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Chantal W. P. M. Hukkelhoven, Ewout W. Steyerberg, Anneke J. J. Rampen, Elana Farace, J. Dik F. Habbema, Lawrence F. Marshall, Gordon D. Murray, and Andrew I. R. Maas

I ncreasing age is associated with worse outcome in patients with systemic diseases such as cancer, coronary heart disease, and neurological diseases such as SAH, TBI, and dementia. 1, 5, 10, 11, 20, 37, 38, 42, 43, 46 Traumatic brain injury is a major health and socioeconomic problem throughout the world and is the leading cause of death and disability in younger patients in more economically developed countries. It remains unclear how the association between patient age and outcome after closed TBI can be described best, however. In some studies researchers

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Chantal W. P. M. Hukkelhoven, Ewout W. Steyerberg, Elana Farace, J. Dik F. Habbema, Lawrence F. Marshall, and Andrew I. R. Maas

bicycles and mopeds. Traumatic brain injuries caused by falls were more common in Europe (20% in the ES compared with 15% in the NAS), whereas assaults were more common in North America (11% in the NAS and 2.6% in the ES [ Table 3 ]). The proportion of patients with secondary insults (hypoxia or hypotension) or the absence of pupillary reactivity was larger in North America than in Europe. The incidence of traumatic SAH and the status of the basal cisterns were similar between continents; however, in Europe mass lesions were noted more frequently (46% in the ES compared

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Lawrence F. Marshall

, Ahmed H , Bahari A , Prevedello DM , : Outcome following decompressive craniectomy in children with severe traumatic brain injury: a 10-year single-center experience with long-term follow up . J Neurosurg 106 : 4 Suppl 268 – 275 , 2007 2 Juul N , Morris GF , Marshall SB , Marshall LF : Intracranial hypertension and cerebral perfusion pressure: influence on neurological deterioration and outcome in severe head injury. The Executive Committee of the International Selfotel Trial . J Neurosurg 92 : 1 – 6 , 2000

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Lawrence F. Marshall

hyperventilation after severe traumatic brain injury. J Neurosurg 96 : 103 – 108 , 2002 Diringer MN, Videen TO, Yundt K, et al: Regional cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury. J Neurosurg 96:103–108, 2002 See the corresponding article in this issue, pp 376–383.

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and much less expensive than any technique based on CPP management alone. References 1. Bouma GJ , Muizelaar JP , Choi SC , et al : Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg 75 : 685 – 693 , 1991 Bouma GJ, Muizelaar JP, Choi SC, et al: Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg 75: 685–693, 1991 2. Cruz J : The first decade of continuous monitoring of jugular bulb oxyhemoglobin saturation: management

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Azadeh Farin, Reena Deutsch, Anat Biegon, and Lawrence F. Marshall

differences in traumatic brain injury outcome. J Neurosurg 93 : 539 – 545 , 2000 Farace E, Alves WM: Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg 93: 539–545, 2000 6. Farlow MR , Lahiri DK , Poirier J , et al : Treatment outcome of tacrine therapy depends on apolipoprotein genotype and gender of the subjects with Alzheimer's disease. Neurology 50 : 669 – 677 , 1998 Farlow MR, Lahiri DK, Poirier J, et al: Treatment outcome of tacrine therapy

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Niels Juul, Gabrielle F. Morris, Sharon B. Marshall, the Executive Committee of the International Selfotel Trial, and Lawrence F. Marshall

, 1999 Morris GF, Bullock R, Marshall SB, et al: Failure of the competitive N -methyl- d -aspartate antagonist Selfotel (CGS 19755) in the treatment of severe head injury: results of two Phase III clinical trials. J Neurosurg 91: 737–743, 1999 15. Morris GF , Juul N , Marshall SB , et al : Neurological deterioration as a potential alternative endpoint in human clinical trials of experimental pharmacological agents for treatment of severe traumatic brain injuries. Neurosurgery 43 : 1369 – 1374 , 1998 Morris GF, Juul N, Marshall SB, et al: Neurological

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Cecilia L. Dalle Ore, Robert C. Rennert, Alexander J. Schupper, Brandon C. Gabel, David Gonda, Bradley Peterson, Lawrence F. Marshall, Michael Levy, and Hal S. Meltzer

T raumatic subarachnoid hemorrhage (tSAH) occurs in almost 6% of patients with traumatic brain injury (TBI), 21 and in as many as 30%–60% of patients with moderate to severe TBI, 4 , 28 and is a common sequela of pediatric head injury. 4 , 28 The presence of tSAH following neurotrauma has been linked to unfavorable outcomes, including severe disability and death, 4 , 16 , 27 , 28 and patients with tSAH are at theoretical risk for rebleeding, ischemic complications, and posttraumatic hydrocephalus. 4 Due to concerns over neurological deterioration, pediatric

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Howard M. Eisenberg, Ralph F. Frankowski, Charles F. Contant, Lawrence F. Marshall, Michael D. Walker, and Comprehensive Central Nervous System Trauma Centers

doses of mannitol, were hyperventilated, and in many cases had drainage of ventricular fluid before randomization. Furthermore, as presented in the introduction, there is now evidence that in the setting of traumatic brain injury pressures even lower than formerly presumed to be safe may be harmful. 10, 20 How do the data from this study compare with other clinical studies designed to examine the effect on ICP in patients with severe head injuries? Nonrandomized studies from San Diego 19 and Minnesota 18 both indicated a somewhat greater drug efficacy than did our