Ivan Janciak

Severe Traumatic Brain Injury in Austria II: Epidemiology of hospital admissions

ZusammenfassungZIELE: Das Ziel der vorliegenden Arbeit ist es, anhand von Spitalsaufnahmen die Epidemiologie von Patienten mit schwerem Schädelhirntrauma (SHT) darzustellen. PATIENTEN UND METHODEN: Es standen Datensätze von 492 Patienten zur Verfügung, die von 5 österreichischen Zentren in die Studie inkludiert worden waren. Alters- und Geschlechtsverteilung, Ausbildung, Beruf, Unfallort und-mechanismus, Alkoholisierung, Art und Schweregrad des Traumas, Begleitverletzungen, sowie Dauer und Ergebnis der Intensivbehandlung wurden für jedes der beteiligten Zentren evaluiert. ERGEBNISSE: Die Stichprobe repräsentiert ungefähr 13% aller Fälle von schwerem SHT, welche während des Studienzeitraums in österreichischen Spitälern behandeltwurden. Das mittlere Alter betrug 48 ± 21 Jahre, und die Mehrzahl (72%) der Patienten war männlich. Die Unfälle ereigneten sich am häufigsten auf der Straße (50%), zu Hause (44%), in freier Natur (10%) und am Arbeitsplatz (7%). Verkehrsunfall (44%), Sturz (< 3 m; 30%), Fall (> 3 m; 11%) und Sportunfall (5%) waren die häufigsten Ursachen. Unter den Verkehrsunfällen waren Autolenker und -beifahrer am häufigsten (45%) betroffen, gefolgt von Fußgängern (20%), Motorradfahrern (19%) und Radfahrern (16%). Für die meisten der untersuchten Variablen fanden sich signifikante Unterschiede zwischen den Zentren. Das SHT war in 10% mit einer Rückenmarksverletzung und in 38% mit anderen schweren Verletzungen kombiniert. Die Intensivstations-Mortalität betrug 31,7%. Zwischen Unfallmechanismus und Verletzungsschwere oder Behandlungsergebnis fanden sich keine signifikanten Korrelationen. SCHLUSSFOLGERUNGEN: Die Epidemiologie des schweren SHT in Österreich ist nicht sehr verschieden von der in anderen Industrieländern. Die häufigste Ursache ist der Verkehrsunfall, was die Bedeutung der Verhütung dieser Unfälle aufzeigt. Die spezifischen Risken Älterer und die Verhütung von Unfällen im häuslichen Bereich verdienen besondere Beachtung.SummaryOBJECTIVES: The goal of this paper is to describe the hospital-based epidemiology of severe TBI in Austria. PATIENTS AND METHODS: Data sets from 492 patients included in the study by 5 Austrian hospitals were available. Age and gender distribution, education, occupation, location of trauma, mechanism of injury, alcohol use, type and severity of injury, associated injuries, length of intensive care unit stay, and intensive care unit outcome were evaluated for each of the 5 centers. RESULTS: The sample represents roughly 13% of all cases with severe TBI which were treated in Austrian hospitals during the study period. Mean age was 48 ± 21 years, and most patients were male (72%). The most important trauma locations were roads (50%), home (24%), outdoors (10%), and workplace (7%). Transportrelated trauma was the most important mechanism (44%) followed by falls < 3 m (30%), falls > 3 m (11%), and sports injuries (5%). Detailed analysis of transport-related trauma showed that car accidents (45%) were most common, followed by pedestrian (20%), motorbike (19%), and bicycle (16%) accidents. Significant differences between the centers were found for most of the variables analyzed. The severe traumatic brain injury was associated with spinal cord injury in 10%, and with severe multiple trauma in 38% of cases. Intensive care mortality was 31.7%. There were no significant correlations between mechanisms of injury and severity of trauma, nor between mechanisms and ICU outcome. CONCLUSIONS: Epidemiology of severe traumatic brain injuries in Austria is not much different from other industrialized countries. Traffic accidents are responsible for the majority of traumas, stressing the importance of road injury prevention. Attention should also be paid to the specific risks of older people and to prevent injuries at home.

Severe Traumatic Brain Injury in Austria V: CT findings and surgical management

ZusammenfassungZIEL: Das Ziel dieser Arbeit ist es, CT-Befunde und chirurgisches Management von Patienten mit schwerem Schädel-Hirn-Trauma (SHT) in Österreich darzustellen. PATIENTEN UND METHODEN: Es standen Datensätze von 415 Patienten zur Verfügung, die von 5 österreichischen Zentren in die Studie inkludiert worden waren. Analysiert wurden Inzidenz, chirurgisches Management und Behandlungsergebnis unterschiedlicher intrakranieller Läsionen, sowie das Behandlungsergebnis von Patienten mit/ohne chirurgischer Intervention und mit/ohne Hirndruckmessung. Für die erste Analyse wurde die Patienten je nach dem CT-Befund insgesamt 16 Gruppen zugeordnet. Für die zweite Fragestellung wurden die Patienten in 4 Gruppen (mit/ohne Operation jeweils mit/ohne Hirndruckmessung) eingeteilt. RESULTS: Das mittlere Alter betrug 48,9 Jahre; das Verhältnis von Männern zu Frauen betrug 299:116. Die häufigstenisolierten Läsionen waren Kontusionen (CONT) und diffuses Ödem. Kombinierte Läsionen waren viel häufiger; die häufigsten Kombinationen waren CONT plus Subarachnoidalblutung (SAH) mit und ohne Subduralhämatom (SDH). 276 (66,5%) Patienten wurden operativ behandelt. Osteoplastistische Operationen (OPS; n = 221) wurden häufiger durchgeführt als osteoklastische (OCS; n = 91) und dekompressive Eingriffe (DEC; n = 15). Die Intensivstations(ICU)-Mortalität betrug 29,7% für operativ versorgte Patienten; bei konservativ behandelten Patienten lag diese etwas höher (33,1%). Die ICU-Mortalität von Patienten mit SDH war nach OCS niedriger (18,8%) als nach OPS (36,0%). Patienten die eine Hirndruckmessung erhielten, jedoch keine sonstige chirurgische Therapie benötigten, hatten die niedrigste 90-Tage Mortalität (17,5%). SCHLUSSFOLGERUNGEN: Hirndruckmessung scheint sowohl chirurgisch versorgten wie auch konservativ behandelten Patienten Vorteile zu bringen. Bei Patienten mit SDH, die operativ versorgt wurden, fand sich ein signifikant besseres Ergebnis. Bei Patienten mit SDH war das Ergebnis nach osteoklastischer Operation signifikant besser als nach osteoplastischer Operation.SummaryOBJECTIVES: The aim of this paper is to describe CT findings and surgical management of patients with severe traumatic brain injury (TBI) in Austria. PATIENTS AND METHODS: Data sets from 415 patients treated by 5 Austrian hospitals were available. The analysis focused on incidence, surgical management, and outcome of different types of intracranial lesions, and outcome of surgical interventions with and without monitoring of intracranial pressure (ICP). For the first analysis we assigned the patients to 16 groups based on the type of lesion as evaluated by CT scan. For the second analysis we created 4 groups based on surgical treatment (yes/no) and ICP monitoring (yes/no). RESULTS: The mean age was 48.9 years with a male to female ratio of 299:116. The most frequent single lesions were contusions (CONT) and diffuse brain edema. Combined lesions were far more common than single lesions; the most frequently observed combinations included CONT and subarachnoid hemorrhage (SAH) with or without subdural hematoma (SDH). Surgery was done in 276 (66.5%) patients. Osteoplastic surgery (OPS; n = 221) was the most common method followed by osteoclastic surgery (OCS; n = 91) and decompressive craniectomy (DEC; n = 15). ICU mortality was 29.7% for all patients who had any kind of surgery, which was lower than that of patients who were treated non-operatively (33.1%). The ICU mortality of patients with SDH was lower with OCS (18.8%) than with OPS (36.0%). Patients who received ICP monitoring but did not require surgery had the lowest 90 day mortality (17.5%). CONCLUSIONS: ICP monitoring seems to be beneficial in both operatively and non-operatively treated patients with severe TBI. Patients with SDH who were operated on had significantly better outcomes. In patients with SDH, their outcome after osteoclastic surgery was significantly better than after osteoplastic procedures.

Severity and outcome of traumatic brain injuries (TBI) with different causes of injury

Introduction: Most epidemiological studies and reports have reached a consensus on the leading causes of traumatic brain injury (TBI). Despite the fact that the area of TBI is relatively well studied, reports on differences in severity and outcome of TBI with different causes are lacking. Goal: This paper analyses the differences in severity and in short- and long-term outcome of TBIs with different causes. Method: This study analysed data on 1109 patients with severe TBI by dividing them into three injury-cause groups: ‘traffic-related’, ‘falls’ and ‘other causes’. Severity and outcome was evaluated using chosen direct and indirect indicators. Results: The most severe trauma occurred in the traffic-related group followed by falls and injuries with other causes. On the other hand, patients with traffic-related TBI had the best outcome. Age improves the outcome in the traffic-related group significantly. However, in the multivariate analysis after adjusting for age (and other important predictors including level of care) the odds for favourable long-term outcome stayed significantly higher in the traffic-related group. Conclusions: It is concluded that the causes of TBI should be considered by both clinicians and public health professionals as a lead in prognosis of outcome and policy planning.

GridMiner: A Fundamental Infrastructure for Building Intelligent Grid Systems

The grid is considered as a crucial technology for the future knowledge-based economy and science. The Wisdom Grid project (a joint research effort of the University of Vienna and the Vienna University of Technology) aims, as the first research effort, to cover all aspects of the knowledge life cycle on the grid - from discovery in grid data repositories, to processing, sharing and finally reusing of knowledge as input for a new discovery. This paper first outlines the architecture of the Wisdom Grid infrastructure and then focuses on the kernel architecture component called Grid-Miner, which realizes the knowledge discovery, based on data mining and on-line analytical processing (OLAP) in grid repositories. A running GridMiner prototype is already available to the scientific community as an open service system.

Workflow enactment engine for WSRF-compliant services orchestration

The convergence of grid services more closely to the Web services in the recent years has opened new challenges in designing modern system architectures. Scientific applications based on the grid service architectures can be now viewed as complex processes utilizing available resources so that they co-operate to implement the desired behavior of the system. The workflows became a natural method for describing such processes typically executed on various dispersed resources. Moreover, a number of new specifications and standards is continuously being developed to support the unavoidable and highly demanded interoperability between the services composing the processes. In order to orchestrate the grid services, a workflow engine able to cope with the different standards is highly desirable. The work presented in this paper is carried out in the context of the Globus Incubator project named Workflow Enactment Engine Project. The project was established to provide an easy-to-use and manage workflow enactment engine for grid services orchestration using the WS-BPEL 2.0 language.

Traumatic brain injuries caused by traffic accidents in five European countries: outcome and public health consequences

BACKGROUND Road traffic accidents (RTAs) have been identified by public health organizations as being of major global concern. Traumatic brain injuries (TBIs) are among the most severe injuries and are in a large part caused by RTA. The objective of this article is to analyse the severity and outcome of TBI caused by RTA in different types of road users in five European countries. METHODS The demographic, severity and outcome measures of 683 individuals with RTA-related TBI from Austria, Slovakia, Bosnia, Croatia and Macedonia were analysed. Five types of road users (car drivers, car passengers, motorcyclists, bicyclists and pedestrians) were compared using univariate and multivariate statistical methods. Short-term outcome [intensive care unit (ICU) survival] and last available long-term outcome of patients were analysed. RESULTS In our data set, 44% of TBI were traffic related. The median age of patients was 32.5 years, being the lowest (25 years) in car passengers. The most severe and extensive injuries were reported in pedestrians. Pedestrians had the lowest rate of ICU survival (60%) and favourable long-term outcome (46%). Drivers had the highest ICU survival (73%) and car passengers had the best long-term outcome (59% favourable). No differences in the outcome were found between countries with different economy levels. CONCLUSION TBI are significantly associated with RTA and thus, tackling them together could be more effective. The population at highest risk of RTA-related TBI are young males (in our sample median age: 32.5 years). Pedestrians have the most severe TBI with the worst outcome. Both groups should be a priority for public health action.

Outcome of brain trauma patients who have a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils in the field.

Objective To investigate the outcome of brain trauma patients who had a Glasgow Coma Scale score (GCS) of 3 and bilateral fixed and dilated pupils (BFDP) in the field. Methods Between January 2001 and December 2005, 13 European centres enrolled patients with severe brain trauma. Data sets of all patients who had a GCS of 3 as well as BFDP were analysed. Patients were classified according to the Glasgow Outcome Scale, 12 months after trauma as ‘good’ (Glasgow Outcome Scale of 5 or 4) or ‘poor’ functional recovery; relevant data for these two groups were compared. Variables that showed differences in univariate analyses (χ2 and Wilcoxon–Mann–Whitney tests) were then used as covariates in logistic regression models. A P value of less than 0.05 was considered significant. Results Ninety-two (7.8%) of 1172 patients had a GCS of 3 and BFDP; eight had ‘good’, 84 had ‘poor’ recovery. We found no significant differences in sex (79% male), age (median 32 years), and trauma mechanisms. Trauma was significantly less severe, probability of survival significantly higher (0.48 vs. 0.23) in the ‘good’ group. Only one of 39 patients who had closed basal cisterns on the first computed tomography scan, and none of the patients with midline shift greater than 15 mm had good outcomes. Logistic regression revealed that age, trauma severity, and status of basal cisterns on the first computed tomography scan were the factors determining outcomes. Conclusion Patients with a GCS of 3 and BFDP in the field should be resuscitated aggressively, especially if the trauma seems to be not too severe.

Knowledge grid support for treatment of traumatic brain injury victims

Traumatic brain injuries (TBIs) typically result from accidents in which the head strikes an object. Among all traumatic causes of death, the TBI is the most serious one. Moreover, TBI can also significantly affect many cognitive, physical, and psychological skills of the cases that survive. It is clear from the data presented in many international studies, that improvement of outcomes is useful not only for the patients, but also for entire national economy. This paper introduces a new software infrastructure, called TBI Knowledge Grid that will provide health professionals involved in the treatment and management of TBI patients with Information Technology tools, which will enable them to discover and access relevant knowledge and information from different distributed and heterogeneous data sources.

A grid services cloud for molecular modelling workflows

Scientific workflows require seamless access to HPC applications, deployed on remote, globally distributed computing resources. Typically, scientific workflows are both compute- and data-intensive, and often require dynamic execution control mechanisms. We present a service-oriented infrastructure that addresses these challenges by seamlessly integrating grid computing technologies with a Cloud infrastructure to support the scheduling of dynamic scientific workflows. A case study implementing a complex scientific workflow for computing photodynamics of biologically relevant molecules, a simulation of the non-adiabatic dynamics of 2,4-pentadieneiminum-cation (Protonated Schiff Base 3 (PSB3)) solvated in Water, is realised via the presented infrastructure.

Distributed classification of textual documents on the grid

Efficient access to information and integration of information from various sources and leveraging this information to knowledge are currently major challenges in life science research. However, a large fraction of this information is only available from scientific articles that are stored in huge document databases in free text format or from the Web, where it is available in semi-structured format. Text mining provides some methods (e.g., classification, clustering, etc.) able to automatically extract relevant knowledge patterns contained in the free text data. The inclusion of the Grid text-mining services into a Grid-based knowledge discovery system can significantly support problem solving processes based on such a system. Motivation for the research effort presented in this paper is to use the Grid computational, storage, and data access capabilities for text mining tasks and text classification in particular. Text classification mining methods are time-consuming and utilizing the Grid infrastructure can bring significant benefits. Implementation of text mining techniques in distributed environment allows us to access different geographically distributed data collections and perform text mining tasks in parallel/distributed fashion.