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Biomedical subjects

B Jennett

Publications and source records attributed to B Jennett.

At least 163 records · Page 9Linked to original sources
PubMed1975

Patients with head injury who talk and die.

Of 66 patients with head injuries who had talked at some time after injury, 25% did not have intracranial haematoma at necropsy. Most of these had raised intracranial pressure (I.C.P.), and the commonest finding was local swelling related to contusions. Almost half of the non-haematoma cases had ischaemic or hypoxic brain damage, usually without contusions; 3 were children who had had status epilepticus. Fatality without raised I.C.P. was most often due to meningitis. In deteriorating patients without haematoma mortality and morbidity might be reduced by more diagnosis and treatment, particularly of raised I.C.P.

Adolescent↗
PubMed1975

Who cares for head injuries?

Patterns of management for head injury in the acute and late stages are reviewed in respect of both mild and severe injuries. Because so many disciplines are involved, continuity of care if often difficult to achieve; and no one discipline is concerned with planning for the care of head injuries in a strategic way. The needs of head-injured patients are defined and suggestions made for improving care by the reorganization of existing facilities. What is most needed is to concentrate on patients with head injuries, both in the acute and in the late stages. Only then can medical, nursing, and paramedical personnel become skilled in dealing with the many problems which such patients present.

Adult↗
PubMed1975

Assessment of outcome after severe brain damage.

Persisting disability after brain damage usually comprises both mental and physical handicap. The mental component is often the more important in contributing to overall social disability. Lack of an objective scale leads to vague and over-optimistic estimates of outcome, which obscure the ultimate results of early management. A five-point scale is described--death, persistent vegetative state, severe disability, moderate disability, and good recovery. Duration as well as intensity of disability should be included in an index of ill-health; this applies particularly after head injury, because many disabled survivors are young.

Activities of Daily Living↗
PubMed1975

Prognosis after severe head injury.

Prognosis depends on establishing a relationship between the patient's state in the early stages and the ultimate outcome. Both the severity of the initial damage (including early complications) and the degree of recovery need to be defined, but practical and statistical considerations impose a limit on the number of variables which can be manipulated. Variables chosen should be those likely to be relevant, and pilot studies are more reliable than intuition in indicating which items should be included. Data chosen should be of a kind likely to be readily available for most patients and should not therefore depend on complex laboratory investigation. The most reliable indicant of initial severity appears to be the depth and duration of coma or altered consciousness, and a scale has been devised for measuring these. Measures of outcome should include separate assessment of mental and physical disability as well as the overall social consequence of the brain damage. Prognosis should be expressed as the probability (mathematically expressed) that a patient will reach certain defined outcome categories, five of which are recognized in the present study. Predictions should begin only after initial resuscitative measures are complete (say six hours after ictus); they need not be limited to the early stages but can include estimates of the degree of further improvement expected in the light of progress in the early weeks after injuries. New methods of management cannot be critically assessed unless factors influencing prognosis are reliably identified and can be matched in comparative patient groups. An estimate of prognosis is also required for the selection of patients for intensive treatment, both in the acute and in the rehabilitation stage. Without such data there is a tendency to deploy an unduly high proportion of scarce resources on patients who have little prospect of recovery; this may deny the best chance of recovery to patients with severe, but less overwhelming, brain damage.

Adult↗
PubMed1975

Outcome of severe damage to the central nervous system. Scale, scope and philosophy of the clinical problem.

The recovery process after acute brain damage has attracted little interest from either basic or clinical scientists who seem to be most concerned with the acute stage. Much might be learnt about the mechanisms of the nervous system from study of the recovery process. The number of patients with permanent brain damage is growing as the result of the increased survival rate from such common conditions as severe head injury and non-geriatric stroke. Response to this problem has largely come from other disciplines, and in the form of supportive care rather than scientific enquiry. Such an enquiry might seek to answer three outstanding questions. (1) What is the nature of the persisting disability? (2) Can more scientifically based rehabilitation, including physical, mental and social components, either accelerate the rate of recovery or reduce the degree of ultimate disability? (3) Can the ultimate outcome be predicted in the acute stage; and can the amount of further improvement be estimated in the later stages of recovery?

Brain Injuries↗
PubMed1975

EEG prediction of post-traumatic epilepsy.

EEGs from 722 patients with injuries associated with a high risk of late traumatic epilepsy were analyzed. Although abnormal records were more common in patients who developed epilepsy, they reflected the more severe brain damage in these patients, which was already evident from clinical features. In individual patients the EEG does not improve the accuracy of the prediction calculated from clinical data. Patients with persisting or newly developing EEG abnormalities may never have a fit, while 20% of those with late epilepsy had at least one normal record in the first 3 months after injury. The conclusion that the EEG does not contribute usefully to the prediction of traumatic epilepsy appears to reflect a consensus among recent writers on the subject.

Craniocerebral Trauma↗
PubMed1975

Epilepsy and acute traumatic intracranial haematoma.

Acute intracranial haematoma significantly increases the incidence of traumatic epilepsy, both early (first week) and late. Early epilepsy can cause diagnostic and management problems, while late epilepsy may produce persisting disability.

Acute Disease↗