Biomedical subjects

Edward C Jauch

Publications and source records attributed to Edward C Jauch.

24 records · Page 2Linked to original sources

PubMed2002

Intracerebral hemorrhage.

There is a significant variation in the management of ICH by neurologists, neurosurgeons, and emergency physicians. Most of the randomized clinical therapeutic trials have focused on subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS). Well-organized practice guidelines are now available for the management of ICH. Exciting research areas are being aggressively explored. Medical and surgical interventions for SAH, AIS, and ICH are always time-dependent, which places additional responsibility on the EP to correctly and promptly recognize these conditions to prevent further injury. The time-dependent care of these patients places the EP on the front lines of future stroke care. Special thanks to Dr. Daniel Woo and Dr. Stewart Wright for their assistance in reviewing the manuscript and Amy Hess for preparation of the manuscript.

Algorithms↗

PubMed2002

Serum cleaved tau protein levels and clinical outcome in adult patients with closed head injury.

STUDY OBJECTIVE: Intracranial injuries (ICI) are associated with high mortality and morbidity. Unfortunately, tools for diagnosis and risk stratification of ICIs are limited in the emergency department setting. We determine the relationship between the presence or absence of a detectable cleaved serum tau protein (tau(c)), ICI, and outcome at hospital discharge in adults with closed head injuries (CHI). METHODS: This was a prospective pilot study of adult patients with CHI presenting to the ED of an urban Level I trauma center. Patients presenting within 10 hours of a CHI who underwent a head computed tomographic (CT) scan were eligible. A blood sample was collected at presentation and the tau(c) level was measured. Initial Glasgow Coma Scale scores and demographic information were recorded. A chart review was performed to determine outcome and final readings on the initial head CT scan. RESULTS: Patients were dichotomized to 1 of 2 groups, those with an ICI (n=17) and those with an isolated skull fracture or no CT abnormality (NICI) (n=11). The 2 groups were similar in regard to demographic composition, mechanism of injury, and coexisting injuries. A tau(c) level of more than 0 was associated with an increased chance of an ICI on the initial head CT scan (odds ratio 11.25; 95% confidence interval [CI] 1.17 to 108.4) and a greater chance of poor outcome, defined as death while in hospital or transfer to a nursing home at hospital discharge (odds ratio 8.17; 95% CI 1.42 to 47). CONCLUSION: A tau(c) level of more than 0 is associated with a greater chance of intracranial injury and poor outcome in patients with CHI.

Adult↗

PubMed2002

Genetic and environmental risk factors for intracerebral hemorrhage: preliminary results of a population-based study.

BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) has a 30-day mortality rate of 40% to 50% and lacks a proven treatment. We report a preplanned, midpoint analysis of the first population-based, case-control study that examines both genetic and environmental risk factors of ICH. METHODS: We prospectively identified cases of hemorrhagic stroke at all 16 hospitals in the Greater Cincinnati/Northern Kentucky region. All cases underwent medical record and neuroimaging review. Cases enrolled in the direct interview and genetic sampling arm of the study were matched to population-based control subjects by age, race, and sex. Multivariable logistic regression was performed to identify significant independent risk factors. RESULTS: We enrolled 188 cases of ICH (67 lobar, 121 nonlobar) and 366 control subjects in the direct interview arm of the study. Significant independent risk factors for lobar ICH included the presence of an apolipoprotein E2 or E4 allele, frequent alcohol use, prior stroke, and first-degree relative with ICH. Significant independent risk factors for nonlobar ICH were hypertension, prior stroke, and first-degree relative with ICH. An increasing level of education was associated with a decreased risk of nonlobar ICH. The attributable risk of apolipoprotein E2 or E4 for lobar ICH was 29%, and the attributable risk of hypertension for nonlobar ICH was 54%. CONCLUSIONS: There is significant epidemiological evidence that the pathophysiology of ICH varies by location. We estimate that a third of all cases of lobar ICH are attributable to possession of an apolipoprotein E4 or E2 allele and that half of all cases of nonlobar ICH are attributable to hypertension.

Age Distribution↗

PubMed2002

Relative edema volume is a predictor of outcome in patients with hyperacute spontaneous intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Little is known about the relationship between perihematomal edema in spontaneous intracerebral hemorrhage (ICH) and outcome. The purpose of this study was to determine whether absolute or relative edema volume (edema volume divided by hematoma volume) predicts mortality or functional outcome in patients with hyperacute spontaneous ICH. We hypothesized that increasing baseline relative edema volume is associated with greater probability of poor functional outcome. METHODS: This was a secondary analysis of a prospective, population-based study of hematoma growth in 142 patients with spontaneous ICH. Patients were imaged within 3 hours of onset, then 1 and 20 hours later. Our primary analysis excluded patients with anticoagulant use (n=7), underlying aneurysm/vascular malformation (n=9), trauma (n=1), incomplete data (n=20), infratentorial ICH (n=17), intraventricular extension (n=38), and no consent (n=2). We analyzed whether associations existed between baseline edema volumes or other clinical/radiological variables and either 12-week modified Rankin Scale score >2 or 30-day mortality. Secondary analyses used 20-hour CT scan data, all patients with supratentorial ICH, and 12-week Barthel Index score <85. RESULTS: By multivariable logistic regression analysis, baseline relative edema was the strongest independent predictor of functional outcome and was associated with lesser odds of poor 3-month functional outcome (odds ratio, 0.09 per 1.0-unit [100%] increase; 95% CI, 0.01 to 0.64; P=0.016) and 12-week Barthel Index score <85 (odds ratio, 0.12; 95% CI, 0.02 to 0.91; P=0.039) but did not predict mortality. Secondary analyses confirmed this result. Absolute edema volume predicted neither mortality nor functional outcome. CONCLUSIONS: Relative edema is strongly predictive of functional outcome in patients with hyperacute supratentorial spontaneous ICH without intraventricular extension.

Acute Disease↗

PubMed2002

Natural history of perihematomal edema in patients with hyperacute spontaneous intracerebral hemorrhage.

BACKGROUND AND PURPOSE: The natural history of perihematomal edema in human hyperacute spontaneous intracerebral hemorrhage (ICH) has not been well described. METHODS: This study was a secondary analysis of a previously reported prospective, population-based study of hematoma growth in 142 patients with spontaneous ICH. Patients were first imaged within 3 hours of onset, then 1 and 20 hours later. We excluded patients with anticoagulant use (n=7), underlying aneurysm/vascular malformation (n=9), trauma (n=1), incomplete data (n=20), infratentorial ICH (n=17), and no consent (n=2), leaving an overall study population of 86 patients. From this overall group we further excluded patients with intraventricular extension (n=38), subsequent surgery (n=5), or death (n=2) before 20-hour postbaseline CT. This second, "restricted" analysis group of 41 patients was relatively devoid of clinical or radiological variables likely to confound edema measurement. Absolute and relative edema volumes (edema volume divided by hematoma volume) were descriptively summarized. Correlations between baseline edema volumes and relevant clinical and radiological variables were then performed. RESULTS: Overall, median absolute edema volume increased from 6.93 to 14.4 cm(3) during the first 24 hours after ICH, and median relative edema volume increased from 0.47 to 0.81. In the restricted group, median absolute edema volume was 7.4 cm(3) at baseline and 11.0 cm(3) at 24 hours after ICH, and median relative edema volume increased from 0.55 to 0.81. Baseline relative edema volume was significantly negatively correlated with subsequent change in relative edema volume from baseline to 20-hour CT (r=0.57, P=0.0002) but was not significantly correlated with other clinical and radiological variables, including hematoma volume or change in hematoma volume. CONCLUSIONS: Perihematomal edema volume increases by approximately 75% during the first 24 hours after hyperacute spontaneous ICH. Patients with the least amounts of baseline relative edema volume were most likely to develop significant additional amounts of edema during the first 24 hours after spontaneous ICH.

Acute Disease↗

PubMedDate not supplied

Teaching ACLS stroke objectives to prehospital providers: a case-based approach.

OBJECTIVES: To determine whether a case-based educational module would increase prehospital care providers' short-term and long-term knowledge about stroke and to compare the educational impact when the module was moderated by a physician versus an advanced cardiac life support (ACLS) instructor. METHODS: A stroke module consisting of two case-based scenarios was administered to emergency medical services (EMS) personnel by either an ACLS instructor or a physician. Identical 25-question tests (based on 1997 ACLS prehospital stroke objectives) were administered before and after the module. Descriptive statistics were calculated by groups, and Wilcoxon tests were used to assess the significance of improvement in scores based on the paired data. RESULTS: Two hundred six EMS personnel [112 (54%) emergency medical technician (EMT)-P, 91 (44%) EMT-B/EMT-I, and three (2%) other training levels] participated in the module, of whom 74 [30 (41%) EMT-P, 42 (57%) EMT-B/EMT-I, and two (2%) other training levels] participated in follow-up testing between six and seven months. Overall, there was a 32% improvement in test scores immediately after completion of the module (p < 0.001) and an 18% improvement at six months (p < 0.001). No significant difference in pretest scores existed between the physician-led and ACLS instructor-led groups (mean EMT-P pretest scores 69% versus 70% and EMT-B/EMT-I scores 55% versus 54%, respectively). There was no significant difference in short-term (p = 0.36) or long-term (p = 0.074) score improvements between the two groups. CONCLUSION: This case-based approach to EMS stroke education is effective and can achieve equal benefit when administered by a physician or an ACLS instructor.

Advanced Cardiac Life Support↗