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Biomedical subjects

R W Rimel

Publications and source records attributed to R W Rimel.

At least 19 recordsLinked to original sources
PubMed1996

Neuropsychological functioning and recovery after mild head injury in collegiate athletes.

OBJECTIVE: This study prospectively examined neuropsychological functioning in 2300 collegiate football players from 10 National Collegiate Athletic Association Division A universities. The study was designed to determine the presence and duration of neuropsychological symptoms after mild head injury. METHODS: A nonequivalent repeated measures control group design was used to compare the neuropsychological test scores and symptoms of injured players (n = 183) with those of gender, age, and education matched controls. A number of neuropsychological tests, including the Paced Auditory Serial Addition Test, the Digit Symbol Test, and the Trail Making Test, as well as a symptom checklist were used. TECHNIQUE: Players and controls were assessed before engaging in game activity and 24 hours, 5 days, and 10 days after injury, using the standardized test battery and symptom checklist. RESULTS: Players with head injuries displayed impaired performance and increased symptoms in comparison to controls, but this impairment resolved within 5 days in most players. Players with head injuries showed significant improvement between 24 hours and 5 days, as well as between 5 and 10 days. CONCLUSION: Although single, uncomplicated mild head injuries do cause limited neuropsychological impairment, injured players generally experience rapid resolution of symptoms with minimal prolonged sequelae.

Adolescent↗
PubMed1987

University of Virginia prospective study of football-induced minor head injury: status report.

We have recently completed the field work phase of a 4-year prospective study of football-induced minor head injuries. Players from 10 University football teams were monitored up to 4 years, and a brief neuropsychological and psychosocial assessment battery was administered to them up to five times before and after injury. Objectives of this project focus on the frequency of head injuries in college football, the impairments that might result from such injury, the duration of impairments, the time course of their recovery, and the possibility of cumulative effects of multiple injuries during the player's college career. Approximately 2500 players were monitored during the study, and nearly 200 players were restudied following minor head injuries. A series of nearly 60 players with orthopedic injuries were tested using the same protocol, and a college student control series of 50 patients were similarly studied. Data analyses are currently underway, and the first report of the findings of this study will be available soon. This article has described the objectives and design of this study, outlined the neuropsychological and psychosocial assessment protocol, and discussed some of the issues related to project implementation. Current data analyses focus on the size of the effects of minor head injury on cognitive and psychosocial performance observed following minor head injury. Upon completion of the initial data analyses, our analysis plan includes having at least two neuropsychologists make independent assessments of the clinical significance of the findings. Similar assessments will be made of the neurophysical symptoms and complaints and psychosocial performance of players after injury.

Academic Medical Centers↗
PubMed1986

Neurosurgical complications after apparently minor head injury. Assessment of risk in a series of 610 patients.

A small number of patients with an apparently minor head injury will develop a life-threatening intracranial hematoma that must be rapidly detected and removed. To assess the risk of a significant intracranial neurosurgical complication after apparently minor head injury, the authors collected data prospectively on 610 patients who had sustained a transient posttraumatic loss of consciousness or other neurological function and who had a Glasgow Coma Scale (GCS) score of 13, 14, or 15 in the emergency room. Skull x-ray films were obtained in 583 patients, 66 of whom (10.8% of the study population) had cranial fractures. Eighteen of the 610 patients (3.0%) required a neurosurgical procedure. Three acute subdural hematomas, one epidural hematoma, and one traumatic intracerebral hematoma required craniotomy. Of the 66 patients who had skull fracture, 7.6% required a craniotomy for intracranial hematoma. Thirteen (19.7%) of the 66 patients with skull fracture required an operative procedure as compared to five (1.0%) of the 517 patients without skull fracture. Two patients with a normal GCS score of 15 and normal skull x-ray films subsequently underwent operative treatment. The cost of three alternative management schemes for these patients was estimated. A 50% reduction in cost of management could be effected by the use of computerized tomography (CT) scans (or possibly skull x-ray films) in determining which of the patients who are alert at the time of presentation should be admitted for observation. Several other conclusions can be drawn from this study. First, an initial GCS score between 13 and 15 does not necessarily indicate that a patient has sustained a trivial head injury, since 3% of such patients will require an operative procedure despite an initially normal level of alertness. Second, an abnormal skull x-ray film increases by a factor of 20 the probability that a patient will need neurosurgical treatment. Third, it is very unusual for patients who have a GCS score of 15 and a normal skull x-ray film to have a significant neurosurgical complication. Fourth, the alternative management schemes that depend on selective use of skull films and CT scans may significantly reduce the cost of caring for patients with minor head injury.

Adolescent↗
PubMed1984

Epidemiologic features of head injury in a predominantly rural population.

The characteristics of occurrence of head trauma were studied in north central Virginia. In 1978, 735 cases of head trauma were identified with documented head injuries occurring within the defined service area, and with a minimum overnight hospital stay. Overall occurrence was 208/100,000 population. The highest occurrence was found in the 15-19 age group (407/100,000). Nonwhites showed higher rates than whites. Motor vehicle crashes were the most frequent mechanism of injury (55% of patients) followed by falls (20%), and interpersonal violence (11%). Short-term time trends reveal unique daily, weekly, and seasonal patterns for motor vehicle crashes, falls, and interpersonal violence. Selected prevention strategies are discussed. The use of passive restraints in motor vehicles is recommended as one important means of reducing the occurrence and severity of head injuries.

Adolescent↗
PubMed1982

Prognosis in head injury.

The prognosis of head injury when viewed from the perspective of the Glasgow Coma Scale confirms the utility of this measure. In particular, decrease in mortality is associated with an increase in GCS. In addition, the motor score portion of the GCS was of predictive value when taken alone. The outcome of patients in coma (GCS less than 8) was closely related to three preventable or treatable factors, namely, hypoxia, shock, and increased intracranial pressure. These three factors, when considered in combination, powerfully predicted mortality. Of considerable interest was the finding that moderate head injury (GCS 9-12) was associated with a small but perhaps preventable mortality. The morbidity was intermediate between that of severe and minor and was surprisingly high. Minor head injury, while not associated with significant mortality, also resulted in considerable morbidity. Neuropsychological evaluation of the patients and an experimental study suggests that an organic component may be involved even in this group. To deal with head injury, distinctions must be made between grades of severity. The Glasgow Coma Scale is suited for this task. Nonetheless, the recognition of this basic continuity should elicit the further recognition that different health providers may be involved in the case of, say, severe, as opposed to mild, injury, and that different outcome measures are suitable for one group but not another.

Craniocerebral Trauma↗
PubMed1982

Moderate head injury: completing the clinical spectrum of brain trauma.

We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3-8; moderate, 9-12; and minor, 13-15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow-up examinations at 3 months. In contrast to patients with minor head injury, half as many were students (17%) and twice as many were intoxicated (53%). Seventy-five patients were studied with computed tomographic (CT) scanning; 30% of the scans were negative and 31% showed a space-occupying mass. As reported by Gennarelli et al. in patients with severe head injuries, those with moderate head injury and subdural hematoma had a very poor outcome: 65% died or were severely disabled and none made a good recovery as measured by the Glasgow Outcome Scale. At 3 months, 38% of the moderate head injury patients had made a good recovery compared with 75% of the minor head injury patients. Within the good recovery category, however, there was much disability (headache, 93%; memory difficulties, 90%; difficulties with activities of daily living, 87%), and only 7% of the patients were asymptomatic. The Halstead-Reitan Neuropsychological Battery in an unselected subset (n = 32) showed significant deficits on all test measures. Sixty-six per cent of the patients previously employed had not returned to work, compared to 33% of the minor head injury patients. The major predictors of unemployment after minor head injury were premorbid characteristics (age, education, and socio-economic status). In contrast, all predictors in moderate head injury were measures of the severity of injury (length of coma, CT diagnosis, GCS on discharge). We conclude that: (a) moderate head injury, not described previously in the literature, results in mortality and substantial morbidity intermediate between those of severe and minor head injury; (b) unlike minor head injury, the principal predictors of outcome after moderate head injury are measures of the severity of injury; and (c) more attention should be directed to patients with moderate head injury than to those with the most severe injuries, in whom brain damage is probably irreversible and all forms of management have demonstrated little success.

Accidents, Traffic↗
PubMed1981

An educational training program for the care at the site of injury of trauma to the central nervous system.

The treatment of head and spinal cord injuries must be directed towards prevention of secondary insults which will increase the extent of permanent disability. Improved extrication techniques at the scene of the accident, earlier recognition and treatment of complications and improved transfer management have all reduced the acute morbidity and mortality of injuries to the central nervous system. At the University of Virginia we have implemented a comprehensive training program in the acute care of the head and spinal cord injured patient for Emergency Medical Technicians (EMT), nurse, community referring physicians, and house staff within the medical center. A booklet, prepared for care at the site of injury, outlines the assessment, care and intervention with the head and spinal injury patient for the EMT. Another booklet provides guidelines for care of the patient in the emergency department. Included here are instructions in respiratory care, adequate circulation and spinal splinting. The greatest emphasis is placed on the history and physical examinations, which documentation of the extent of neurologic deficit, including the Glasgow coma scale. Data on 900 pre-hospital calls by volunteer EMTs demonstrate a 90% compliance in basic life support skills outlined in the educational program. A similar compliance has been achieved with referring physicians and house staff in the medical center, in the acute management of the CNS injured patient, due primarily to this educational program and increase in the optimal care of these patients has resulted.

Accidents↗
PubMed1981

Emergency management of head injuries.

Sophisticated care of the head injury patient in the emergency department does not demand sophisticated knowledge of neurosurgery. Instead it depends upon: (1) Meticulous attention to the fundamental principles of resuscitation; (B) Prevention of secondary cardiopulmonary abnormalities which can further injure the traumatized brain; (C) Performance of serial neurologic examinations. (In the case of acute head injury, a simple neurologic examination performed repeatedly usually provides the physician with more useful information than a more elaborate examination performed only once). (D) Consultation with the neurosurgeon. If there is any possibility that neurosurgical consultation might enhance the emergency department management of the patient, one should not hesitate to contact him. There is no question that protocols for any phase of emergency management of central nervous system (CNA) trauma are of no values unless there is a high degree of compliance. This can only be achieved through persons dedicated to training emergency medical technicians, nurses and physicians in the optimal care that can be afforded these patients. If advances are to be made in decreasing the morbidity and mortality of the CNS trauma patient, those actively involved in emergency medicine are going to have to take an active role in training programs, seminars and clinical practice for physicians, emergency department nurses, and emergency medical technicians.

Coma↗
PubMed1980

The evolving role of the nurse practitioner in neurosurgery.

The authors examine the many important roles for the nurse practitioner in neurosurgery, including patient care in academic departments and private practice, and research and scholarship. The responsibilities of nurse practitioners in a hospital can be varied: they may take some responsibility for all patients on the neurosurgery service, or their assignment may be more specific, such as to the intensive care unit; or they may be assigned to all patients with a specified neurosurgical disorder, such as head injury of intractable pain. Nurse practitioners can become coordinators of clinical research programs, with responsibility for collecting and collating the data and assisting in data analysis and manuscript preparation. Detailed clinical protocols must be developed for nurse practitioners, and those protocols then become the basis for their employment and legal status. Licensure requirements vary greatly among states, and are continuing to change.

Humans↗
PubMed1979

An injury severity scale for comprehensive management of central nervous system trauma.

The Glasgow Coma Scale (GCS) is used in central Virginia by emergency medical technicians (EMT's), emergency department personnel and neurosurgical staff to evaluate patients with central nervous system (CNS) trauma. In a series of 406 patients admitted to the neurosurgical services at the University of Virgina Hospital between October 1977 and February 1978, a GCS score was recorded by the neurosurgeon, nurse, and EMT. All 250 data points, including clinical diagnosis and incidence of associated injuries were entered into our information system analysis. The scale can be easily mastered by all members of the emergency medical team giving reproducible results. It also appears to be a valid predictor of the ultimate outcomes of head injury. The GCS has substantial clinical value in the management of the nuerotrauma patient. It is presently being employed in all phases of the emergency medical system to monitor the progression of the neurologic injury. Ultimately, this injury severity scoring system will be used to standardize patient populations in well controlled clinical studies in which different treatment parameters will be assessed.

Adolescent↗
PubMed1979

The neurologic examination in patients with central nervous system trauma.

The neurological assessment of the head injured patient must be integrated into the emergency management and daily care of the patient. Neurosurgical nurses are in the best position to perform serial neurologic examinations and assess changes in the patient's clinical picture. If this added responsibility is assumed, neurosurgical nurses must take an active role in improving assessment skills. The improved assessment of the head injured patient will result in early intervention in the patient's course to avert potential problems, thus resulting in improved morbidity and eventual outcome. As neurosurgical nurses expand their roles in nursing, improved patient assessments are mandatory to deliver optimal patient care.

Humans↗