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Biomedical subjects

R Braakman

Publications and source records attributed to R Braakman.

At least 91 records · Page 5Linked to original sources
PubMed1979

Interobserver agreement in assessment of ocular signs in coma.

There is interobserver agreement in the assessment of various ocular signs found in coma patients. As measure for observer agreement the parameter kappa (K) was determined for (in-)equality of pupils, reaction of pupils, spontaneous eye movements, and oculocephalic responses. The agreement in the assessment of the pupils to light and in the assessment of (in-)equality of pupils appeared to be satisfactory, but more disagreement occurred in assessing spontaneous eye movements and oculocephalic responses.

Coma↗
PubMed1979

Prognosis of patients with severe head injury.

The relationship between clinical features of brain dysfunction in the first week after severe head injury and outcome 6 months later has been analyzed for 1000 patients. Depth of coma, pupil reaction, eye movements, and motor response pattern, and patient age prove to be the most reliable predictors. The degree of brain dysfunction changes markedly soon after injury, and more reliable predictions of outcome result when assessment is based on the best level of functioning recorded in each early epoch. Predictions based on very early assessment are, therefore, often unduly pessimistic. Individual predictions of outcome, based on a large data bank, provide a powerful tool for assessing the relative efficacy of alternative treatments.

Adolescent↗
PubMed1977

Severe head injuries in three countries.

Methods for assessing early characteristics and late outcome after severe head injury have been devised and applied to 700 cases in three countries (Scotland, Netherlands, and USA). There was a close similarity between the initial features of patients in the three series; in spite of differences on organisation of care and in details of management , the mortality was exactly the same in each country. This data bank of cases (which is still being enlarged) can be used for predicting outcome in new cases, and for setting up trials of management.

Adolescent↗
PubMed1976

[Whiplash].

Explore the source record for details and available documents.

Automobile Driving↗
PubMed1976

Predicting outcome in individual patients after severe head injury.

Clinical data available in the first few days after severe head injury have been collected prospectively on 600 patients from Glasgow and the Netherlands and stored on computer; the patients in the two countries were similar in initial severity and in their outcome on a defined scale at 6 months. Calculated predictions of outcome were made in 200 randomly selected cases, using Bayesian statistics to compare the data from each patient with those from the 400 remaining cases whose outcome was known. Confident predictions (greater than 0-97 probability) were made in 44% of cases within the first 24 hours of coma, and in 52-61% when data up to 3 days were available. The higher confidence-rate occurred when prediction was limited to two outcomes (death or survival). Comparison of predicted with actual outcomes showed that 96-98% of confident predictions were correct. More logical clinical decisions should be possible when these predictions are available.

Adult↗
PubMed1976

Information in the early stages after spinal cord injury.

The information of the patient in the early stages after his spinal cord injury is often deficient. The opinion of 60 patients regarding some aspects of the information given to them during these early stages is discussed. The actual approach of patients with acute traumatic para- or tetraplegia, providing early detailed information and including a psychological interview, is presented.

Counseling↗
PubMed1976

Carotid ligation for carotid aneurysms.

Thirty patients with subarachnoid haemorrhage due to rupture of a carotid aneurysm were treated by ligation of the common carotid artery. Two patients died as a result of the procedure, two patients developed persisting hemisphere deficit. Eight of the ten patients who developed cerebral ischemia after the operation were operated within ten days after the bleeding. At present out aim is to guide the patient safely through the first ten days after his haemorrhage and perform ligation at the end of the second week. After a follow up period of 1-8 years recurrent haemorrhage did not occur. Common carotid ligation, preferably with control of carotid artery end pressure, cerebral blood-flow and EEG is considered to be a valuable method to treat ruptured intracranial carotid aneurysm.

Adolescent↗
PubMed1972

Depressed skull fracture: data, treatment, and follow-up in 225 consecutive cases.

Data are given of a consecutive series of 225 cases with depressed skull fracture, admitted within 48 hours after the accident. The series is considered to represent the full range of this type of injury in a densely populated area in the Netherlands. The predominance of young male patients with a compound fracture is stressed. The data are compared with other series. The results of long-term follow-up are presented and particular attention is paid to the rate of early and late epilepsy and persisting neurological deficit. The significance of complications like intracranial haematoma and venous sinus involvement is confirmed. Treatment is discussed. In 66% of cases, most of which were compound, some even severely contaminated, the indriven bone fragments were completely or partially replaced with excellent cosmetic result and low infection rate.

Adolescent↗