Prediction of discharge destination after traumatic brain injury in children using the head abbreviated injury scale

INTRODUCTION

Traumatic brain injury (TBI) is a major public health problem, particularly in children. Prognostication of injury severity at the time of presentation is difficult. The Abbreviated Injury Scale (AIS) is a commonly used anatomical-based coding system created to classify and describe injury severity after initial presentation, once test results are able to better define the anatomical characteristics of the injury. We hypothesize that the Head AIS can predict discharge destination in children after TBI.

METHODS

The trauma registry database for a Pediatric Level 1 Trauma center was queried for patients age ≤14 years from 2006 to 2015 with a Head AIS>2. All diagnoses with head AIS>2 were retrieved. Since one patient can have multiple diagnoses with an AIS>2, we selected the diagnosis with highest Head AIS associated with each patient. The demographics, length of stay, and the discharge disposition of patients were retrieved. Descriptive statistics were performed and association of Head AIS with the length of stay and discharge disposition was determined using logistic regression.

RESULTS

393 pediatric patients (age≤14 years) with an Head AIS ≥3, (64.0% males, mean age = 6.2 S.D. 4.58) presented over 10 years. Head AIS was strongly associated with mortality; with 0.8%, 1.1% and 42.0% of patients with Head AIS of 3, 4 and 5, respectively, dying - odds ratio for Head AIS 5 over Head AIS 3 = 89 (logistic regression, p-value<0.001). 80.0% of deaths (23 patients) in this cohort occurred within 24-h of presentation. Head AIS was associated with an increase likelihood of discharge to rehabilitation with 1.2%, 7.7% and 47.0% of survivors discharging to rehabilitation for Head AIS of 3, 4 and 5.

CONCLUSION

Head AIS can reliably predict discharge disposition to home, rehab or death. Calculation of Head AIS prior to discharge could lead to accurate prediction of discharge destination.

A comparison of bovine seminal quality assessments using different viewing chambers with a computer-assisted semen analyzer

Computer-assisted sperm analysis of fresh and frozen-thawed bovine sperm requires proper handling and preparation, and the type of slide used in the assessment is critical if the resultant data are to be useful quality control measurements. In the present study, 4 different slide viewing chambers, a Makler chamber, a clean slide-coverslip, or a 2- or 4-cell chamber Leja slide, were compared with assess their utility in providing reliable measurements of sperm motility variables. A Hamilton-Thorne IVOS Computer-Assisted Semen Analyzer (CASA) was the instrument used to determine sperm measurements utilizing the 4 different chambers. Fifty-eight different freeze batches of bovine semen that had been collected from 47 bulls at 7 sites that sex-sort sperm using Sexing Technologies sorting criteria were incorporated into the trial. Neither the percentage of motile sperm nor the percentage of progressively motile sperm differed for the Makler chamber vs. slide-coverslip comparisons. Similarly, total and progressively motile sperm did not differ between the 2- and 4-cell chambered Leja slides. However, total and progressive motility of sperm determined with the Makler chamber and slide-coverslip were greater (P < 0.0001) than motilities recorded by the 2- or 4-cell chambered Leja slides. Based on the results, the type of viewing chamber can affect the range of sperm motility values when CASA is used for quality control evaluations of thawed, cryopreserved sex-sorted sperm samples.