Acute and Critical Care

Original Articles

Cardiology
Managing symptomatic intermediate or high-risk pulmonary embolism presenting concomitantly with intracranial bleeding: case series and literature review: Pipin Kojodjojo, Keith YC Goh, Chieh Yang Koo, Peter Chang, Philip SS Koh; Acute Crit Care. 2026;41(2):344-355. Published online March 4, 2026; DOI: https://doi.org/10.4266/acc.001075

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Abstract PDF: Background
Managing patients with concomitant intracranial bleeding (ICB) and symptomatic pulmonary embolism (PE) is challenging and there are no guidelines. Methods: We identified patients with intermediate or high-risk PE and concomitant ICB referred to our institutional PE response teams. A literature review was performed to evaluate the effectiveness and risks of various treatment strategies for this challenging clinical conundrum. Results: Two patients with subdural hematoma, symptomatic intermediate-high risk PE and deep vein thrombi were identified in our institutions. Both patients were treated with lytic-free mechanical thrombectomy combined with inferior vena cava (IVC) filter implantation. This allowed for an anticoagulation-free period, during which surgical drainage was performed. Anticoagulation was safely started several days after neurosurgery. A literature review identified 148 similar cases. There was significant risk of in-hospital mortality due to PE in patients who were left untreated. Early anticoagulation was associated with elevated risks of hematoma expansion, extracranial bleeding and residual risk of PE mortality. Patients undergoing surgical or lytic-free mechanical thrombectomy all survived to discharge without bleeding complications. Conclusions: Combining thrombolytic-free mechanical thrombectomy with an IVC filter allows for effective PE treatment and temporary avoidance of anticoagulation whilst patients undergo definitive neurosurgery for concomitant ICB. Such an approach seems safer, less invasive and more clinically effective compared to other strategies reported in the literature.

Neurosurgery
Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural hematoma: Anukoon Kaewborisutsakul, Thara Tunthanathip; Acute Crit Care. 2022;37(3):429-437. Published online June 23, 2022; DOI: https://doi.org/10.4266/acc.2021.01795

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15 Web of Science
17 Crossref

Background
A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.
Methods
In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King’s Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.
Results
The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0–42.9), Glasgow coma scale scores of 3–8 (OR, 8.2; 95% CI, 1.7–38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6–8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6–7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62–10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003–26.1) were also included.
Conclusions
SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.

Citations

Citations to this article as recorded by

Impact of Preoperative Hair Removal on Self-Esteem after Brain Tumor Surgery
Thara Tunthanathip, Natthanee Pisitthaworakul
Asian Journal of Neurosurgery.2026; 21(01): 147. CrossRef
Prognostic value of CT scoring systems and a simplified prediction model for pediatric moderate-to-severe traumatic brain injury
Yangyang Diao, Ping Liang
Chinese Journal of Traumatology.2026; 29(3): 219. CrossRef
Traumatic intraventricular haemorrhages: clinical indicators determining morbidity and mortality in paediatric patients
Zeynep Ölmez Mart, Emel Ulusoy, Bahar Uyuşkan, İlknur Akansu, Anıl Er, Koray Ur, Öznur Eser, Merve Eraslan Canbeldek, Özge Günal, Murat Duman
European Journal of Pediatrics.2026;[Epub] CrossRef
Long-Term Outcome and Prognostic Factors of Mortality in Patients With Surgical Pulmonary Embolectomy
Supakorn Soontrapornchai, Voravit Chittithavorn, Thara Tunthanathip
Journal of Health and Allied Sciences NU.2026; 0: 1. CrossRef
Transfusion Indexes and Machine Learning Prediction of Red Cell Transfusion in Brain Tumor Surgery
Thara Tunthanathip, Natthanee Pisitthaworakul
Indian Journal of Neurosurgery.2026;[Epub] CrossRef
The Prognostic Value of Immunonutritional Indexes in Pineal Region Tumor
Suchada Supbumrung, Anukoon Kaewborisutsakul, Thara Tunthanathip
Journal of Health and Allied Sciences NU.2025; 15(01): 109. CrossRef
Dynamic nomogram for predicting long-term survival in patients with brain abscess
Thara Tunthanathip, Rakkrit Duangsoithong, Waranyu Kittirojkasem, Akira Pongweat, Rattiyaphon Khongthep, Benchamat Sutchai, Assama Tohyunuh
Chinese Neurosurgical Journal.2025;[Epub] CrossRef
A nomogram for the prediction of traumatic intracranial abnormalities in the elderly: Development and validation
Apisorn Jongjit, Thara Tunthanathip
Chinese Journal of Traumatology.2025;[Epub] CrossRef
Deep learning-based model for detection of intracranial waveforms with poor brain compliance in southern Thailand
Thara Tunthanathip, Avika Trakulpanitkit
Acute and Critical Care.2025; 40(3): 473. CrossRef
Feasibility comparison of deep learning image regressions to estimate intracranial pressure from cranial computed tomography in hydrocephalus
Thara Tunthanathip, Rakkrit Duangsoithong, Sakchai Sae-Heng
Journal of Neurosciences in Rural Practice.2025; 16: 606. CrossRef
Risk factors and dose-response relationship of catheter-associated urinary tract infection in neurosurgical patients
Thara Tunthanathip, Natthanee Pisitthaworakul
International Journal of Nutrition, Pharmacology, Neurological Diseases.2025; 15(4): 451. CrossRef
Prognosis of subarachnoid hemorrhage determined by intracranial pressure thresholds
Thara Tunthanathip, Rakkrit Duangsoithong, Sakchai Sae-Heng
Journal of Cerebrovascular and Endovascular Neurosurgery.2025; 27(4): 309. CrossRef
Prognostic factors and clinical nomogram for in-hospital mortality in traumatic brain injury
Thara Tunthanathip, Nakornchai Phuenpathom, Apisorn Jongjit
The American Journal of Emergency Medicine.2024; 77: 194. CrossRef
Development of a Clinical Nomogram for Predicting Shunt-Dependent Hydrocephalus
Avika Trakulpanitkit, Thara Tunthanathip
Journal of Health and Allied Sciences NU.2024; 14(04): 516. CrossRef
Prediction performance of the machine learning model in predicting mortality risk in patients with traumatic brain injuries: a systematic review and meta-analysis
Jue Wang, Ming Jing Yin, Han Chun Wen
BMC Medical Informatics and Decision Making.2023;[Epub] CrossRef
Development and internal validation of a nomogram to predict massive blood transfusions in neurosurgical operations
Kanisorn Sungkaro, Chin Taweesomboonyat, Anukoon Kaewborisutsakul
Journal of Neurosciences in Rural Practice.2022; 13: 711. CrossRef
Prediction of massive transfusions in neurosurgical operations using machine learning
Chin Taweesomboonyat, Anukoon Kaewborisutsakul, Kanisorn Sungkaro
Asian Journal of Transfusion Science.2022;[Epub] CrossRef

Case Reports

Hematology/Vascular surgery
A Fatal Case of a Large Abdominal Wall Muscle Hematoma Secondary to Low-Molecular-Weight Heparin Injections: Mi Yeon Kim, Hyeon Ju Kang, Min Sun Ryu, Seo Woo Kim, Yon Ju Ryu, Seok Jeong Lee, Jin Hwa Lee, Jung Hyun Chang, Ji Young Hwang; Korean J Crit Care Med. 2014;29(2):126-130. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.126

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1 Crossref

Abstract PDF

The use of low-molecular-weight heparin (LMWH) can lead to major life threatening complications, including hematomas. Abdominal wall muscle hematomas are rarely fatal, and encompass a wide spectrum of severity depending on size, etiology, and associated complications; but because of their rarity may be misdiagnosed clinically. We report a fatal case of an 80-year-old female who received LMWH after an episode of pulmonary thromboembolism and was subsequently diagnosed with a large right abdominal wall hematoma complicated with hypovolemic shock and acute kidney injury.

Citations

Citations to this article as recorded by

Hemorrhage of the Ramus Lumbalis of the Iliolumbar Artery as a Cause for Shock in Blunt Trauma Victims on Therapeutic Anticoagulation
Thomas Patrick Sullivan, Eduardo Smith-Singares, Hajime Imura
Case Reports in Surgery.2021; 2021: 1. CrossRef

Neurosurgery
Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis: Chul Hee Lee; Korean J Crit Care Med. 2014;29(2):114-118. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.114

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Abstract PDF: A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurological examination the Glasgow Coma Scale (GCS) score was 15 and his brain CT showed acute subdural hematoma over the right cerebral convexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurological examination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week) without using heparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage and midline shift. Emergency burr hole trephination and removal of the hematoma were performed, after which symptoms improved. However, nine days after the operation a sudden onset of general tonic-clonic seizure developed and a brain CT demonstrated an increased amount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred to the intensive care unit (ICU) in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitol infusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he was discharged without specific neurological deficits.

Inhospital Spontaneous Acute Subdural Hematoma (SADH) Patient with Antiplatelet Therapy due to Acute Cerebral Ischemia: A Case Report: Hyo Chang Kim, Chun Sik Choi, Jae Young Yang, Hyun Chul Shin, Yu Sam Won, Young Jun Kwon; Korean J Crit Care Med. 2011;26(2):94-97.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.94

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Abstract PDF: A case of "spontaneous" acute subdural hematoma caused by aspirin and plavix therapy has not been described previously. As an isolated cerebrovascular event related to aspirin and plavix therapy, this is the first report described in the literature. It also represents a new differential diagnosis for nontraumatic acute subdural hematomas.

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