{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T05:00:50Z","timestamp":1666674050573},"reference-count":48,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg A Cent Eur Neurosurg"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Objective\u2003The presence of multiple injuries in addition to a traumatic brain injury (TBI) is initially uncertain in most patients with posttraumatic coma. The interdisciplinary team of physicians in charge of initial treatment after hospital admission may face a collision of vital priorities. The purpose of this study was to analyze which diagnostic and surgical measures were given priority over others in comatose patients after injury and to draw conclusions from these data.<\/jats:p><jats:p>Methods\u2003In this prospective multicenter cohort study, the outcomes of 1,003 comatose patients with suspected multiple injuries were studied. The analysis was divided into an early and a late stage. Diagnostic and surgical measures were analyzed for a 6-month period. The prognostic value of the Glasgow Coma Scale (GCS) and the World Federation of Neurosurgical Societies grading scale were investigated.<\/jats:p><jats:p>Results\u2003Removal of intracranial hematomas and decompressive craniotomies were the most frequent procedures within the first 48\u2009hours after admission to the hospital. Prognosis depends on the location and the combination of injuries. Outcome is significantly correlated to initial signs of brainstem dysfunction. The GCS did not adequately predict clinical outcome.<\/jats:p><jats:p>Conclusion\u2003Comatose patients with suspected multiple injuries should only be admitted to hospitals with a continuous neurosurgical service because intracranial operations are more frequent in the first 48\u2009hours than extracranial operations. Depending on the neurologic status of the patient, an urgent surgical decompression may be essential for a good outcome. The GCS alone is not a sufficient tool for the neurologic assessment and the prognosis of patients with multiple injuries. The onset of clinical signs of brainstem dysfunction indicates a critical deterioration of the functioning of the central nervous system. The priority of surgical measures should be tailored accordingly.<\/jats:p>","DOI":"10.1055\/s-0040-1701620","type":"journal-article","created":{"date-parts":[[2020,5,21]],"date-time":"2020-05-21T22:52:30Z","timestamp":1590101550000},"page":"430-441","source":"Crossref","is-referenced-by-count":0,"title":["Collision of Priorities in Posttraumatic Coma and Suspected Multiple Injuries: A Prospective Multicenter Trial"],"prefix":"10.1055","volume":"81","author":[{"given":"Raimund","family":"Firsching","sequence":"additional","affiliation":[{"name":"Otto-von-Guericke-Universit\u00e4t Magdeburg, Universit\u00e4tsklinikum, Klinik f\u00fcr Neurochirurgie, Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Voellger","sequence":"additional","affiliation":[{"name":"Otto-von-Guericke-Universitaet, Klinik f\u00fcr Neurochirurgie, Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dieter","family":"Woischneck","sequence":"additional","affiliation":[{"name":"Klinikum Landshut, Klinik f\u00fcr Neurochirurgie, Landshut, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali Mohammed","family":"Rashidi","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Neurochirurgie Magdeburg, Universit\u00e4tsklinikum Magdeburg, Sachsen-Anhalt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"K\u00f6nig","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Neurochirurgie Magdeburg, Universit\u00e4tsklinikum Magdeburg, Sachsen-Anhalt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Luchtmann","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Neurochirurgie Magdeburg, Universit\u00e4tsklinikum Magdeburg, Sachsen-Anhalt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,5,21]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1136\/jnnp.60.4.362","article-title":"Epidemiology of head injury","volume":"60","author":"B Jennett","year":"1996","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref2","volume-title":"Statistisches Bundesamt","year":"2015"},{"issue":"02","key":"ref3","first-page":"52","article-title":"Management of multiple injured patients: treatment algorithms according to ATLS principles","volume":"24","author":"F Hokema","year":"2008","journal-title":"Notarzt"},{"issue":"05","key":"ref4","first-page":"279","article-title":"Interdisciplinary teamwork in the emergency room: a review of the literature","volume":"44","author":"M Burkhardt","year":"2007","journal-title":"Intensivmed Notfallmed"},{"issue":"11","key":"ref5","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1007\/s001040050111","article-title":"Das Sch\u00e4del-Hirn-Trauma in der chirurgischen Akutversorgung Prim\u00e4rversorgung in einem Krankenhaus der Grund- und Regelversorgung","volume":"67","author":"W Friedl","year":"1996","journal-title":"Der Chirurg."},{"issue":"07","key":"ref6","first-page":"350","article-title":"Results of treatment of polytraumatized patients. 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