Hospital Volume-Outcome Relationship in Severe Traumatic Brain Injury: A Nationwide Observational Study in Japan.

Objective: The hospital volume-outcome relationship in patients with severe traumatic brain injury (TBI) remains unclear. This study investigated the association between the volume of patients with severe TBI and in-hospital mortality.

Methods: This observational study identified patients with severe TBI (Glasgow Coma Scale score <9 and Abbreviated Injury Scale head score ≥3) from the Japan Trauma Databank (2010-2018).

Older Adults with Traumatic Brain Injury in the Most Aged and Most Rapidly Aging Country: An Analysis of the Nationwide Trauma Registry of Japan.

Background: Despite the increasing numbers of older adults with traumatic brain injury (TBI), minimal data are available to support the development of treatment strategies. We aimed to comprehensively describe the incidence, characteristics, outcomes, and predictive accuracy of the severity indicators among older adults with TBI.

Methods: Using the Japan Trauma Data Bank, we identified patients aged ≥18 years with TBI from 2004 to 2019.

Derivation and validation of a quantitative screening model for blunt cerebrovascular injury.

Objective: The objective of this study was to derive and validate a new screening model using a nomogram that allows clinicians to quantify the risk of blunt cerebrovascular injury (BCVI).

Methods: In this study, the authors examined 258,935 patients from a prospectively collected nationwide Japanese database (January 2009-December 2018) who experienced blunt injury. Patients were randomly divided into training (n = 129,468) and validation (n = 129,467) cohorts.

Acceptable Blood Pressure Levels in the Prehospital Setting for Patients with Traumatic Brain Injury: A Multicenter Observational Study.

Background: Safe blood pressure levels in the prehospital setting for patients with traumatic brain injury (TBI) remain unclear. We aimed to investigate the association between prehospital blood pressure and the outcomes of patients with TBI to determine optimal threshold for hypotension that could be considered in the prehospital setting.

Methods: Using data from the Japan Trauma Data Bank, we identified adult patients (aged ≥18 years) who experienced severe TBI (maximum head Abbreviated Injury Severity score ≥3) and were transported directly from the scene of the blunt trauma occurrence to the hospital, between 2004 and 2019.

Long-term Functional Outcomes for World Federation of Neurosurgical Societies Grade V Aneurysmal Subarachnoid Hemorrhage after Active Treatment.

This study investigated the long-term outcomes of patients with World Federation of Neurosurgical Societies (WFNS) grade V aneurysmal subarachnoid hemorrhage (SAH) who underwent early aneurysm repair. We evaluated consecutive patients with WFNS grade V aneurysmal SAH from April 2010 to March 2015 who underwent aneurysm repair within 72 h after onset. We assessed the functional outcomes at discharge and 3 years after onset using the modified Rankin Scale (mRS).

Sumo-Associated Traumatic Vertebral Artery Dissection Precipitating Subarachnoid Hemorrhage in Association with Bifid Origins of the Posterior Inferior Cerebellar Artery.

Background: Traumatic vertebral artery dissection (tVAD) is frequently accompanied by cerebellar infarction, but subarachnoid hemorrhage (SAH) is rare.

Case Description: We report a unique case of tVAD precipitating SAH, from which the patient fully recovered, most likely because of the protective effects of an anomalously duplicated posterior inferior cerebellar artery (PICA) origin. A 17-year-old Sumo wrestler experienced a brief loss of consciousness after an attack by an opponent to his neck.

Can the shock index be a reliable predictor of early mortality after trauma in older patients? A retrospective cohort study.

Aim: Older patients have different physiological characteristics; thus, the reliability of the shock index (SI) to predict mortality could depend on age. We investigated whether the SI is a reliable predictor of early mortality in older patients and evaluated the clinical benefit of age in the interpretation of the SI.

Methods: Using data from the Japan Trauma Data Bank, we identified injured patients aged 20-84 years.

A Successful Treatment Strategy for Paradoxical Cerebral Embolism Accompanied by Entrapped Thrombus in Patent Foramen Ovale.

A 73-year-old man was transferred to our hospital with dyspnea and left hemiplegia. The diagnosis of pulmonary embolism, entrapped thrombus in patent foramen ovale (PFO), and internal carotid artery occlusion was made by imaging studies. We decided to perform endovascular treatment without the administration of tissue plasminogen activator (tPA) for cerebral embolism because of concern about further embolism caused by fragmented thrombi.

Initial Results of Empirical Cryoprecipitate Transfusion in the Treatment of Isolated Severe Traumatic Brain Injury: Use of In-house-produced Cryoprecipitate.

Acute coagulopathy is common after traumatic brain injury (TBI), particularly in severe cases of acute subdural hemorrhage (ASDH). Although acute coagulopathy is associated with poor outcomes, the optimal treatment strategy remains unknown. Here, we report the initial results of an empirical cryoprecipitate transfusion strategy that we developed as an early intervention for acute coagulopathy after TBI.

In-hospital mortality and length of hospital stay with craniotomy versus craniectomy for acute subdural hemorrhage: a multicenter, propensity score-matched analysis.

Objective: The optimal surgical treatment for acute subdural hemorrhage (ASDH) remains controversial. The purpose of this study was to compare outcomes in patients who underwent craniotomy with those in patients who underwent decompressive craniectomy for the treatment of ASDH.

Methods: Using the Japan Trauma Data Bank, a nationwide trauma registry, the authors identified patients aged ≥ 18 years with ASDH who underwent surgical evacuation after blunt head trauma between 2004 and 2015.

Bilateral Internal Carotid and Left Vertebral Artery Dissection after Blunt Trauma: A Case Report and Literature Review.

Multi-vessel cervical arterial injury after blunt trauma is rare, and its pathophysiology is unclear. Although blunt cerebrovascular injury is a common cause of cerebral ischemia, its management is still controversial. We describe a 23-year-old man in previously good health who developed three-vessel cervical arterial dissections due to blunt trauma.

Defining Hypotension in Patients with Severe Traumatic Brain Injury.

Background: Hypotension, a risk factor for increased mortality following traumatic brain injury (TBI), is traditionally defined as systolic blood pressure (SBP) <90 mm Hg. We aimed to redefine hypotension and determine its optimal threshold in patients with TBI.

Methods: We identified patients with severe TBI (Glasgow Coma Scale score ≤8 on admission) between 2004 and 2015 using data from the Japan Trauma Data Bank.

Traumatic Posterior Fossa Subdural Hemorrhage: A Multicenter, Retrospective Cohort Study.

Background: Traumatic posterior fossa subdural hemorrhage (SDH) is a rare subtype of subdural hemorrhage in head injuries. Existing data on its pathophysiology and outcome are currently limited; therefore, the condition is not yet fully understood. The present study aimed to determine the incidence, outcome, and prognostic factors for traumatic posterior fossa SDH.

Intraventricular Hemorrhage After Head Injury: A Multicenter, Retrospective, Cohort Study.

Background: Data on traumatic intraventricular hemorrhage (IVH) are currently limited, and therefore, the condition is not fully understood. The aim of this study was to determine the epidemiology of traumatic IVH and its effects on outcome in patients with blunt head trauma.

Methods And Materials: Using a nationwide trauma registry-the Japan Trauma Data Bank, we identified patients who underwent head computed tomography (CT) after blunt head trauma and had intracranial injuries between 2004 and 2015.

Serious Concomitant Injuries in Pediatric Patients with Severe Traumatic Brain Injury.

Background: Severe traumatic brain injury (TBI) is a leading cause of death among children. Although several studies have reported the negative effects of concomitant injuries on mortality in adults with TBI, their effect on pediatric patients remains unclear. Our objective was to describe the effect of serious concomitant injuries on outcomes in pediatric patients with severe TBI.

Multicenter Retrospective Cohort Study of "Talk and Die" After Traumatic Brain Injury.

Background: Patients who "talk and die" after traumatic brain injury (TBI) are potentially salvageable. The reported incidences and risk factors for the "talk and die" phenomenon are conflicting and do not take into account recent improvements in trauma care. The aim of this study was to determine the incidences of "talk and die" after TBI in a modern trauma care system, as well as associated risk factors.

Skeletal Muscle as a Factor Contributing to Better Stratification of Older Patients with Traumatic Brain Injury: A Retrospective Cohort Study.

Background: Traumatic brain injury (TBI) in older patients is becoming an increasing problem, and methods that help predict outcomes in this population are needed. The objective of this study was to evaluate skeletal muscle mass as a predictive marker for TBI outcome in older patients.

Methods: Older patients (age ≥60 years) with TBI were included in this study.

Emergency Trepanation as an Initial Treatment for Acute Subdural Hemorrhage: A Multicenter Retrospective Cohort Study.

Background: Rapid decompression with trepanation and drainage in an emergency room has been proposed as a potentially effective initial intervention for early-stage acute subdural hemorrhage; however, the actual safety and efficacy of the procedure remain unclear. The aim of this study was to evaluate the feasibility of emergency trepanation as an initial treatment for acute subdural hemorrhage.

Methods: We investigated patients with thick subdural hemorrhages who had undergone craniotomy between 2004 and 2015 in Japan using a nationwide trauma registry (the Japan Trauma Data Bank).

Cranioplasty Outcomes and Analysis of the Factors Influencing Surgical Site Infection: A Retrospective Review of More than 10 Years of Institutional Experience.

Background: As a large amount of clinical evidence supports the use of craniectomy, the frequency of subsequent cranioplasty is increasing. Conflicting complication rates and risk factors of cranioplasty have been reported. We reviewed >10 years of institutional experience to identify risk factors of surgical site infection (SSI) after cranioplasty.

The Serum Phosphorylated Neurofilament Heavy Subunit as a Predictive Marker for Outcome in Adult Patients after Traumatic Brain Injury.

The serum phosphorylated neurofilament heavy subunit (pNF-H) is a nervous system-specific protein that is released from damaged neural tissue after traumatic brain injury (TBI). The aim of this study was to elucidate the usefulness of serum pNF-H as a predictive marker for the outcome of patients after TBI. Patients with TBI (Glasgow Coma Scale score of 13 or less on admission) were included.

Contralateral subdural hematoma development following unilateral acute subdural hematoma evacuation.

The development of a contralateral subdural hematoma (SDH) following unilateral acute SDH evacuation represents a devastating complication that requires urgent treatment in traumatic brain injury. However, few studies have attempted to analyze the risk factors for this phenomenon. The goal of this study was to determine the incidence, mortality and predictive risk factors of delayed SDH contralateral to the side of surgery.