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Paul M. Brennan, Gordon D. Murray and Graham M. Teasdale

Prognosis and Clinical Trials in TBI). 10 In the CRASH study 10,008 adults with head injury were recruited from 239 hospitals in 49 countries. The IMPACT database, on the other hand, contains data on 11,989 patients with traumatic brain injury (TBI), which were collected prospectively for 11 different studies including 8 randomized controlled trials and 3 epidemiological studies. GCS Score and Pupil Reactivity From the CRASH and IMPACT databases we identified patients for whom both GCS score and pupil reactivity information were available. In the CRASH study, the eye

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Gordon D. Murray, Paul M. Brennan and Graham M. Teasdale

GCS Score In the CRASH study the eye, verbal, and motor components of the Glasgow Coma Scale were recorded for each patient at the time of randomization, from which the GCS total score was calculated. In each of the 11 studies included in the IMPACT database the GCS score was determined at different time periods and the IMPACT model was developed using a “derived GCS score,” defined as the GCS score obtained closest to randomization or on entry into the study. 28 Pupil Reactivity Pupil reaction to light was coded separately for each eye and was recorded at the same

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John C. Andrefsky, Jeffrey I. Frank and Douglas Chyatte

durations (30–45 seconds) of direct light were applied, delayed pupillary reaction occurred in all patients. The consensual response to direct light was preserved during the CSR. Although the CSR did occur spontaneously in our patients, it was most frequently provoked during and after routine nursing care. TABLE 2 Data for pentobarbital coma with burst suppression in 40 trials in six patients * Case No. EEG (bursts/min) PB Level (µg/ml) Pupil Reactivity Duration of CSR (min) 1 1 35.4 yes 0 4 46.7 yes 0 8 36.9 yes 3 2 56.9 no 0 5 48.9 yes 0 3 54.8 yes 0 11 49.4 yes 0 2 5

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center? Also, after the initial enthusiastic “single high dose” of mannitol, there is no mention as to whether it was continued and, if so, at what dose and for what duration in the two groups. In spite of these apparent shortcomings the paper certainly makes one consider mannitol with new respect and appeal when managing acutely head injured patients. References 1. Lieberman JD , Pasquale MD , Garcia R , et al : Use of admission Glasgow Coma Score, pupil size, and pupil reactivity to determine outcome for trauma patients. J

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Anthony A. Figaji, Eugene Zwane, A. Graham Fieggen, Jonathan C. Peter and Peter D. Leroux

's Hospital and the University of Cape Town. Patient Selection Clinical and physiological data were retrospectively obtained from a larger prospective observational study of severe TBI in children at Red Cross Children's Hospital. Patients were included in this study if they met the following criteria: 1) they underwent continuous ICP, CPP, and PbtO 2 monitoring; and 2) the initial injury was classified according to the GCS, motor component of the GCS, PTS, PIM2, pupil reactivity, and the Marshall CT classification of head injury. Each of these grades had to be

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Harald Wolf, Wolfgang Machold, Sophie Frantal, Mathias Kecht, Gholam Pajenda, Johannes Leitgeb, Harald Widhalm, Stefan Hajdu and Kambiz Sarahrudi

record the obtained findings. The inclusion criteria were: blunt head trauma, age > 16 years, GCS score of 13–15, injury within 24 hours prior to admission to the emergency room, a brief neurological examination of the cranial nerves, and strength and sensation in the arms and legs. We recorded pupil reactivity and pupil size. Loss of consciousness (< 5 minutes) was considered if reported by a witness or the patient could not remember the traumatic event (retrograde and/or anterograde amnesia). All participants were asked about nausea. The evaluation included drug or

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Howard J. Senter, Aizik Wolf and Franklin C. Wagner Jr.

3 days: ICP < 12 torr Decadron only 4 9 59 suicide attempt with barbiturates < 10 pupils reactive & midposition; no dolls eye sign or corneal reflexes; flaccid 36 hrs: ICP < 10 torr Decadron only 2 10 3 outpatient tracheostomy obstructed < 15 pupils reactive; intact corneal reflexes & dolls eye sign; decorticate-decerebrate 3 days: ICP < 15 torr Decadron only 2 11 40 accidental drowning < 10 eyes closed; pupils reactive; intact dolls eyes sign and

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Krijn J. van Dongen, Reinder Braakman and Geert Jan Gelpke

the obliteration of cisterns and pupil reactivity ( Table 9 ). TABLE 9 Association between pupil reactivity and state of basal cisterns on admission in 115 patients * State of Cisterns Reacting Pupils Both One or None Total Cases cisterns partially or completely open 40 17 57 cisterns completely obliterated 14 44 58 total cases 54 61 115 * The correlation was significant (p < 0.001). Discussion This study shows that CT findings at

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Kenji Fujimoto, Masaki Miura, Tadahiro Otsuka and Jun-ichi Kuratsu

surgical procedure to evacuate a space-occupying lesion and subsequently had delayed brain swelling. Patient data collected included age, sex, preoperative Glasgow Coma Scale (GCS) score, preoperative pupil reactivity, lesion location, time from head injury to DC, head Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), international normalized ratio of prothrombin time (PT-INR), use of anticoagulants and/or antiplatelet agents prior to head injury, previous medical history, mechanism of trauma incurring injury, and initial and preoperative Rotterdam CT

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Yu-Hua Huang, Tao-Chen Lee, Tsung-Han Lee, Chen-Chieh Liao, Jason Sheehan and Aij-Lie Kwan

morbidity. Trained research staff collected detailed clinical data, including patients' demographic information, underlying medical diseases, mechanisms of injury, ISS, GCS score, and pupil reactivity, from computerized or paper medical records using standardized abstraction forms. The clinical indications of decompressive craniectomy for TBI were as follows: evacuation of an intradural lesion and lowering of elevated and medically refractory intracranial pressure. 19 Primary decompressive craniectomy was defined as surgical decompression, with or without brain tissue