[Dangers of safety].
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Accident Prevention↗
Biomedical subjects
T Ingebrigtsen
Publications and source records attributed to T Ingebrigtsen.
[Epidemiology of head injuries in Troms].
This retrospective population-based survey describes the epidemiology of head injury in a defined population in Troms. It includes all 247 patients with head injury referred to the University Hospital of Tromsø during 1993. Head injury was defined as physical damage to the brain or skull caused by external force. The annual incidence rate of hospital-referred head injury was 229/100,000 population with a male preponderance of 1.7:1.0. Causes were fall in 62%, traffic accident in 21%, and assault in 7% of the cases. The observed incidence rate is low despite the use of wide inclusion criteria, probably due to a decrease in road traffic accidents and fewer referrals. A further decrease in the number of head injuries in our region may be achieved by preventing falls.
Adolescent↗
[Management of minor head injuries in Norwegian hospitals--can the quality be improved?].
Management protocols for minor head injury should include strategies for early detection of intracranial haematomas. This study focuses on the management of minor head injury in 63 Norwegian hospitals. We report considerable inter-hospital variation. In most (81%) hospitals, minor head injury patients were treated by general surgeons. Emergency room evaluation included routine radiological evaluation, usually skull radiography, in 18 (29%) hospitals, and assessment according to the Glasgow Coma Scale (GCS) in 27 (43%). GCS was used during in-hospital observation in 32 (51%) hospitals. 33 (52%) discharged selected minor head injury patients without in-hospital observation. We conclude that the quality of care for minor head injury patients in Norwegian hospitals can be improved through extended use of routine early CT and consistent evaluation according to GCS.
Brain Injuries↗
Traumatic brain damage in minor head injury: relation of serum S-100 protein measurements to magnetic resonance imaging and neurobehavioral outcome.
OBJECTIVE: The present study was conducted to validate S-100 protein as a marker of brain damage after minor head injury. METHODS: We studied 50 patients with minor head injuries and Glasgow Coma Scale scores of 13 to 15 in whom computed tomographic scans of the brain revealed no abnormalities. Serum levels of S-100 protein were measured at admittance and hourly thereafter until 12 hours after injury. Magnetic resonance imaging and baseline neuropsychological examinations were performed within 48 hours, and neuropsychological follow-up was conducted at 3 months postinjury. RESULTS: Fourteen patients (28%) had detectable serum levels of S-100 protein (mean peak value, 0.4 microg/L [standard deviation, +/- 0.3]). The S-100 protein levels were highest immediately after the trauma, and they declined each hour thereafter. At 6 hours postinjury, the serum level was below the detection limit (0.2 microg/L) in five (36%) of the patients with initially detectable levels. Magnetic resonance imaging revealed brain contusions in five patients, four of whom demonstrated detectable levels of S-100 protein in serum. The proportion of patients with detectable serum levels was significantly higher when magnetic resonance imaging revealed a brain contusion. In patients with detectable serum levels, we observed a trend toward impaired neuropsychological functioning on measures of attention, memory, and information processing speed. CONCLUSION: Determination of S-100 protein levels in serum provides a valid measure of the presence and severity of traumatic brain damage if performed within the first hours after minor head injury.
Adolescent↗
Survey of the management of patients with minor head injuries in hospitals in Sweden.
OBJECTIVES: Development of guidelines for quality assurance in head injury care has to be based on knowledge about how today's management is organized. To address the need for guidelines in minor head injury (MHI), the authors studied management practice in Sweden. METHODS: We performed a cross-sectional mail survey including all 76 hospitals treating head-injured patients. The questionnaire outlined present management practice in MHI; including routines for clinical and radiological examinations, in-hospital observation, discharge criteria and follow-up. RESULTS: The initial evaluation is frequently performed by inexperienced physicians. The level of consciousness is assessed according to the Swedish Reaction Level Scale or the Glasgow Coma Scale in 96% of the hospitals. Routine computerized tomography is used in 4%. Skull radiography is not routinely performed. Eighty percent of the hospitals discharge selected patients without in-hospital observation and most (93%) offer no routine follow-up. CONCLUSIONS: This survey shows a variation in the management of MHI in hospitals in Sweden. Routines for assessment of consciousness level are satisfactory, but CT scan for detection of skull fracture and early diagnoses of intracranial complications is usually not performed. Guidelines should be based on present routines including decision rules for CT scan.
Adult↗
Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients.
Post-concussion symptoms (PCS) (such as headaches, irritability, anxiety, dizziness, fatigue and impaired concentration) are frequently experienced by patients who have sustained a minor head injury (MHI). The post-concussion syndrome has been defined as a clinical state where 3 or more symptoms persist for more than 3 months. This report focuses on the quantification of PCS according to the Rivermead Postconcussion Symptoms Questionnaire (RPQ). We studied 100 consecutive patients with MHI and normal computed tomography of the brain. At 3 months after injury, 62% reported the presence of one or more symptoms, and 40% fulfilled the diagnostic criteria for post-concussion syndrome. Patients with post-concussion syndrome had significantly (P < 0.001) higher RPQ scores (mean 19.1, SD 11.9) than those without (mean 1.2, SD 1.8). Patients on sick leave owing to the injury reported significantly (P = 0.05) higher RPQ scores (mean 10.3, SD 13.2) than those not on sick leave (mean 5.5, SD 8.6). We observed no association between age, gender, cause of injury, severity of injury, duration of amnesia and RPQ score. RPQ score provides useful information about the severity of PCS regardless of whether the diagnostic criteria for the post-concussion syndrome are met or not.
Adolescent↗
The epidemiology of hospital-referred head injury in northern Norway.
This retrospective population-based survey describes the epidemiology of head injury in a defined population in Northern Norway. It includes all 247 patients with head injury referred to the University Hospital of Tromsø, Norway, during 1993. Head injury was defined as physical damage to the brain or skull caused by external force. The annual incidence rate of hospital-referred head injury was 229/100,000 population with a male preponderance of 1.7:1.0. The cause was a fall in 62%, road traffic accident in 21% and assault in 7% of the cases. The observed incidence rate is low despite the use of wide inclusion criteria, probably due to a decrease in road traffic accidents. A further decrease in the number of head injuries in our region may be achieved by preventing falls.
Accidental Falls↗
[Ten years of neurosurgery at the University Hospital in Tromsø. Need for further development].
The Department of Neurosurgery at the University Hospital of Tromsø was established in January 1986 to provide neurosurgical treatment for the population of northern Norway. During the first ten years, 3,225 patients were operated on, including 1,157 craniotomies and 1,335 spinal procedures. The annual number of operations increased from 201 to 442, and the number of hospitalized patients from 265 to 908. The number of patients treated per employee increased by 250%, while the mean duration of hospital stay decreased by 43% to 4.5 days. The growth in activity is expected to continue. This is because of improved diagnostics of nervous system disease, a growing number of elderly patients and new treatment options. The falling number of spinal surgical procedures in local hospitals is also a contributing factor. Neurosurgery is highly cost-effective. It is impossible to make further cost savings without a decline in quality. The department must be expanded to cater for more operations by increasing both the number of beds and employees.
Health Services Needs and Demand↗
Neuropsychological function in patients with increased serum levels of protein S-100 after minor head injury.
Protein S-100 is a calcium binding protein, synthetized in astroglial cells in all parts of the central nervous system (CNS). We have previously reported high serum levels of protein S-100 in patients after minor head injury (MHI). A battery of conventional and computerized neuropsychological measures was administered to two groups of MHI patients. Neuropsychological outcome at 12 months postinjury was examined in a group of 7 patients with increased serum levels of protein S-100 after MHI and 7 age- and sex-matched controls without detectable S-100 in serum after MHI. Our results demonstrate no overall cognitive dysfunction in either of the two groups. Our findings indicate specific dysfunction on measures of reaction time, attention and speed of information processing for the S-100 group. Posttraumatic depression does not explain the neuropsychological differences between the groups. These findings support that increased serum levels of protein S-100 may be of predictive and prognostic value for longlasting neurocognitive abnormalities after minor head injury. Presence of S-100 in serum may indicate the presence of diffuse brain damage. Our results suggest that information processing measures in computerized neuropsychological assessment are more sensitive for detecting small signs of neurocognitive abnormalities after MHI than conventional test batteries.
Adolescent↗
Management of minor head injuries in hospitals in Norway.
Management protocols for minor head injury (MHI) should include strategies for early detection of intracranial hematomas and prevention of persistent sequelae. This study focuses on today's management of MHI in Norwegian hospitals. We report considerable inter-hospital variation in the management of MHI. In most hospitals (81%), MHI patients are treated by general surgeons. The management is focused on the risk of complications in the acute stage. Emergency room evaluation includes assessment according to the Glasgow Coma Scale in 27 (43%) hospitals and routine radiological examination in 18 (29%). Thirty-three (52%) hospitals discharge MHI patients without in-hospital observation. Most hospitals (83%) offer no follow-up. We conclude that the acute care as well as the follow-up of MHI patients can be improved in Norwegian hospitals. Neurosurgeons and neurologists should initiate this process.
Aftercare↗
[Minor head injuries in sport. Occurrence, management, sequelae and prevention].
Approximately 10% of all head injuries are caused during sport and about 10% of all sport-related injuries are head injuries. Most of these are minor head injuries. Many sports involve risk of repeated head injury. The classic punch-drunk syndrome in boxers reflects severe chronic traumatic encephalopathy. Recent research shows that repeated head injury can entail encephalopathy also in other types of athletes. They may experience symptoms such as headache, dizziness, irritability, memory deficit and concentration deficit. Neuropsychological testing reveals such cognitive deficits as impaired memory and attention, and reduced speed of information processing. Persistent sequelae can be prevented by correct management in the acute stage, appropriate follow-up, and prevention of repeated head injuries.
Athletic Injuries↗
Methylprednisolone attenuates airway and vascular responses induced by reactive oxygen species in isolated, plasma-perfused rat lungs.
The effects of methylprednisolone (MP) on the acute airway and pulmonary vascular responses induced by reactive oxygen species (ROS) were investigated in isolated, plasma-perfused rat lungs. ROS were generated by adding xanthine oxidase and hypoxanthine to the perfusate. MP was administered in 3 different ways: 1. Added to the perfusate (1 mg*ml-1) 5 min prior to xanthine oxidase and hypoxanthine, 2. Given as intraperitoneal injections (40 mg*kg-1) to lung donor rats 12 and 2 hours prior to the experiments, or 3. Combining 1 and 2. The lungs were perfused at constant volume inflow (15 ml*min-1). Pulmonary arterial pressure and transpulmonary pressure were followed for 30 min after addition of xanthine oxidase and hypoxanthine. ROS induced a powerful, acute broncho- and vasoconstriction, which was inhibited by addition of MP to the perfusate. Pretreatment with MP also inhibited the vascular and airway responses. Adding MP to the perfusate of pretreated lungs further reduced the ROS-induced smooth muscle constriction. In conclusion, MP inhibits vasoconstriction and bronchoconstriction induced by ROS in isolated rat lungs.
Animals↗
Serial S-100 protein serum measurements related to early magnetic resonance imaging after minor head injury. Case report.
The authors studied 24 patients with a Glasgow Coma Scale score of 14 or 15 and normal computerized tomography scans after minor head injury. The study protocol included obtaining serial measurements of S-100 protein in serum during the first 12 hours after injury and early magnetic resonance (MR) imaging. Four patients (17%) had detectable levels of S-100 protein in serum. The S-100 protein levels were highest immediately after trauma, declining hour by hour. In two patients, MR imaging revealed intracranial contusion. Levels of S-100 protein were not detectable in serum in one patient with MR-verified cerebral contusion, but the first measurements were made late, 6 hours after trauma. The highest serum level of S-100 protein (0.9 microgram/L) was seen in a 73-year-old man 2 hours after injury. Magnetic resonance imaging revealed a contusion of the left cerebellar hemisphere, and the patient suffered permanent sequelae of impaired posture and dizziness.
Adolescent↗
[Minor head injuries. May early CT-scanning replace in-hospital observation?].
A one-year prospective study was undertaken to judge whether in-hospital observation after minor head injury could be partly replaced by early computerized tomography (CT), and if such a practice would save hospital resources. All 146 patients had a Glasgow Coma Score (GCS) > or = 14 and no neurological deficits. 128 had suffered loss of consciousness. CT of 97 (67%) patients revealed intracranial lesions in eight (contusions six, oedema one and epidural haematoma in one). Mean duration of hospitalization was 9.4 days in patients with intracranial lesions and 1.6 days in patients without such lesions. We observed no complications to the head injury in patients with normal CT. There is no need for hospitalization after minor head injury in patients with GCS > or = 14 with no neurological deficits and normal CT. We advocated wide use of early CT in cases of minor head injury, to allow early detection of intracranial haematomas, diagnoses of brain contusions and avoidance of unnecessary hospitalization.
Adult↗
Increased serum concentrations of protein S-100 after minor head injury: a biochemical serum marker with prognostic value?
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Adolescent↗
Large peripheral cystic schwannomas. Two case reports and a review.
Two patients presented with benign cystic schwannomas, which originated from the brachial plexus and the sciatic nerve, respectively. The tumours were single, egg-shaped growths that were excised completely without damage to the nerve. Histopathological examination confirmed the diagnosis of encapsulated, cystic, benign schwannomas. Preoperative magnetic resonance imaging provided useful information and is recommended in the evaluation of peripheral nerve tumours.
Adult↗
Toxic oxygen metabolites increase microvascular permeability in isolated perfused rat lungs: the effect of methylprednisolone.
Toxic oxygen metabolites (TOM) have been suggested to be mediators of permeability edema associated with the adult respiratory distress syndrome (ARDS). Because corticosteroids have possible beneficial effects in ARDS, we have examined the effect of methylprednisolone (MP) on TOM-induced lung edema in isolated, plasma-perfused rat lungs. TOM were generated by adding xanthine oxidase (XO) and hypoxanthine (HX) to the perfusate. Microvascular permeability was assessed by fluid filtration rate (FFR). FFR was determined before and 30 min after administration of XO and HX by measuring the weight increase of the lungs for the last 3 min during a standard 5 min elevation of the outlet pressure. MP was administered in two different ways: 1) Added to the perfusate 5 or 60 min before XO and HX (0.1 and 1 mg ml-1), and 2) given as pretreatment to the rats 12 and 2 hr before preparation of the lungs (40 mg kg -1). XO and HX significantly increased FFR compared to lungs perfused with untreated plasma. Pretreatment with MP significantly attenuated the increase in FFR caused by XO and HX. Addition of MP to the perfusate also inhibited the effect of TOM. This latter protection occurred irrespective of when MP was added before XO and HX. However, when the highest dose of MP was added 5 min before XO and HX, there was a loss of the protective effect. In summary, this study provides evidence that MP may directly prevent microvascular injury induced by TOM in isolated perfused rat lungs. The effect was dependent on the dose of MP applied, but not on when MP was administered prior to exposure to TOM.
Animals↗
Routine early CT-scan is cost saving after minor head injury.
Significant hospital resources are invested in early detection of intracranial complications after minor head injuries (MHI). This study focuses on economic aspects of MHI management. 88 MHI patients underwent routine early CT-scan and at least 24 h in-hospital observation. The cost of this management was calculated, and compared to estimated costs of three alternative management protocols. CT-scans demonstrated intracranial lesions in eight (9%) patients, but none required neurosurgical intervention. The expense of our management was Norwegian Kroner (NOK) 576,136. An alternative management protocol including routing early CT-scan and discharge of patients with normal CT-findings, Glasgow coma score > or = 14 and no neurological deficits, was found to be safe, and estimated to reduce costs with 43% to NOK 326,669. It is concluded that routine early CT-scan is the most reliable and cost saving management procedure after MHI.
Adolescent↗