Neurotrauma Quiz: August 2016^[*]

Q1. In context of randomized clinical trial what is true?

• Each participant has equal likelihood of being assigned to various arms of a study.

• Selection and accidental bias is a possibility.

• There is a possibility that unequal number of individuals may be assigned to each arm of the study.

• All of the above.

Q2. What is not true about block randomization?

• High chances of unequal number of individuals assigned to various arms of a study.

• Decrease the power to detect statistically significant differences between groups.

• Block randomization is better than simple random allocation.

• Simple random allocation is better than block randomization.

Q3. What is one of the biomarkers that shows promise in the evaluation of traumatic brain injury?

• Creatine kinase

• Nitrotyrosine

• Rubidium chloride

• Troponin-I

Q4. In block randomization, what is not true?

• Allocation of participants may be predictable.

• Selection bias can occur if the study groups are unmasked.

• Selection bias can be reduced by using fixed block sizes.

• Selection bias can be reduced by keeping the investigator blind to the size of each block.

Q5. What is not true about INTRUST Trial?

• It is a randomized clinical trial of glyburide for traumatic brain injury.

• Glyburide is an antihypertensive drug.

• Study will measure swelling and bleeding in the brain, as measured with magnetic resonance imaging and computed tomography scans.

• Intravenous formulation of glyburide will be used in the trial.

Q6. What is not true about HOPES Trial?

• To find out if therapeutic hypothermia improves outcome following traumatic brain injury which requires surgery.

• Therapeutic hypothermia body temperature target is about 33°C or 91.4°F.

• Only patients requiring surgery will be included in the trial.

• Severe head injury patients not requiring surgery will be included in the trial.

Q7. What is not true about DECRA Trial?

• Study included patients with severe diffuse traumatic brain injury.

• The two arms of the trial were bifrontal decompressive craniectomy and standard medical management or standard medical management alone.

• Trial provided convincing evidence that early neuroprotective bifrontal decompressive craniectomy is not superior to medical management for patients with diffuse traumatic brain injury.

• All of the above are wrong.

Q8. What is not true about RESCUEicp Trial?

• Duration of refractory intracranial hypertension was 1 hour.

• The study recruited 400 patients.

• Intracranial pressure threshold used was 20 mm Hg.

• Only patients with severe, sustained and refractory posttraumatic intracranial hypertension were recruited.

Q9. What is not true about RESCUE-ASDH Trial?

• Eligible patients are randomized to craniotomy or decompressive craniectomy intraoperatively.

• Both bilateral acute subdural hematomas requiring evacuation are excluded.

• Study will compare the clinical effectiveness of primary decompressive craniectomy versus craniotomy.

• Large Intracerebral hematomas causing mass effect are included in the study.

Q10. What is not true about CRASH 3 Trial?

• Trial is studying tranexamic acid for the treatment of significant traumatic brain injury.

• Adults with traumatic brain injury who are within 12 hours of injury are recruited.

• A loading dose of tranexamic acid used is 1 g by intravenous injection

• A total of 10,000 adult traumatic brain injury patients will be randomized in this study.

Q11. What special provision must be made during air transfer of a patient with a comorbid pulmonary injury?

• Nonpressurized cabin.

• Presence of a physician on board.

• Shorter flight time.

• Lower flight altitude.

Q12. What is not true about CRASH 2 Trial?

• Studied the effects of the early administration of tranexamic acid on death, vascular events, and transfusion requirements.

• Adults with trauma within 8 hours of injury and have significant hemorrhage were included,

• Tranexamic acid in loading dose of 2 gm or placebo was given intravenously.

• Tranexamic acid in maintenance dose of 1 gm intravenously over 8 hours was used.

Q13. What is not true about CRASH 2 Trial?

• Early administration of tranexamic acid safely reduced the risk of death in bleeding trauma patients.

• Treatment beyond 3 hours of injury is unlikely to be effective.

• More than 10,000 patients were recruited in each arm.

• Increase in vascular occlusive events was observed in this study.

Q14. According to the Rancho Los Amigos Scale, Level VIII is reported as:

• Confused—appropriate.

• Localized response.

• No response.

• Purposeful and appropriate response.

Q15. A patient who has sustained a fracture to the middle cranial fossa following a fall from a height, might have any of these nerves injured except:

• Trigeminal

• Abducens

• Trochlear

• Hypoglossal

Key to Neurotrauma Quiz: August 2016

Question no.	Question	Key
1.	In context of randomized clinical trial what is true?	D
2.	What is not true about block randomization?	D
3.	What is one of the biomarkers that shows promise in the evaluation of TBI?	B
4.	In block randomization what is not true?	C
5.	What is not true about INTRUST Trial?	B
6.	What is not true about HOPES Trial?	D
7.	What is not true about DECRA Trial?	D
8.	What is not true about RESCUEicp Trial?	C
9.	What is not true about RESCUE-ASDH Trial?	D
10.	What is not true about CRASH 3 Trial?	B
11.	What special provision must be made during air transfer of a patient with a comorbid pulmonary injury?	D
12.	What is not true about CRASH 2 Trial?	C
13.	What is not true about CRASH 2 Trial?	D
14.	According to the Rancho Los Amigos Scale, Level VIII is reported as:	D
15.	A patient who has sustained a fracture to the middle cranial fossa following a fall from a height, might have any of these nerves injured except:	D

^* The key to this Neurotrauma Quiz can be found in online version of the issue (August 2016).