Acute and Critical Care

Original Articles

Nutrition
Effect of standard- versus high-protein enteral feeding on rectus femoris muscle mass in mechanically ventilated traumatic brain injury patients: a prospective randomized study in Egypt and the United States: Hanan Elkalawy, Pavan Sekhar, Mona Fayad, Mohamed Barrima, Mohammad Abdullah; Acute Crit Care. 2026;41(1):160-173. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.001025

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Abstract PDF: Background
Critically ill patients with muscle wasting experience prolonged intensive care unit (ICU) stays, delayed weaning, and higher mortality. Trauma-induced stress disrupts protein metabolism, leading to immunosuppression and muscle loss. This study evaluates whether high-protein intake through enteral nutrition preserves muscle mass and improves clinical outcomes compared to standard protein intake. Methods: In our multicenter research, 102 critically ill, mechanically ventilated patients (age, 39±7; female, 51; body mass index, 30.3±1.8 kg/m2 ) were assigned randomly to receive either a high-protein (2.2 g/kg BW/day) or standard (1.5 g/kg BW/day) diet. Enteral nutrition was individualized based on energy expenditure. Ultrasound measured whether the rectus femoris muscle cross-sectional area (RFM-9 CSA) and pennation angle correlated with dietary intake. The data are presented as mean±standard deviation. Results: Protein intake was 1.8±0.2 vs. 1.2±0.4 g/kg/day in high-protein and standard groups, respectively. In the intervention and standard groups, the baseline RFM-CSA and Pennation angle were 11.43±0.87 mm vs. 11.3±0.91 mm and 9.1±0.58 mm vs. 8.91±1.04 mm (P>0.05). Days 5, 10, and 20 showed significant variations in RFM-CSA and pennation angle (P<0.001). The intervention group experienced a shorter ICU length of stay (47.0±19.5 vs. 56.3±26.9 days, P=0.001) and a shorter period of mechanical ventilation (33±3.5 vs. 33±2.3 days, P=0.001). Conclusions: Early high protein intake significantly preserves muscle mass, reducing the duration of stay in the ICU and the need for mechanical ventilation.

Neurosurgery
Cost-effectiveness of intracranial pressure monitoring in severe traumatic brain injury in Southern Thailand: Jidapa Jitchanvichai, Thara Tunthanathip; Acute Crit Care. 2025;40(1):69-78. Published online February 21, 2025; DOI: https://doi.org/10.4266/acc.004080

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Background
Traumatic brain injury (TBI) is a leading cause of fatalities and disabilities in the public health domain, particularly in Thailand. Guidelines for TBI patients advise intracranial pressure monitoring (ICPm) for intensive care. However, information about the cost-effectiveness (CE) of ICPm in cases of severe TBI is lacking. This study assessed the CE of ICPm in severe TBI.
Methods
This was a retrospective cohort economic evaluation study from the perspective of the healthcare system. Direct costs were sourced from electronic medical records, and quality-adjusted life years (QALY) for each individual were computed using multiple linear regression with standardization. Incremental costs, incremental QALY, and the incremental CE ratio (ICER) were estimated, and the bootstrap method with 1,000 iterations was used in uncertainty analysis.
Results
The analysis included 821 individuals, with 4.1% undergoing intraparenchymal ICPm. The average cost of hospitalization was United States dollar ($)8,697.13 (±6,271.26) in both groups. The incremental cost and incremental QALY of the ICPm group compared with the non-ICPm group were $3,322.88 and –0.070, with the base-case ICER of $–47,504.08 per additional QALY. Results demonstrated that 0.007% of bootstrapped ICERs were below the willingness-to-pay (WTP) threshold of Thailand.
Conclusions
ICPm for severe TBI was not cost-effective compared with the WTP threshold of Thailand. Resource allocation for TBI prognosis requires further development of cost-effective treatment guidelines.

Citations

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Impact of Preoperative Hair Removal on Self-Esteem after Brain Tumor Surgery
Thara Tunthanathip, Natthanee Pisitthaworakul
Asian Journal of Neurosurgery.2026; 21(01): 147. CrossRef
Deep learning-based model for detection of intracranial waveforms with poor brain compliance in southern Thailand
Thara Tunthanathip, Avika Trakulpanitkit
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Trauma
Bedside ultrasonographic evaluation of optic nerve sheath diameter for monitoring of intracranial pressure in traumatic brain injury patients: a cross sectional study in level II trauma care center in India: Sujit J. Kshirsagar, Anandkumar H. Pande, Sanyogita V. Naik, Alok Yadav, Ruchira M. Sakhala, Sangharsh M. Salve, Aysath Nuhaimah, Priyanka Desai; Acute Crit Care. 2024;39(1):155-161. Published online February 23, 2024; DOI: https://doi.org/10.4266/acc.2023.01172

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Abstract PDF

Background
Optic nerve sheath diameter (ONSD) is an emerging non-invasive, easily accessible, and possibly useful measurement for evaluating changes in intracranial pressure (ICP). The utilization of bedside ultrasonography (USG) to measure ONSD has garnered increased attention due to its portability, real-time capability, and lack of ionizing radiation. The primary aim of the study was to assess whether bedside USG-guided ONSD measurement can reliably predict increased ICP in traumatic brain injury (TBI) patients.
Methods
A total of 95 patients admitted to the trauma intensive care unit was included in this cross sectional study. Patient brain computed tomography (CT) scans and Glasgow Coma Scale (GCS) scores were assessed at the time of admission. Bedside USG-guided binocular ONSD was measured and the mean ONSD was noted. Microsoft Excel was used for statistical analysis.
Results
Patients with low GCS had higher mean ONSD values (6.4±1.0 mm). A highly significant association was found among the GCS, CT results, and ONSD measurements (P<0.001). Compared to CT scans, the bedside USG ONSD had 86.42% sensitivity and 64.29% specificity for detecting elevated ICP. The positive predictive value of ONSD to identify elevated ICP was 93.33%, and its negative predictive value was 45.00%. ONSD measurement accuracy was 83.16%.
Conclusions
Increased ICP can be accurately predicted by bedside USG measurement of ONSD and can be a valuable adjunctive tool in the management of TBI patients.

Citations

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Comparison of the Effects of Conventional and Piezoelectric Osteotomy on Intracranial Pressure Changes in Rhinoplasty Using Ultrasonographic Measurement of Optic Nerve Sheath Diameter
Akif Gunes, Elif Karali, Yusuf Ozgur Bicer, Isa Yildiz, Sıddıka Halicioglu, Nurcan Akbas Gunes
Aesthetic Plastic Surgery.2026;[Epub] CrossRef
Exploring the impact of electroconvulsive therapy on intracranial pressure: A study of optic nerve sheath diameter measurements
Iram Fatima, Aung Khine Phyoe, Abhimanyu Sharma, Shubh Mehta, Sara Tabassum, Manjeet Singh, Rama Siddiqui, Shivendra Shah, Kirpa Kaur, Hend Makky, Aadil Mahmood Khan
The International Journal of Psychiatry in Medicine.2026; 61(1): 39. CrossRef
Personalized treatment approaches in neurocritical care
Jae Hyun Kim, Chang-Hyun Kim, Hanwool Jeon, Hyun-Chul Jung, Seungjoo Lee
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Optic nerve changes detected with ocular ultrasonography during epiduroscopy: a narrative review
İlker Çöven, Yasin Tire, Aydın Mermer, Abdullah Celep, Serhat Cömert
Frontiers in Surgery.2026;[Epub] CrossRef
Relationship between optic nerve sheath diameter, Glasgow Coma Scale, and the impact of PEEP in critically ill patients: a prospective observational study
Merve İkbal Göncü, Engin İhsan Turan, Ezgi Aydın İnan, Oktay İnan, Ebru Kaya, Ayça Sultan Şahin
Turkish Journal of Intensive Care.2026; 24(1): 21. CrossRef
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Mohammed Alsabri, Emma Cravo, Chibuike Daniel Onyejesi, Louna Abouainain, Eslam Abady, Vincent Tsoi, Ammarah TariQ, Sohaila Abdelbar
Current Emergency and Hospital Medicine Reports.2026;[Epub] CrossRef
Assessment of optic nerve sheath enlargement and Frisen classification in idiopathic intracranial hypertension: Implications for estimating intracranial pressure and grading chronic papilledema
Raghda Shawky El-Gendy, Ahmad Shehata Abd ElHamid, Ayman ElSayed Ali Galhom, Nihal Adel Hassan, Ehab Mahmoud Ghoneim
Taiwan Journal of Ophthalmology.2025; 15(4): 618. CrossRef
Bedside Ultrasonographic Measurement of Optic Nerve Sheath Diameter for Assessing Increased Intracranial Pressure: An Observational Study
Saurav Shekhar, Raj B Singh, Preeti Sharma, Swapna Lata, Nitin Kumar, Ranjeet Rana De, Amit Kumar
Cureus.2025;[Epub] CrossRef
Noninvasive Intracranial Pressure Prediction Using a Multimodal Ultrasound-Based Hemispheric Modeling Strategy: A Prospective Dual-Center Study
Jun Qiu, Tong-Juan Zou, Dong-Mei Wang, Hai-Rong Luo, Hai-Tao Yu, Ling Lei, Wan-Hong Yin
Neurocritical Care.2025; 43(3): 911. CrossRef
Correlation of Optic Nerve Sheath Diameter With Severity and Outcome in Head Injury: Ultrasonographic and CT Evaluation
Syed Ali Mehsam, Sarosh Alam, Zunaira Rizwan , Haris Hanif, Fatima Tariq, Saharish Mansoor Khan
Cureus.2025;[Epub] CrossRef
Measurement of Optic Nerve Sheath Diameter by Bedside Ultrasound in Patients With Traumatic Brain Injury Presenting to Emergency Department: A Review
Preethy Koshy, Charuta Gadkari
Cureus.2024;[Epub] CrossRef

Review Article

Trauma
Mobilization phases in traumatic brain injury: Tommy Alfandy Nazwar, Ivan Triangto, Gutama Arya Pringga, Farhad Bal’afif, Donny Wisnu Wardana; Acute Crit Care. 2023;38(3):261-270. Published online August 1, 2023; DOI: https://doi.org/10.4266/acc.2023.00640

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Abstract PDF

Mobilization in traumatic brain injury (TBI) have shown the improvement of length of stay, infection, long term weakness, and disability. Primary damage as a result of trauma’s direct effect (skull fracture, hematoma, contusion, laceration, and nerve damage) and secondary damage caused by trauma’s indirect effect (microvasculature damage and pro-inflammatory cytokine) result in reduced tissue perfusion & edema. These can be facilitated through mobilization, but several precautions must be recognized as mobilization itself may further deteriorate patient’s condition. Very few studies have discussed in detail regarding mobilizing patients in TBI cases. Therefore, the scope of this review covers the detail of physiological effects, guideline, precautions, and technique of mobilization in patients with TBI.

Citations

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Benchmarking mobilization practice and functional outcomes in traumatic brain injury patients admitted to the intensive care unit: a three-year service evaluation
Fiona Howroyd, James Hodson, Anne Preece, Tammy Lea, Samantha Rooney, Hon Sing Geoffrey Wu, Simran Rahania, Fang Gao Smith, Tonny Veenith, Niharika A. Duggal, Zubair Ahmed, Jonathan Weblin
Frontiers in Neurology.2026;[Epub] CrossRef
The Impact of a Prior Traumatic Brain Injury and Injury Characteristics on Frailty in the Canadian Longitudinal Study on Aging
Molly K. Courish, Myles W. O’Brien, Madeline E. Shivgulam, Emily E. MacDonald, Said Mekari, Olga Theou
Archives of Physical Medicine and Rehabilitation.2026;[Epub] CrossRef
Reversing Persistent PTEN Activation after Traumatic Brain Injury Fuels Long‐Term Axonal Regeneration via Akt/mTORC1 Signaling Cascade
Ziyu Shi, Leilei Mao, Shuning Chen, Zhuoying Du, Jiakun Xiang, Minghong Shi, Yana Wang, Yuqing Wang, Xingdong Chen, Zhi‐Xiang Xu, Yanqin Gao
Advanced Science.2025;[Epub] CrossRef
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Yoo Jin Choo, Jun Sung Moon, Gun Woo Lee, Wook-Tae Park, Min Cheol Chang
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Effects of using conventional assistive devices on spatiotemporal gait parameters of adults with neurological disorders: A systematic review protocol
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PLOS ONE.2025; 20(4): e0321019. CrossRef
Impact of Early Mobilisation on the Clinical Outcomes of Patients With Traumatic Brain Injury
Fei Xia, Caiyun Li, Yiwen Liu
Nursing in Critical Care.2025;[Epub] CrossRef
Acute orthostatic responses during early mobilisation of patients with acquired brain injury - Innowalk pro versus standing frame
Matthijs F Wouda, Espen I Bengtson, Ellen Høyer, Alhed P Wesche, Vivien Jørgensen
Journal of Rehabilitation and Assistive Technologies Engineering.2024;[Epub] CrossRef
Aktuelle Aspekte der intensivmedizinischen Versorgung bei Schädel-Hirn-Trauma – Teil 2
André Hagedorn, Helge Haberl, Michael Adamzik, Alexander Wolf, Matthias Unterberg
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Original Article

Trauma
Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India: Nishant Agrawal, Shivakumar S Iyer, Vishwanath Patil, Sampada Kulkarni, Jignesh N Shah, Prashant Jedge; Acute Crit Care. 2023;38(2):226-233. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2023.00570

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Abstract PDF

Background
This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury.
Methods
We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson’s correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P<0.01.
Results
In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively.
Conclusions
The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome.

Citations

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Association Between Glasgow Coma Scale Trajectory and In‐Hospital Mortality in Traumatic Brain Injury in the ICU: A Retrospective Cohort Study
Yangchun Zhang, Feng Chen, Na Ma, Cairong Liu, Xufeng Chen, Xueli Ji
Nursing in Critical Care.2025;[Epub] CrossRef
Epidemiology and Outcome of Traumatic Brain Injuries: A Retrospective Study in a Tertiary Care Center
Rudra N Shah, Yam B Roka, Ashish J Thapa, Alok Jha, Chandan N Sah
Cureus.2025;[Epub] CrossRef
Comparison of the Accuracy of the GCS and FOUR Scores in Predicting Mortality of Patients with Traumatic Brain Injury (TBI) Admitted to the Emergency Department: A Prospective Study in Khorramabad, Iran
Amirhossein Pashaei, Soodabeh Zare, Peiman Bakhshi, Sara Fakhri
Shiraz E-Medical Journal.2025;[Epub] CrossRef
Dynamic assessment of the prognostic value of scoring systems FOUR, GCS and CRS-R in patients with chronic critical illness after acute brain injury
L. B. Berikashvili, M. Ya. Yadgarov, D. V. Zhidilyaev, K. K. Kadantseva, E. M. Korolenok, A. A. Yakovlev, A. N. Kuzovlev, V. V. Likhvantsev
Messenger of ANESTHESIOLOGY AND RESUSCITATION.2025; 22(6): 39. CrossRef
ASSOCIATION OF AGE AND FOUR SCORE WITH ICU LENGTH OF STAY IN POST-CRANIOTOMY PATIENTS AT SAKINAH HOSPITAL MOJOKERTO
Rudi Hariyono, Ika Ainur Rofi’ah
International Journal of Nursing and Midwifery Science (IJNMS).2025; 9(3): 506. CrossRef
Development of a Novel Neurological Score Combining GCS and FOUR Scales for Assessment of Neurosurgical Patients with Traumatic Brain Injury: GCS-FOUR Scale
Ali Ansari, Sina Zoghi, Amirabbas Khoshbooei, Mohammad Amin Mosayebi, Maryam Feili, Omid Yousefi, Amin Niakan, Seyed Amin Kouhpayeh, Reza Taheri, Hosseinali Khalili
World Neurosurgery.2024; 182: e866. CrossRef
Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury
Indu Kapoor, Hemanshu Prabhakar, Arvind Chaturvedi, Charu Mahajan, Abraham L Chawnchhim, Tej P Sinha
Indian Journal of Critical Care Medicine.2024; 28(3): 256. CrossRef
Machine learning for the prediction of in-hospital mortality in patients with spontaneous intracerebral hemorrhage in intensive care unit
Baojie Mao, Lichao Ling, Yuhang Pan, Rui Zhang, Wanning Zheng, Yanfei Shen, Wei Lu, Yuning Lu, Shanhu Xu, Jiong Wu, Ming Wang, Shu Wan
Scientific Reports.2024;[Epub] CrossRef
The assessment of consciousness status in primary brainstem hemorrhage (PBH) patients can be achieved by monitoring changes in basic vital signs
Shiyi Zuo, Yuting Feng, Juan Sun, Guofang Liu, Hanxu Cai, Xiaolong Zhang, Zhian Hu, Yong Liu, Zhongxiang Yao
Geriatric Nursing.2024; 59: 498. CrossRef
Traumatic brain injury in companion animals: Pathophysiology and treatment
Molly Wart, Thomas H. Edwards, Julie A. Rizzo, Geoffrey W. Peitz, Armi Pigott, Jonathan M. Levine, Nicholas D. Jeffery
Topics in Companion Animal Medicine.2024; 63: 100927. CrossRef

Review Article

Neurosurgery
Target temperature management in traumatic brain injury with a focus on adverse events, recognition, and prevention: Kwang Wook Jo; Acute Crit Care. 2022;37(4):483-490. Published online November 10, 2022; DOI: https://doi.org/10.4266/acc.2022.01291

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Abstract PDF

Traumatic brain injury (TBI) is a critical cause of disability and death worldwide. Many studies have been conducted aimed at achieving favorable neurologic outcomes by reducing secondary brain injury in TBI patients. However, ground-breaking outcomes are still insufficient so far. Because mild-to-moderate hypothermia (32°C–35°C) has been confirmed to help neurological recovery for recovered patients after circulatory arrest, it has been recognized as a major neuroprotective treatment plan for TBI patients. Thereafter, many clinical studies about the effect of therapeutic hypothermia (TH) on severe TBI have been conducted. However, efficacy and safety have not been demonstrated in many large-scale randomized controlled studies. Rather, some studies have demonstrated an increase in mortality rate due to complications such as pneumonia, so it is not highly recommended for severe TBI patients. Recently, some studies have shown results suggesting TH may help reperfusion/ischemic injury prevention after surgery in the case of mass lesions, such as acute subdural hematoma, and it has also been shown to be effective in intracranial pressure control. In conclusion, TH is still at the center of neuroprotective therapeutic studies regarding TBI. If proper measures can be taken to mitigate the many adverse events that may occur during the course of treatment, more positive efficacy can be confirmed. In this review, we look into adverse events that may occur during the process of the induction, maintenance, and rewarming of targeted temperature management and consider ways to prevent and address them.

Citations

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Target temperature management in acute ischemic stroke
Lan Gao, Ting Yang, Hong Chong, Longfei Wu, Jinming Han
Frontiers in Molecular Biosciences.2026;[Epub] CrossRef
Blood pressure variability and functional outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction
Jae Wook Jung, Ilmo Kang, Jin Park, Sang‐Beom Jeon
European Journal of Neurology.2025;[Epub] CrossRef
State-of-the-art for automated machine learning predicts outcomes in poor-grade aneurysmal subarachnoid hemorrhage using routinely measured laboratory & radiological parameters: coagulation parameters and liver function as key prognosticators
Ali Haider Bangash, Jayro Toledo, Muhammed Amir Essibayi, Neil Haranhalli, Rafael De la Garza Ramos, David J. Altschul, Stavropoula Tjoumakaris, Reza Yassari, Robert M. Starke, Redi Rahmani
Neurosurgical Review.2025;[Epub] CrossRef
Advancements in the application of multimodal monitoring and machine learning for the development of personalized therapeutic strategies in traumatic brain injury
Zhijing Wei, Lingda Meng, Wei Chong
Frontiers in Human Neuroscience.2025;[Epub] CrossRef
Trends and hotspots in research of traumatic brain injury from 2000 to 2022: A bibliometric study
Yan-rui Long, Kai Zhao, Fu-chi Zhang, Yu Li, Jun-wen Wang, Hong-quan Niu, Jin Lei
Neurochemistry International.2024; 172: 105646. CrossRef
Targeted temperature control following traumatic brain injury: ESICM/NACCS best practice consensus recommendations
Andrea Lavinio, Jonathan P. Coles, Chiara Robba, Marcel Aries, Pierre Bouzat, Dara Chean, Shirin Frisvold, Laura Galarza, Raimund Helbok, Jeroen Hermanides, Mathieu van der Jagt, David K. Menon, Geert Meyfroidt, Jean-Francois Payen, Daniele Poole, Frank R
Critical Care.2024;[Epub] CrossRef
A review on targeted temperature management for cardiac arrest and traumatic brain injury
Hiroshi Ito, Sanae Hosomi, Takeshi Nishida, Youhei Nakamura, Jiro Iba, Hiroshi Ogura, Jun Oda
Frontiers in Neuroscience.2024;[Epub] CrossRef
Intracranial pressure trends and clinical outcomes after decompressive hemicraniectomy in malignant middle cerebral artery infarction
Jae Wook Jung, Ilmo Kang, Jin Park, Seungjoo Lee, Sang-Beom Jeon
Annals of Intensive Care.2024;[Epub] CrossRef
Severe traumatic brain injury in adults: a review of critical care management
Siobhan McLernon
British Journal of Neuroscience Nursing.2023; 19(6): 206. CrossRef

Original Articles

Trauma
C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury: Canan Gürsoy, Güven Gürsoy, Semra Gümüş Demirbilek; Acute Crit Care. 2022;37(3):462-467. Published online August 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00052

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Abstract PDF

Background
Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI.
Methods
Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively.
Results
The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR.
Conclusions
This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.

Citations

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Performance and accuracy of blood glucose and neutrophil-lymphocyte ratio as predictors of mortality in children and adolescents with traumatic brain injury
José Roberto Tude Melo, Caio Vinicius de Almeida Chaves, Cindy Kawano, Isabela Zampirolli Leal, Maria Antonia Coladeti Fernandes, Stephannie Monaco Bodra, Jean Gonçalves de Oliveira, José Carlos Esteves Veiga
Child's Nervous System.2026;[Epub] CrossRef
Prognostic value of CAR, FIB-4, and procalcitonin in subdural hematoma: associations with mortality and 90-day functional outcomes running title: CAR, FIB-4, and procalcitonin in SDH outcomes
Tamer Tamdoğan, İlke Tamdoğan
Journal of Health Sciences and Medicine.2026; 9(1): 19. CrossRef
One-Year Mortality After Percutaneous Endoscopic Gastrostomy: The Prognostic Role of Nutritional Biomarkers and Care Settings
Nermin Mutlu Bilgiç, Güldan Kahveci, Ekmel Burak Özşenel, Sema Basat
Nutrients.2025; 17(5): 904. CrossRef
Elevation of C-reactive protein and homocysteine levels as reliable biomarkers for assessing injury severity and prognosis in traumatic brain injury
Zi-Yan Wang, Wei Du, Xian-Zhi Liu, Yuan Li, Jun Liu
Scientific Reports.2025;[Epub] CrossRef
Prognostic value of procalcitonin and IL-6 with a composite model in moderate-severe traumatic brain injury
Xin-meng Li, Zi-wei Liu, Wei-yu Liu, Gao-jian Su, Xian-jian Huang
Journal of Clinical Neuroscience.2025; 140: 111516. CrossRef
Development and validation of a prediction model for pulmonary infection in elderly patients with traumatic brain injury
Shuai Tian, Ali Shang, Wenqian Zhou, Zhen Xu, Yunpeng Kou, Zhenyu Guo, Fan Chen, Peigang Ji, Yulong Zhai, Wenjian Zhao, Yang Jiao, Zhipeng Song, Shunnan Ge, Yuan Wang, Liang Wang, Shaochun Guo
Neurochirurgie.2025; 71(6): 101733. CrossRef
Albuminemia as a Potential Predictor of Clinical Outcomes in Patients with Severe Traumatic Brain Injury (TBI)
Luka Stepanovic, Usha Govindarajulu, George Agriantonis, Navin D. Bhatia, Jasmine Dave, Shalini Arora, Zahra Shafaee, Kate Twelker, Jennifer Whittington, Bharti Sharma
Journal of Clinical Medicine.2025; 14(21): 7499. CrossRef
Research Advances in CAR, NLR, and S100β for Assessing Neurological Functional Prognosis in Traumatic Brain Injury Patients
明隆陈
Advances in Clinical Medicine.2025; 15(10): 2518. CrossRef
Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury
Kathryn S. Gerber, Gemayaret Alvarez, Arsham Alamian, Victoria Behar-Zusman, Charles A. Downs
Journal of Trauma Nursing.2024; 31(2): 72. CrossRef
Association of C-reactive protein/albumin ratio with mortality in patients with Traumatic Brain Injury: A systematic review and meta-analysis
Yuyang Liu, Yaheng Tan, Jun Wan, Qiwen Chen, Yuxin Zheng, Wenhao Xu, Peng Wang, Weelic Chong, Xueying Yu, Yu Zhang
Heliyon.2024; 10(13): e33460. CrossRef

Neurosurgery
Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural hematoma: Anukoon Kaewborisutsakul, Thara Tunthanathip; Acute Crit Care. 2022;37(3):429-437. Published online June 23, 2022; DOI: https://doi.org/10.4266/acc.2021.01795

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Abstract PDF

Background
A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.
Methods
In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King’s Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.
Results
The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0–42.9), Glasgow coma scale scores of 3–8 (OR, 8.2; 95% CI, 1.7–38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6–8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6–7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62–10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003–26.1) were also included.
Conclusions
SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.

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Basic science and research
A machine learning model for predicting favorable outcome in severe traumatic brain injury patients after 6 months: Mehdi Nourelahi, Fardad Dadboud, Hosseinali Khalili, Amin Niakan, Hossein Parsaei; Acute Crit Care. 2022;37(1):45-52. Published online January 21, 2022; DOI: https://doi.org/10.4266/acc.2021.00486

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Abstract PDF

Background
Traumatic brain injury (TBI), which occurs commonly worldwide, is among the more costly of health and socioeconomic problems. Accurate prediction of favorable outcomes in severe TBI patients could assist with optimizing treatment procedures, predicting clinical outcomes, and result in substantial economic savings.
Methods
In this study, we examined the capability of a machine learning-based model in predicting “favorable” or “unfavorable” outcomes after 6 months in severe TBI patients using only parameters measured on admission. Three models were developed using logistic regression, random forest, and support vector machines trained on parameters recorded from 2,381 severe TBI patients admitted to the neuro-intensive care unit of Rajaee (Emtiaz) Hospital (Shiraz, Iran) between 2015 and 2017. Model performance was evaluated using three indices: sensitivity, specificity, and accuracy. A ten-fold cross-validation method was used to estimate these indices.
Results
Overall, the developed models showed excellent performance with the area under the curve around 0.81, sensitivity and specificity of around 0.78. The top-three factors important in predicting 6-month post-trauma survival status in TBI patients are “Glasgow coma scale motor response,” “pupillary reactivity,” and “age.”
Conclusions
Machine learning techniques might be used to predict the 6-month outcome in TBI patients using only the parameters measured on admission when the machine learning is trained using a large data set.

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Trauma
The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury: Young Hoon Park, Dong Hyun Ryu, Byung Kook Lee, Dong Hun Lee; Acute Crit Care. 2019;34(4):255-262. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00640

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149 Download
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Abstract PDF

Background
Exsanguination is a major cause of death in severe trauma patients. The purpose of this study was to analyze the prognostic impact of the initial lactate level for massive transfusion (MT) in severe trauma. We divided patients according to subgroups of traumatic brain injury (TBI) and non-TBI.
Methods
This single-institution retrospective study was conducted on patients who were admitted to hospital for severe trauma between January 2016 and December 2017. TBI was defined by a head Abbreviated Injury Scale ≥3. Receiver operating characteristic analysis was used to analyze the prognostic impact of the lactate level. Multivariate analyses were performed to evaluate the relationship between the MT and lactate level. The primary outcome was MT.
Results
Of the 553 patients, MT was performed in 62 patients (11.2%). The area under the curve (AUC) for the lactate level for predicting MT was 0.779 (95% confidence interval [CI], 0.742 to 0.813). The AUCs for lactate level in the TBI and non-TBI patients were 0.690 (95% CI, 0.627 to 0.747) and 0.842 (95% CI, 0.796 to 0.881), respectively. In multivariate analyses, the lactate level was independently associated with the MT (odds ratio [OR], 1.179; 95% CI, 1.070 to 1.299). The lactate level was independently associated with MT in non-TBI patients (OR, 1.469; 95% CI, 1.262 to 1.710), but not in TBI patients.
Conclusions
The initial lactate level may be a possible prognostic factor for MT in severe trauma. In TBI patients, however, the initial lactate level was not suitable for predicting MT.

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