a well-characterized cohort, which may help guide new research and treatment initiatives. DESIGN: A secondary analysis of a phase 3, randomized, controlled trial that compared therapeutic hypothermia versus normothermia following severe traumatic brain injury in children. SETTING: Fifteen sites in the United States, Australia, and New Zealand. PATIENTS: Children (< 18 yr old) with severe traumatic brain injury. MEASUREMENTS AND MAIN RESULTS: Baseline, clinical, and CT characteristics of patients (n = 77) were examined for association with mortality and outcome, as measured by the Glasgow Outcome Scale-Extended Pediatric Revision 3 months after traumatic brain injury. Data are presented as odds ratios with 95% CIs. No demographic, clinical, or CT characteristic was associated with mortality in bivariate analysis. Characteristics associated with worse Glasgow Outcome Scale-Extended Pediatric Revision in bivariate analysis were two fixed pupils (14.17 [3.38-59.37]), abdominal Abbreviated Injury Severity score (2.03 [1.19-3.49]), and subarachnoid hemorrhage (3.36 [1.30-8.70]). Forward stepwise regression demonstrated that Abbreviated Injury Severity spine (3.48 [1.14-10.58]) and midline shift on CT (8.35 [1.05-66.59]) were significantly associated with mortality. Number of fixed pupils (one fixed pupil 3.47 [0.79-15.30]; two fixed pupils 13.61 [2.89-64.07]), hypoxia (5.22 [1.02-26.67]), and subarachnoid hemorrhage (3.01 [1.01-9.01]) were independently associated with worse Glasgow Outcome Scale-Extended Pediatric Revision following forward stepwise regression. CONCLUSIONS: Severe traumatic brain injury is a clinically heterogeneous disease that can be accompanied by a range of neurologic impairment and a variety of injury patterns at presentation. This secondary analysis of prospectively collected data identifies several characteristics associated with outcome among children with severe traumatic brain injury. Future, larger trials are needed to better characterize phenotypes within this population.
Assuntos
Lesões Encefálicas Traumáticas/terapia , Hipotermia Induzida/métodos , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/mortalidade , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Humanos , Hipóxia/epidemiologia , Escala de Gravidade do Ferimento , Masculino , Medição de Risco , Traumatismos da Coluna Vertebral/epidemiologia , Tomografia Computadorizada por Raios XRESUMO
STUDY OBJECTIVES: The neurobiological mechanisms of insomnia may involve altered patterns of activation across sleep-wake states in brain regions associated with cognition, self-referential processes, affect, and sleep-wake promotion. The objective of this study was to compare relative regional cerebral metabolic rate for glucose (rCMRglc) in these brain regions across wake and nonrapid eye movement (NREM) sleep states in patients with primary insomnia (PI) and good sleeper controls (GS). METHODS: Participants included 44 PI and 40 GS matched for age (mean = 37 y old, range 21-60), sex, and race. We conducted [18F]fluoro-2-deoxy-D-glucose positron emission tomography scans in PI and GS during both morning wakefulness and NREM sleep at night. Repeated measures analysis of variance was used to test for group (PI vs. GS) by state (wake vs. NREM sleep) interactions in relative rCMRglc. RESULTS: Significant group-by-state interactions in relative rCMRglc were found in the precuneus/posterior cingulate cortex, left middle frontal gyrus, left inferior/superior parietal lobules, left lingual/fusiform/occipital gyri, and right lingual gyrus. All clusters were significant at Pcorrected < 0.05. CONCLUSIONS: Insomnia was characterized by regional alterations in relative glucose metabolism across NREM sleep and wakefulness. Significant group-by-state interactions in relative rCMRglc suggest that insomnia is associated with impaired disengagement of brain regions involved in cognition (left frontoparietal), self-referential processes (precuneus/posterior cingulate), and affect (left middle frontal, fusiform/lingual gyri) during NREM sleep, or alternatively, to impaired engagement of these regions during wakefulness.
Assuntos
Encéfalo/metabolismo , Metabolismo Energético/fisiologia , Glucose/metabolismo , Tomografia por Emissão de Pósitrons/métodos , Distúrbios do Início e da Manutenção do Sono/metabolismo , Sono/fisiologia , Adulto , Encéfalo/diagnóstico por imagem , Feminino , Fluordesoxiglucose F18/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Vigília/fisiologia , Adulto JovemRESUMO
OBJECTIVES: The purpose of this study was to critically evaluate the efficacy of single screw and washer fixation in comparison with other methods for securing olecranon osteotomies. The hypothesis is that screw and washer fixation is a safe and effective means of olecranon osteotomy fixation with fusion and complication rates similar to other methods of fixation. DESIGN: Retrospective review. SETTING: Two Level I Urban Trauma Centers. PATIENTS/PARTICIPANTS: Patients were treated within the last 20 years and received 1 of 4 types of fixation (screw and washer alone, screw and washer augmented with tension band, tension band alone, or plate and screws) after osteotomy. INTERVENTION: Open reduction and internal fixation of OTA/AO 13B/C distal humerus fractures with an olecranon osteotomy. MAIN OUTCOME MEASUREMENTS: The primary outcome measure was the presence of osteotomy union. Secondary outcome measures were olecranon nonunion, loss of articular reduction, and removal of hardware. Logistic regression was used to determine the associations between method of osteotomy fixation and removal of hardware or nonunion rates. Comorbidities were stratified using the Charlson comorbidity index. RESULTS: One hundred sixty patients met the inclusion criteria. Thirty-nine patients underwent screw fixation alone, 47 had tension band fixation, 16 had plate fixation, and 58 had tension band and screw fixation. Screw fixation demonstrated equal or better rates of union, maintenance of reduction, absence of infection, and implant removal compared with alternative fixation techniques. Higher Charlson scores were associated with higher rates of nonunion. CONCLUSIONS: Screw and washer fixation is a safe and effective means of securing an olecranon osteotomy. Charlson comorbidity score is one factor that may influence the development of nonunion after osteotomy. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.