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Absence of electroencephalographic seizure activity in patients treated for head injury with an intracranial pressure-targeted therapy.

https://arctichealth.org/en/permalink/ahliterature92263
Source
J Neurosurg. 2009 Feb;110(2):300-5
Publication Type
Article
Date
Feb-2009
Author
Olivecrona Magnus
Zetterlund Bo
Rodling-Wahlström Marie
Naredi Silvana
Koskinen Lars-Owe D
Author Affiliation
Department of Neurosurgery, University Hospital, Umeå, Sweden. magnus.olivecrona@vll.se
Source
J Neurosurg. 2009 Feb;110(2):300-5
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Conscious Sedation
Drug Therapy, Combination
Electroencephalography - drug effects
Epilepsy, Post-Traumatic - physiopathology - prevention & control
Female
Fentanyl
Frontal Lobe - drug effects - physiopathology
Glasgow Coma Scale
Humans
Hypnotics and Sedatives
Intensive Care
Intracranial Pressure - drug effects - physiology
Male
Midazolam
Middle Aged
Parietal Lobe - drug effects - physiopathology
Propofol
Thiopental
Abstract
OBJECT: The authors prospectively studied the occurrence of clinical and nonclinical electroencephalographically verified seizures during treatment with an intracranial pressure (ICP)-targeted protocol in patients with traumatic brain injury (TBI). METHODS: All patients treated for TBI at the Department of Neurosurgery, University Hospital Umeå, Sweden, were eligible for the study. The inclusion was consecutive and based on the availability of the electroencephalographic (EEG) monitoring equipment. Patients were included irrespective of pupil size, pupil reaction, or level of consciousness as long as their first measured cerebral perfusion pressure was > 10 mm Hg. The patients were treated in a protocol-guided manner with an ICP-targeted treatment based on the Lund concept. The patients were continuously sedated with midazolam, fentanyl, propofol, or thiopental, or combinations thereof. Five-lead continuous EEG monitoring was performed with the electrodes at F3, F4, P3, P4, and a midline reference. Sensitivity was set at 100 muV per cm and filter settings 0.5-70 Hz. Amplitude-integrated EEG recording and relative band power trends were displayed. The trends were analyzed offline by trained clinical neurophysiologists. RESULTS: Forty-seven patients (mean age 40 years) were studied. Their median Glasgow Coma Scale score at the time of sedation and intubation was 6 (range 3-15). In 8.5% of the patients clinical seizures were observed before sedation and intubation. Continuous EEG monitoring was performed for a total of 7334 hours. During this time neither EEG nor clinical seizures were observed. CONCLUSIONS: Our protocol-guided ICP targeted treatment seems to protect patients with severe TBI from clinical and subclinical seizures and thus reduces the risk of secondary brain injury.
PubMed ID
18759609 View in PubMed
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Acute global outcome in patients with mild uncomplicated and complicated traumatic brain injury.

https://arctichealth.org/en/permalink/ahliterature116563
Source
Brain Inj. 2013;27(2):189-99
Publication Type
Article
Date
2013
Author
Jehane H Dagher
Andreane Richard-Denis
Julie Lamoureux
Elaine de Guise
Mitra Feyz
Author Affiliation
Physical Medicine and Rehabilitation Department, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada.
Source
Brain Inj. 2013;27(2):189-99
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Brain Injuries - epidemiology - rehabilitation
Canada - epidemiology
Cohort Studies
Cross-Sectional Studies
Disability Evaluation
Female
Glasgow Coma Scale
Glasgow Outcome Scale
Humans
Length of Stay
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Care Planning
Patient Discharge - statistics & numerical data
Recovery of Function
Retrospective Studies
Treatment Outcome
United States - epidemiology
Abstract
This study assesses the influence of socio-demographic, psychosocial, clinical and radiological variables on the outcome of patients with mild traumatic brain injury (MTBI) in an acute care inpatient setting.
Retrospective cohort study.
A total of 2127 inpatients with MTBI were included. Outcomes measured were Extended Glasgow Outcome Scale (GOS-E), the FIM® instrument, length of stay (LOS) and discharge destination.
Fifty-four per cent of patients with MTBI with a median GOS-E of 2 were discharged home with no need for further follow-up. Age, LOS, lower Glasgow score (GCS) at admission, insurance coverage and positive CT scans were associated with rehabilitation referrals on discharge. Age, LOS, alcohol and drug abuse, motor vehicle collision and lower GCS at admission were associated with greater physical disabilities and functional impairment at discharge. FIM® cognitive functional scores were higher in women, younger patients and patients without psychiatric disorders. Brain lesions were correlated with longer LOS. CT scan findings in patients with MTBI may help clinicians predict the final outcome and resources required for patient care during their hospitalization and on discharge.
This study can help healthcare professionals in treating and planning future care of patients with MTBI.
PubMed ID
23384216 View in PubMed
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Acute neurosurgery for traumatic brain injury by general surgeons in Swedish county hospitals: a regional study.

https://arctichealth.org/en/permalink/ahliterature105985
Source
Acta Neurochir (Wien). 2014 Jan;156(1):177-85
Publication Type
Article
Date
Jan-2014
Author
Ann Fischerström
Lena Nyholm
Anders Lewén
Per Enblad
Author Affiliation
Department of Neuroscience, Section of Neurosurgery, Uppsala University, SE-751 85, Uppsala, Sweden.
Source
Acta Neurochir (Wien). 2014 Jan;156(1):177-85
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Aged
Brain Injuries - surgery
Child
Child, Preschool
Craniocerebral Trauma - surgery
Female
Glasgow Coma Scale
Hospitals, County
Humans
Male
Middle Aged
Physician's Role
Retrospective Studies
Sweden
Treatment Outcome
Young Adult
Abstract
Traditionally acute life-saving evacuations of extracerebral haematomas are performed by general surgeons on vital indication in county hospitals in the Uppsala-Örebro health care region in Sweden, a region characterized by long distances and a sparsely distributed population. Recently, it was stated in the guidelines for prehospital care of traumatic brain injury from the Scandinavian Neurosurgical Society that acute neurosurgery should not be performed in smaller hospitals without neurosurgical expertise. The aim of this study was to investigate: how often does acute decompressive neurosurgery occur in county hospitals in the Uppsala-Örebro region today, what is the indication for surgery, and what is the clinical outcome? Finally, the goal was to evaluate whether the current practice in the Uppsala-Örebro region should be revised.
Patients referred to the neurointensive care unit at the Department of Neurosurgery in Uppsala after acute evacuation of intracranial haematomas in the county hospitals 2005-2010 were included in the study. Data was collected retrospectively from the medical records following a predefined protocol. The presence of vital indication, radiological and clinical results, and long-term outcome were evaluated.
A total of 49 patients (17 epidural haematomas and 32 acute subdural haematomas) were included in the study. The operation was judged to have been performed on vital indication in all cases. The postoperative CT scan was improved in 92% of the patients. The reaction level and pupillary reactions were significantly improved after surgery. Long-term outcomes showed 51% favourable outcome, 33% unfavourable outcome, and in 16% the outcome was unknown.
Looking at the indication for acute neurosurgery, the postoperative clinical and radiological results, and the long-term outcome, it appears that our regional policy regarding life-saving decompressive neurosurgery in county hospitals by general surgeons should not be changed. We suggest a curriculum aimed at educating general surgeons in acute neurosurgery.
PubMed ID
24272412 View in PubMed
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Acute physiology and chronic health evaluation (APACHE II) and Glasgow coma scores as predictors of outcome from intensive care after cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature225250
Source
Crit Care Med. 1991 Dec;19(12):1465-73
Publication Type
Article
Date
Dec-1991
Author
M. Niskanen
A. Kari
P. Nikki
E. Iisalo
L. Kaukinen
V. Rauhala
E. Saarela
M. Halinen
Author Affiliation
Department of Anesthesiology, Kuopio University Hospital, Finland.
Source
Crit Care Med. 1991 Dec;19(12):1465-73
Date
Dec-1991
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Cardiopulmonary Resuscitation - standards
Critical Care - standards
Female
Finland - epidemiology
Glasgow Coma Scale
Heart Arrest - mortality - therapy
Humans
Length of Stay - statistics & numerical data
Logistic Models
Male
Middle Aged
Patient Admission
Predictive value of tests
Prognosis
Prospective Studies
Risk factors
Severity of Illness Index
Survival Analysis
Survival Rate
Treatment Outcome
Abstract
a) To examine the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Glasgow Coma Scores as predictors of the outcome of patients following resuscitation from cardiac arrest; b) to study the impact of the components of APACHE II on the prediction.
A nationwide study in Finland with prospectively collected data on all patients admitted to intensive care after cardiac arrest during a 14-month period. Two thirds of the cardiac arrest patients included in the study were randomly selected to derive predictive models, and the remaining one third constituted the validation sample.
A total of 25 medical and surgical ICUs in Finland (13 in tertiary referral centers).
Six-hundred nineteen consecutive cardiac arrest patients. Fifteen patients less than 16 yrs were excluded.
Variables included in the APACHE II or Glasgow Coma Scores were collected at the time of ICU admission and then three times after admission, at 24-hr intervals. ICU- and hospital-mortality rates and a 6-month mortality rate after ICU admission were studied.
Of 604 study patients, 370 (61.3%) patients died in the hospital. The most accurate prediction of hospital outcome was based on data collected after the first day of ICU care, not on the admission values. Twenty-one (21.9%) of 96 patients with a low APACHE II score (less than or equal to 9) died compared with 66 (84.6%) of 78 patients with a high APACHE II score (greater than or equal to 25) (p less than .001). Of 160 patients with a normal Glasgow Coma Score (14 to 15), 45 (28.1%) died, whereas there were 114 (81.4%) nonsurvivors among 140 patients with a low Glasgow Coma Score of 3 (p less than .001). The performance of predictive models, including age, the Chronic Health Evaluation, and either the Acute Physiology Score (Acute Physiology Score model) or the Glasgow Coma Score (Glasgow Coma Score model) were compared with the prediction according to the APACHE II in the validation sample. When using 80% probability of death as a decision rule, the Acute Physiology Score model determined 35 of 153 patients to have high risk of death, 29 of whom died (the positive predictive value being 82.9%). The Glasgow Coma Score model predicted 34 patients to die, 26 of whom died (positive predictive value 76.5%), and the APACHE II score predicted seven deaths, five of whom actually died (positive predictive value 71.4%).
The APACHE II scoring system cannot be recommended as a prognostic tool to support clinical judgement in cardiac arrest patients, but by modifying it, a more accurate prediction of poor outcome could be achieved. The Glasgow Coma Score explained to a great extent the predictive power of the APACHE II.
Notes
Comment In: Crit Care Med. 1991 Dec;19(12):1460-11959362
Comment In: Crit Care Med. 1992 Dec;20(12):1736-81458955
PubMed ID
1959364 View in PubMed
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Acute Traumatic Brain Injury: Mortality in the Elderly.

https://arctichealth.org/en/permalink/ahliterature266044
Source
World Neurosurg. 2015 Jun;83(6):996-1001
Publication Type
Article
Date
Jun-2015
Author
Erik Herou
Bertil Romner
Gregor Tomasevic
Source
World Neurosurg. 2015 Jun;83(6):996-1001
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Acute Disease
Age Factors
Aged
Aged, 80 and over
Anticoagulants - administration & dosage
Brain Injuries - complications - diagnosis - mortality - surgery - therapy
Craniotomy
Female
Glasgow Coma Scale
Head Injuries, Closed - complications - diagnosis - mortality - surgery - therapy
Hematoma, Subdural - etiology - surgery
Humans
Male
Prognosis
Retrospective Studies
Risk factors
Sweden - epidemiology
Treatment Outcome
Warfarin - administration & dosage
Abstract
Despite recent progress, prognosis for the elderly (defined as aged =70 years) afflicted by traumatic brain injury (TBI) is unfavorable and surgical intervention remains controversial. Research during the past decade on the mortality rates or prognostic factors for survival in the elderly is limited.
We analyzed 97 patients aged =70 years who were treated surgically for closed TBI at our neurosurgical unit between January 1, 2003 and December 31, 2012. In addition, we analyzed 22 patients aged =70 years who had sustained a closed TBI and on whom no neurosurgical intervention was performed. Outcome in both groups was measured as 30-, 90- and 180-day mortality.
Surgically treated patients: median age, 76 years' 30-day overall mortality rate, 36%. Higher mortality was seen with lower level of consciousness, high energy trauma, one pupil fixed and dilated, and more extensive intracranial pathology. Presence of warfarin, more advanced age, or degree of midline shift were not associated with worsened outcome. Patients not treated neurosurgically: median age. 81.5 years; 30-day overall mortality rate, 23%. Mortality for patients with Glasgow coma scale (GCS) 10-15 was 6%, GCS 6-9 67%, and GCS 3-5 100%.
Selected patients aged =70 years can benefit from surgical intervention for closed TBI. Level of consciousness, radiologic type of injury, mechanism of injury, and pupil abnormalities should be carefully evaluated. There also seems to exist a group of patients in whom surgical intervention offers little benefit, as mortality rate is low without surgical intervention.
PubMed ID
25731794 View in PubMed
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Advancing care for traumatic brain injury: findings from the IMPACT studies and perspectives on future research.

https://arctichealth.org/en/permalink/ahliterature106604
Source
Lancet Neurol. 2013 Dec;12(12):1200-10
Publication Type
Article
Date
Dec-2013
Author
Andrew I R Maas
Gordon D Murray
Bob Roozenbeek
Hester F Lingsma
Isabella Butcher
Gillian S McHugh
James Weir
Juan Lu
Ewout W Steyerberg
Author Affiliation
Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium. Electronic address: andrew.maas@uza.be.
Source
Lancet Neurol. 2013 Dec;12(12):1200-10
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adult
Blood pressure
Brain Injuries - epidemiology - therapy
Canada
Data Collection - standards
Disease Management
Europe
Forecasting
Glasgow Coma Scale
Humans
International Cooperation
Middle Aged
Models, Neurological
Multicenter Studies as Topic - methods - standards
National Institute of Neurological Disorders and Stroke
National Institutes of Health (U.S.)
Prognosis
Randomized Controlled Trials as Topic - methods - standards
Research Design
Symptom Assessment - standards
Trauma Severity Indices
Treatment Outcome
United States
Abstract
Research in traumatic brain injury (TBI) is challenging for several reasons; in particular, the heterogeneity between patients regarding causes, pathophysiology, treatment, and outcome. Advances in basic science have failed to translate into successful clinical treatments, and the evidence underpinning guideline recommendations is weak. Because clinical research has been hampered by non-standardised data collection, restricted multidisciplinary collaboration, and the lack of sensitivity of classification and efficacy analyses, multidisciplinary collaborations are now being fostered. Approaches to deal with heterogeneity have been developed by the IMPACT study group. These approaches can increase statistical power in clinical trials by up to 50% and are also relevant to other heterogeneous neurological diseases, such as stroke and subarachnoid haemorrhage. Rather than trying to limit heterogeneity, we might also be able to exploit it by analysing differences in treatment and outcome between countries and centres in comparative effectiveness research. This approach has great potential to advance care in patients with TBI.
Notes
Comment In: Lancet Neurol. 2013 Dec;12(12):1132-324139679
PubMed ID
24139680 View in PubMed
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Algorithm for head computed tomography imaging in patients with mandible fractures.

https://arctichealth.org/en/permalink/ahliterature154766
Source
J Oral Maxillofac Surg. 2008 Oct;66(10):2093-7
Publication Type
Article
Date
Oct-2008
Author
Marcin Czerwinski
Wendy L Parker
H Bruce Williams
Author Affiliation
Division of Plastic Surgery, McGill University Health Sciences Center, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada. marcin.czerwinski@mail.mcgill.ca
Source
J Oral Maxillofac Surg. 2008 Oct;66(10):2093-7
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Alcohol Drinking
Algorithms
Brain Injuries - etiology - radiography
Canada
Female
Glasgow Coma Scale
Head - radiography
Humans
Logistic Models
Male
Mandibular Fractures - complications - radiography
Maxillofacial Injuries
Middle Aged
Multiple Trauma
Retrospective Studies
Risk factors
Tomography, X-Ray Computed - methods
Unconsciousness
Vomiting
Abstract
Trauma to the mandible can potentially increase our predictive accuracy for intracranial injuries (ICIs) because of the mandible's strength, anatomic proximity, and direct connection to the skull base. Our goals were to: 1) investigate the association of mandible fractures with traumatic brain injury (TBI) and intracranial lesions (ICLs); and 2) determine predictors of ICIs in a level 1 Canadian trauma center with distinct patient demographics and fracture etiologies.
A retrospective chart review was performed of medical records of mandible-fracture patients treated at our institution from 1997 to 2003. Patients who had undergone postinjury computed tomography (CT) of the head with a minimum of 4 weeks' follow-up were considered eligible. Data collected included patient and fracture characteristics, neurologic evaluation, and the presence of concomitant injuries.
One hundred eighty-one patients were reviewed, of whom 86 were found eligible, with demographics representative of an urban-trauma population. The incidence of TBI was 68.6%, and of ICLs, 27%. Logistic regression identified alcohol (odds ratio [OR], 3.97), concomitant facial fracture (OR, 2.77), and other systemic injury (OR, 2.59) as independent predictors of an ICI in mandibular fracture patients. Importantly, ICIs were observed in 19% of mandible-fracture patients, satisfying the criteria for mild TBI, and in 17% of patients without any evidence of TBI.
Some authors have advocated treating mandible fractures on an outpatient basis, with a focused workup. Our results of significant concomitant ICI in mandible-fracture patients, conversely, suggest that such management may inadvertently result in the oversight of potentially life-threatening injuries. Thus, we recommend mandatory intracranial CT imaging if the patient's neurologic status at time of injury is unknown or meets the criteria of TBI, or if positive predictors for ICL are present.
PubMed ID
18848107 View in PubMed
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[A new reaction level scale is recommended in Sweden].

https://arctichealth.org/en/permalink/ahliterature229241
Source
Lakartidningen. 1990 Apr 25;87(17):1466-9
Publication Type
Article
Date
Apr-25-1990
Author
J E Starmark
D. Stålhammar
Author Affiliation
Båda vid neurokirurgiska kliniken, Sahlgrenska sjukhuset, Göteborg.
Source
Lakartidningen. 1990 Apr 25;87(17):1466-9
Date
Apr-25-1990
Language
Swedish
Publication Type
Article
Keywords
Glasgow Coma Scale
Humans
Sweden
Trauma Severity Indices
Abstract
Assessment of the reaction level is the single most important investigation in patients with acute cerebral disorders. The Reaction Level Scale, RLS-85, a recently developed and scientifically based method, is recommended for introduction in Sweden.
PubMed ID
2338854 View in PubMed
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An outcome study of severe traumatic head injury using the "Lund therapy" with low-dose prostacyclin.

https://arctichealth.org/en/permalink/ahliterature195052
Source
Acta Anaesthesiol Scand. 2001 Apr;45(4):402-6
Publication Type
Article
Date
Apr-2001
Author
S. Naredi
M. Olivecrona
C. Lindgren
A L Ostlund
P O Grände
L O Koskinen
Author Affiliation
Department of Anaesthesia and Intensive Care, Umeå University Hospital, Sweden. silvana.naredi.us@vll.se
Source
Acta Anaesthesiol Scand. 2001 Apr;45(4):402-6
Date
Apr-2001
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antihypertensive Agents - administration & dosage - adverse effects - therapeutic use
Clinical Protocols
Craniocerebral Trauma - therapy
Epoprostenol - administration & dosage - adverse effects - therapeutic use
Female
Glasgow Coma Scale
Humans
Male
Middle Aged
Monitoring, Physiologic
Tomography, X-Ray Computed
Treatment Outcome
Abstract
There are two independent head injury outcome studies using the "Lund concept", and both showed a mortality rate of about 10%, and a favourable outcome (Glasgow outcome scale, GOS 4 and 5) of about 70%. The Lund concept aims at controlling intracranial pressure, and improving microcirculation around contusions. Intracranial pressure is controlled by maintaining a normal colloid osmotic pressure and reducing the hydrostatic capillary pressure. Microcirculation is improved by ensuring strict normovolaemia and reducing sympathetic discharge. The endogenous substance prostacyclin with its antiaggregatory/antiadhesive effects may further improve microcirculation, which finds support from a microdialysis-based clinical study and an experimental brain trauma study. The present clinical outcome study aims at evaluating whether the previously obtained good outcome with the Lund therapy can be reproduced, and whether the addition of prostacyclin has any adverse side-effects.
All 31 consecutive patients with severe head injury, Glasgow coma scale (GCS) 10 months after the injury.
One patient died, another suffered vegetative state and 7 severe disability. Of the 22 patients with favourable outcome, 19 showed good recovery and 3 moderate disability. No adverse side-effects of prostacyclin were observed.
The outcome results from previous studies using the Lund therapy were reproduced, and no adverse side-effects of low-dose prostacyclin were observed.
Notes
Comment In: Acta Anaesthesiol Scand. 2001 Apr;45(4):399-40111300375
PubMed ID
11300376 View in PubMed
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Assessing bicycle-related trauma using the biomarker S100B reveals a correlation with total injury severity.

https://arctichealth.org/en/permalink/ahliterature284995
Source
Eur J Trauma Emerg Surg. 2016 Oct;42(5):617-625
Publication Type
Article
Date
Oct-2016
Author
E P Thelin
E. Zibung
L. Riddez
C. Nordenvall
Source
Eur J Trauma Emerg Surg. 2016 Oct;42(5):617-625
Date
Oct-2016
Language
English
Publication Type
Article
Keywords
Adult
Bicycling - injuries
Biomarkers - blood
Female
Glasgow Coma Scale
Humans
Injury Severity Score
Length of Stay - statistics & numerical data
Male
Middle Aged
Predictive value of tests
Retrospective Studies
S100 Calcium Binding Protein beta Subunit - blood
Sweden
Tomography, X-Ray Computed
Trauma Centers
Wounds and Injuries - blood - diagnosis
Abstract
Worldwide, the use of bicycles, for both recreation and commuting, is increasing. S100B, a suggested protein biomarker for cerebral injury, has been shown to correlate to extracranial injury as well. Using serum levels of S100B, we aimed to investigate how S100B could be used when assessing injuries in patients suffering from bicycle trauma injury. As a secondary aim, we investigated how hospital length of stay and injury severity score (ISS) were correlated to S100B levels.
We performed a retrospective, database study including all patients admitted for bicycle trauma to a level 1 trauma center over a four-year period with admission samples of S100B (n = 127). Computerized tomography (CT) scans were reviewed and remaining data were collected from case records. Univariate- and multivariate regression analyses, linear regressions and comparative statistics (Mann-Whitney) were used where appropriate.
Both intra- and extracranial injuries were correlated with S100B levels. Stockholm CT score presented the best correlation of an intracranial parameter with S100B levels (p  15 had higher S100 levels than patients with ISS 
Notes
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PubMed ID
26490563 View in PubMed
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179 records – page 1 of 18.