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2. The Roles of Protocols and Protocolization in Improving Outcome From Severe Traumatic Brain Injury.

Author

Chesnut, Randall M., Temkin, Nancy, Videtta, Walter, Lujan, Silvia, Petroni, Gustavo, Pridgeon, Jim, Dikmen, Sureyya, Chaddock, Kelley, Hendrix, Terence, Barber, Jason, Machamer, Joan, Guadagnoli, Nahuel, Hendrickson, Peter, Alanis, Victor, La Fuente, Gustavo, Lavadenz, Arturo, Merida, Roberto, Sandi Lora, Freddy, Romero, Ricardo, and Pinillos, Oscar

Published
2024
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3. The Roles of Protocols and Protocolization in Improving Outcome From Severe Traumatic Brain Injury

Author

Chesnut, Randall M., Temkin, Nancy, Videtta, Walter, Lujan, Silvia, Petroni, Gustavo, Pridgeon, Jim, Dikmen, Sureyya, Chaddock, Kelley, Hendrix, Terence, Barber, Jason, Machamer, Joan, Guadagnoli, Nahuel, Hendrickson, Peter, Alanis, Victor, La Fuente, Gustavo, Lavadenz, Arturo, Merida, Roberto, Sandi Lora, Freddy, Romero, Ricardo, Pinillos, Oscar, Urbina, Zulma, Figueroa, Jairo, Ochoa, Marcelo, Davila, Rafael, Mora, Jacobo, Bustamante, Luis, Perez, Carlos, Leiva, Jorge, Carricondo, Carlos, Mazzola, Ana Maria, and Guerra, Juan

Published
2024
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4. Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations.

Author

Chesnut, Randall M., Aguilera, Sergio, Buki, Andras, Bulger, Eileen M., Citerio, Giuseppe, Cooper, D. Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Guoyi Gao, Geocadin, Romergryko G., Ghajar, Jamshid, Harris, Odette, Hawryluk, Gregory W. J., Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, and Mayer, Stephan

Published
2023
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5. Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations

Author

Chesnut, Randall M., Aguilera, Sergio, Buki, Andras, Bulger, Eileen M., Citerio, Giuseppe, Cooper, D. Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko G., Ghajar, Jamshid, Harris, Odette, Hawryluk, Gregory W. J., Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K, Meyfroidt, Geert, Michael, Daniel B., Oddo, Mauro, Okonkwo, David O., Patel, Mayur B., Robertson, Claudia, Rosenfeld, Jeffrey V., Rubiano, Andres M., Sahuquillo, Juain, Servadei, Franco, Shutter, Lori, Stein, Deborah M., Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly D., Tsai, Eve C., Ullman, Jamie S., Videtta, Walter, Wright, David W., and Zammit, Christopher

Published
2023
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6. Testing the Impact of Protocolized Care of Patients With Severe Traumatic Brain Injury Without Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol.

Author

Chesnut, Randall M., Temkin, Nancy, Videtta, Walter, Lujan, Silvia, Petroni, Gustavo, Pridgeon, Jim, Dikmen, Sureyya, Chaddock, Kelley, Hendrix, Terence, Barber, Jason, Machamer, Joan, Guadagnoli, Nahuel, Hendrickson, Peter, Alanis, Victor, La Fuente, Gustavo, Lavadenz, Arturo, Merida, Roberto, Lora, Freddy Sandi, Romero, Ricardo, and Pinillos, Oscar

Published
2023
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7. Testing the Impact of Protocolized Care of Patients With Severe Traumatic Brain Injury Without Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol

Author

Chesnut, Randall M., Temkin, Nancy, Videtta, Walter, Lujan, Silvia, Petroni, Gustavo, Pridgeon, Jim, Dikmen, Sureyya, Chaddock, Kelley, Hendrix, Terence, Barber, Jason, Machamer, Joan, Guadagnoli, Nahuel, Hendrickson, Peter, Alanis, Victor, La Fuente, Gustavo, Lavadenz, Arturo, Merida, Roberto, Lora, Freddy Sandi, Romero, Ricardo, Pinillos, Oscar, Urbina, Zulma, Figueroa, Jairo, Ochoa, Marcelo, Davila, Rafael, Mora, Jacobo, Bustamante, Luis, Perez, Carlos, Leiva, Jorge, Carricondo, Carlos, Mazzola, Ana Maria, and Guerra, Juan

Published
2023
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14. Fixed, Dilated, and Conversing—Unreactive Pupil With Preserved Consciousness Indicating Acutely Rising Intracranial Pressure due to Traumatic Intraparenchymal Contusions: Case Report and Review of the Literature

Author

McAvoy, Malia, Lee, Gina, Boop, Scott, Greil, Madeline E., Durler, Kayla A., Young, Christopher C., Craft, Lindy, Chesnut, Randall M., and Wahlster, Sarah

Abstract

Patients with fixed and dilated pupils (FDPs) due to rising intracranial pressure (ICP) typically experience a deterioration in consciousness. We describe an exceptional case of a patient with bifrontal contusions who developed worsening edema and a unilaterally FDP while maintaining consciousness and the ability to communicate. A 58-year-old man with history of hypertension and diabetes mellitus type II presented after being assaulted, with bifrontal contusions and right frontal intraparenchymal hemorrhage. On hospital day 8, his right pupil became fixed (NPi 0) and dilated (4.8 mm). The patient was drowsy, arousable to tactile stimuli, answering questions, oriented to place and time, following commands on his right side, maintaining Glasgow Coma Scale of 14 (E4, V5, M6). He described complete loss of vision and could not identify objects or count fingers. His gaze was dysconjugate with impaired vertical excursion and inability to fully abduct to the right side. Corneal reflexes were intact bilaterally. Hypertonic saline and mannitol produced no improvement in his pupillary exam. Head computed tomography showed worsening midline shift and interval increase in subfalcine herniation related to increased peri-hematoma edema. We performed an emergent right-sided decompressive hemicraniectomy with durotomy and duraplasty. His pupil became reactive 5 hours after surgery. While FDP without deterioration of consciousness has been described due to traumatic subdural and epidural hematomas, we report this unusual constellation as a sign of rising ICP and impeding herniation due to intraparenchymal contusions, highlighting that any pupillary change warrants prompt work-up and intervention.

Published
2022
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15. Re-examining decompressive craniectomy medial margin distance from midline as a metric for calculating the risk of post-traumatic hydrocephalus.

Author

Williams, John R., Meyer, Michael R., Ricard, Jocelyn A., Sen, Rajeev, Young, Christopher C., Feroze, Abdullah H., Greil, Madeline E., Barros, Guilherme, Durfy, Sharon, Hanak, Brian, Morton, Ryan P., Temkin, Nancy R., Barber, Jason K., Mac Donald, Christine L., and Chesnut, Randall M.

Abstract

Decompressive craniectomy (DC) is a life-saving procedure in severe traumatic brain injury, but is associated with higher rates of post-traumatic hydrocephalus (PTH). The relationship between the medial craniectomy margin's proximity to midline and frequency of developing PTH is controversial. The primary study objective was to determine whether average medial craniectomy margin distance from midline was closer to midline in patients who developed PTH after DC for severe TBI compared to patients that did not. The secondary objective was to determine if a threshold distance from midline could be identified, at which the risk of developing PTH increased if the DC was performed closer to midline than this threshold. A retrospective review was performed of 380 patients undergoing DC at a single institution between March 2004 and November 2014. Clinical, operative and demographic variables were collected, including age, sex, DC parameters and occurrence of PTH. Statistical analysis compared mean axial craniectomy margin distance from midline in patients with versus without PTH. Distances from midline were tested as potential thresholds. No significant difference was identified in mean axial craniectomy margin distance from midline in patients developing PTH compared with patients with no PTH (n = 24, 12.8 mm versus n = 356, 16.6 mm respectively, p = 0.086). No significant cutoff distance from midline was identified (n = 212, p = 0.201). This study, the largest to date, was unable to identify a threshold with sufficient discrimination to support clinical recommendations in terms of DC margins with regard to midline, including thresholds reportedly significant in previously published research. [ABSTRACT FROM AUTHOR]

Published
2021
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16. Cardiac-cerebral-renal associations in pediatric traumatic brain injury: Preliminary findings.

Author

Lele, Abhijit V., Alunpipatthanachai, Bhunyawee, Clark-Bell, Crystalyn, Watanitanon, Arraya, Min Xu, M., Anne Moore, R.V.T., Zimmerman, Jerry J., Portman, Michael A., Chesnut, Randall M., and Vavilala, Monica S.

Abstract

• In children with isolated traumatic brain injury, elevation in troponin (cTnI) is common. • Elevated cTnI occurs across all age groups, in both sexes and regardless of lesion type, and across injury severity. • Age-adjusted tachycardia may be a clinical indicator of myocardial injury. The clinical epidemiology of organ outcomes in pediatric traumatic brain injury (TBI) has not been examined. We describe associated markers of cerebral, cardiac and renal injury after pediatric TBI. Prospective observational study. Children 0–18 years who were hospitalized with TBI. Measures of myocardial (at least one elevated plasma troponin [cTnI] ≥ 0.4 ng/ml) and multiorgan (hemodynamic variables, cerebral perfusion, and renal) function were examined within the first ten days of hospital admission and within 24 h of each other. Data from 28 children who were 11[IQR 10.3] years, male (64.3%), with isolated TBI (67.9%), injury severity score (ISS) 25[10], and admission Glasgow coma score (GCS) 11[9] were examined. Overall, 50% (14 children) had elevated cTnI, including those with isolated TBI (57.9%; 11/19), polytrauma (33.3%; 3/9), mild TBI (57.1% 8/14), and severe TBI (42.9%; 6/11). Elevated cTnI occurred within the first six days of admission and across all age groups, in both sexes, and regardless of TBI lesion type, GCS, and ISS. Age-adjusted admission tachycardia was associated with cTnI elevation (AUC 0.82; p < 0.001). Reduced urine output occurred more commonly in patients with isolated TBI (27.3% elevated cTnI vs. 0% normal cTnI). Myocardial injury commonly occurs during the first six days after pediatric TBI irrespective of injury severity, age, sex, TBI lesion type, or polytrauma. Age-adjusted tachycardia may be a clinical indicator of myocardial injury, and elevated troponin may be associated with cardio-cerebro-renal dysfunction. [ABSTRACT FROM AUTHOR]

Published
2020
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22. The Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in severe traumatic brain injury: a single-centre hybrid implementation and effectiveness study

Author

Vavilala, Monica S, King, Mary A, Yang, Jen-Ting, Erickson, Scott L, Mills, Brianna, Grant, Rosemary M, Blayney, Carolyn, Qiu, Qian, Chesnut, Randall M, Jaffe, Kenneth M, Weiner, Bryan J, and Johnston, Brian D

Abstract

As far as we know, there are no tested in-hospital care programmes for paediatric traumatic brain injury. We aimed to assess implementation and effectiveness of the Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in children with severe traumatic brain injury.

Published
2019
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25. Natural History and Management of Blunt Traumatic Pseudoaneurysms of the Internal Carotid Artery.

Author

Morton, Ryan P., Levitt, Michael R., Emerson, Samuel, Ghodke, Basavaraj V., Hallam, Danial K., Sekhar, Laligam N., Kim, Louis J., and Chesnut, Randall M.

Abstract

Objective: To define the natural history of, and treatment strategy for, blunt traumatic internal carotid artery (ICA) pseudoaneurysms. Background: The natural history and management of traumatic ICA pseudoaneurysms is controversial. Methods: We retrospectively identified all traumatic ICA pseudoaneurysms diagnosed on head/neck computed tomographic angiography at a highvolume trauma center over a 10-year period. Radiographic and clinical data were recorded, and a treatment algorithm was derived. Results: Forty-three pseudoaneurysms were diagnosed in 39 patients. All patients were treated with daily aspirin unless contraindicated, and 82% underwent daily transcranial Doppler ultrasonography with embolic monitoring. A rate of 8 or more emboli per hour was predictive of embolic stroke (P=0.0076). Acute ischemic or embolic stroke was seen in 7 patients (16%) with an overall mortality in this subpopulation of 42% (n=3). Four patients (9%) underwent acute surgical treatment (parent vessel sacrifice and/or arterial bypass) for ongoing ischemia. Long-term radiographic and clinical follow-up was obtained for 36 surviving patients (mean = 8 months; range: 1 week-5 years), all of whom were maintained on daily aspirin. No delayed ischemic or embolic events were reported. For ICA pseudoaneurysms treated with aspirin and observation alone, 9 (28%) increased in size, 17 (53%) decreased or stabilized, and 6 (19%) resolved. Enlargement of 5mm or more in maximal diameter underwent delayed endovascular treatment with a 100% obliteration rate and no complications. Conclusions: Traumatic ICA pseudoaneurysms are safely treated with daily aspirin, embolic monitoring, and radiographic surveillance. Acute stroke or hemorrhage, or delayed radiographic progression, are indications for endovascular or surgical treatment. [ABSTRACT FROM AUTHOR]

Published
2016
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26. Response.

Author

Bonow, Robert H., Witt, Cordelie E., Mossa-Basha, Mahmud, Cuschieri, Joseph, Arbabi, Saman, Vavilala, Monica S., Rivara, Frederick P., and Chesnut, Randall M.

Published
2022
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32. Traumatic Brain Injury in Latin America.

Author

Chesnut, Randall M., Temkin, Nancy, Carney, Nancy, Dikmen, Sureyya, Pridgeon, Jim, Barber, Jason, Celix, Juanita M., Chaddock, Kelley, Cherner, Marianna, Hendrix, Terence, Lujan, Silvia, Machamer, Joan, Petroni, Gustavo, Rondina, Carlos, and Videtta, Walter

Published
2012
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36. Summary Report: Evidence for the Effectiveness of Rehabilitation for Persons with Traumatic Brain Injury.

Author

Chesnut, Randall M., Carney, Nancy, Maynard, Hugo, Mann, N. Clay, Patterson, Patricia, and Helfand, Mark

Abstract

Presents a study which evaluated the evidence for effectiveness of rehabilitation methods throughout the phases of recovery from traumatic brain injury in adults. Use of the phases of recovery to design individualized rehabilitation interventions; Methodology; Results; Conclusion.

Published
1999
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37. Prevalence and Risk Factors for Intraoperative Hypotension During Craniotomy for Traumatic Brain Injury

Author

Sharma, Deepak, Brown, Michelle J., Curry, Parichat, Noda, Sakura, Chesnut, Randall M., and Vavilala, Monica S.

Abstract

Hypotension after traumatic brain injury (TBI) is associated with poor outcomes. However, data on intraoperative hypotension (IH) are scarce and the effect of anesthetic agents on IH is unknown. We examined the prevalence and risk factors for IH, including the effect of anesthetic agents during emergent craniotomy for isolated TBI.

Published
2012
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38. Chapter 16. Glucose and nutrition

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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39. Chapter 15. Analgesics, sedatives, and neuromuscular blockade

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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40. Chapter 11. Barbiturates

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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42. Chapter 8. Hyperosmolar therapy

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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43. Chapter 9. Temperature control

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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44. Chapter 3. Indications for intracranial pressure monitoring

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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45. Chapter 4. Threshold for treatment of intracranial hypertension

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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46. Chapter 5. Cerebral perfusion pressure thresholds

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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47. Chapter 1. Introduction

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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48. Chapter 2. Methods

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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49. Chapter 17. Antiseizure prophylaxis

Author

Kochanek, Patrick M., Carney, Nancy, Adelson, P. David, Ashwal, Stephen, Bell, Michael J., Bratton, Susan, Carson, Susan, Chesnut, Randall M., Ghajar, Jamshid, Goldstein, Brahm, Grant, Gerald A., Kissoon, Niranjan, Peterson, Kimberly, Selden, Nathan R., Tong, Karen A., Tasker, Robert C., Vavilala, Monica S., Wainwright, Mark S., and Warden, Craig R.

Published
2012
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50. Talk and Die Revisited Bifrontal Contusions and Late Deterioration

Author

Peterson, Eric Cecala and Chesnut, Randall M.

Abstract

Severe bifrontal contusions in an awake traumatic brain injury (TBI) patient is a challenging clinical picture, as they are prone to late deterioration. We evaluated our series of patients with severe bifrontal contusions, characterizing their clinical course and suggestions for management.

Published
2011
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