International Classification of Diseases the 10th Revision (ICD-10) was implemented October 1, 2015, and there was little knowledge how the transition to ICD-10 would impact the revenue cycle for intraoperative neurophysiological monitoring medical practices in Oklahoma. This correlational quantitative study examined the changes in dependent variables of reimbursements due to the change from ICD-9 to ICD-10 for independent variables of intraoperative neurophysiological monitoring procedure codes. The reimbursements from 2014 were compared to reimbursements from 2016. Prices were adjusted for inflation to 2016 dollar values. Annual reimbursements decreased for all intraoperative neurophysiological monitoring procedures examined except the remote monitoring code. The intraoperative neurophysiological monitoring procedure with the greatest mean annual decreases in reimbursement was the lower somatosensory evoked potentials. The intraoperative neurophysiological monitoring procedures with the least annual reimbursement decreases were transcranial electrical motor potential monitoring and electromyography. The findings of the budget-impact analysis and cost-effectiveness analysis indicated that reimbursement for procedures has steadily decreased from 2014 to 2016, causing a negative effect on practices' revenue cycle management. The findings of this study could benefit intraoperative neurophysiological monitoring companies in Oklahoma by supporting adjustments essential for healthcare leaders to maintain a financially sustainable intraoperative neurophysiological monitoring medical practice.

Introdução: No campo do tratamento cirúrgico de Gliomas, tem se observado um interesse crescente no uso de novas tecnologias de suporte como métodos auxiliares na obtenção do equilíbrio entre radicalidade cirúrgica e preservação da funcionalidade cerebral. Na maior parte dos estudos, a localização tumoral tem sido pouco considerada e a real eficácia das tecnologias de suporte ainda está pouco investigada nos gliomas insulares. Objetivos: avaliar a eficácia da fluorescência intraoperatória com 5-ALA, monitorização neurofisiológica, neuronavegação e tractografia no grau de ressecção tumoral (GRT), escores de funcionalidade, sobrevida global e sobrevida livre de progressão em uma coorte retrospectiva de gliomas insulares. Métodos: revisamos todos os casos de tumores insulares operados no Departamento de Neurocirurgia da Universidade de Tübingen - Alemanha, entre maio de 2008 e novembro de 2013. O grau de ressecção foi avaliado por volumetria. Foram utilizados os testes de Mann Whitney, Qui-quadrado e funções de Kaplan Meier para análise do efeito de cada tecnologia nos desfechos primários e secundários. Resultados: 28 casos - 18 homens (64%) e 10 mulheres (36%); idade média 52,5 anos (12 - 59) - foram inclusos para análise. Gliomas de alto grau corresponderam a 20 casos (71%), com 8 lesões de baixo grau (29%). As tecnologias mais utilizadas foram monitorização neurofisiológica (64%) e neuronavegação (68%). 5-ALA foi a única modalidade associada a taxas de ressecção > 90% (p = 0,05). O uso de tractografia determinou melhora no KPS (50% vs 5%, p = 0,02). Houve associação positiva entre o uso de neuronavegação e sobrevida global (23 vs. 27,4 meses, p = 0,03), mas o uso de 5-ALA se associou a piora na sobrevida global (34,8 vs 21,1 meses, p = 0,01) e sobrevida livre de progressão (24,4 vs. 11,8 meses, p = 0,01). Conclusões: Considerando os gliomas insulares, o presente trabalho demonstra pioneiramente que o uso de 5-ALA tem papel na obtenção de maiores taxas de ressecção, ainda que este achado possa estar associado a piora nas sobrevidas global e livre de progressão. Tractografia e neuronavegação parecem desempenhar papel importante no tratamento dos gliomas insulares, na medida em que determinaram melhor sobrevida global e funcionalidade, respectivamente. Estudos prospectivos com uma amostra mais proeminente e análise multivariada permitirão a avaliação do benefício real destas tecnologias de suporte no tratamento dos gliomas insulares / Introduction: In the field of Glioma surgery, there has been an increasing interest in the use of assistive technologies to overcome the difficulty of preserving brain function while improving surgical radicality. In most reports, tumor localization has seldom been considered a variable and the role of intraoperative adjuncts is yet to be determined for gliomas of the insula. Objectives: to evaluate the efficacy of fluorescence-guided resection with 5-ALA, intraoperative neurophysiological monitoring (IOM), neuronavigation, and tractography in the Extent of Resection (EOR), functionality scores, overall survival (OS) and progression-free survival (PFS) in a retrospective cohort of insular gliomas. Methods: we reviewed all cases of insular tumors operated on at the Department of Neurosurgery, University Hospital of Tübingen - Germany, between May 2008 and November 2013. EOR was determined by volumetric analysis. Mann Whitney, Chi-square and Kaplan Meier functions were used for assessment of each technology\'s effect on primary and secondary outcomes. Results: 28 cases (18 men (64%) and 10 women (36%); median age at diagnosis: 52.5 years, range 12 - 59) were considered eligible for analysis. High grade and low grade gliomas accounted for 20 (71%) and 8 (29%) cases, respectively. The most used technologies were IOM (64%) and Neuronavigation (68%). 5-ALA was the only technique associated with EOR > 90% (p = 0.05). Tractography determined improvement in the Karnofsky Performance Scale (50% vs 5% cases improved, p = 0.02). There was a positive association between the use of neuronavigation and overall survival (23 vs. 27.4 months, p = 0.03), but the use of 5-ALA was associated with shorter OS (34.8 vs. 21.1 months, p = 0.01) and PFS (24.4 vs. 11.8, p = 0.01). Conclusions: we demonstrate for the first time that for insular gliomas 5-ALA plays a role in achieving higher EOR, although this technology was associated with poor OS and PFS; Also tractography and neuronavigation can be of great importance in the treatment of insular gliomas as they determined better functionality and overall survival in this study, respectively. Prospective studies with a more prominent sample and proper multivariate analysis will help determine the real benefit of these adjuncts in the setting of insular gliomas

Introdução: No campo do tratamento cirúrgico de Gliomas, tem se observado um interesse crescente no uso de novas tecnologias de suporte como métodos auxiliares na obtenção do equilíbrio entre radicalidade cirúrgica e preservação da funcionalidade cerebral. Na maior parte dos estudos, a localização tumoral tem sido pouco considerada e a real eficácia das tecnologias de suporte ainda está pouco investigada nos gliomas insulares. Objetivos: avaliar a eficácia da fluorescência intraoperatória com 5-ALA, monitorização neurofisiológica, neuronavegação e tractografia no grau de ressecção tumoral (GRT), escores de funcionalidade, sobrevida global e sobrevida livre de progressão em uma coorte retrospectiva de gliomas insulares. Métodos: revisamos todos os casos de tumores insulares operados no Departamento de Neurocirurgia da Universidade de Tübingen - Alemanha, entre maio de 2008 e novembro de 2013. O grau de ressecção foi avaliado por volumetria. Foram utilizados os testes de Mann Whitney, Qui-quadrado e funções de Kaplan Meier para análise do efeito de cada tecnologia nos desfechos primários e secundários. Resultados: 28 casos - 18 homens (64%) e 10 mulheres (36%); idade média 52,5 anos (12 - 59) - foram inclusos para análise. Gliomas de alto grau corresponderam a 20 casos (71%), com 8 lesões de baixo grau (29%). As tecnologias mais utilizadas foram monitorização neurofisiológica (64%) e neuronavegação (68%). 5-ALA foi a única modalidade associada a taxas de ressecção > 90% (p = 0,05). O uso de tractografia determinou melhora no KPS (50% vs 5%, p = 0,02). Houve associação positiva entre o uso de neuronavegação e sobrevida global (23 vs. 27,4 meses, p = 0,03), mas o uso de 5-ALA se associou a piora na sobrevida global (34,8 vs 21,1 meses, p = 0,01) e sobrevida livre de progressão (24,4 vs. 11,8 meses, p = 0,01). Conclusões: Considerando os gliomas insulares, o presente trabalho demonstra pioneiramente que o uso de 5-ALA tem papel na obtenção de maiores taxas de ressecção, ainda que este achado possa estar associado a piora nas sobrevidas global e livre de progressão. Tractografia e neuronavegação parecem desempenhar papel importante no tratamento dos gliomas insulares, na medida em que determinaram melhor sobrevida global e funcionalidade, respectivamente. Estudos prospectivos com uma amostra mais proeminente e análise multivariada permitirão a avaliação do benefício real destas tecnologias de suporte no tratamento dos gliomas insulares / Introduction: In the field of Glioma surgery, there has been an increasing interest in the use of assistive technologies to overcome the difficulty of preserving brain function while improving surgical radicality. In most reports, tumor localization has seldom been considered a variable and the role of intraoperative adjuncts is yet to be determined for gliomas of the insula. Objectives: to evaluate the efficacy of fluorescence-guided resection with 5-ALA, intraoperative neurophysiological monitoring (IOM), neuronavigation, and tractography in the Extent of Resection (EOR), functionality scores, overall survival (OS) and progression-free survival (PFS) in a retrospective cohort of insular gliomas. Methods: we reviewed all cases of insular tumors operated on at the Department of Neurosurgery, University Hospital of Tübingen - Germany, between May 2008 and November 2013. EOR was determined by volumetric analysis. Mann Whitney, Chi-square and Kaplan Meier functions were used for assessment of each technology\'s effect on primary and secondary outcomes. Results: 28 cases (18 men (64%) and 10 women (36%); median age at diagnosis: 52.5 years, range 12 - 59) were considered eligible for analysis. High grade and low grade gliomas accounted for 20 (71%) and 8 (29%) cases, respectively. The most used technologies were IOM (64%) and Neuronavigation (68%). 5-ALA was the only technique associated with EOR > 90% (p = 0.05). Tractography determined improvement in the Karnofsky Performance Scale (50% vs 5% cases improved, p = 0.02). There was a positive association between the use of neuronavigation and overall survival (23 vs. 27.4 months, p = 0.03), but the use of 5-ALA was associated with shorter OS (34.8 vs. 21.1 months, p = 0.01) and PFS (24.4 vs. 11.8, p = 0.01). Conclusions: we demonstrate for the first time that for insular gliomas 5-ALA plays a role in achieving higher EOR, although this technology was associated with poor OS and PFS; Also tractography and neuronavigation can be of great importance in the treatment of insular gliomas as they determined better functionality and overall survival in this study, respectively. Prospective studies with a more prominent sample and proper multivariate analysis will help determine the real benefit of these adjuncts in the setting of insular gliomas

Background: The use of intraoperative neurophysiological monitoring, including direct nerve stimulation (especially the facial nerve), acoustic evoked potentials (AEP) and somatosensory evoked potentials (SSEP), is a helpful tool in the microsurgery of vestibular schwannoma to prevent nerve injury. Patient characteristics and intraoperative and postoperative variables might also influence the postoperative facial nerve function. The study was performed to investigate these variables and the intraoperative neurophysiological monitoring values. Methods: Seventy-nine patients with vestibular schwannoma were included consecutively into this study. Intraoperative neurophysiological monitoring, including SSEP, AEP, and direct nerve stimulation for facial and trigeminal nerve electromyography, was performed utilizing digital data storage in all cases. The intensity (in volts) of the direct stimulation and the latency (in ms) for the orbicularis oculi and the orbicularis oris muscle and the amplitude (in mV) was measured. Univariate and multivariate statistical analyses concerning the different parameters was performed directly after the operation and in the subsequent follow-ups 3 and 6 months after the operation. Results: The mean intensity was 0.79 V (SD.29). The latency and amplitude for the oris muscle was 5.2ms (SD 2.07) and 0.68mV (SD.57), respectively. The mean latency for the occuli muscle was 5.58ms (SD 2.2) and the amplitude was 0.58mV (SD 1.04). The univariate and multivariate statistical analyses showed significance concerning the postoperative facial nerve function and the amplitude of the direct stimulation of the facial nerve in the orbicularis oris muscle (p = 0.03), so repeated direct nerve stimulation might show FN function deterioration. The mean diameter of the tumors was 24mm (range 10–57mm). Cross total resection and near total was achieved in 76 patients (96%) and subtotal in three patients (4%). The preoperative House–Brakeman score (HBS) 1 was constant in 65 (82%) cases. The mortality in our series was 0%; the overall morbidity was 10%. The HBS was not influenced concerning the extent of resection. The mean follow-up was 28 months (range 6 to 60 months). The limitations of the study might be a low number of patients and the retrospective character of the study. Conclusion: Intraoperative neurophysiological monitoring is crucial in vestibular schwannoma surgery. Repeated direct nerve stimulation and a detected decreased amplitude might show facial nerve function deterioration.

<p>Degenerativne bolesti kičme nastaju kao posledica promena na dinamičkim segmentima kičmenog stuba. Klinički ove promene se mogu manifestovati u vidu radikulopatije, mijelopatije i radikulomijelopatije. Najče&scaron;će primenjivana metoda operativnog lečenja kod ovih pacijenata je prednja cervikalna diskektomija sa fuzijom koja omogućava adekvatnu anatomsku i funkcionalnu restituciju degenerativno promenjene cervikalne kičme. Imajući u vidu da su već kompromitovane nervne strukture u riziku od dodatnih o&scaron;tećenja u različitim fazama operativnog zahvata primena intraoperativnog neurofiziolo&scaron;kog monitoringa je dobila svoje mesto i u hirur&scaron;kim tretmanima degenerativnih oboljenja kičme. Svrha primene neuromonitoringa je da obezbedi povratnu informaciju hirurgu o promenama u funkciji nervnih struktura pre nego &scaron;to dođe do ireverzibilnih o&scaron;tećenja. Na ovaj način moguće je prevenirati nastanak novog ili pogor&scaron;anje postojećeg deficita. Takođe intraoperativni nalazi neurofiziolo&scaron;kih parametara mogu da ukažu na težinu postojećeg oboljenja i da budu prediktori ishoda lečenja. Ciljevi ove doktorske disertacije bili su utvrđivanje faza operativnog zahvata u kojima najče&scaron;će dolazi do promena u neurofiziolo&scaron;kim parametrima, kao i postojanje korelacije nalaza intraoperativnog neurofiziolo&scaron;kog monitoringa sa preoperativnim kliničkim nalazom pacijenta kao i rezultatima procene ishoda nakon prednje cervikalne diskektomije se fuzijom. Ova studija je obuhvatila 30 pacijenata kod kojih je indikovano operativno lečenje degenerativnih promena u vratnom segmentu kičmenog stuba prednjom mikrodiskektomijom sa fuzijom. Preoperativno je izvođen klinički pregled pacijenata i kori&scaron;teni su Numerička skala bola i Upitnik za pacijente sa bolom u vratnoj kičmi, koji su takođe popunjavani na otpustu i mesec dana nakon operacije. U toku hirur&scaron;ke procedure upotrebom intraoperativnog neurofiziolo&scaron;kog monitoringa registrovani su somatosenzorni (SSEP) i motorni evocirani potencijali (MEP), kao i spontana elektromiografija. Kod svih SSEP do&scaron;lo je do statistički značajnog povećanja amplitude (p&lt;0,05), dok je kod desnog n. medianusa zabeleženo i statistički značajno skraćenje latence (p&lt;0,05). Značajne promene se beleže između početka i kraja operativnog zahvata, kao i u fazi uklanjanja intervertebralnog diska kada dolazi do dekompresije. U vrednostima pražne struje potrebne za dobijanje MEP nije bilo statistički značajnih promena izuzev kod m. triceps brachii obostrano. Kod pacijenata sa radikulopatijom vrednost pražne struje za dobijanje mi&scaron;ićnog odgovora je statistčki značajno niža u odnosu na pacijente sa mijelopatijom (p&lt;0,05). SSEP koreliraju sa poremećajem senzibiliteta, refleksnim odgovorom i bolom. MEP koreliraju takođe sa refleksnim odgovorom, dok negativna korelacija sa manuelnim mi&scaron;ićnim testom pokazuje da klinički očuvana gruba mi&scaron;ićna snaga ne mora biti pokazatelj pravog stanja motornog sistema. Preoperativne vrednosti NDI su se statistički značajno smanjile mesec dana nakon operacije (p&lt;0,05). U vrednostima bola postoji statistčki značajna razlika između svih merenje (p&lt;0,008), izuzev između bola na otpustu i mesec dana nakon operacije (p&gt;0,008). Latenca desnog n.medianusa pokazuje negativnu, a amplituda pozitivnu korelaciju sa vrednostima bola mesec dana postoperativno (p&lt;0,05). Povećanje amplitude i skraćenje latence SSEP ukazuje na značajan stepen dekompresije. Stabilnost MEP ukazuje na intraoperativnu očuvanost motornih puteva i da nije do&scaron;lo do novog motornog deficita niti produbljivanja postojećeg. SSEP i MEP koreliraju sa kliničkim nalazom, dok su vrednosti bola i NDI statistički značajno manje nakon operacije. Ovi rezultati ukazuju da klinički nalaz pacijenta korelira sa neurofiziolo&scaron;kim nalazom, kao i da introperativne promene neurofiziolo&scaron;kih parametara mogu biti prediktivni faktor ishoda operativnog lečenja.</p> / <p>Degenerative spinal diseases are consequence of spondylotic changes on dynamic segments of spinal column. These changes can result in different clinical appearances such as radiculopathy, myelopathy and radiculomyelopathy. The most common surgical procedure used in treatment of this group of patients is anterior cervical discectomy and fusion (ACDF) which can provide adequate anatomical and functional restitution of degenerative cervical spine. Considering the fact that already compromised neural structure can be additionally damaged in different stages of surgical procedure, use of intraoperative neurophysiological monitoring (IONM) has role in surgical treatment of degenerative spinal diseases. The aim of use of IONM is to provide real time feedback for surgeon regarding changes in function of neural structures before irreversible damage occurs. This is the way to prevent new neurological deficit from occurring or to prevent worsening of preexisting deficit. Results of intraoperative monitoring can additionally emphasize severity of disease and help in outcome assessment. The aim of this doctoral thesis was to determine phases of surgical procedure in which changes in neurophysiological parameters occurs most commonly. Another aim was to determine correlation between findings of intraoperative neurophysiological monitoring and clinical assessment and outcome prediction in patients treated with anterior cervical discectomy with fusion. Thirty patients who met inclusion criteria were enrolled in this study. All of them were treated surgically due to degenerative changes of cervical spine and ACDF were performed in all cases. Patients were thoroughly examined before surgery. Detailed neurological examination were performed together with Numeric pain rating scale (NPRS) and Neck Disability index (NDI) questionnaire. NPRS and NDI were applied on discharge from the hospital and one month after surgery. During surgery we registered somatosensory evoked potentials (SSEP), motor evoked potentials (MEP) and spontaneous elektromiography. In all SSEP there were statistically significant increase in amplitude (p&lt;0.05), while in the case of right n. medianus statistically significant shortening of the latency (p&lt;0.05) was recorded. Significant changes are recorded between beginning and the end of the surgical procedure, as well as in the phase of removing of the intervertebral disc when decompression occurs. In the threshold intensity needed to elicit the MEP there were no statistically significant changes except for m. triceps brachii bilaterally. In patients with radiculopathy, the value of the stimulus intensity needed for obtaining muscular response was statistically significantly lower in comparison with patients with myelopathy (p&lt;0.05). SSEP showed the best correlation with sensory disorder, tendon reflexes and pain. MEPs also correlate with tendon reflexes, while a negative correlation with a manual muscle strength testing results shows that clinically preserved muscle strength does not have to be reliable indicator of the motor system condition. Preoperative NDI values were statistically significantly reduced a month after surgery (p&lt;0.05). In pain values there is a statistically significant difference between all measurements (p&lt;0.008), except between pain on release and a month after surgery (p&gt;0.008). The right n.medianus latency shows a negative, and the amplitude shows positive correlation with pain values one month postoperatively (p&lt;0.05). Increasing amplitude and shortening latency of the SSEP indicates a significant degree of decompression. The stability of the MEP indicates the intraoperative preservation of motor pathways and absence of both new motor deficiency or worsening of the existing one. SSEP and MEP correlate with clinical findings, while pain and NDI values are statistically significantly less after surgery. These results indicate that clinical findings in the patients correlate with the neurophysiological findings. Results also points out that the intraoperative changes in neurophysiological parameters can be a predictive factor for the outcome of surgical treatment.</p>

<p>Трауматско оштећење мозга (ТОМ) настаје услед дејства спољашње мехничке силе на кранијум и ендокранијални садржај, које се карактерише привременим или трајним неуролошким оштећењем, функционалном онеспособљеношћу или психосоцијалном неприлагођеношћу. Најчешће коришћени предиктори исхода су године повређеног, иницијални Гласгов кома скор (ГКС), статус зеница на пријему, време протекло од момента повређивања до неурохируршког збрињавања, удружене повреде, хипоксија, хипертензија и налаз компјутерско-томографског снимања. Основни циљ истраживања је израда алгоритма ургентног лечења трауматског можданог оштећења и дизајн скале за рану предикцију исхода ТОМ уз додатну анализу појединих фактора на пријему (ГКС, неуролошки налаз, радиолошки налаз, клинички симптоми). Спроведено је ретроспективно и проспективно истраживање којим је обухваћено 568 испитаника који су у периоду од 1.6.2018. до 31.05.2019. лечени унутар Клиничког центра Војводине у Новом Саду због трауматске озледе мозга. Узорак је чинило 34,3% жена и 65,7 % мушкараца. Старосна структура узорка је од 18-96 године (М=56,56; SD=20,17). Свим пацијентима је по пријему начињена радиолошка дијагностика компјутеризованом томографијом (ЦТ), начињен је детаљан физикални и неуролошки преглед, те је детаљно узета анамнеза. Нотирани су следећи подаци: витални параметри (артеријски крвни притисак, сатурација крви кисеоником), статус и повреде других система органа, знаци повређивања главе и врата. За неуролошки преглед је коришћена ГКС скала. За ЦТ преглед је нотирано присуство интракранијалних трауматских лезија и прелома лобање. Резултати овог истраживања указали су на неопходност пажљивог разматрања бројних фактора (радиолошких и клиничких) који се могу испољити већ на самом пријему. Иако ЦТ има висок појединачни допринос предвиђању исхода у моделу са више варијабли није се издвојио као значајан. Пацијенти који су имали дужи период између времена протеклог од момента повређивања до неурохируршког збрињавања имали су бољи исход лечења. Предпоставља се да су пацијенти који су стизали раније у здравствену установу имали тежа трауматска оштећења мозга и самим тим исход је био лошији, док су пацијенти са благим оштећењима долазили касније управо из разлога што манифестације проблема нису биле хитне. Ротердам скала се издвојила добром дискриминативном способношћу када се користи као изолован инструмент. Као најјачи предиктори издвојили су се следећи предиктори: нису показане цистерне на ЦТ-у, присутан САХ, померање више од 5 mm, присутан мали субдурални хематом, присутна велика контузија, примена антиагрегациона тераpија. Успешност предвиђања на основу новог модела је 96%. Резултати студије се могу искористити за боље разумевање ТОМ у смислу лакшег решавања дијагностичких дилема и терапијских, креирање ефикаснијих дијагностичких протокола и прецизније процене исхода након повређивања. Предикција исхода лечења је од великог значаја како би се благовермено направио алгоритам лечења и праћења ових пацијената.</p> / <p>Traumatsko oštećenje mozga (TOM) nastaje usled dejstva spoljašnje mehničke sile na kranijum i endokranijalni sadržaj, koje se karakteriše privremenim ili trajnim neurološkim oštećenjem, funkcionalnom onesposobljenošću ili psihosocijalnom neprilagođenošću. Najčešće korišćeni prediktori ishoda su godine povređenog, inicijalni Glasgov koma skor (GKS), status zenica na prijemu, vreme proteklo od momenta povređivanja do neurohirurškog zbrinjavanja, udružene povrede, hipoksija, hipertenzija i nalaz kompjutersko-tomografskog snimanja. Osnovni cilj istraživanja je izrada algoritma urgentnog lečenja traumatskog moždanog oštećenja i dizajn skale za ranu predikciju ishoda TOM uz dodatnu analizu pojedinih faktora na prijemu (GKS, neurološki nalaz, radiološki nalaz, klinički simptomi). Sprovedeno je retrospektivno i prospektivno istraživanje kojim je obuhvaćeno 568 ispitanika koji su u periodu od 1.6.2018. do 31.05.2019. lečeni unutar Kliničkog centra Vojvodine u Novom Sadu zbog traumatske ozlede mozga. Uzorak je činilo 34,3% žena i 65,7 % muškaraca. Starosna struktura uzorka je od 18-96 godine (M=56,56; SD=20,17). Svim pacijentima je po prijemu načinjena radiološka dijagnostika kompjuterizovanom tomografijom (CT), načinjen je detaljan fizikalni i neurološki pregled, te je detaljno uzeta anamneza. Notirani su sledeći podaci: vitalni parametri (arterijski krvni pritisak, saturacija krvi kiseonikom), status i povrede drugih sistema organa, znaci povređivanja glave i vrata. Za neurološki pregled je korišćena GKS skala. Za CT pregled je notirano prisustvo intrakranijalnih traumatskih lezija i preloma lobanje. Rezultati ovog istraživanja ukazali su na neophodnost pažljivog razmatranja brojnih faktora (radioloških i kliničkih) koji se mogu ispoljiti već na samom prijemu. Iako CT ima visok pojedinačni doprinos predviđanju ishoda u modelu sa više varijabli nije se izdvojio kao značajan. Pacijenti koji su imali duži period između vremena proteklog od momenta povređivanja do neurohirurškog zbrinjavanja imali su bolji ishod lečenja. Predpostavlja se da su pacijenti koji su stizali ranije u zdravstvenu ustanovu imali teža traumatska oštećenja mozga i samim tim ishod je bio lošiji, dok su pacijenti sa blagim oštećenjima dolazili kasnije upravo iz razloga što manifestacije problema nisu bile hitne. Roterdam skala se izdvojila dobrom diskriminativnom sposobnošću kada se koristi kao izolovan instrument. Kao najjači prediktori izdvojili su se sledeći prediktori: nisu pokazane cisterne na CT-u, prisutan SAH, pomeranje više od 5 mm, prisutan mali subduralni hematom, prisutna velika kontuzija, primena antiagregaciona terapija. Uspešnost predviđanja na osnovu novog modela je 96%. Rezultati studije se mogu iskoristiti za bolje razumevanje TOM u smislu lakšeg rešavanja dijagnostičkih dilema i terapijskih, kreiranje efikasnijih dijagnostičkih protokola i preciznije procene ishoda nakon povređivanja. Predikcija ishoda lečenja je od velikog značaja kako bi se blagovermeno napravio algoritam lečenja i praćenja ovih pacijenata.</p> / <p>Traumatic brain injury (TBI) Is defined as temporary or permanent neurological damage, functional disability or psychosocial inadaptability occurring due to effects of external mechanical force to brain and cranium. Mostly used predictors are age, Glasgow coma scale score, pupillary reactivity, time from injury to neurosurgical intervention, combined injuries, hypoxia, hypertension and computed tomography (CT) findings. Basic goal of this research was to analyse TBI and design early outcome prediction scale together with the analysis of individual factors on admission (GCS, neurological status, radiological findings). This research was both retro and prospective and included 568 patients treated for TBI at Clinical centre of Vojvodina in Novi Sad from 01.06.2018. to 31.05.2019. Sample was made out of 34,3% females and 65,7 % males aged from 18 to 96 years ( M=56,56; SD=20,17). All patients had CT diagnostics preformed upon admission, had undergone detailed general and neurological examination and patient&rsquo;s history was taken. Physical examination included: vitals (arterial blood pressure, blood oxygenation), status and injuries of other organs, signs of injury to head and neck. GCS scale was used for neurological examination Computed tomography (CT) included presence of intracranial lesions and skull fractures. Results of this research showed importance of careful observation of multiple factors (radiological and clinical) that can be present at the time of admission. Despite CT having high individual predictive power for outcome, in multiple variable model it was not significant. Patients with longer time elapsed to treatment had better outcome. It is assumed that patients who arrived shortly after injury had severe TBI thus having worse outcome, while patients suffering from mild TBI arrived later and thus had better outcome right because their symptoms of TBI were not very symptomatic. Rotterdam scale showed good disciminative power. The strongest predictors were: CT absence of cisterns, present subarachnoid haemorrhage, midline shift over 5mm, presence of small subdural haematoma, presence of large contusion, presence of antiaggregational therapy. Predictive power based on primary model was 96%. Results of this study can be used for better understanding of TBI in order to solve some diagnostic dilemma, create more efficient diagnostic protocols and facilitate more precise outcome assessment after TBI. Prediction of treatment outcome is very important in order to timely design treatment algorithm of treatment and follow up of TBI patients.</p>