Extracranial complications of severe head injury

View More View Less
  • 1 Neurochirurgische Klinik, Universitäl Düsseldorf, Düsseldorf, Germany; Division of Neurological Surgery and Department of Community and Family Medicine, University of California, San Diego Medical Center, San Diego, California; University of Texas Medical Branch, Galveston, Texas; University of Virginia School of Medicine, Charlottesville, Virginia; and National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

✓ In order to define the role of intracranial and extracranial complications in determining outcome from severe head injury, 734 patients from the Traumatic Coma Data Bank were analyzed. Nine classes of intracranial and 13 classes of extracranial complications occurring within the first 14 days after admission were analyzed, while controlling for age, admission Glasgow Coma Scale motor score, early hypoxia or hypotension, and severe extracranial trauma. Outcome for survivors was based on the last recorded Glasgow Outcome Scale score, obtained a median of 521 days after injury. Intracranial complications did not significantly alter outcome for the study group. Of the extracranial complications, pulmonary, cardiovascular, coagulation, and electrolyte disorders occurred most frequently at 2 to 4 days. Infections developed later, peaking at 5 to 11 days. Gastrointestinal, renal, and hepatic complications followed no specific time course. Electrolyte abnormalities were the most frequent occurrence (59% of patients) but did not alter outcome. Pulmonary infections (41%), shock (29%, systemic blood pressure ≤ 90 mm Hg for 30 minutes or more), coagulopathy (19%), and septicemia (10%) were significant independent predictors of an unfavorable outcome. Backward-elimination, stepwise logistic regression modeling indicated that the estimated reduction of unfavorable outcome was 2.9% for the elimination of pneumonia, 3.1% for coagulation disturbances, 1.5% for septicemia, and 9.3% for shock. These data suggest that extracranial complications are highly influential in determining the outcome from severe head injury and that significant improvements in outcome in a sizeable proportion of patients could be accomplished by improving the ability to prevent or reverse pneumonia, hypotension, coagulopathy, and sepsis.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    The Abbreviated Injury Scale, 1985 Revision. Arlington Heights, Ill: American Association of Automotive Medicine, 1985 The Abbreviated Injury Scale, 1985 Revision. Arlington Heights, Ill: American Association of Automotive Medicine, 1985

    • Search Google Scholar
    • Export Citation
  • 2.

    Alberico AM, , Ward JD, & Choi SC, et al: Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 67:648656, 1987 Alberico AM, Ward JD, Choi SC, et al: Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 67:648–656, 1987

    • Search Google Scholar
    • Export Citation
  • 3.

    Baigelman W, & O'Brien JC: Pulmonary effects of head trauma. Neurosurgery 9:729740, 1981 Baigelman W, O'Brien JC: Pulmonary effects of head trauma. Neurosurgery 9:729–740, 1981

    • Search Google Scholar
    • Export Citation
  • 4.

    Becker DP, , Miller JD, & Ward JD, et al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491502, 1977 Becker DP, Miller JD, Ward JD, et al: The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502, 1977

    • Search Google Scholar
    • Export Citation
  • 5.

    Berger MS, , Pitts LH, & Lovely M, et al: Outcome from severe head injury in children and adolescents. J Neurosurg 62:194199, 1985 Berger MS, Pitts LH, Lovely M, et al: Outcome from severe head injury in children and adolescents. J Neurosurg 62:194–199, 1985

    • Search Google Scholar
    • Export Citation
  • 6.

    Bloomfield EL: Extracerebral complications of head injury. Crit Care Clin 5:881892, 1989 Bloomfield EL: Extracerebral complications of head injury. Crit Care Clin 5:881–892, 1989

    • Search Google Scholar
    • Export Citation
  • 7.

    Born JD, , Albert A, & Hans P, et al: Relative prognostic value of best motor response and brain stem reflexes in patients with severe head injury. Neurosurgery 16:595601, 1985 Born JD, Albert A, Hans P, et al: Relative prognostic value of best motor response and brain stem reflexes in patients with severe head injury. Neurosurgery 16:595–601, 1985

    • Search Google Scholar
    • Export Citation
  • 8.

    Bowers SA, & Marshall LF: Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospective analysis. Neurosurgery 6:237242, 1980 Bowers SA, Marshall LF: Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospective analysis. Neurosurgery 6:237–242, 1980

    • Search Google Scholar
    • Export Citation
  • 9.

    Braakman R, , Gelpke GJ, & Habbema JDF, et al: Systemic selection of prognostic features in patients with severe head injury. Neurosurgery 6:362370, 1980 Braakman R, Gelpke GJ, Habbema JDF, et al: Systemic selection of prognostic features in patients with severe head injury. Neurosurgery 6:362–370, 1980

    • Search Google Scholar
    • Export Citation
  • 10.

    Braun SR, , Levin AB, & Clark KL: Role of corticosteroids in the development of pneumonia in mechanically ventilated head-trauma victims. Crit Care Med 14:198201, 1986 Braun SR, Levin AB, Clark KL: Role of corticosteroids in the development of pneumonia in mechanically ventilated head-trauma victims. Crit Care Med 14:198–201, 1986

    • Search Google Scholar
    • Export Citation
  • 11.

    Carlsson CA, , von Essen C, & Löfgren J: Factors affecting the clinical course of patients with severe head injuries. Part 1: Influence of biological factors. Part 2: Significance of posttraumatic coma. J Neurosurg 29:242251, 1968 Carlsson CA, von Essen C, Löfgren J: Factors affecting the clinical course of patients with severe head injuries. Part 1: Influence of biological factors. Part 2: Significance of posttraumatic coma. J Neurosurg 29:242–251, 1968

    • Search Google Scholar
    • Export Citation
  • 12.

    Chesnut RM: Medical management of the head injured patient, in Cooper PR (ed): Head Injury, ed 3. Baltimore: Williams & Wilkins, 1992, pp 459501 Chesnut RM: Medical management of the head injured patient, in Cooper PR (ed): Head Injury, ed 3. Baltimore: Williams & Wilkins, 1992, pp 459–501

    • Search Google Scholar
    • Export Citation
  • 13.

    Chesnut RM, , Marshall LF, & Bowers-Marshall S: Medical management of elevated intracranial pressure, in Cooper PR (ed): Head Injury, ed 3. Baltimore: Williams & Wilkins, 1992, pp 225246 Chesnut RM, Marshall LF, Bowers-Marshall S: Medical management of elevated intracranial pressure, in Cooper PR (ed): Head Injury, ed 3. Baltimore: Williams & Wilkins, 1992, pp 225–246

    • Search Google Scholar
    • Export Citation
  • 14.

    Choi SC, , Ward JD, & Becker DP: Chart for outcome prediction in severe head injury. J Neurosurg 59:294297, 1983 Choi SC, Ward JD, Becker DP: Chart for outcome prediction in severe head injury. J Neurosurg 59:294–297, 1983

    • Search Google Scholar
    • Export Citation
  • 15.

    Craven DE, , Kunches LM, & Killinsky V, et al: Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 133:792796, 1986 Craven DE, Kunches LM, Killinsky V, et al: Risk factors for pneumonia and fatality in patients receiving continuous mechanical ventilation. Am Rev Respir Dis 133:792–796, 1986

    • Search Google Scholar
    • Export Citation
  • 16.

    DeSalles AAF, , Kontos HA, & Becker DP, et al: Prognostic significance of ventricular CSF lactic acidosis in severe head injury. J Neurosurg 65:615624, 1986 DeSalles AAF, Kontos HA, Becker DP, et al: Prognostic significance of ventricular CSF lactic acidosis in severe head injury. J Neurosurg 65:615–624, 1986

    • Search Google Scholar
    • Export Citation
  • 17.

    Driks MR, , Craven DE, & Celli BR, et al: Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med 317:13761382, 1987 Driks MR, Craven DE, Celli BR, et al: Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med 317:1376–1382, 1987

    • Search Google Scholar
    • Export Citation
  • 18.

    Eisenberg HM, , Gary HE Jr, & Aldrich EF, et al: Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 73:688698, 1990 Eisenberg HM, Gary HE Jr, Aldrich EF, et al: Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 73:688–698, 1990

    • Search Google Scholar
    • Export Citation
  • 19.

    Feinstein DI: Diagnosis and management of disseminated intravascular coagulation: the role of heparin therapy. Blood 60:284287, 1982 Feinstein DI: Diagnosis and management of disseminated intravascular coagulation: the role of heparin therapy. Blood 60:284–287, 1982

    • Search Google Scholar
    • Export Citation
  • 20.

    Frowein RA, , auf der Haar K, & Terhaag D: Assessment of coma reliability of prognosis. Neurosurg Rev 3:6774, 1980 Frowein RA, auf der Haar K, Terhaag D: Assessment of coma reliability of prognosis. Neurosurg Rev 3:67–74, 1980

    • Search Google Scholar
    • Export Citation
  • 21.

    Gaab MR, & Haubitz I: Intracranial pressure, primary/secondary brain stem injury and prognosis in cerebral trauma, in Ishii S, , Nagai H, & Brock M (eds): Intracranial Pressure V. Berlin: Springer-Verlag, 1983, pp 501506 Gaab MR, Haubitz I: Intracranial pressure, primary/secondary brain stem injury and prognosis in cerebral trauma, in Ishii S, Nagai H, Brock M (eds): Intracranial Pressure V. Berlin: Springer-Verlag, 1983, pp 501–506

    • Search Google Scholar
    • Export Citation
  • 22.

    Gennarelli TA, , Spielman GM, & Langfitt TW: Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification study. J Neurosurg 56:2632, 1982 Gennarelli TA, Spielman GM, Langfitt TW: Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification study. J Neurosurg 56:26–32, 1982

    • Search Google Scholar
    • Export Citation
  • 23.

    Greenberg RP, , Newlon PG, & Hyatt MS, et al: Prognostic implications of early multimodality evoked potentials in severely head-injured patients. A prospective study. J Neurosurg 55:227236, 1981 Greenberg RP, Newlon PG, Hyatt MS, et al: Prognostic implications of early multimodality evoked potentials in severely head-injured patients. A prospective study. J Neurosurg 55:227–236, 1981

    • Search Google Scholar
    • Export Citation
  • 24.

    Grindlinger GA, , Niehoff J, & Hughes SL, et al: Acute paranasal sinusitis related to nasotracheal intubation of head-injured patients. Crit Care Med 15:214217, 1987 Grindlinger GA, Niehoff J, Hughes SL, et al: Acute paranasal sinusitis related to nasotracheal intubation of head-injured patients. Crit Care Med 15:214–217, 1987

    • Search Google Scholar
    • Export Citation
  • 25.

    Hosmer DW, & Lemeshow S: Applied Logistic Regression. New York: John Wiley & Sons, 1989 Hosmer DW, Lemeshow S: Applied Logistic Regression. New York: John Wiley & Sons, 1989

    • Search Google Scholar
    • Export Citation
  • 26.

    Jacobs S, , Chang RW, & Lee B, et al: Continuous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients. J Parenter Enteral Nutr 14:353356, 1990 Jacobs S, Chang RW, Lee B, et al: Continuous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients. J Parenter Enteral Nutr 14:353–356, 1990

    • Search Google Scholar
    • Export Citation
  • 27.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 28.

    Jennett B, , Teasdale G, & Braakman R, et al: Predicting outcome in individual patients after severe head injury. Lancet 1:10311034, 1976 Jennett B, Teasdale G, Braakman R, et al: Predicting outcome in individual patients after severe head injury. Lancet 1:1031–1034, 1976

    • Search Google Scholar
    • Export Citation
  • 29.

    Jennett B, , Teasdale G, & Braakman R, et al: Prognosis of patients with severe head injury. Neurosurgery 4:283289, 1979 Jennett B, Teasdale G, Braakman R, et al: Prognosis of patients with severe head injury. Neurosurgery 4:283–289, 1979

    • Search Google Scholar
    • Export Citation
  • 30.

    Jennett B, , Teasdale G, & Galbraith S, et al: Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40:291298, 1977 Jennett B, Teasdale G, Galbraith S, et al: Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40:291–298, 1977

    • Search Google Scholar
    • Export Citation
  • 31.

    Jiménez P, , Torres A, & Rodriguez-Roisin R, et al: Incidence and etiology of pneumonia acquired during mechanical ventilation. Crit Care Med 17:882885, 1989 Jiménez P, Torres A, Rodriguez-Roisin R, et al: Incidence and etiology of pneumonia acquired during mechanical ventilation. Crit Care Med 17:882–885, 1989

    • Search Google Scholar
    • Export Citation
  • 32.

    Kaufman HH, , Hui KS, & Mattson JC, et al: Clinicopathological correlations of disseminated intravascular coagulation in patients with head injury. Neurosurgery 15:3442, 1984 Kaufman HH, Hui KS, Mattson JC, et al: Clinicopathological correlations of disseminated intravascular coagulation in patients with head injury. Neurosurgery 15:34–42, 1984

    • Search Google Scholar
    • Export Citation
  • 33.

    Klauber MR, , Marshall LF, & Luerssen TG, et al: Determinants of head injury mortality: importance of the low risk patient. Neurosurgery 24:3136, 1989 Klauber MR, Marshall LF, Luerssen TG, et al: Determinants of head injury mortality: importance of the low risk patient. Neurosurgery 24:31–36, 1989

    • Search Google Scholar
    • Export Citation
  • 34.

    Langer M, , Cigada M, & Mandelli M, et al: Early onset pneumonia: a multicenter study in intensive care units. Intens Care Med 13:342346, 1987 Langer M, Cigada M, Mandelli M, et al: Early onset pneumonia: a multicenter study in intensive care units. Intens Care Med 13:342–346, 1987

    • Search Google Scholar
    • Export Citation
  • 35.

    Lobato RD, , Cordobes F, & Rivas JJ, et al: Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 59:762774, 1983 Lobato RD, Cordobes F, Rivas JJ, et al: Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 59:762–774, 1983

    • Search Google Scholar
    • Export Citation
  • 36.

    Luerssen TG, , Klauber MR, & Marshall LF: Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury. J Neurosurg 68:409416, 1988 Luerssen TG, Klauber MR, Marshall LF: Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury. J Neurosurg 68:409–416, 1988

    • Search Google Scholar
    • Export Citation
  • 37.

    Marmarou A, , Anderson RL, & Ward JD, et al: Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75:S59S66, 1991 Marmarou A, Anderson RL, Ward JD, et al: Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg 75:S59–S66, 1991

    • Search Google Scholar
    • Export Citation
  • 38.

    Marshall LF, , Becker DP, & Bowers SA, et al: The National Traumatic Coma Data Bank. Part I: Design, purpose, goals and results. J Neurosurg 59:276284, 1983 Marshall LF, Becker DP, Bowers SA, et al: The National Traumatic Coma Data Bank. Part I: Design, purpose, goals and results. J Neurosurg 59:276–284, 1983

    • Search Google Scholar
    • Export Citation
  • 39.

    Marshall LF, , Gautille T, & Klauber MR, et al: The outcome of severe closed head injury. J Neurosurg 75:S28S36, 1991 Marshall LF, Gautille T, Klauber MR, et al: The outcome of severe closed head injury. J Neurosurg 75:S28–S36, 1991

    • Search Google Scholar
    • Export Citation
  • 40.

    Marshall LF, , Marshall SB, & Klauber MR, et al: A new classification of head injury based on computerized tomography. J Neurosurg 75:S14S20, 1991 Marshall LF, Marshall SB, Klauber MR, et al: A new classification of head injury based on computerized tomography. J Neurosurg 75:S14–S20, 1991

    • Search Google Scholar
    • Export Citation
  • 41.

    Miller JD: ICP monitoring — current status and future directions. Acta Neurochir 85:8086, 1987 Miller JD: ICP monitoring — current status and future directions. Acta Neurochir 85:80–86, 1987

    • Search Google Scholar
    • Export Citation
  • 42.

    Miller JD, , Becker DP, & Ward JD, et al: Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503516, 1977 Miller JD, Becker DP, Ward JD, et al: Significance of intracranial hypertension in severe head injury. J Neurosurg 47:503–516, 1977

    • Search Google Scholar
    • Export Citation
  • 43.

    Miner ME, , Kaufman HH, & Graham SH, et al: Disseminated intravascular coagulation fibrinolytic syndrome following head injury in children: frequency and prognostic implications. J Pediatr 100:687691, 1982 Miner ME, Kaufman HH, Graham SH, et al: Disseminated intravascular coagulation fibrinolytic syndrome following head injury in children: frequency and prognostic implications. J Pediatr 100:687–691, 1982

    • Search Google Scholar
    • Export Citation
  • 44.

    Newlon PG, & Greenberg RP: Evoked potentials in severe head injury. J Trauma 24:6166, 1984 Newlon PG, Greenberg RP: Evoked potentials in severe head injury. J Trauma 24:61–66, 1984

    • Search Google Scholar
    • Export Citation
  • 45.

    Olson JD, , Kaufman HH, & Moake J, et al: The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery 24:825832, 1989 Olson JD, Kaufman HH, Moake J, et al: The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery 24:825–832, 1989

    • Search Google Scholar
    • Export Citation
  • 46.

    Papanicolaou AC, , Loring DW, & Eisenberg HM, et al: Auditory brain stem evoked responses in comatose head-injured patients. Neurosurgery 18:173175, 1986 Papanicolaou AC, Loring DW, Eisenberg HM, et al: Auditory brain stem evoked responses in comatose head-injured patients. Neurosurgery 18:173–175, 1986

    • Search Google Scholar
    • Export Citation
  • 47.

    Price JE, & Murray A: The influence of hypoxia and hypotension on recovery from head injury. Br J Accid Surg 3:218224, 1972 Price JE, Murray A: The influence of hypoxia and hypotension on recovery from head injury. Br J Accid Surg 3:218–224, 1972

    • Search Google Scholar
    • Export Citation
  • 48.

    Riffel B, , Stöhr M, & Trost E, et al: Frühzeitige prognostische Aussage mittels evozierter Potentiale beim schweren Schädel-Hirn-Trauma. EEG EMG 18:192199, 1987 Riffel B, Stöhr M, Trost E, et al: Frühzeitige prognostische Aussage mittels evozierter Potentiale beim schweren Schädel-Hirn-Trauma. EEG EMG 18:192–199, 1987

    • Search Google Scholar
    • Export Citation
  • 49.

    Saul TG, & Ducker TB: Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 56:498503, 1982 Saul TG, Ducker TB: Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury. J Neurosurg 56:498–503, 1982

    • Search Google Scholar
    • Export Citation
  • 50.

    Seales DM, , Rossiter VS, & Weinstein ME: Brainstem auditory evoked responses in patients comatose as a result of blunt head trauma. J Trauma 19:347353, 1979 Seales DM, Rossiter VS, Weinstein ME: Brainstem auditory evoked responses in patients comatose as a result of blunt head trauma. J Trauma 19:347–353, 1979

    • Search Google Scholar
    • Export Citation
  • 51.

    Stoutenbeek CP, , van Saene HKF, & Miranda DR, et al: The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 27:357364, 1987 Stoutenbeek CP, van Saene HKF, Miranda DR, et al: The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients. J Trauma 27:357–364, 1987

    • Search Google Scholar
    • Export Citation
  • 52.

    Teasdale G, & Jennett B: Assessment and prognosis of coma after head injury. Acta Neurochir 34:4555, 1976 Teasdale G, Jennett B: Assessment and prognosis of coma after head injury. Acta Neurochir 34:45–55, 1976

    • Search Google Scholar
    • Export Citation
  • 53.

    Teasdale G, & Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:8184, 1974 Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84, 1974

    • Search Google Scholar
    • Export Citation
  • 54.

    Teasdale G, , Skene A, & Parker L, et al: Age and outcome of severe head injury. Acta Neurochir Suppl 28:140143, 1979 Teasdale G, Skene A, Parker L, et al: Age and outcome of severe head injury. Acta Neurochir Suppl 28:140–143, 1979

    • Search Google Scholar
    • Export Citation
  • 55.

    Tobin MJ, & Grenvik A: Nosocomial lung infection and its diagnosis. Crit Care Med 12:191199, 1984 Tobin MJ, Grenvik A: Nosocomial lung infection and its diagnosis. Crit Care Med 12:191–199, 1984

    • Search Google Scholar
    • Export Citation
  • 56.

    Torres A, , Aznar R, & Gatell JM, et al: Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 142:523528, 1990 Torres A, Aznar R, Gatell JM, et al: Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 142:523–528, 1990

    • Search Google Scholar
    • Export Citation
  • 57.

    Toutant SM, , Klauber MR, & Marshall LF, et al: Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 61:691694, 1984 Toutant SM, Klauber MR, Marshall LF, et al: Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 61:691–694, 1984

    • Search Google Scholar
    • Export Citation
  • 58.

    Tryba M: Risk of acute stress bleeding and nosocomial pneumonia in ventilated intensive care unit patients: sucralfate versus antacids. Am J Med 83 (3B):117124, 1987 Tryba M: Risk of acute stress bleeding and nosocomial pneumonia in ventilated intensive care unit patients: sucralfate versus antacids. Am J Med 83 (3B):117–124, 1987

    • Search Google Scholar
    • Export Citation
  • 59.

    Ueda S, , Fujitsu K, & Fujino H, et al: Correlation between plasma fibrin-fibrinogen degradation product values and CT findings in head injury. J Neurol Neurosurg Psychiatry 48:5860, 1985 Ueda S, Fujitsu K, Fujino H, et al: Correlation between plasma fibrin-fibrinogen degradation product values and CT findings in head injury. J Neurol Neurosurg Psychiatry 48:58–60, 1985

    • Search Google Scholar
    • Export Citation
  • 60.

    van Dongen KJ, , Braakman R, & Gelpke G: The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:951957, 1983 van Dongen KJ, Braakman R, Gelpke G: The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:951–957, 1983

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 2159 398 15
Full Text Views 886 16 5
PDF Downloads 201 24 8
EPUB Downloads 0 0 0