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Biomedical subjects

B Jennett

Publications and source records attributed to B Jennett.

At least 91 records · Page 5Linked to original sources
PubMed1983

Risks of intracranial haematoma in head injured adults.

A study was conducted to estimate the risk that an adult (age 15 or over) will develop a surgically significant intracranial haematoma after a head injury. Two simple features were used that can be recognised by clinicians with minimal training: a skull fracture and the conscious level. The risks were calculated from samples of 545 patients with haematomas, 2773 head injured patients in accident and emergency departments, and 2783 head injured patients in primary surgical wards. With radiological evidence of skull fracture and any impairment of consciousness (including disorientation) one patient in four in an accident and emergency department or primary surgical ward will develop a haematoma. With no skull fracture and preserved orientation the risk to a patient in an accident and emergency department is one in 6000. The use of risk levels as a basis for decision making about head injured patients may result in fewer haematomas being detected too late and savings of resources by reducing the admission and investigation of low risk categories of patients.

Adolescent↗
PubMed1983

Neurosurgical resources and transfer policies for head injuries.

Criteria for transferring head injured patients to a regional neurosurgical unit were changed to enable a larger proportion of patients admitted to primary surgical wards to have a CT scan. The yearly number of transfers doubled, more intracranial haematomas were detected, and mortality from this complication was reduced. To operate such a policy requires seven neurosurgical beds per million for head injuries, given the Glasgow practice of early return of patients to primary surgical wards.

Bed Occupancy↗
PubMed1983

Brain death 1983.

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Brain Death↗
PubMed1982

Admission after mild head injury: benefits and costs.

Large numbers of patients are admitted to hospital in Britain after mild head injury in the hope of anticipating complications. Investigation of 1442 consecutive admissions with head injury to the Edinburgh Royal Infirmary yielded 56 intracranial haematomas. Of 865 patients who were alert and orientated in the accident and emergency department after having been briefly knocked out but who had no skull fracture, no focal neurological signs, and no history of headache or vomiting, only one developed an intracranial haematoma. In deciding which patients should be admitted a skull fracture is a much more important risk factor than is a history of brief unconsciousness. If criteria for admission took account of this fewer patients would be admitted and the saving would be considerable.

Cerebral Hemorrhage↗
PubMed1982

Brain death.

Mechanical ventilation frequently saves lives that are threatened by temporary respiratory failure; but when breathing stops due to irreversible brain damage ventilation only prolongs the process of dying, as organs serially cease to function. The possibility of extending from a few minutes to many days the interval between final failure of the brain and ultimate cardiac asystole emphasises that death is not an event, but a process.

Brain Death↗
PubMed1981

Skull X-rays.

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Brain Diseases↗
PubMed1981

Hazards of inter-hospital transfer of comatose head-injured patients.

A study of 150 comatose patients transferred to one neurosurgical unit after head injury showed that untoward incidents which could cause secondary brain damage were present in 61 patients, and that extracranial injuries were overlooked or inadequately treated in 21. The commonest mishaps were airways obstruction and hypotension, which affected outcome adversely. Distance from the neurosurgical unit had little effect on rapidity of transfer or the occurrence of untoward incidents. Optimum care requires the rapid transfer of many comatose patients to neurosurgical units, and a systematic approach to minimising the hazards of transfer would reduce mortality and morbidity.

Adolescent↗
PubMed1981

Brain death in Britain as reflected in renal donors.

The diagnostic mix of 1228 brain-dead renal donors in Britain was similar to that of 479 cases of brain death recently reported from three neurosurgical units. About half the donors came from non-teaching hospitals without a neurosurgical unit, many of them small and distant from the centre. The different circumstances that preceded brain deaths were examined--namely, diagnosis and whether the fatal ictus of brain damage occurred when the patient was already in hospital--to explain why donors spend varying times on the ventilator. Head injuries accounted for half the donors, and intracranial haemorrhage for almost a third. While many potential donors are not made available, the size of the pool has been overestimated, particularly in regard to head injury. Reduction in organ donation since "Panorama" has been very uneven, with some places increasing their yield; this suggests reluctance of doctors to initiate donation rather than relatives withholding permission.

Adolescent↗
PubMed1981

Brain death in three neurosurgical units.

The validity of clinical criteria for diagnosing brain death has been investigated in three ways. A total of 447 published cases were reviewed. In three neurosurgical units (Cambridge, Glasgow, and Swansea) 609 patients diagnosed clinically as brain dead were studied; 326 had final cardiac asystole while still being ventilated, and ventilation was discontinued in the remainder. No patient recovered. The median time in hospital before the heart finally stopped was 3 1/2-4 1/2 days, with 30-40 hours on the ventilator. Analysis of prospective data from three countries on patients with severe head injuries showed that not one of 1003 survivors would ever have been suspected of being brain dead even in their worst state soon after injury. Recovery after supposed brain death has been alleged in patients who were thought to be brain dead but in fact were not and in cases where reflex movements in the limbs were mistaken for signs of life. The safeguards in diagnosing brain death include establishing irreversible structural brain damage, excluding the effects of drugs, and allowing enough time to elapse to establish the diagnosis beyond doubt. The studies reported here show that the clinical criteria used in the United Kingdom are reliable. There is no need for confirmatory tests such as an electroencephalogram provided that all the conditions for clinical diagnosis have been fulfilled and all the tests carried out.

Brain Death↗
PubMed1981

Epidemiology of head injury.

To find the incidence of the various types of head injury that occur in the community separate yearly rates (per 10(5) population in Scotland) for deaths, admissions to hospital, and attendance at accident and emergency departments were estimated and compared (when possible) with rates in England and Wales and the United States. Hospital admissions provide the best data for comparing incidences in different geographical areas and rates of attendance at accident and emergency departments the most reliable guide to incidences in the community. Admission rates, however, vary with local facilities and policies, and these also determine the proportion of patients referred to regional neurosurgical units. Such epidemiological data must be sought both for planning health care for head injury and for monitoring the effectiveness of services.

Adolescent↗
PubMed1981

Brain Death.

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Brain Death↗
PubMed1981

Disability after severe head injury: observations on the use of the Glasgow Outcome Scale.

The nature of the neurological and mental disabilities resulting from severe head injuries are analysed in 150 patients. Mental handicap contributed more significantly to overall social disability than did neurological deficits. This social handicap is readily described by the Glasgow Outcome Scale, an extended version of which is described and compared with alternatives. Comments are made about the quality of life in disabled survivors.

Adult↗
PubMed1981

Brain death 1981.

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Brain Death↗
PubMed1980

Serious head injury in sport.

Of 1900 head injuries serious enough to be admitted to the neurosurgical unit in Glasgow over a five year period, 52 (2.7%) were due to "sport." Golf, horse-riding, and Association football were the sports most commonly linked with serious head injury. Golfing injuries were all compound depressed fractures, and all these patients made a good recovery; horse-riding produced more severe injuries, three of the eight patients being left with residual disability. Much attention has been directed to preventing repeated minor head injury in boxing, but this study emphasises the need for preventing both the primary head injury and secondary complications associated with other sports.

Athletic Injuries↗