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Momenyan S, Chan H, Erdelyi S, Pei LX, Shum LK, Jae L, Taylor J, Staples JA, Brubacher JR. Health-related quality of life in the year following road trauma: Longitudinal analysis using piecewise latent curve modeling. J Affect Disord 2024; 354:509-518. [PMID: 38490589 DOI: 10.1016/j.jad.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Road trauma (RT) survivors have reduced health-related quality of life (HRQoL). We identified phases and predictors of HRQoL change following RT injury. METHODS In a prospective cohort study of 1480 Canadian RT survivors aged 16 to 103 years (July 2018 - March 2020), physical component (PCS) and mental component (MCS) summary scores from the SF-12v2 were measured pre-injury and 2, 4, 6, and 12 months post-injury and their trajectories were analyzed with piecewise latent growth curve modeling. Potential predictors of HRQoL changes included sociodemographic, psychological, medical, and trauma-related factors. RESULTS PCS and MCS scores worsened from pre-injury to 2-months (phase 1) and then improved (phase 2), but never regained baseline values. Older age, somatic symptoms and pain catastrophizing were associated with lower preinjury PCS and MCS scores. Psychological distress was associated with lower preinjury MCS scores and higher preinjury PCS scores. Phase 1 PCS scores decreased most in females, participants with fewer pre-injury somatic symptoms and those without expectations for fast recovery. Phase 1 MCS decreases were associated with younger age, female sex, living alone, lower psychological distress, lack of expectation for fast recovery and higher injury pain. In phase 2, MCS improved most in participants not using recreational drugs; PCS improved most in participants with higher education and longer recovery expectations. LIMITATIONS There may be recall bias with reporting pre-injury HRQoL. Selection bias is possible. CONCLUSIONS Many factors influence HRQoL following RT. These findings may inform measures to minimize HRQoL reduction following RT and speed up subsequent recovery.
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Affiliation(s)
- Somayeh Momenyan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Herbert Chan
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - Shannon Erdelyi
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lulu X Pei
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leona K Shum
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lina Jae
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Taylor
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John A Staples
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Anderson JFI. Heterogeneity of health-related quality of life after mild traumatic brain injury with systemic injury: a cluster analytic approach. Disabil Rehabil 2024:1-10. [PMID: 38655716 DOI: 10.1080/09638288.2024.2345278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Health-related quality of life (HRQoL) is a key component of evaluating outcome after mild traumatic brain injury (mTBI). As outcome is heterogeneous following mTBI, it is relevant to examine individual differences in HRQoL. This study investigated whether multiple homogenous subgroups could be meaningfully identified, 10 weeks after hospitalised mTBI with systemic injury, on the basis of HRQoL profiles. METHODS Ninety-one adults were assessed for HRQoL, pain, fatigue, sleep quality, psychological distress, cognition and post-concussion symptoms. RESULTS Cluster analyses revealed three separate subgroups based on physical, mental, social and energy HRQoL. One group (42%) demonstrated normative levels of HRQoL on all subdomains. The remaining two groups demonstrated significantly reduced HRQoL on all subdomains. These groups had equivalently poor mental, social and energy HRQoL, but the smallest group (27%) had significantly poorer physical HRQoL. Multinomial logistic regression revealed that pain significantly and independently predicted group membership for the particularly poor physical HRQoL group. Fatigue was the only significant independent predictor of group membership for the remaining group with reduced HRQoL. CONCLUSION These findings suggest more than 50% of hospitalised individuals with mTBI and systemic injury, have reduced HRQoL, 10 weeks after mTBI. Pain and fatigue warrant clinical attention in these individuals.IMPLICATIONS FOR REHABILITATIONMild traumatic brain injury is a common event that has been shown to be associated with persistently reduced health-related quality of life in approximately 50% of individuals 6 to 12 months after injury.Health-related quality of life likely varies between individuals after injuryRelative to the "normal" population, most individuals in this cohort of individuals with mTBI and systemic injury had reduced mental, social and energy quality of life 10 weeks after injury.Fatigue and pain are important factors in reduced health-related quality of life after mTBI with systemic injury.Further research is needed to determine whether these fatigue and pain issues are related to mTBI-factors, such as headache, and/or related to systemic injury factors, which are common in the mTBI population.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, Australia
- Senior Clinical Neuropsychologist, Psychology Department, The Alfred hospital, Commercial Rd, Melbourne, Australia
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Suzuki M, Wu YJ, Ota K, von Wild KRH, Naito M, Maeda A, Hirano A, Yamada M, Saitoh E, Kondo I, Zeldovich M, von Steinbüchel N. Quality of life after brain injury-overall scale, Japanese version: assessment of reliability and validity. Brain Inj 2024; 38:260-266. [PMID: 38297434 DOI: 10.1080/02699052.2024.2309652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/21/2024] [Indexed: 02/02/2024]
Abstract
This study analyzed the linguistic and psychometric validation of the Japanese version of the Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS) consisting of six items which cover several TBI-relevant domains. We hypothesized that the Japanese version has good reliability, convergent validity, and divergent validity, compared with its long version, the 37-item QOLIBRI. The QOLIBRI-OS Japanese version was forward and back-translated from the English version. In total, 129 individuals participated in this study after experiencing a traumatic brain injury and attending clinics, rehabilitation centers, and support centers in Japan. The structure of the QOLIBRI-OS was investigated by confirmatory factor analyses and compared with the QOLIBRI. Only one factor was extracted, and a model with one underlying factor had a good fit. The QOLIBRI-OS showed good-to-excellent internal consistency and test-retest reliability. The QOLIBRI-OS was positively correlated with the QOLIBRI, Short Form Health Survey-36 version 2, and Glasgow Outcome Scale Extended, and negatively correlated with the Hospital Anxiety and Depression Scale. The results suggest that the QOLIBRI-OS Japanese version is a reliable and valid tool for assessing disease-specific health-related QOL in individuals after traumatic brain injury in Japan.
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Affiliation(s)
- Megumi Suzuki
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Yi-Jhen Wu
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Kikuo Ota
- School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | | | - Mariko Naito
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima-city, Hiroshima, Japan
| | - Akiko Maeda
- School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Asuka Hirano
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Masayuki Yamada
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima-city, Hiroshima, Japan
| | - Eiichi Saitoh
- School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Marina Zeldovich
- Institute for Psychology, University of Innsbruck, Wien, Austria
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
- Institute for Psychology, University of Innsbruck, Wien, Austria
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Asturias A, Knoblauch T, Rodriguez A, Vanier C, Le Tohic C, Barrett B, Eisenberg M, Gibbert R, Zimmerman L, Parikh S, Nguyen A, Azad S, Germin L, Fazzini E, Snyder T. Diffusion in the corpus callosum predicts persistence of clinical symptoms after mild traumatic brain injury, a multi-scanner study. FRONTIERS IN NEUROIMAGING 2023; 2:1153115. [PMID: 38025312 PMCID: PMC10654678 DOI: 10.3389/fnimg.2023.1153115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/23/2023] [Indexed: 12/01/2023]
Abstract
Background Mild traumatic brain injuries (mTBIs) comprise 80% of all TBI, but conventional MRI techniques are often insensitive to the subtle changes and injuries produced in a concussion. Diffusion tensor imaging (DTI) is one of the most sensitive MRI techniques for mTBI studies with outcome and symptom associations described. The corpus callosum (CC) is one of the most studied fiber tracts in TBI and mTBI, but the comprehensive post-mTBI symptom relationship has not fully been explored. Methods This is a retrospective observational study of how quantitative DTI data of the CC and its sub-regions may relate to clinical presentation of symptoms and timing of resolution of symptoms in patients diagnosed with uncomplicated mTBI. DTI and clinical data were obtained retrospectively from 446 (mean age 42 years, range 13-82) civilian patients. From patient medical charts, presentation of the following common post-concussive symptoms was noted: headache, balance issues, cognitive deficits, fatigue, anxiety, depression, and emotional lability. Also recorded was the time between injury and a visit to the physician when improvement or resolution of a particular symptom was reported. FA values from the total CC and 3 subregions of the CC (genu or anterior, mid body, and splenium or posterior) were obtained from hand tracing on the Olea Sphere v3.0 SP12 free-standing workstation. DTI data was obtained from 8 different 3T MRI scanners and harmonized via ComBat harmonization. The statistical models used to explore the association between regional Fractional Anisotropy (FA) values and symptom presentation and time to symptom resolution were logistic regression and interval-censored semi-parametric Cox proportional hazard models, respectively. Subgroups related to age and timing of first scan were also analyzed. Results Patients with the highest FA in the total CC (p = 0.01), anterior CC (p < 0.01), and mid-body CC (p = 0.03), but not the posterior CC (p = 0.91) recovered faster from post-concussive cognitive deficits. Patients with the highest FA in the posterior CC recovered faster from depression (p = 0.04) and emotional lability (p = 0.01). There was no evidence that FA in the CC or any of its sub-regions was associated with symptom presentation or with time to resolution of headache, balance issues, fatigue, or anxiety. Patients with mTBI under 40 had higher FA in the CC and the anterior and mid-body subregions (but not the posterior subregion: p = 1.00) compared to patients 40 or over (p ≤ 0.01). There was no evidence for differences in symptom presentation based on loss of consciousness (LOC) or sex (p ≥ 0.18). Conclusion This study suggests that FA of the CC has diagnostic and prognostic value for clinical assessment of mTBI in a large diverse civilian population, particularly in patients with cognitive symptoms.
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Affiliation(s)
- Alexander Asturias
- Imgen Research Group, Las Vegas, NV, United States
- Touro University Nevada, Henderson, NV, United States
| | - Thomas Knoblauch
- Imgen Research Group, Las Vegas, NV, United States
- Touro University Nevada, Henderson, NV, United States
- School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, United States
| | - Alan Rodriguez
- Imgen Research Group, Las Vegas, NV, United States
- Touro University Nevada, Henderson, NV, United States
| | - Cheryl Vanier
- Imgen Research Group, Las Vegas, NV, United States
- Touro University Nevada, Henderson, NV, United States
| | - Caroline Le Tohic
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States
| | - Brandon Barrett
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States
| | - Matthew Eisenberg
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States
| | | | - Lennon Zimmerman
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States
| | | | - Anh Nguyen
- Touro University Nevada, Henderson, NV, United States
| | - Sherwin Azad
- MountainView Hospital, HCA Healthcare, Las Vegas, NV, United States
| | - Leo Germin
- Clinical Neurology Specialists, Las Vegas, NV, United States
| | | | - Travis Snyder
- Imgen Research Group, Las Vegas, NV, United States
- Touro University Nevada, Henderson, NV, United States
- MountainView Hospital, HCA Healthcare, Las Vegas, NV, United States
- SimonMed Imaging, Scottsdale, AZ, United States
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Faulkner JW, Theadom A, Snell DL, Williams MN. Network analysis applied to post-concussion symptoms in two mild traumatic brain injury samples. Front Neurol 2023; 14:1226367. [PMID: 37545717 PMCID: PMC10398392 DOI: 10.3389/fneur.2023.1226367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Objective A latent disease explanation cannot exclusively explain post-concussion symptoms after mild traumatic brain injury (mTBI). Network analysis offers an alternative form of explanation for relationships between symptoms. The study aimed to apply network analysis to post-concussion symptoms in two different mTBI cohorts; an acute treatment-seeking sample and a sample 10 years post-mTBI. Method The treatment-seeking sample (n = 258) were on average 6 weeks post-injury; the 10 year post mTBI sample (n = 193) was derived from a population-based incidence and outcomes study (BIONIC). Network analysis was completed on post-concussion symptoms measured using the Rivermead Post-Concussion Questionnaire. Results In the treatment-seeking sample, frustration, blurred vision, and concentration difficulties were central to the network. These symptoms remained central in the 10 year post mTBI sample. A Network Comparison Test revealed evidence of a difference in network structure across the two samples (p = 0.045). However, the only symptoms that showed significant differences in strength centrality across samples were irritability and restlessness. Conclusion The current findings suggest that frustration, blurred vision and concentration difficulties may have an influential role in the experience and maintenance of post-concussion symptoms. The impact of these symptoms may remain stable over time. Targeting and prioritising the management of these symptoms may be beneficial for mTBI rehabilitation.
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Affiliation(s)
- Josh W. Faulkner
- Te Herenga Waka – Victoria University of Wellington, Wellington, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
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Faulkner JW, Snell DL, Theadom A, Mahon S, Barker-Collo S. The influence of psychological flexibility on persistent post concussion symptoms and functional status after mild traumatic brain injury. Disabil Rehabil 2023; 45:1192-1201. [PMID: 35382660 DOI: 10.1080/09638288.2022.2055167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This study investigated the predictive role of psychological flexibility on long-term mTBI outcomes. METHOD Adults with mTBI (N = 147) completed a context specific measure of psychological flexibility, (AAQ-ABI), psychological distress, and mTBI outcomes at less than three months post injury (M = 6.02 weeks after injury) and 6 months later (N = 102). Structural equation modelling examined the mediating effects of psychological flexibility on psychological distress and mTBI outcomes at six months. The direct effect of psychological flexibility at less than three months on mTBI outcomes at six months was entered into the model, plus pre-injury and injury risk factors. RESULTS The theoretically derived model had good overall fit (χ2 = 1.42; p = 0.09; NFI = 0.95; TLI = 0.95; CFI = 0.98 and RMSEA = 0.06). Psychological flexibility at less than 3 months was directly significantly related to psychological distress and post-concussion symptoms at six months. Psychological flexibility at 6 months significantly mediated the relationship between psychological distress and functional disability but not post-concussion symptoms at six months post injury. CONCLUSION The exploratory findings suggest that a context specific measure of psychological flexibility assessed acutely and in the chronic phase of recovery may predict longer-term mTBI outcomes.Implications for RehabilitationPersistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI) can have a significant impact on wellbeing, functional status, and quality of life.In this study, psychological flexibility early in recovery, was associated with higher levels of psychological distress and more severe post-concussion symptoms six months later.Psychological flexibility at six months post-injury also mediated the relationship between psychological distress and functional disability.A context specific measure of psychological flexibility may predict poorer long-term outcomes following mTBI.
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Affiliation(s)
| | - Deborah L Snell
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Susan Mahon
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
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von Steinbuechel N, Hahm S, Muehlan H, Arango-Lasprilla JC, Bockhop F, Covic A, Schmidt S, Steyerberg EW, Maas AIR, Menon D, Andelic N, Zeldovich M. Impact of Sociodemographic, Premorbid, and Injury-Related Factors on Patient-Reported Outcome Trajectories after Traumatic Brain Injury (TBI). J Clin Med 2023; 12:jcm12062246. [PMID: 36983247 PMCID: PMC10052290 DOI: 10.3390/jcm12062246] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
Traumatic brain injury (TBI) remains one of the leading causes of death and disability worldwide. To better understand its impact on various outcome domains, this study pursues the following: (1) longitudinal outcome assessments at three, six, and twelve months post-injury; (2) an evaluation of sociodemographic, premorbid, and injury-related factors, and functional recovery contributing to worsening or improving outcomes after TBI. Using patient-reported outcome measures, recuperation trends after TBI were identified by applying Multivariate Latent Class Mixed Models (MLCMM). Instruments were grouped into TBI-specific and generic health-related quality of life (HRQoL; QOLIBRI-OS, SF-12v2), and psychological and post-concussion symptoms (GAD-7, PHQ-9, PCL-5, RPQ). Multinomial logistic regressions were carried out to identify contributing factors. For both outcome sets, the four-class solution provided the best match between goodness of fit indices and meaningful clinical interpretability. Both models revealed similar trajectory classes: stable good health status (HRQoL: n = 1944; symptoms: n = 1963), persistent health impairments (HRQoL: n = 442; symptoms: n = 179), improving health status (HRQoL: n = 83; symptoms: n = 243), and deteriorating health status (HRQoL: n = 86; symptoms: n = 170). Compared to individuals with stable good health status, the other groups were more likely to have a lower functional recovery status at three months after TBI (i.e., the GOSE), psychological problems, and a lower educational attainment. Outcome trajectories after TBI show clearly distinguishable patterns which are reproducible across different measures. Individuals characterized by persistent health impairments and deterioration require special attention and long-term clinical monitoring and therapy.
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Affiliation(s)
- Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
- Correspondence:
| | - Stefanie Hahm
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Holger Muehlan
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Juan Carlos Arango-Lasprilla
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, 907 Floyd Ave., Richmond, VA 23284, USA
| | - Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
| | - Silke Schmidt
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Ewout W. Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 RC Leiden, The Netherlands
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, 2650 Edegem, Belgium
| | - David Menon
- Division of Anaesthesia, University of Cambridge/Addenbrooke’s Hospital, Box 157, Cambridge CB2 0QQ, UK
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0450 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models, Faculty of Medicine, Univeristy of Oslo, 0373 Oslo, Norway
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
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Mulyadi M, Harianto S, Tonapa SI, Lee BO. Early Quality-of-Life Changes in Mild Traumatic Brain Injury: A Prospective Study. J Trauma Nurs 2023; 30:75-82. [PMID: 36881698 DOI: 10.1097/jtn.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Postinjury symptoms and decreased quality of life are common after mild traumatic brain injury. However, few studies have examined how soon, after injury, these changes dissipate. OBJECTIVES This study aimed to compare changes in postconcussion symptoms, posttraumatic stress, and illness representations and identify predictors of health-related quality of life before and 1 month after hospital discharge for mild traumatic brain injury. METHODS A prospective, multicenter, correlational design was used to measure postconcussion symptoms, posttraumatic stress, illness representations, and health-related quality of life. The survey was administered to 136 patients with mild traumatic brain injury between June 2020 and July 2021 at three hospitals in Indonesia. Data were collected at discharge and 1 month later. RESULTS Compared with before hospital discharge, data collected 1 month after discharge showed that patients experienced reduced postconcussion symptoms, posttraumatic stress, better illness perceptions, and quality of life. Those with postconcussion symptoms (β =-.35, p < .001), more posttraumatic stress symptoms (β =-.12, p = .044), more identity symptoms (β = .11, p = .008), worsened personal control (β =-.18, p = .002), worsened treatment control (β =-.16, p = .001), and negative emotional representations (β =-.17, p = .007) were significantly related to worsened health-related quality of life. CONCLUSION This study shows that within 1 month of hospital discharge, patients with mild traumatic brain injury had decreased postconcussion symptoms, posttraumatic stress, and improved illness perceptions. Efforts to impact mild brain injury quality of life should focus on inhospital care to optimize the transition to discharge.
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Affiliation(s)
- Mulyadi Mulyadi
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan (Dr Mulyadi, Mr Tonapa, and Dr Lee); School of Nursing, Faculty of Medicine, Sam Ratulangi University, Manado, Indonesia (Dr Mulyadi); and Faculty of Nursing (Mr Harianto) and Faculty of Vocational Studies (Mr Harianto), Airlangga University, Surabaya, Indonesia
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Faulkner JW. The incidence and severity of symptoms similiar to peristing concussion symptoms in neurologically healthy individuals in aotearoa New Zealand. JOURNAL OF CONCUSSION 2023. [DOI: 10.1177/20597002231160959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
The non-specificity of persisting concussion symptoms (PCS) following concussion can make treatment and rehabilitation a complex and challenging endeavour for clinicians. International studies have demonstrated that in neurologically healthy individuals similar symptoms also exist. This study aimed to examine the presence and frequency of symptoms similar to PCS in neurologically healthy adults in Aotearoa New Zealand and compare these to PCS following concussion. 252 neurologically healthy adults (34.22 years); completed the Rivermead Post-Concussion Questionnaire (RPQ). Scores on this measure were evaluated and compared with 146 individuals who were at least three months post-injury (34.62 years). 25.79% (n = 65) of the neurologically healthy individuals had scores on the RPQ of ≥16. Fatigue was the most commonly endorsed symptom (67.9%), followed by sleep disturbances (59.9%). Certain demographic factors (age, education history and gender) were associated with higher endorsement but only on specific symptoms. The concussion group had significantly higher scores on the RPQ and significantly more individuals with PCS. However, at the individual item level, just over half of PCS symptoms were significantly higher in the concussion group. These symptoms were predominately neurological, with only forgetfulness and irritability significantly different between the concussion and neurologically healthy groups. Symptoms similar to PCS are prevalent in neurologically healthy individuals in Aotearoa New Zealand. The implications of these findings on the rehabilitation and management of PCS are discussed.
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Chung JW, Liu D, Wei L, Wen YT, Lin HY, Chen HC, Chiu HY. Postconcussion Symptoms After an Uncomplicated Mild Traumatic Brain Injury in Older Adults: Frequency, Risk Factors, and Impact on Quality of Life. J Head Trauma Rehabil 2022; 37:278-284. [PMID: 34698683 DOI: 10.1097/htr.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postconcussion symptoms (PCSs) are common complaints reported by patients after a mild traumatic brain injury (TBI), and these symptoms may lower quality of life. Previous investigations have primarily focused on PCSs in children, adults, and athletes. The frequency, and risk factors, and effects of PCSs for older adults with mild TBIs are unclear. PURPOSE To investigate the frequency and risk factors of PCSs, and investigate their effects on quality of life over time after mild TBI in older adults. METHODS A prospective longitudinal study was performed. All participants were enrolled from the emergency department or neurosurgical outpatient clinics of a medical center. The measurement tools were the Rivermead Post-Concussion Symptoms Questionnaire and the Quality of Life after Traumatic Brain Injury. Measurements were performed on the seventh day, at the first month, and at the sixth month after the head injury. A generalized estimating equation model was used for data analyses. RESULTS One hundred and one older adults (mean age of 76.0 years) with mild TBIs with negative neuroimaging findings were included. Overall, 32.7%, 4%, and 15.8% of the sample reported PCS after 7 days, 1 month, and 6 months of head injury, respectively, revealing a U-shaped trend. We observed that comorbidity measured using the modified Charlson Comorbidity Index was associated with differences in PCSs ( P < .05). PCSs were an independent predictor of changes in postinjury quality of life ( P < .001). CONCLUSIONS The results indicate that PCS after a mild TBI in older adults is prevalent, even in the chronic phase after a TBI, and PCSs significantly affected the quality of life of our cohort. Therefore, to improve patient quality of life, healthcare providers should employ effective interventions to manage PCSs at different phases after a TBI.
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Affiliation(s)
- Jia-Wei Chung
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan (Mr Chung and Dr Chiu); Departments of Nursing (Mr Chung and Dr Liu) and Neurosurgery (Drs Wei, Wen, Lin, and Chen), Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan (Dr Wei); and Research Center of Sleep Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan (Dr Chiu)
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11
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Sharma B, Lawrence DW. Top cited articles in concussion: A bibliometric analysis of the state of the science. JOURNAL OF CONCUSSION 2022. [DOI: 10.1177/20597002221086095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Citation analyses identify the most-cited publications in a given field, which aids in understanding areas of the literature that are well-developed and those where additional research is required. Our objective was to perform a citation analysis in concussion to understand the state of the science from a bibliometric perspective. Design We performed a keyword search for articles related to concussion in Harzing's Publish or Perish, which scrapes Google Scholar for citation metrics. This approach was used to identify the 50 articles with the most lifetime citations as well as the 50 articles with the highest citation rate. Main outcome measures Citations and citation rates. Results Per our citation analysis, we found that concussion guidelines are among the most cited publications (comprising ≥20% of each citation cohort), yet there is a dearth of widely cited clinical trials to inform them; only one randomized trial (studying the effects of rest following concussion) was included in our citation analysis. The majority of study designs (≥40% of each citation cohort) were cross-sectional. Concussion recovery and secondary complications of concussion were common study topics, with ≥20% of publications in each citation cohort focused on these issues. The publications included in our analysis were authored by 596 authors from only 12 countries, suggesting a lack of global representation in concussion research. Conclusions Existing reviews and consensus statements have called for additional, high-quality research in concussion; our citation analysis quantifies this need. Further, although concussion is a global problem with its incidence and burden increasing in the developing world, our citation analysis demonstrates that the most-cited and discussed articles in concussion are published by authors from only 12 countries. Going forward, to address the global problem that is concussion, a more global research perspective is called for.
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Affiliation(s)
- Bhanu Sharma
- Department of Medical Sciences, McMaster University, Hamilton, Canada
| | - David Wyndham Lawrence
- Dovigi Sports Medicine Clinic, Mount Sinai Hospital, Sinai Health System, Toronto, Canada
- David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
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12
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Brady M, Hume PA, Mahon S, Theadom A. What Is the Evidence on Natural Recovery Over the Year Following Sports-Related and Non-sports-Related Mild Traumatic Brain Injury: A Scoping Review. Front Neurol 2022; 12:756700. [PMID: 35069407 PMCID: PMC8766792 DOI: 10.3389/fneur.2021.756700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Treatment approaches often differ dependent upon whether a person experiences a sports-related or a non-sports-related mild traumatic brain injury. It remains unclear if recovery from these injuries is comparable or unique to context of the injury. Objective: To identify knowledge gaps on self-reported outcomes and trajectories between sports- and non-sports-related mild traumatic brain injuries and how they are assessed in adults. Methods: This scoping review used a systematic search of key electronic databases, including PubMed, SPORTDiscus, Embase, MEDLINE, and CINAHL for articles published in 1937 until March 10, 2021. Articles were included if they were available in English; full text published in a peer-reviewed journal; had a prospective or retrospective study design; reported data on mild TBI cases >16 years of age, and included data from at least two time points on self-reported outcomes within 12 months post-injury. A standardized data extraction spreadsheet was used to determine the participant characteristics, definitions, assessment methods, outcomes, and recovery time frames. Results: Following removal of duplicates, the search strategy elicited 6,974 abstracts. Following abstract review, 174 were retained for full text review. Of the 42 articles that met inclusion criteria, 18 were sports related (15 in the USA and three in Canada) and 24 were general population studies (six in USA, three in Canada, three in Australasia, nine in Europe, two in Taiwan, and one in Morocco). Direct comparison in recovery trajectories between the sport and general population studies was difficult, given notable differences in methodology, definitions, types of outcome measures, and timing of follow-up assessments. Only one article reported on both sports-related and non-sports-related traumatic brain injuries separately at comparable timepoints. This study revealed no differences in recovery time frames or overall symptom burden. Discussion: Whilst there is a clear benefit in researching specific subpopulations in detail, standardized outcome measures and follow-up time frames are needed across contexts to facilitate understanding of similarities and differences between sports- and non-sports-related mild traumatic brain injuries to inform clinical treatment.
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Affiliation(s)
- Morgan Brady
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Patria A Hume
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Susan Mahon
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Traumatic Brain Injury Network (TBIN), Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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13
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Fordal L, Stenberg J, Iverson GL, Saksvik SB, Karaliute M, Vik A, Olsen A, Skandsen T. Trajectories of Persistent Postconcussion Symptoms and Factors Associated with Symptom Reporting after Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2021; 103:313-322. [PMID: 34695386 DOI: 10.1016/j.apmr.2021.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the trajectories of persistent postconcussion symptoms (PPCS) after mild traumatic brain injury (MTBI) and to investigate which injury-related and personal factors are associated with symptom reporting. DESIGN Prospective longitudinal cohort study. Follow-up at 3 and 12 months postinjury. SETTING A level 1 trauma center and an emergency outpatient clinic. PARTICIPANTS Patients with MTBI (n=358), trauma controls (n=75), and community controls (n=78). MAIN OUTCOME MEASURES Symptoms were assessed with the British Columbia Postconcussion Symptom Inventory. Participants were categorized as having moderate to severe PPCS (msPPCS) when reporting ≥3 moderate/severe symptoms or a BC-PSI total score of ≥13. BC-PSI total scores were compared between the groups and were further used to create cut-offs for reliable change by identifying uncommon and very uncommon change in symptoms in the community control group. Associations between symptom reporting and 25 injury-related and personal factors were examined. RESULTS The MTBI group had a similar prevalence of msPPCS at 3 and 12 months (21%), and reported more symptoms than the control groups. Analyses of individual trajectories, however, revealed considerable change in both msPPCS and BC-PSI total scores in the MTBI group, where both worsening and improvement was common. Intracranial lesions on CT were associated with a greater likelihood of improving from 3 to 12 months. Those with msPPCS at both assessments were more likely to be women and to have these personal preinjury factors: reduced employment, pain, poor sleep, low resilience, high neuroticism and pessimism, and a psychiatric history. CONCLUSIONS Group analyses suggest a stable prevalence of msPPCS the first year postinjury. However, there was considerable intra-individual change. Several personal factors were associated with maintaining symptoms throughout the first year.
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Affiliation(s)
- Linda Fordal
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jonas Stenberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, MA, USA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
| | - Simen B Saksvik
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Migle Karaliute
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Alexander Olsen
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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14
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Factors Associated with Quality of Life in Adults with Persistent Post-Concussion Symptoms. Can J Neurol Sci 2021; 49:109-117. [PMID: 33766169 DOI: 10.1017/cjn.2021.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess demographic, clinical, and injury characteristics associated with health-related quality of life (HRQOL) in adults with persistent post-concussion symptoms (PPCS). METHODS Adults with PPCS presenting to a specialized brain injury clinic completed demographic, injury, and clinical outcome questionnaires at the initial clinic assessment. Clinical outcome measures were collected including the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and the Fatigue Severity Scale (FSS). HRQOL was measured using the Quality of Life after Brain Injury (QOLIBRI) questionnaire. Stepwise hierarchical multiple regression analysis adjusting for age, sex, and months since injury was used to determine associations between quality of life and clinical outcome measures. RESULTS Overall, 125 participants were included. The PHQ-9, FSS, and GAD-7 were significant predictors of QOLIBRI scores (R2 = 0.481, p < .001), indicating that participants with higher levels of depressive symptoms, fatigue, and anxiety reported poorer HRQOL. The PHQ-9 score was the strongest predictor, accounting for 42.0% of the variance in QOLIBRI scores. No demographic or injury characteristics significantly predicted QOLIBRI scores. There was a high prevalence of depressive symptoms with 72.8% of participants having PHQ-9 scores ≥ 10. CONCLUSION Among patients with PPCS, mental health and fatigue are important contributors to HRQOL. As there is a high burden of mood disorders and fatigue in this population, targeted treatments for these concerns may impact the quality of life.
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15
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Martinez-Perez R, Ung TH, Youssef AS. The 100 most-cited articles on vestibular schwannoma: historical perspectives, current limitations, and future research directions. Neurosurg Rev 2021; 44:2965-2975. [PMID: 33523339 DOI: 10.1007/s10143-021-01487-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 12/19/2022]
Abstract
There has been a steady increase of vestibular schwannoma (VS) research in the body of literature. To delineate the most impactful works on VS, a bibliometric analysis is warranted. The Thomson Reuters Web of Sciences database was queried to identify all articles on VS published to June 2020. The articles were sorted in descending order of the number of citations. Titles and abstracts of the top 100 most-cited articles were screened to identify the research area, publication year, author, and country of publication. Our query yielded 6477 research publications. The 100 most-cited articles were cited 15804 times. The most productive decade was the 1990s (40% of the top 100 articles). Twenty-five journals contributed to all included articles. Journal of Neurosurgery contributed most of the articles (20%). Most common contributing country was the USA (60%). "Operative treatment" was the most common research topic (68%), followed by other aspects such as medical management (13%), epidemiology (12%), diagnosis (5%), or translational medicine (2%). The current analysis highlights the importance of the multimodal approach in the study and treatment of VS. While emphasizing the relevance of including highly cited articles in the current education of VS, our results point out the deficiency in certain research areas with high impact in other fields of neuro-oncology, such as translational medicine and molecular epigenetics.
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Affiliation(s)
- Rafael Martinez-Perez
- Departments of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. .,Department of Neurosurgery, University of Colorado School of Medicine, 1635 Aurora Ct, 4th floor, Aurora, CO, 80045, USA.
| | - Timothy H Ung
- Departments of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - A Samy Youssef
- Departments of Neurosurgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA. .,Department of Neurosurgery, University of Colorado School of Medicine, 1635 Aurora Ct, 4th floor, Aurora, CO, 80045, USA.
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16
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Verdugo MA, Aza A, Orgaz MB, Fernández M, Amor AM. Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation. Int J Clin Health Psychol 2021; 21:100219. [PMID: 33552163 PMCID: PMC7848640 DOI: 10.1016/j.ijchp.2020.100219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
After an acquired brain injury (ABI), the person remains with several impairments and disabilities that cause a decrease in his/her quality of life (QoL), which could change over time. The objective of the study was to analyse the evolution patterns of QoL in a sample of persons with ABI for one-year as well as the differences in proxy- and self-report versions of a QoL instrument. Method: The sample comprised 402 persons with ABI with ages ranging between 18 and 91 years, whom 36.20% had had the accident recently (i.e., three years or less). Patients, professionals and relatives responded at three evaluation points to the CAVIDACE scale, an ABI-specific QoL tool. Results: ANOVAs showed an improvement in QoL in the two follow-ups; the improvement was especially significant in the period between baseline and six months. The respondent factor did not interact with the evaluation time, but significant differences were found between respondents, with scores of patients higher than that for proxies. Finally, the QoL’s evolution interacts with the time elapsed since injury, showing significant improvements in the most recent group (i.e., three years or less). Conclusions: QoL must be considered from the earliest moments after ABI to obtain more significant improvements.
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Affiliation(s)
- Miguel A Verdugo
- Institute for Community Inclusion (INICO) and Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Salamanca,Spain
| | - Alba Aza
- Institute for Community Inclusion (INICO) and Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Salamanca,Spain
| | - María Begoña Orgaz
- Institute for Community Inclusion (INICO) and Department of Basic Psychology, Psychobiology and Behavioral Sciences Methodology, Faculty of Psychology, University of Salamanca,Spain
| | - María Fernández
- Institute for Community Inclusion (INICO) and Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Salamanca,Spain
| | - Antonio M Amor
- Institute for Community Inclusion (INICO) and Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Salamanca,Spain
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17
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Aza A, Verdugo MÁ, Orgaz MB, Amor AM, Fernández M. Predictive Factors of Self-Reported Quality of Life in Acquired Brain Injury: One-Year Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030927. [PMID: 33494473 PMCID: PMC7908370 DOI: 10.3390/ijerph18030927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/16/2022]
Abstract
Background: The sequelae and disabilities that follow an acquired brain injury (ABI) may negatively affect quality of life (QoL). The main objective of the study is to describe the QoL after an ABI and identify the predictors of a better QoL. Methods: Prospective cohort study with follow-up measurement after one-year. The sample comprised 203 adults with ABIs (64% male) aged 18–86 years (M = 53.01, SD = 14.44). Stroke was the main etiology of the injury (55.7%), followed by a TBI (32.8%), and the average time since injury was 8 years (M = 8.25, SD = 7.83, range = 0.5–47.5). Patients assessed their QoL through the scale Calidad de Vida en Daño Cerebral (CAVIDACE self-reported version; “quality of life in brain injury” in English), an ABI-specific tool based on the eight-domain QoL model. Other variables measured were: depression, self-awareness, community integration, resilience, and social support at baseline and one-year follow-up. Results: The studied factors showed few significant changes over time. The analyses showed statistically significant differences in QoL scores in several sociodemographic (age, civil status, education, legal capacity, and dependency), injury-related (time, location, and comorbidity), rehabilitation, and personal-social variables (self-awareness, depression, social support, resilience, and community integration). The levels of dependency, depression, and satisfaction with social support were independent predictors of the total QoL score one-year follow-up. Conclusions: QoL after ABI depends on multiple elements that must be considered. There are factors such as satisfaction with social support, depression, community integration, and resilience that must be monitored throughout the rehabilitation process.
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Affiliation(s)
- Alba Aza
- Institute for Community Inclusion, Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (A.M.A.); (M.F.)
- Correspondence: ; Tel.: +34-670576341
| | - Miguel Á. Verdugo
- Institute for Community Inclusion, Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (A.M.A.); (M.F.)
| | - María Begoña Orgaz
- Institute for Community Inclusion, Department of Basic Psychology, Psychobiology and Behavioral Sciences Methodology, Faculty of Psychology, University of Salamanca, 37005 Salamanca, Spain;
| | - Antonio M. Amor
- Institute for Community Inclusion, Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (A.M.A.); (M.F.)
| | - María Fernández
- Institute for Community Inclusion, Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (A.M.A.); (M.F.)
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18
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Roy D, Peters ME, Everett AD, Leoutsakos JMS, Yan H, Rao V, T Bechtold K, Sair HI, Van Meter T, Falk H, Vassila A, Hall A, Ofoche U, Akbari F, Lyketsos C, Korley F. Loss of Consciousness and Altered Mental State as Predictors of Functional Recovery Within 6 Months Following Mild Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2020; 32:132-138. [PMID: 31530119 DOI: 10.1176/appi.neuropsych.18120379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors tested the hypothesis that a combination of loss of consciousness (LOC) and altered mental state (AMS) predicts the highest risk of incomplete functional recovery within 6 months after mild traumatic brain injury (mTBI), compared with either condition alone, and that LOC alone is more strongly associated with incomplete recovery, compared with AMS alone. METHODS Data were analyzed from 407 patients with mTBI from Head injury Serum Markers for Assessing Response to Trauma (HeadSMART), a prospective cohort study of TBI patients presenting to two urban emergency departments. Four patient subgroups were constructed based on information documented at the time of injury: neither LOC nor AMS, LOC only, AMS only, and both. Logistic regression models assessed LOC and AMS as predictors of functional recovery at 1, 3, and 6 months. RESULTS A gradient of risk of incomplete functional recovery at 1, 3, and 6 months postinjury was noted, moving from neither LOC nor AMS, to LOC or AMS alone, to both. LOC was associated with incomplete functional recovery at 1 and 3 months (odds ratio=2.17, SE=0.46, p<0.001; and odds ratio=1.80, SE=0.40, p=0.008, respectively). AMS was associated with incomplete functional recovery at 1 month only (odds ratio=1.77, SE=0.37 p=0.007). No association was found between AMS and functional recovery in patients with no LOC. Neither LOC nor AMS was predictive of functional recovery at later times. CONCLUSIONS These findings highlight the need to include symptom-focused clinical variables that pertain to the injury itself when assessing who might be at highest risk of incomplete functional recovery post-mTBI.
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Affiliation(s)
- Durga Roy
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Matthew E Peters
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Allen D Everett
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Jeannie-Marie Sheppard Leoutsakos
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Haijuan Yan
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Vani Rao
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Kathleen T Bechtold
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Haris I Sair
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Tim Van Meter
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Hayley Falk
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Alexandra Vassila
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Anna Hall
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Uju Ofoche
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Freshta Akbari
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Constantine Lyketsos
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
| | - Frederick Korley
- The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari)
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19
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Vanier C, Pandey T, Parikh S, Rodriguez A, Knoblauch T, Peralta J, Hertzler A, Ma L, Nam R, Musallam S, Taylor H, Vickery T, Zhang Y, Ranzenberger L, Nguyen A, Kapostasy M, Asturias A, Fazzini E, Snyder T. Interval-censored survival analysis of mild traumatic brain injury with outcome based neuroimaging clinical applications. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220947194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective The purpose of this study was to assess the relationship between MRI findings and clinical presentation and outcomes in patients following mild traumatic brain injury (mTBI). We hypothesize that imaging findings other than hemorrhages and contusions may be used to predict symptom presentation and longevity following mTBI. Methods Patients (n = 250) diagnosed with mTBI and in litigation for brain injury underwent 3T magnetic resonance imaging (MRI). A retrospective chart review was performed to assess symptom presentation and improvement/resolution. To account for variable times of clinical presentation, nonuniform follow-up, and uncertainty in the dates of symptom resolution, a right censored, interval censored statistical analysis was performed. Incidence and resolution of headache, balance, cognitive deficit, fatigue, anxiety, depression, and emotional lability were compared among patients. Image findings analyzed included white matter hyperintensities (WMH), Diffusion Tensor Imaging (DTI) fractional anisotropy (FA) values, MR perfusion, auditory functional MRI (fMRI) activation, hippocampal atrophy (HA) and hippocampal asymmetry as defined by NeuroQuant ® volumetric software. Results Patients who reported LOC were significantly more likely to present with balance problems (p < 0.001), cognitive deficits (p = 0.010), fatigue (p = 0.025), depression (p = 0.002), and emotional lability (p = 0.002). Patients with LOC also demonstrated significantly slower recovery of cognitive function than those who did not lose consciousness (p = 0.044). Patients over the age of 40 had significantly higher odds of presenting with balance problems (p = 0.006). Additionally, these older patients were slower to recover cognitive function (p = 0.001) and less likely to experience improvement of headaches (p = 0.007). Abnormal MRI did not correlate significantly with symptom presentation, but was a strong indicator of symptom progression, with slower recovery of balance (p = 0.009) and cognitive deficits (p < 0.001). Conclusion This analysis demonstrates the utility of clinical data analysis using interval-censored survival statistical technique in head trauma patients. Strong statistical associations between neuroimaging findings and aggregate clinical outcomes were identified in patients with mTBI.
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Affiliation(s)
- Cheryl Vanier
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Trisha Pandey
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Shaunaq Parikh
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
- IMGEN LLC., Las Vegas, NV, USA
- Department of Family Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, USA
| | | | | | - John Peralta
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Amanda Hertzler
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Leon Ma
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Ruslan Nam
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Sami Musallam
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Hallie Taylor
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Taylor Vickery
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Yolanda Zhang
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Logan Ranzenberger
- Department of Radiology, Michigan State University, East Lansing, MI, USA
- Department of Radiology, McClaren Health Care, Flint, MI, USA
| | - Andrew Nguyen
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Mike Kapostasy
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
- IMGEN LLC., Las Vegas, NV, USA
| | - Alex Asturias
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Enrico Fazzini
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
| | - Travis Snyder
- Department of Research, Touro University Nevada, Las Vegas, NV, USA
- IMGEN LLC., Las Vegas, NV, USA
- SimonMed Imaging, Las Vegas, NV, USA
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20
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Summaka M, Zein H, Elias E, Naim I, Fares Y, Nasser Z. Prediction of quality of life by Helsinki computed tomography scoring system in patients with traumatic brain injury. Brain Inj 2020; 34:1229-1236. [PMID: 32730092 DOI: 10.1080/02699052.2020.1799435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this study is to assess the association between the Computed Tomography (CT) findings on admission, according to the Helsinki computed tomography CT score, and patient's Quality of Life (QoL) following traumatic brain injury (TBI) in Lebanon. METHODS A retrospective study was performed on 49 males suffering from war induced TBI. Participants were stratified into two groups based on the date of injury. Helsinki CT score was calculated for CT scans of participants. Outcomes were assessed using QoL scales including the Project for the Epidemiological Analysis of Critical Care Patients scale (PAEEC). RESULTS Correlation analysis showed that QoL, up to 4 years post-TBI, was significantly associated with Helsinki CT classification. Group 1 of subjects living with TBI for 1-2 years revealed a correlation coefficient r = 0.536, p-value = 0.027, whereas, group 2 including subjects who are injured since 3-4 years, had a correlation coefficient r = 0.565, p-value = 0.001. CONCLUSION The present study showed that patients with traumatic brain injury experienced significant quality of life deterioration up to 4 years post-TBI. Our findings propose the important role of Helsinki score in predicting the quality of life among patients with TBI.
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Affiliation(s)
- Marwa Summaka
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University , Hadath, Lebanon
| | - Hiba Zein
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University , Hadath, Lebanon
| | - Elias Elias
- Department of Complex and minimally invasive spine surgery, Swedish Neuroscience Institute , Seattle, Washington, USA
| | - Ibrahim Naim
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University , Hadath, Lebanon
| | - Youssef Fares
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University , Hadath, Lebanon
| | - Zeina Nasser
- Faculty of Medical Sciences, Neuroscience Research Center, Lebanese University , Hadath, Lebanon
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21
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Clinical Predictors of 3- and 6-Month Outcome for Mild Traumatic Brain Injury Patients with a Negative Head CT Scan in the Emergency Department: A TRACK-TBI Pilot Study. Brain Sci 2020; 10:brainsci10050269. [PMID: 32369967 PMCID: PMC7287871 DOI: 10.3390/brainsci10050269] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 01/25/2023] Open
Abstract
A considerable subset of mild traumatic brain injury (mTBI) patients fail to return to baseline functional status at or beyond 3 months postinjury. Identifying at-risk patients for poor outcome in the emergency department (ED) may improve surveillance strategies and referral to care. Subjects with mTBI (Glasgow Coma Scale 13–15) and negative ED initial head CT < 24 h of injury, completing 3- or 6-month functional outcome (Glasgow Outcome Scale-Extended; GOSE), were extracted from the prospective, multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study. Outcomes were dichotomized to full recovery (GOSE = 8) vs. functional deficits (GOSE < 8). Univariate predictors with p < 0.10 were considered for multivariable regression. Adjusted odds ratios (AOR) were reported for outcome predictors. Significance was assessed at p < 0.05. Subjects who completed GOSE at 3- and 6-month were 211 (GOSE < 8: 60%) and 185 (GOSE < 8: 65%). Risk factors for 6-month GOSE < 8 included less education (AOR = 0.85 per-year increase, 95% CI: (0.74–0.98)), prior psychiatric history (AOR = 3.75 (1.73–8.12)), Asian/minority race (American Indian/Alaskan/Hawaiian/Pacific Islander) (AOR = 23.99 (2.93–196.84)), and Hispanic ethnicity (AOR = 3.48 (1.29–9.37)). Risk factors for 3-month GOSE < 8 were similar with the addition of injury by assault predicting poorer outcome (AOR = 3.53 (1.17–10.63)). In mTBI patients seen in urban trauma center EDs with negative CT, education, injury by assault, Asian/minority race, and prior psychiatric history emerged as risk factors for prolonged disability.
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22
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Ledger C, Karameh WK, Munoz DG, Fischer CE, Schweizer TA. Gender role in sleep disturbances among older adults with traumatic brain injury. Int Rev Psychiatry 2020; 32:39-45. [PMID: 31544552 PMCID: PMC7255060 DOI: 10.1080/09540261.2019.1657384] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/14/2019] [Indexed: 10/25/2022]
Abstract
Older adults are particularly vulnerable to poor long-term outcomes, and the rate of TBI in this group is increasing. Studies have shown females experience worse outcomes from TBI than males, however this research has been limited. The aim of this study is to examine gender effects on the frequency of sleep disturbances in older adults post-TBI. An analysis was conducted on data obtained from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set. A total of 405 patients greater than 60 years of age were examined. Sleep disturbances were measured using the Nighttime Behavioural Disturbances domain of the Neuropsychiatric Inventory-Questionnaire (NPI-Q). A significant difference (p = 0.025) in reported sleep disturbance was identified in the female TBI population relative to the female non-TBI population. In the male non-TBI group, 14.8% (n = 12) experienced nighttime disturbances while 19.8% (n = 17) of those with TBI experienced nighttime disturbances. This difference was not significant (p = 0.305). These results suggest there is a greater impact from traumatic brain injury on sleep disturbances in older females than males. Further research examining gender differences in older adults related to neuropsychiatric outcomes of TBI should be considered given the implications for treatment.
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Affiliation(s)
- Conor Ledger
- Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Wael K. Karameh
- Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Geriatric Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - David G. Munoz
- Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Pathology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Corinne E. Fischer
- Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Geriatric Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Tom A. Schweizer
- Keenan Research Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
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23
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Watkin C, Phillips J, Radford K. What is a ‘return to work’ following traumatic brain injury? Analysis of work outcomes 12 months post TBI. Brain Inj 2019; 34:68-77. [DOI: 10.1080/02699052.2019.1681512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Connor Watkin
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Julie Phillips
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Kathryn Radford
- School of Medicine, University of Nottingham, Nottingham, UK
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24
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Maillard J, De Pretto M, Delhumeau C, Walder B. Prediction of long-term quality of life after severe traumatic brain injury based on variables at hospital admission. Brain Inj 2019; 34:203-212. [PMID: 31648571 DOI: 10.1080/02699052.2019.1683227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Variables collected early after severe traumatic brain injury (sTBI) could predict health-related quality of life (HRQoL). Our aim was to determine the prevalence of patients with a low HRQoL 4 years after sTBI and to develop a prediction model including early variables.Methods: Adult patients with both sTBI [abbreviated injury score of the head region (HAIS) >3] and disease-specific HRQoL assessments using the 'Quality of Life after Brain Injury' (QOLIBRI) were included. The outcome was the total score (TS) of QOLIBRI; cutoff for low HRQoL: <60 points. A multivariate logistic regression model and prediction model were performed.Results: One hundred-sixteen patients [median age 50.8 years (IQR 25.9-62.8; 21.6% >65 years)] were included; 68 (58.6%) with HAIS = 4, 48 (41.4%) with HAIS = 5. Median Glasgow Coma Scale (GCS) was 13 (IQR 3-15). Median TS was 77 (IQR 60-88). Low HRQoL was observed in 28 patients (24.1%). Two variables were associated with low HRQoL: GCS <13, working situation other than employed or retired. The prediction model had an AUROC of 0.765; calibration was moderate (Hosmer Lemeshow Chi2 6.82, p = .556).Conclusion: One in four patients had a low HRQoL after 4 years. A lower GCS and working situations were associated with low HRQoL.
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Affiliation(s)
- Julien Maillard
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Geneva Perioperative Basic, Translational and Clinical Research Group, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Michael De Pretto
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Science and Medicine, University of Fribourg, Switzerland
| | - Cecile Delhumeau
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Bernhard Walder
- Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Geneva Perioperative Basic, Translational and Clinical Research Group, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
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25
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Gardner RC, Cheng J, Ferguson AR, Boylan R, Boscardin J, Zafonte RD, Manley GT. Divergent Six Month Functional Recovery Trajectories and Predictors after Traumatic Brain Injury: Novel Insights from the Citicoline Brain Injury Treatment Trial Study. J Neurotrauma 2019; 36:2521-2532. [PMID: 30909795 DOI: 10.1089/neu.2018.6167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cross-sectional approaches to outcome assessment may not adequately capture heterogeneity in recovery after traumatic brain injury (TBI). Using latent class mixed models (LCMM), a data-driven analytic that identifies groups of patients with similar trajectories, we identified distinct 6 month functional recovery trajectories in a large cohort (n = 1046) of adults 18-70 years of age with complicated mild to severe TBI who participated in the Citicoline Brain Injury Treatment Trial (COBRIT). We used multinomial logistic fixed effect models and backward elimination, forward selection, and forward stepwise selection with several stopping rules to explore baseline predictors of functional recovery trajectory. Based on statistical and clinical considerations, the seven-class model was deemed superior. Visualization of these seven functional recovery trajectories revealed that each trajectory class started at one of three recovery levels at 1 month, which, for ease of reference we labeled groups A-C: Group A, good recovery (two classes; A1 and A2); Group B, moderate disability (two classes; B1 and B2); and Group C, severe disability (three classes; C1, C2, and C3). By 6 months, these three groups experienced dramatically divergent trajectories. Group A experienced stable good recovery (A1, n = 115) or dramatic decline (A2, n = 4); Group B experienced rapid complete recovery (B1, n = 71) or gradual recovery (B2, n = 742); Group C experienced dramatic rapid recovery (C1, n = 12), no recovery (C2, n = 91), or death (C3, n = 11). Trajectory class membership was not predicted by citicoline treatment (p = 0.57). The models identified demographic, pre-injury, and injury-related predictors of functional recovery trajectory, including: age, race, education, pre-injury employment, pre-injury diabetes, pre-injury psychiatric disorder, site, Glasgow Coma Scale (GCS) score, post-traumatic amnesia, TBI mechanism, major extracranial injury, hemoglobin, and acute computed tomographic (CT) findings. GCS was the most consistently selected predictor across all models. All models also selected at least one demographic or pre-injury medical predictor. LCMM successfully identified dramatically divergent, clinically meaningful 6 month recovery trajectories with utility to inform clinical trial design.
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Affiliation(s)
- Raquel C Gardner
- Department of Neurology, Memory and Aging Center, and Weill Institute for Neurosciences, University of California, San Franscisco, San Francisco, California.,Department of Neurology and Center for Population Brain Health, San Francisco Veterans Affairs Mecical Center, San Francisco, California
| | - Jing Cheng
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Adam R Ferguson
- Department of Neurological Surgery and Weil Institute for Neurosciences, University of California San Francisco, San Francisco, California.,Brain and Spinal Injury Center, Zuckerberg san Francisco General Hospital, San Francisco, California.,Department of Research and Development, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Ross Boylan
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - John Boscardin
- Deparment of Epidemiology and Biostatistics, University of California, San Francisco, California.,Department of Research and Development, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Medicine, University of California, san Francisco, California
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Geoffrey T Manley
- Department of Neurological Surgery and Weil Institute for Neurosciences, University of California San Francisco, San Francisco, California.,Brain and Spinal Injury Center, Zuckerberg san Francisco General Hospital, San Francisco, California
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Abstract
PURPOSE Occupational injuries have considerable impact on workers' lives. However, data regarding workers' health-related quality of life (HRQOL) at several years after the injury are lacking. This study assessed workers' HRQOL at 6 years after occupational injury and determined related factors in each HRQOL domain. METHODS Workers who sustained an occupational injury in 2009 and who responded to a previous survey at 3 or 12 months after their injury were followed up in 2015. A total of 1715 participants were candidates for this study. The Taiwanese version of the World Health Organization Quality of Life scale-abbreviated version (WHOQOL-BREF) was used to assess their HRQOL. Multiple linear regression analysis identified predictive factors for HRQOL at 6 years after occupational injury. RESULTS A total of 563 workers completed the questionnaire (response rate, 32.8%). Adverse life events and additional severe occupational injuries that occurred within the follow-up period, and decreased salary after the injury were significant factors for low scores in all domains of the WHOQOL-BREF. In addition, unmarried participants had low scores in the social relationship domain. Workers with family members requiring care scored low in the physical and environment domains. Workers whose injuries had major effects on their physical appearance had low scores in the physical and psychological domains. Workers with unstable employment had low scores in physical, psychological, and environment domains. CONCLUSION At 6 years after occupational injury, workers' HRQOL was poor among those whose salaries decreased after the injury, after adjustment for other factors.
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27
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Kenardy J, Heron-Delaney M, Hendrikz J, Warren J, Edmed SL, Brown E. Recovery trajectories for long-term health-related quality of life following a road traffic crash injury: Results from the UQ SuPPORT study. J Affect Disord 2017; 214:8-14. [PMID: 28260620 DOI: 10.1016/j.jad.2017.02.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/17/2017] [Accepted: 02/28/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Diminished physical and mental health-related quality of life (HRQoL) is a common consequence of road traffic crash (RTC) injury. This study aimed to (a) determine the probable recovery trajectories in physical and mental HRQoL; (b) examine the impact of posttraumatic stress disorder (PTSD) on HRQoL scores within these trajectory groups; and (c) examine the influence of predictor covariates on trajectory group membership. METHODS 336 (63% female, Mage =44.72; SD =14.77) injured RTC survivors completed the SF-36v2 at approximately 6, 12, and 24 months after sustaining a RTC injury. Participants also completed telephone interviews to assess prior history of psychological disorder and current PTSD at each wave. RESULTS Three trajectories were identified for SF-36v2 Physical Component Score (PCS): "gradual recovery" (27.3%);"low but improving" (54.7%); and"severe and chronic" (17.9%). Four trajectories were defined for SF36v2 Mental Component Score (MCS): "unaffected" (19.1%);"severe but improving" (24.1%);"severe and declining" (17.3%); and"low but improving" (39.5%). A PTSD diagnosis significantly reduced SF36v2 component scores only in trajectories associated with poorer outcome. Age was predictive of trajectory group membership for PCS, whereas injury severity was predictive of trajectory group membership for MCS. LIMITATIONS Use of a compensation seeking sample affects generalizability to the general RTC population. CONCLUSIONS This study identified a concerning subgroup of individuals who have chronic and/or declining physical and mental HRQoL that can be impacted by a diagnosis of PTSD. The development of interventions with a special focus on associated psychological injury is needed to improve the HRQoL of at-risk individuals following RTC injury.
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Affiliation(s)
- Justin Kenardy
- Recover Injury Research Centre, University of Queensland, Brisbane, Queensland, Australia; School of Psychology, University of Queensland, Brisbane, Queensland, Australia.
| | | | - Joan Hendrikz
- Recover Injury Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Jacelle Warren
- Recover Injury Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Shannon L Edmed
- Recover Injury Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Erin Brown
- Recover Injury Research Centre, University of Queensland, Brisbane, Queensland, Australia
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28
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Korley FK, Diaz-Arrastia R, Falk HJ, Peters ME, Leoutsakos JMS, Roy D, Rao V, Sair HI, Ofoche U, Hall AJ, Akbari F, Van Meter TE, Everett AD, Van Eyk JE, Bechtold KT. Prevalence of Incomplete Functional and Symptomatic Recovery among Patients with Head Injury but Brain Injury Debatable. J Neurotrauma 2017; 34:1531-1538. [PMID: 27784200 PMCID: PMC11093106 DOI: 10.1089/neu.2016.4723] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Head injury patients not meeting the American Congress of Rehabilitation Medicine (ACRM)'s criteria for mild traumatic brain injury (mTBI), referred to hereafter as HIBRID (Head Injury BRain Injury Debatable), are often excluded from studies. The prognostic importance of HIBRID is unclear. We investigated the differences in functional and symptomatic recovery at 1 month post-injury among TBI patients classified as: HIBRID, ACRM+ cranial computed tomography (CT)-, and cranial CT+; and trauma and healthy controls. Subjects were enrolled in an ongoing prospective cohort (Head Injury Serum Markers for Assessing Response to Trauma; HeadSMART). Outcomes measured at 1 month post-injury include: incomplete functional recovery (Glasgow Outcome Scale Extended <8); moderate/severe post-concussive symptoms (PCS), defined according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision definition; and moderate/severe depressive symptoms (Patient Health Questionnaire 9 ≥ 10). Between April 2014 and May 2016, 500 TBI and 100 control subjects were enrolled and 376 TBI and 78 control subjects completed outcome assessment. The HIBRID group, constituting 23.9% of study population, had a lower incidence of incomplete functional recovery (36.7% [33 of 90]) than ACRM+, CT- (60.7% [125 of 206]; p < 0.01) and CT+ (78.8% [63 of 80]; p < 0.01) groups. However, the incidence of delayed functional recovery within the HIBRID group was higher than in trauma (9.3% [5 of 54]; p < 0.01) and healthy controls (0% [0 of 24]; p < 0.01). Compared to trauma/healthy controls, the HIBRID group had a higher incidence of moderate/severe depressive symptoms and a similar incidence of moderate/severe PCS. Subjects in the HIBRID group are at high risk for adverse outcomes following head injury and warrant further investigation.
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Affiliation(s)
- Frederick K. Korley
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Hayley J. Falk
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E. Peters
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeannie-Marie S. Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vani Rao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Haris Iqbal Sair
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Uju Ofoche
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anna J. Hall
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Freshta Akbari
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Allen D. Everett
- Department of Pediatrics, Johns Hopkins University School of Medicine, Bloomberg Children's Center, Baltimore, Maryland
| | - Jennifer E. Van Eyk
- Advanced Clinical Biosystems Research, Heart Institute, Department of Medicine, Cedar Sinai Medical Center, Los Angeles, California
| | - Kathleen T. Bechtold
- Department of Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Polimanti R, Chen CY, Ursano RJ, Heeringa SG, Jain S, Kessler RC, Nock MK, Smoller JW, Sun X, Gelernter J, Stein MB. Cross-Phenotype Polygenic Risk Score Analysis of Persistent Post-Concussive Symptoms in U.S. Army Soldiers with Deployment-Acquired Traumatic Brain Injury. J Neurotrauma 2016; 34:781-789. [PMID: 27439997 DOI: 10.1089/neu.2016.4550] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) contributes to the increased rates of suicide and post-traumatic stress disorder in military personnel and veterans, and it is also associated with the risk for neurodegenerative and psychiatric disorders. A cross-phenotype high-resolution polygenic risk score (PRS) analysis of persistent post-concussive symptoms (PCS) was conducted in 845 U.S. Army soldiers who sustained TBI during their deployment. We used a prospective longitudinal survey of three brigade combat teams to assess deployment-acquired TBI and persistent physical, cognitive, and emotional PCS. PRS was derived from summary statistics of large genome-wide association studies of Alzheimer's disease, Parkinson's disease, schizophrenia, bipolar disorder, and major depressive disorder (MDD); and for years of schooling, college completion, childhood intelligence, infant head circumference (IHC), and adult intracranial volume. Although our study had more than 95% of statistical power to detect moderate-to-large effect sizes, no association was observed with neurodegenerative and psychiatric disorders, suggesting that persistent PCS does not share genetic components with these traits to a moderate-to-large degree. We observed a significant finding: subjects with high IHC PRS recovered better from cognitive/emotional persistent PCS than the other individuals (R2 = 1.11%; p = 3.37 × 10-3). Enrichment analysis identified two significant Gene Ontology (GO) terms related to this result: GO:0050839∼Cell adhesion molecule binding (p = 8.9 × 10-6) and GO:0050905∼Neuromuscular process (p = 9.8 × 10-5). In summary, our study indicated that the genetic predisposition to persistent PCS after TBI does not have substantial overlap with neurodegenerative and psychiatric diseases, but mechanisms related to early brain growth may be involved.
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Affiliation(s)
- Renato Polimanti
- 1 Department of Psychiatry, Yale School of Medicine and VA CT Healthcare Center , West Haven, Connecticut
| | - Chia-Yen Chen
- 2 Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard , Cambridge, Massachusetts
| | - Robert J Ursano
- 3 Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences , Bethesda, Maryland
| | - Steven G Heeringa
- 4 Institute for Social Research, University of Michigan , Ann Arbor, Michigan
| | - Sonia Jain
- 5 Department of Family Medicine and Public Health, University of California , La Jolla, California
| | - Ronald C Kessler
- 6 Department of Health Care Policy, Harvard Medical School , Boston, Massachusetts
| | - Matthew K Nock
- 7 Department of Psychology, Harvard University , Cambridge, Massachusetts
| | - Jordan W Smoller
- 2 Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard , Cambridge, Massachusetts
| | - Xiaoying Sun
- 5 Department of Family Medicine and Public Health, University of California , La Jolla, California
| | - Joel Gelernter
- 8 Departments of Psychiatry, Genetics, and Neuroscience, Yale School of Medicine and VA CT Healthcare Center , West Haven, Connecticut
| | - Murray B Stein
- 5 Department of Family Medicine and Public Health, University of California , La Jolla, California.,9 Department of Psychiatry, University of California , La Jolla, California.,10 VA San Diego Healthcare System , San Diego, California
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