The ever-increasing use of direct (or novel) oral anticoagulants (DOACs) has had a profound effect on primary and secondary prevention of thromboembolic events, especially in the elderly. Whilst many patients benefit from switching over to these newer drugs from older anticoagulants like warfarin, thus foregoing such nuisances as INR-guided dosing, they have also inevitably led… Continue reading Impact of DOACs in TBI in the over 60s
It is widely accepted that hypotension in patients with traumatic brain injury is associated with poorer outcomes, as confirmed in a number of studies. But is there really a reliable cut-off for when we should be happy with a TBI patient´s blood pressure in a prehospital setting? A recent article in JAMA Surgery (Spaite et… Continue reading Prehospital BP and Mortality in TBI: Time to Reevaluate Our Haemodynamic Targets?
After completing recruitment of some 408 TBI patients in 2014, the RESCUEicp group finally published the results from this eagerly awaited trial. The article by Hutchinson et al, titled Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, was published on September 7th in the New England Journal of Medicine. So let´s go straight to the core: The study… Continue reading RESCUEicp Trial Results Finally Out: Craniectomy in TBI Lowers Mortality, But Survivors Suffer Worse Neurological Outcomes
In a recent article in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine by Pakkanen et al, retrospective data from a Finnish prehospital service is presented. They looked at prehospital management of severe TBI (severe head injury with GCS 8 or lower) over a 6-year period, including some 458 patients for analysis. They found a… Continue reading SJTREM: Physician Staffed EMS Associated With Improved Outcomes From TBI
There´s a paucity of guidelines and recommendations on diagnostic pathways in patients on warfarin who sustain head injuries. This article by Alrajhi et al from 2015 (J Emerg Med) looked at an historical cohort of patients on warfarin admitted for either minor (Glasgow Coma Score 13-15, with loss of consciousness, amnesia, or confusion) or minimal (Glasgow Coma Score… Continue reading To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin
The long-awaited Eurotherm trial was published in NEJM in autumn 2015. The premise of the study was to examine the impact of induced hypothermia on outcomes after traumatic brain injury. In a multi center randomized controlled trial patients were allocated to either therapeutic hypothermia (32-35 degrees) or the control group (standard care, normothermia). The study… Continue reading Eurotherm 3235 Trial
SMACC Dublin is behind us. It was a phenomenal 3 days of inspiring talks, discussions and events. Here are a few neuro-related impressions: Martin Smith (Neurocritical Care consultant at the National Hospital for Neurology and Neurosurgery in the UK) gave a solid talk highlighting the challenges pertaining to the concept of brain death, especially the… Continue reading SMACC Dub Neuro Take Home