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Alanezi ST, Almutairi WM, Cronin M, Gobbo O, O'Mara SM, Sheppard D, O'Connor WT, Gilchrist MD, Kleefeld C, Colgan N. Whole-brain traumatic controlled cortical impact to the left frontal lobe: Magnetic resonance image-based texture analysis. J Neuropathol Exp Neurol 2024; 83:94-106. [PMID: 38164986 DOI: 10.1093/jnen/nlad110] [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: 01/03/2024] Open
Abstract
This research assesses the capability of texture analysis (TA) derived from high-resolution (HR) T2-weighted magnetic resonance imaging to identify primary sequelae following 1-5 hours of controlled cortical impact mild or severe traumatic brain injury (TBI) to the left frontal cortex (focal impact) and secondary (diffuse) sequelae in the right frontal cortex, bilateral corpus callosum, and hippocampus in rats. The TA technique comprised first-order (histogram-based) and second-order statistics (including gray-level co-occurrence matrix, gray-level run length matrix, and neighborhood gray-level difference matrix). Edema in the left frontal impact region developed within 1 hour and continued throughout the 5-hour assessments. The TA features from HR images confirmed the focal injury. There was no significant difference among radiomics features between the left and right corpus callosum or hippocampus from 1 to 5 hours following a mild or severe impact. The adjacent corpus callosum region and the distal hippocampus region (s), showed no diffuse injury 1-5 hours after mild or severe TBI. These results suggest that combining HR images with TA may enhance detection of early primary and secondary sequelae following TBI.
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Affiliation(s)
- Saleh T Alanezi
- Physics Department, Faculty of Science, Northern Border University, ArAr, Saudi Arabia
- School of Natural Sciences, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Waleed M Almutairi
- Medical Imaging Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
- Department of Physics, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Michelle Cronin
- Conway Institute, University College Dublin, Belfield, Dublin, Ireland
| | - Oliviero Gobbo
- School of Pharmacy and Pharmaceutical Sciences & Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - Shane M O'Mara
- Institute of Neuroscience, Trinity College, Dublin, Ireland
| | - Declan Sheppard
- Department of Radiology, University Hospital Galway, Galway, Ireland
| | - William T O'Connor
- University of Limerick School of Medicine, Castletroy, Limerick, Ireland
| | - Michael D Gilchrist
- School of Mechanical & Materials Engineering, University College Dublin, Belfield, Dublin, Ireland
| | - Christoph Kleefeld
- School of Natural Sciences, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Niall Colgan
- School of Natural Sciences, College of Science and Engineering, University of Galway, Galway, Ireland
- Department of Engineering, Technological University of the Shannon, Athlone, Ireland
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Ling Y, Xu C, Wen X, Li J, Gao J, Luo B. Cortical responses to auditory stimulation predict the prognosis of patients with disorders of consciousness. Clin Neurophysiol 2023; 153:11-20. [PMID: 37385110 DOI: 10.1016/j.clinph.2023.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 05/15/2023] [Accepted: 06/03/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE This study aimed to assess the prognosis of patients with disorders of consciousness (DoC) using auditory stimulation with electroencephalogram (EEG) recordings. METHODS We enrolled 72 patients with DoC in the study, which involved subjecting patients to auditory stimulation while EEG responses were recorded. Coma Recovery Scale-Revised (CRS-R) scores and Glasgow Outcome Scale (GOS) were determined for each patient and followed up for three months. A frequency spectrum analysis was performed on the EEG recordings. Finally, the power spectral density (PSD) index was used to predict the prognosis of patients with DoC based on a support vector machine (SVM) model. RESULTS Power spectral analyses revealed that the cortical response to auditory stimulation showed a decreasing trend with decreasing consciousness levels. Auditory stimulation-induced changes in absolute PSD at the delta and theta bands were positively correlated with the CRS-R and GOS scores. Furthermore, these cortical responses to auditory stimulation had a good ability to discriminate between good and poor prognoses of patients with DoC. CONCLUSIONS Auditory stimulation-induced changes in the PSD were highly predictive of DoC outcomes. SIGNIFICANCE Our findings showed that cortical responses to auditory stimulation may be an important electrophysiological indicator of prognosis in patients with DoC.
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Affiliation(s)
- Yi Ling
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Chuan Xu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Xinrui Wen
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Jingqi Li
- Department of Rehabilitation, Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou 311215, China
| | - Jian Gao
- Department of Rehabilitation, Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou 311215, China
| | - Benyan Luo
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China.
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Larson KR, Demers LA, Holding EZ, Williams CN, Hall TA. Variability Across Caregiver and Performance-Based Measures of Executive Functioning in an Acute Pediatric Neurocritical Care Population. Neurotrauma Rep 2023; 4:97-106. [PMID: 36895819 PMCID: PMC9989517 DOI: 10.1089/neur.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Youth admitted to the pediatric intensive care unit (PICU) for traumatic brain injury (TBI) commonly struggle with long-term residual effects in the domains of physical, cognitive, emotional, and psychosocial/family functioning. In the cognitive domain, executive functioning (EF) deficits are often observed. The Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2) is a parent/caregiver-completed measure that is regularly utilized to assess caregivers' perspectives of daily EF abilities. Using parent/caregiver-completed measures like the BRIEF-2 in isolation as outcome measures for capturing symptom presence and severity might be problematic given that caregiver ratings are vulnerable to influence from external factors. As such, this study aimed to investigate the association between the BRIEF-2 and performance-based measures of EF in youth during the acute recovery period post-PICU admission for TBI. A secondary aim was to explore associations among potential confounding factors, including family-level distress, injury severity, and the impact of pre-existing neurodevelopmental conditions. Participants included 65 youths, 8-19 years of age, admitted to the PICU for TBI, who survived hospital discharge and were referred for follow-up care. Non-significant correlations were found between BRIEF-2 outcomes and performance-based measures of EF. Measures of injury severity were strongly correlated with scores from performance-based EF measures, but not BRIEF-2. Parent/caregiver-reported measures of their own health-related quality of life were related to caregiver responses on the BRIEF-2. Results demonstrate the differences captured by performance-based versus caregiver-report measures of EF, and also highlight the importance of considering other morbidities related to PICU admission.
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Affiliation(s)
- Kera R Larson
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Lauren A Demers
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Emily Z Holding
- Developmental Medical Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cydni N Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
| | - Trevor A Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, USA
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de Oliveira DV, Vieira RDCA, Pipek LZ, de Sousa RMC, de Souza CPE, Santana-Santos E, Paiva WS. Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study. J Clin Med 2022; 11:6466. [PMID: 36362693 PMCID: PMC9655294 DOI: 10.3390/jcm11216466] [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: 09/13/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 04/03/2024] Open
Abstract
OBJECTIVE The presence of focal lesion (FL) after a severe traumatic brain injury is an important factor in determining morbidity and mortality. Despite this relevance, few studies show the pattern of recovery of patients with severe traumatic brain injury (TBI) with FL within one year. The objective of this study was to identify the pattern of recovery, independence to perform activities of daily living (ADL), and factors associated with mortality and unfavorable outcome at six and twelve months after severe TBI with FL. METHODOLOGY This is a prospective cohort, with data collected at admission, hospital discharge, three, six, and twelve months after TBI. RESULTS The study included 131 adults with a mean age of 34.08 years. At twelve months, 39% of the participants died, 80% were functionally independent by the Glasgow Outcome Scale Extended, 79% by the Disability Rating Scale, 79% were independent for performing ADLs by the Katz Index, and 53.9% by the Lawton Scale. Report of alcohol intake, sedation time, length of stay in intensive care (ICU LOS), Glasgow Coma Scale, trauma severity indices, hyperglycemia, blood glucose, and infection were associated with death. At six and twelve months, tachypnea, age, ICU LOS, trauma severity indices, respiratory rate, multiple radiographic injuries, and cardiac rate were associated with dependence. CONCLUSIONS Patients have satisfactory functional recovery up to twelve months after trauma, with an accentuated improvement in the first three months. Clinical and sociodemographic variables were associated with post-trauma outcomes. Almost all victims of severe TBI with focal lesions evolved to death or independence.
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Affiliation(s)
- Daniel Vieira de Oliveira
- Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil
| | | | - Leonardo Zumerkorn Pipek
- Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil
| | | | | | | | - Wellingson Silva Paiva
- Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil
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Satyadev N, Warman PI, Seas A, Kolls BJ, Haglund MM, Fuller AT, Dunn TW. Machine Learning for Predicting Discharge Disposition After Traumatic Brain Injury. Neurosurgery 2022; 90:768-774. [PMID: 35319523 DOI: 10.1227/neu.0000000000001911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Current traumatic brain injury (TBI) prognostic calculators are commonly used to predict the mortality and Glasgow Outcome Scale, but these outcomes are most relevant for severe TBI. Because mild and moderate TBI rarely reaches severe outcomes, there is a need for novel prognostic endpoints. OBJECTIVE To generate machine learning (ML) models with a strong predictive capacity for trichotomized discharge disposition, an outcome not previously used in TBI prognostic models. The outcome can serve as a proxy for patients' functional status, even in mild and moderate patients with TBI. METHODS Using a large data set (n = 5292) of patients with TBI from a quaternary care center and 84 predictors, including vitals, demographics, mechanism of injury, initial Glasgow Coma Scale, and comorbidities, we trained 6 different ML algorithms using a nested-stratified-cross-validation protocol. After optimizing hyperparameters and performing model selection, isotonic regression was applied to calibrate models. RESULTS When maximizing the microaveraged area under the receiver operating characteristic curve during hyperparameter optimization, a random forest model exhibited top performance. A random forest model was also selected when maximizing the microaveraged area under the precision-recall curve. For both models, the weighted average area under the receiver operating characteristic curves was 0.84 (95% CI 0.81-0.87) and the weighted average area under the precision-recall curves was 0.85 (95% CI 0.82-0.88). CONCLUSION Our group presents high-performing ML models to predict trichotomized discharge disposition. These models can assist in optimization of patient triage and treatment, especially in cases of mild and moderate TBI.
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Affiliation(s)
- Nihal Satyadev
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Pranav I Warman
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Andreas Seas
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Brad J Kolls
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Timothy W Dunn
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
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Sleep and Executive Functioning in Pediatric Traumatic Brain Injury Survivors after Critical Care. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050748. [PMID: 35626925 PMCID: PMC9139390 DOI: 10.3390/children9050748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022]
Abstract
Over 50,000 children are hospitalized annually for traumatic brain injury (TBI) and face long-term cognitive morbidity. Over 50% develop sleep/wake disturbances (SWDs) that can affect brain development and healing. We hypothesized SWDs would portend worse executive function outcomes in children aged 3−18 years with TBI 1−3 months after hospital discharge. SWDs were defined using the Sleep Disturbances Scale for Children (t-scores ≥ 60). Outcomes included the Global Executive Composite (GEC, t-score) from the Behavior Rating Inventory of Executive Function, Second and Preschool Editions, and multiple objective executive function assessments combined through Principal Components Analysis into a Neurocognitive Index (NCI, z-score). Multiple linear regression evaluated associations between SWDs and executive function outcomes, controlling for covariates. Among 131 children, 68% had clinically significant SWDs, which were associated with significantly worse median scores on the GEC (56 vs. 45) and NCI (−0.02 vs. 0.42; both p < 0.05). When controlling for baseline characteristics and injury severity in multivariable analyses, SWDs were associated with worse GEC (β-coefficient = 7.8; 95% Confidence Interval = 2.5, 13.1), and worse NCI (β-coefficient = −0.4; 95% Confidence Interval = −0.8, −0.04). SWDs in children with TBI are associated with worse executive function outcomes after hospital discharge, and may serve as modifiable targets to improve outcomes.
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Automated detection of cerebral microbleeds via segmentation in susceptibility-weighted images of patients with traumatic brain injury. Neuroimage Clin 2022; 35:103027. [PMID: 35597029 PMCID: PMC9127224 DOI: 10.1016/j.nicl.2022.103027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 12/24/2022]
Abstract
Cerebral microbleeds (CMBs) are a recognised biomarker of traumatic axonal injury (TAI). Their number and location provide valuable information in the long-term prognosis of patients who sustained a traumatic brain injury (TBI). Accurate detection of CMBs is necessary for both research and clinical applications. CMBs appear as small hypointense lesions on susceptibility-weighted magnetic resonance imaging (SWI). Their size and shape vary markedly in cases of TBI. Manual annotation of CMBs is a difficult, error-prone, and time-consuming task. Several studies addressed the detection of CMBs in other neuropathologies with convolutional neural networks (CNNs). In this study, we developed and contrasted a classification (Patch-CNN) and two segmentation (Segmentation-CNN, U-Net) approaches for the detection of CMBs in TBI cases. The models were trained using 45 datasets, and the best models were chosen according to 16 validation sets. Finally, the models were evaluated on 10 TBI and healthy control cases, respectively. Our three models outperform the current status quo in the detection of traumatic CMBs, achieving higher sensitivity at low false positive (FP) counts. Furthermore, using a segmentation approach allows for better precision. The best model, the U-Net, achieves a detection rate of 90% at FP counts of 17.1 in TBI patients and 3.4 in healthy controls.
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Ozevren H, Cetin A, Hattapoglu S, Baloglu M. Burr hole and craniotomy in the treatment of subdural hematoma: A comparative study. Niger J Clin Pract 2022; 25:1056-1060. [DOI: 10.4103/njcp.njcp_1511_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Li Z, Xiao J, Xu X, Li W, Zhong R, Qi L, Chen J, Cui G, Wang S, Zheng Y, Qiu Y, Li S, Zhou X, Lu Y, Lyu J, Zhou B, Zhou J, Jing N, Wei B, Hu J, Wang H. M-CSF, IL-6, and TGF-β promote generation of a new subset of tissue repair macrophage for traumatic brain injury recovery. SCIENCE ADVANCES 2021; 7:7/11/eabb6260. [PMID: 33712456 PMCID: PMC7954455 DOI: 10.1126/sciadv.abb6260] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/18/2020] [Indexed: 05/13/2023]
Abstract
Traumatic brain injury (TBI) leads to high mortality rate. We aimed to identify the key cytokines favoring TBI repair and found that patients with TBI with a better outcome robustly increased concentrations of macrophage colony-stimulating factor, interleukin-6, and transforming growth factor-β (termed M6T) in cerebrospinal fluid or plasma. Using TBI mice, we identified that M2-like macrophage, microglia, and endothelial cell were major sources to produce M6T. Together with the in vivo tracking of mCherry+ macrophages in zebrafish models, we confirmed that M6T treatment accelerated blood-borne macrophage infiltration and polarization toward a subset of tissue repair macrophages that expressed similar genes as microglia for neuroprotection, angiogenesis and cell migration. M6T therapy in TBI mice and zebrafish improved neurological function while blocking M6T-exacerbated brain injury. Considering low concentrations of M6T in some patients with poor prognostic, M6T treatment might repair TBI via generating a previously unidentified subset of tissue repair macrophages.
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Affiliation(s)
- Zhiqi Li
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
- Neurosurgical Institute, Fudan University, Shanghai 200040 China
| | - Jun Xiao
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Xiaoyan Xu
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
- Experimental Immunology Branch, National Cancer Institute, U.S. National Institutes of Health, Bethesda, MD, USA
| | - Weiyun Li
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
- School of Life Sciences, Xiamen University, Xiamen, Fujian, China
| | - Ruiyue Zhong
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Linlin Qi
- School of Life Sciences, Shanghai University, Shanghai 200444, China
- Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - Jiehui Chen
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Guizhong Cui
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Shuang Wang
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Yuxiao Zheng
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Ying Qiu
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Sheng Li
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Xin Zhou
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
- Cancer Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yao Lu
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Jiaying Lyu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Bin Zhou
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Jiawei Zhou
- Institute of Neuroscience, Chinese Academy of Sciences, Shanghai 200031, China
| | - Naihe Jing
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai 200031, China
| | - Bin Wei
- School of Life Sciences, Shanghai University, Shanghai 200444, China.
- Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
- Cancer Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Jin Hu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai, China
| | - Hongyan Wang
- Neurosurgical Institute, Fudan University, Shanghai 200040 China.
- School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China
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Keenan HT, Clark AE, Holubkov R, Cox CS, Patel RP, Moore KR, Ewing-Cobbs L. Latent Class Analysis to Classify Injury Severity in Pediatric Traumatic Brain Injury. J Neurotrauma 2020; 37:1512-1520. [PMID: 32103698 PMCID: PMC8024352 DOI: 10.1089/neu.2019.6874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Heterogeneity of injury severity among children with traumatic brain injury (TBI) classified by the Glasgow Coma Scale (GCS) makes comparisons across research cohorts, enrollment in clinical trials, and clinical predictions of outcomes difficult. The present study uses latent class analysis (LCA) to distinguish severity subgroups from a prospective cohort of 433 children 2.5-15 years of age with TBI who were recruited from two level 1 pediatric trauma centers. Indicator variables available within 48 h post-injury including emergency department (ED) GCS, hospital motor GCS, Abbreviated Injury Score (AIS), Rotterdam Score, hypotension in the ED, and pre-hospital loss of consciousness, intubation, seizures, and sedation were evaluated to define subgroups. To understand whether latent class subgroups were predictive of clinically meaningful outcomes, the Pediatric Injury Functional Outcome Scale (PIFOS) at 6 and 12 months, and the Behavior Rating Inventory of Executive Function at 12 months, were compared across subgroups. Then, outcomes were examined by GCS (primary) and AIS (secondary) classification alone to assess whether LCA provided improved outcome prediction. LCA identified four distinct increasing severity subgroups (1-4). Unlike GCS classification, mean outcome differences on PIFOS at 6 months showed decreasing function across classes. PIFOS differences relative to the lowest latent class (LC1) were: LC2 2.27 (0.83, 3.72), LC3 3.99 (1.88, 6.10), and LC4 11.2 (7.04, 15.4). Differences in 12 month outcomes were seen between the most and least severely injured groups. Differences in outcomes in relation to AIS were restricted to the most and less severely injured at both time points. This study distinguished four latent classes that are clinically meaningful, distinguished a more homogenous severe injury group, and separated children by 6-month functional outcomes better than GCS alone. Systematic reporting of these variables would allow comparisons across research cohorts, potentially improve clinical predictions, and increase sensitivity to treatment effects in clinical trials.
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Affiliation(s)
- Heather T. Keenan
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Amy E. Clark
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Charles S. Cox
- Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Rajan P. Patel
- Division of Neuroradiology, Department of Diagnostic and Interventional Radiology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Kevin R. Moore
- Department of Medical Imaging, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Clinical Outcomes of MLC601 (NeuroAiD TM) in Traumatic Brain Injury: A Pilot Study. Brain Sci 2020; 10:brainsci10020060. [PMID: 31973204 PMCID: PMC7071378 DOI: 10.3390/brainsci10020060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 12/31/2019] [Accepted: 01/16/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND MLC601 is a natural product formulation from Chinese medicine that is extensively studied in ischemic stroke. Traumatic brain injury (TBI) shares pathophysiological mechanisms with ischemic stroke, yet there are few studies on the use of MLC601 in treating TBI. This Indonesian pilot study aimed to investigate clinical outcomes of MLC601 for TBI. METHODS This randomized controlled trial included subjects with nonsurgical moderate TBI allocated into two groups: with and without MLC601 over three months in addition to standard TBI treatment. Clinical outcomes were measured by the Glasgow Outcome Scale (GOS) and Barthel Index (BI) observed upon discharge and at months (M) 3 and 6. RESULTS Thirty-two subjects were included. The MLC601 group (n = 16) had higher GOS than the control group (n = 16) at all observation timepoints, though these differences were not statistically significant (p = 0.151). The BI values indicated a significant improvement for the MLC601 group compared to the control group at M3 (47.5 vs. 35.0; p = 0.014) and at M6 (67.5 vs. 57.5; p = 0.055). No adverse effects were associated with MLC601 treatment. CONCLUSION In this cohort of nonsurgical moderate TBI subjects, MLC601 showed potential for a positive effect on clinical outcome with no adverse effects.
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Long-Term Follow-Up of Disability, Cognitive, and Emotional Impairments after Severe Traumatic Brain Injury. Behav Neurol 2019; 2019:9216931. [PMID: 31534558 PMCID: PMC6732613 DOI: 10.1155/2019/9216931] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/16/2019] [Indexed: 11/29/2022] Open
Abstract
Aim To assess the clinical course of disability, cognitive, and emotional impairments in patients with severe TBI (s-TBI) from 3 months to up to 7 years post trauma. Methods A prospective cohort study of s-TBI in northern Sweden was conducted. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Glasgow Outcome Scale Extended (GOSE), the Hospital Anxiety and Depression Scale (HADS), and the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) at 3 months, 1 year, and 7 years after the injury. Results The scores on both GOSE and BNIS improved significantly from 3 months (GOSE mean: 4.4 ± 2.3, BNIS mean: 31.5 ± 7.0) to 1 year (GOSE mean: 5.5 ± 2.7, p = 0.003, BNIS mean: 33.2 ± 6.3, p = 0.04), but no significant improvement was found from 1 year to 7 years (GOSE mean: 4.7 ± 2.8, p = 0.13, BNIS mean: 33.5 ± 3.9, p = 0.424) after the injury. The BNIS subscale “speech/language” at 1 year was significantly associated with favourable outcomes on the GOSE at 7 years (OR = 2.115, CI: 1.004-4.456, p = 0.049). Conclusions These findings indicate that disability and cognition seem to improve over time after s-TBI and appear to be relatively stable from 1 year to 7 years. Since cognitive function on some of the BNIS subscales was associated with outcome on the GOSE, these results indicate that both screening and follow-up of cognitive function could be of importance for the rehabilitation of persons with s-TBI.
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Samal J, Rebelo AL, Pandit A. A window into the brain: Tools to assess pre-clinical efficacy of biomaterials-based therapies on central nervous system disorders. Adv Drug Deliv Rev 2019; 148:68-145. [PMID: 30710594 DOI: 10.1016/j.addr.2019.01.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/04/2019] [Accepted: 01/28/2019] [Indexed: 12/13/2022]
Abstract
Therapeutic conveyance into the brain is a cardinal requirement for treatment of diverse central nervous system (CNS) disorders and associated pathophysiology. Effectual shielding of the brain by the blood-brain barrier (BBB) sieves out major proportion of therapeutics with the exception of small lipophilic molecules. Various nano-delivery systems (NDS) provide an effective solution around this obstacle owing to their small size and targeting properties. To date, these systems have been used for several pre-clinical disease models including glioma, neurodegenerative diseases and psychotic disorders. An efficacy screen for these systems involves a test battery designed to probe into the multiple facets of therapeutic delivery. Despite their wide application in redressing various disease targets, the efficacy evaluation strategies for all can be broadly grouped into four modalities, namely: histological, bio-imaging, molecular and behavioural. This review presents a comprehensive insight into all of these modalities along with their strengths and weaknesses as well as perspectives on an ideal design for a panel of tests to screen brain nano-delivery systems.
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Affiliation(s)
- Juhi Samal
- CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Ana Lucia Rebelo
- CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Abhay Pandit
- CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
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Liu Z, Chen Q, Chen Z, Wang J, Tian D, Wang L, Liu B, Zhang S. Clinical analysis on risk factors and prognosis of early post-traumatic epilepsy. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:375-380. [PMID: 31314838 DOI: 10.1590/0004-282x20190071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/10/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the risk factors and prognosis related to early post-traumatic epilepsy (EPTE). METHODS One hundred and eighty-six patients with traumatic brain injury were enrolled. Their full clinical data were collected. Single factor analysis and logistic regression analysis of risk factors related to EPTE were performed. The prognosis of patients was determined. RESULTS Single factor analysis showed that there were significant differences of age (p = 0.011), epilepsy history (p < 0.001), injury site (p = 0.004), injury type (p < 0.001) and injury degree (p < 0.001) between the EPTE group (40 patients) and non-EPTE group (146 patients). Logistic regression analysis showed that the injury site, injury type and injury degree were the main risk factors for EPTE. The odds ratio values of injury site, injury type and injury degree were 1.977 (1.473-2.679), 2.096 (1.543-2.842) and 2.376 (1.864-3.609), respectively. The logistic regression equation was P = Exp (-1.473 + 0.698 × injury site + 0.717 × injury type + 0.935 × injury degree). The sensitivity and specificity of injury site, injury type and injury degree for predicting EPTE were 79.2% and 80.5%, 78.9% and 85.7% and 84.2% and 81.0%, respectively. The analysis of prognosis showed that the Glasgow Outcome Scale/Activity of Daily Living Scale scores in the EPTE group were significantly lower than those in non-EPTE group (p < 0.05). CONCLUSIONS Injury site, injury type and injury degree are the main risk factors for EPTE. The prognosis of patients with traumatic brain injury can be affected by EPTE.
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Affiliation(s)
- Zaiming Liu
- Renmin Hospital of Wuhan University, Department of Neurosurgery, Hubei, China
| | - Qianxue Chen
- Renmin Hospital of Wuhan University, Department of Neurosurgery, Hubei, China
| | - Zhibiao Chen
- Renmin Hospital of Wuhan University, Department of Neurosurgery, Hubei, China
| | - Junmin Wang
- Renmin Hospital of Wuhan University, Department of Neurosurgery, Hubei, China
| | - Daofeng Tian
- Renmin Hospital of Wuhan University, Department of Neurosurgery, Hubei, China
| | - Long Wang
- Renmin Hospital of Wuhan University, Department of Neurosurgery, Hubei, China
| | - Baohui Liu
- Renmin Hospital of Wuhan University, Department of Neurosurgery, Hubei, China
| | - Shenqi Zhang
- Renmin Hospital of Wuhan University, Department of Neurosurgery, Hubei, China
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Assessment of the ECG T-Wave in Patients With Subarachnoid Hemorrhage. J Neurosurg Anesthesiol 2019; 33:58-64. [PMID: 31290770 DOI: 10.1097/ana.0000000000000624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prolongation of the interval from the peak to the end of the T wave (Tp-Te) on a 12-lead electrocardiogram (ECG) is associated with ventricular arrhythmias. The aim of this study was to clarify associations between Tp-Te, Tp-Te/QT, and Tp-Te/rate-corrected QT (QTc) with clinical severity of subarachnoid hemorrhage (SAH) and clinical outcomes. METHODS This retrospective study included 222 patients with acute SAH (group S) and 306 patients with unruptured cerebral aneurysms (group U). Tp-Te, Tp-Te/QT, and Tp-Te/QTc were manually measured in standard 12-lead ECG recordings on admission and comparisons made between patients in groups S and U. The relationships of these ECG parameters with Hunt and Hess grade and Glasgow outcome scale were analyzed using multiple logistic regression analysis after adjustment for confounding factors. RESULTS Tp-Te, Tp-Te/QT, and Tp-Te/QTc were significantly greater in group S than in group U (group S: 109±30, 0.26±0.07, and 0.24±0.06 ms; group U: 84±12, 0.22±0.03, and 0.21±0.03 ms, respectively; P < 0.0001). In addition, in the multiple logistic regression analyses these variables were positively correlated with the Hunt and Hess grade (Tp-Te odds ratio [95% confidence interval], 2.414 [1.375-4.238], P=0.002; Tp-Te/QT, 1.886 [1.085-3.277], P = 0.024; Tp-Te/QTc, 1.873 [1.07-3.278], P=0.028, and negatively correlated with Glasgow outcome scale Tp-Te odds ratio [95% confidence interval], 4.168 [2.409-7.209], P<0.001; Tp-Te/QT, 2.434 [1.413-4.192], P=0.001; Tp-Te/QTc 2.953 [1.703-5.123], P<0.001). CONCLUSIONS Tp-Te, Tp-Te/QT, and Tp-Te/QTc are associated with disease severity and clinical outcome in patients with SAH.
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Sandhu S, Soule E, Fiester P, Natter P, Tavanaiepour D, Rahmathulla G, Rao D. Brainstem Diffuse Axonal Injury and Consciousness. J Clin Imaging Sci 2019; 9:32. [PMID: 31508267 PMCID: PMC6712553 DOI: 10.25259/jcis-11-2019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/04/2019] [Indexed: 12/20/2022] Open
Abstract
Background Severe traumatic brain injuries (TBI), commonly due to motor vehicle accidents may cause death and long-term disability especially when the acceleration-deceleration force on the brain is massive. This may cause shearing of the axonal connections within the cerebral cortex and brainstem in a process referred to as diffuse axonal injury (DAI). Extensive DAI has been postulated to be a poor prognostic indicator for neurological recovery. In our institution, several patients with Grade 3 DAI were observed to recover and achieve neurological outcomes greater than expected given the presence of brainstem injury. Methods MRI studies from 100 patients admitted to a large tertiary trauma center for TBI were retrospectively analyzed by two fellowship-trained neuroradiologists. The size of DAI lesions, location of injury within the brainstem, and the number of discrete DAI lesions were measured and recorded. Glasgow Coma Scale (GCS) on arrival and at discharge was noted, as well as the presence of other neurological injuries. Results Of 20 patients initially noted to have DAI with lesions of the brainstem, eight of them were discharged with Glasgow Coma Scale (GCS) of 14-15. The 12 patients discharged with reduced consciousness (average GC 7.1) demonstrated a greater number of larger lesions, with a predilection for the dorsal pons. Conclusion These results suggest that large, numerous pontine lesions may indicate worse neurological outcomes in patients with these findings.
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Affiliation(s)
- Sukhwinder Sandhu
- Department of Neuroradiology, Mayo Clinic, University of Florida Health, Jacksonville, Florida, USA
| | - Erik Soule
- Departments of Interventional Radiology, University of Florida Health, Jacksonville, Florida, USA
| | - Peter Fiester
- Neuroradiology, University of Florida Health, Jacksonville, Florida, USA
| | - Patrick Natter
- Neuroradiology, University of Florida Health, Jacksonville, Florida, USA
| | | | | | - Dinesh Rao
- Neuroradiology, University of Florida Health, Jacksonville, Florida, USA
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Gernsback JE, Kolcun JPG, Richardson AM, Jagid JR. Patientem Fortuna Adiuvat: The Delayed Treatment of Surgical Acute Subdural Hematomas—A Case Series. World Neurosurg 2018; 120:e414-e420. [DOI: 10.1016/j.wneu.2018.08.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022]
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Santos JGRPD, Zaninotto ALC, Zângaro RA, Carneiro AMC, Neville IS, de Andrade AF, Teixeira MJ, Paiva WS. Effects of transcranial LED therapy on the cognitive rehabilitation for diffuse axonal injury due to severe acute traumatic brain injury: study protocol for a randomized controlled trial. Trials 2018; 19:249. [PMID: 29690927 PMCID: PMC5916588 DOI: 10.1186/s13063-018-2632-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 04/09/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Photobiomodulation describes the use of red or near-infrared light to stimulate or regenerate tissue. It was discovered that near-infrared wavelengths (800-900 nm) and red (600 nm) light-emitting diodes (LED) are able to penetrate through the scalp and skull and have the potential to improve the subnormal cellular activity of compromised brain tissue. Different experimental and clinical studies were performed to test LED therapy for traumatic brain injury (TBI) with promising results. One of the proposals of this present study is to develop different approaches to maximize the positive effects of this therapy and improve the quality of life of TBI patients. METHODS/DESIGN This is a double-blinded, randomized, controlled trial of patients with diffuse axonal injury (DAI) due to a severe TBI in an acute stage (less than 8 h). Thirty two patients will be randomized to active coil helmet and inactive coil (sham) groups in a 1:1 ratio. The protocol includes 18 sessions of transcranial LED stimulation (627 nm, 70 mW/cm2, 10 J/cm2) at four points of the frontal and parietal regions for 30 s each, totaling 120 s, three times per week for 6 weeks, lasting 30 min. Patients will be evaluated with the Glasgow Outcome Scale Extended (GOSE) before stimulation and 1, 3, and 6 months after the first stimulation. The study hypotheses are as follows: (1) transcranial LED therapy (TCLT) will improve the cognitive function of DAI patients and (2) TCLT will promote beneficial hemodynamic changes in cerebral circulation. DISCUSSION This study evaluates early and delayed effects of TCLT on the cognitive rehabilitation for DAI following severe acute TBI. There is a paucity of studies regarding the use of this therapy for cognitive improvement in TBI. There are some experimental studies and case series presenting interesting results for TBI cognitive improvement but no clinical trials. TRIAL REGISTRATION ClinicalTrials.gov, NCT03281759 . Registered on 13 September 2017.
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Affiliation(s)
- João Gustavo Rocha Peixoto dos Santos
- Department of Neurological Surgery, University of São Paulo School of Medicine, 255 Dr. Enéas de Carvalho Aguiar Av., São Paulo, SP 05403-010 Brazil
| | | | - Renato Amaro Zângaro
- Center for Innovation, Technology and Education (CITÉ) SJ dos Campos, São Paulo, 12245-650 Brazil
| | | | - Iuri Santana Neville
- Department of Neurological Surgery, University of São Paulo School of Medicine, 255 Dr. Enéas de Carvalho Aguiar Av., São Paulo, SP 05403-010 Brazil
| | - Almir Ferreira de Andrade
- Department of Neurological Surgery, University of São Paulo School of Medicine, 255 Dr. Enéas de Carvalho Aguiar Av., São Paulo, SP 05403-010 Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurological Surgery, University of São Paulo School of Medicine, 255 Dr. Enéas de Carvalho Aguiar Av., São Paulo, SP 05403-010 Brazil
| | - Wellingson Silva Paiva
- Department of Neurological Surgery, University of São Paulo School of Medicine, 255 Dr. Enéas de Carvalho Aguiar Av., São Paulo, SP 05403-010 Brazil
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Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury. J Trauma Acute Care Surg 2017; 83:398-405. [PMID: 28538641 DOI: 10.1097/ta.0000000000001581] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma-related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBIs). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improves neurologic function after TBI; however, data in humans are lacking. METHODS We retrospectively identified all patients with multiple injuries age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single Level I trauma center from January 2002 to December 2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBCs) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow-up. RESULTS Of 76 patients meeting inclusion criteria, 53% (n = 40) received prehospital pRBCs and 47% (n = 36) received thawed plasma. Age, gender, injury severity or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p > 0.05). Patients who received thawed plasma had an improved neurologic outcome compared to those receiving pRBCs (median GOSE 7 [7-8] vs. 5.5 [3-7], p < 0.001). Additionally, patients who received thawed plasma had improved functionality compared to pRBCs (median DRS 2 [1-3.5] vs. 9 [3-13], p < 0.001). Calculated GOSE and DRS scores during follow-up, median 6 [5-7] months, demonstrated increased function in those resuscitated with thawed plasma compared to pRBCs by both median GOSE (8 [7-8] vs. 6 [6-7], p < 0.001) and DRS (0 [0-1] vs. 4 [2-8], p < 0.001). CONCLUSION In critically injured trauma patients with TBI, early resuscitation with thawed plasma is associated with improved neurologic and functional outcomes at discharge and during follow-up compared to pRBCs alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. LEVEL OF EVIDENCE Therapeutic, level V.
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Zhu W, Chi N, Zou P, Chen H, Tang G, Zhao W. Effect of docosahexaenoic acid on traumatic brain injury in rats. Exp Ther Med 2017; 14:4411-4416. [PMID: 29075341 DOI: 10.3892/etm.2017.5054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 06/20/2017] [Indexed: 12/23/2022] Open
Abstract
The present study aimed to investigate the protective effects of docosahexaenoic acid (DHA) on traumatic brain injury (TBI) in rats. A model of TBI was induced by lateral fluid percussion injury in adult rats and rats were randomly divided into the TBI-model group, TBI-low DHA group and TBI-high DHA group, while other healthy rats were assigned to the sham-operated group. Motor recovery was tested with beam-walking trials at 2, 7 and 15 days post-TBI. Cognitive recovery was tested with Morris water maze trials at 15 days post-TBI. The expression levels of caspase-3, B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax) were measured by western blotting. DHA protected against motor deficits induced by TBI in beam walking tests. All TBI-model groups had longer escape latency and swimming distances than the sham groups. Compared with the TBI-low DHA group, the TBI-high DHA group demonstrated shorter escape latency and swimming distances. DHA inhibited the expression of caspase-3 and the inhibition effect was more obvious at a high dosage. Furthermore, DHA dose-dependently rescued neurons by upregulating the Bcl-2:Bax ratio. DHA supplementation was a viable strategy to mitigate injury from TBI.
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Affiliation(s)
- Wei Zhu
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Nan Chi
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Peng Zou
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Hongguang Chen
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Guotai Tang
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Wei Zhao
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
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Stenberg M, Koskinen LOD, Jonasson P, Levi R, Stålnacke BM. Computed tomography and clinical outcome in patients with severe traumatic brain injury. Brain Inj 2017; 31:351-358. [PMID: 28296529 DOI: 10.1080/02699052.2016.1261303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To study: (i) acute computed tomography (CT) characteristics and clinical outcome; (ii) clinical course and (iii) Corticosteroid Randomisation after Significant Head Injury acute calculator protocol (CRASH) model and clinical outcome in patients with severe traumatic brain injury (sTBI). METHODS Initial CT (CTi) and CT 24 hours post-trauma (CT24) were evaluated according to Marshall and Rotterdam classifications. Rancho Los Amigos Cognitive Scale-Revised (RLAS-R) and Glasgow Outcome Scale Extended (GOSE) were assessed at three months and one year post-trauma. The prognostic value of the CRASH model was evaluated. RESULTS Thirty-seven patients were included. Marshall CTi and CT24 were significantly correlated with RLAS-R at three months. Rotterdam CT24 was significantly correlated with GOSE at three months. RLAS-R and the GOSE improved significantly from three months to one year. CRASH predicted unfavourable outcome at six months for 81% of patients with bad outcome and for 85% of patients with favourable outcome according to GOSE at one year. CONCLUSION Neither CT nor CRASH yielded clinically useful predictions of outcome at one year post-injury. The study showed encouragingly many instances of significant recovery in this population of sTBI. The combination of lack of reliable prognostic indicators and favourable outcomes supports the case for intensive acute management and rehabilitation as the default protocol in the cases of sTBI.
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Affiliation(s)
- Maud Stenberg
- a Department of Community Medicine and Rehabilitation , Rehabilitation Medicine
| | | | - Per Jonasson
- c Department of Radiation Sciences, Diagnostic Radiology , Umeå University , Umeå , Sweden
| | - Richard Levi
- d Department of Rehabilitation Medicine , Linköping University , Linköping , Sweden
| | - Britt-Marie Stålnacke
- a Department of Community Medicine and Rehabilitation , Rehabilitation Medicine.,e Department of Clinical Sciences , Danderyd University Hospital, Division of Rehabilitation Medicine, Karolinska Institutet , Stockholm , Sweden.,f Department of Rehabilitation Medicine , Danderyd Hospital , Stockholm , Sweden
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Lee JJ, Segar DJ, Morrison JF, Mangham WM, Lee S, Asaad WF. Subdural hematoma as a major determinant of short-term outcomes in traumatic brain injury. J Neurosurg 2017; 128:236-249. [PMID: 28186445 DOI: 10.3171/2016.5.jns16255] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Early radiographic findings in patients with traumatic brain injury (TBI) have been studied in hopes of better predicting injury severity and outcome. However, prior attempts have generally not considered the various types of intracranial hemorrhage in isolation and have typically not excluded patients with potentially confounding extracranial injuries. Therefore, the authors examined the associations of various radiographic findings with short-term outcome to assess the potential utility of these findings in future prognostic models. METHODS The authors retrospectively identified 1716 patients who had experienced TBI without major extracranial injuries, and categorized them into the following TBI subtypes: subdural hematoma (SDH), traumatic subarachnoid hemorrhage, intraparenchymal hemorrhage (which included intraventricular hemorrhage), and epidural hematoma. They specifically considered isolated forms of hemorrhage, in which only 1 subtype was present. RESULTS In general, the presence of an isolated SDH was more likely to result in worse outcomes than the presence of other isolated forms of traumatic intracranial hemorrhage. Discharge to home was less likely and perihospital mortality rates were generally higher in patients with SDH. These findings were not simply related to age and were not fully captured by the admission Glasgow Coma Scale (GCS) score. The presence of SDH had a much higher sensitivity for poor outcome than the presence of other TBI subtypes, and was more sensitive for these poor outcomes than having a low GCS score (3-8). CONCLUSIONS In these ways, SDH was the most important finding associated with poor outcome, and the authors show that consideration of SDH, specifically, can augment age and GCS score in classification and prognostic models for TBI.
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Affiliation(s)
| | | | - John F Morrison
- 1Warren Alpert Medical School of Brown University.,2Department of Neurosurgery, Rhode Island Hospital
| | | | - Shane Lee
- 3Brown Institute for Brain Science.,4Department of Neuroscience, Brown University; and
| | - Wael F Asaad
- 1Warren Alpert Medical School of Brown University.,2Department of Neurosurgery, Rhode Island Hospital.,3Brown Institute for Brain Science.,4Department of Neuroscience, Brown University; and.,5Norman Prince Neurosciences Institute, Rhode Island Hospital, Providence, Rhode Island
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Travers S, Martin S, Litofsky NS. The effects of anaemia and transfusion on patients with traumatic brain injury: A review. Brain Inj 2016; 30:1525-1532. [PMID: 27680103 DOI: 10.1080/02699052.2016.1199907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anaemia in traumatic brain injury (TBI) is frequently encountered. Neurosurgical texts continue to recommend transfusion for hematocrit below 30%, despite clear evidence to do so. Transfusion should increase oxygen delivery to the brain, but it may also increase morbidity and mortality. METHODS This study reviewed the relevant literature to better understand the risks of anaemia and benefits of correction of anaemia by transfusion. RESULTS Of the 21 studies reviewed, eight found that anaemia was harmful to patients with TBI; five found no significant outcome; seven found transfusion was associated with higher rates of morbidity and mortality; two found that transfusion lowered mortality and increased brain tissue oxygen levels; and ten found no correlation between transfusion and outcome. However, the levels of anaemia severity and the outcome measurements varied widely and the majority of outcomes focused on crude measurements rather than detailed functional assessments. CONCLUSIONS No division of response based on gender difference or impact of anaemia in the post-hospital treatment setting was observed. A randomized control trial is recommended to determine the impact of anaemia and transfusion on detailed outcome assessment in comparison of transfusion thresholds ranging from ≤ 7 g dL-1 to ≤ 9 g dL-1 in patients with moderate-to-severe TBI.
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Affiliation(s)
- Sarah Travers
- a Division of Neurological Surgery , University of Missouri School of Medicine , Columbia , MO , USA
| | - Simon Martin
- a Division of Neurological Surgery , University of Missouri School of Medicine , Columbia , MO , USA
| | - N Scott Litofsky
- a Division of Neurological Surgery , University of Missouri School of Medicine , Columbia , MO , USA
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Stier GR, Verde EW. The Postoperative Care of Adult Patients Exposed to Deep Hypothermic Circulatory Arrest. Semin Cardiothorac Vasc Anesth 2016; 11:77-85. [PMID: 17484176 DOI: 10.1177/1089253206298010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deep hypothermic circulatory arrest with cardiopulmonary bypass is indicated for complex surgical operations in adult patients involving the aortic arch, thoracoabdominal aorta, cerebral vasculature, and tumors extending into the vena cava and heart. Understanding the principles of ischemic-reperfusion injury and the effects of hypothermia in attenuating this process is fundamental to the delivery of effective postoperative care. Neurologic injury is the most troublesome adverse effect after the use of deep hypothermic circulatory arrest and cardiopulmonary bypass, presenting as either a transient neurologic deficit (5.9% to 28.1%) or an irreversible neurologic injury (1.8% to 13.6%). In patients with neurological injury, early postoperative mortality is markedly increased (18.2%), and for those patients that survive, long-term cognitive disability is still evident 6 months later. Early postoperative support of organ function, along with timely diagnosis and treatment of organ injury, is essential in minimizing perioperative morbidity, particularly neurologic morbidity. Meticulous management of fluids, maintaining stable cardiovascular hemodynamics with particular attention to systolic blood pressure, optimizing oxygen delivery, limiting ventilatorassociated lung injury, intensive insulin therapy for control of blood glucose levels, and avoidance of hyperthermia are essential in limiting organ injury and reducing perioperative morbidity and mortality.
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Affiliation(s)
- Gary R Stier
- Loma Linda University Medical Center, CA 92354, USA.
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Raman J, Ballal A, Hota B, Mirza S, Lai D, Bleck T, Lateef O. Reconstructive valve surgery within 10 days of stroke in endocarditis. Asian Cardiovasc Thorac Ann 2016; 24:523-9. [DOI: 10.1177/0218492316652746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The optimal timing of surgical treatment for infective endocarditis complicated by cerebrovascular events is controversial, largely due to the perceived risk of perioperative intracranial bleeding. Current guidelines suggest waiting 2 weeks between the diagnosis of stroke and surgery. The aim of this study was to investigate the clinical and neurological outcomes of early surgery following a stroke. Methods This was a single-center retrospective analysis of 12 consecutive patients requiring surgery for infective endocarditis between 2011 and 2014 at Rush University Medical Center, with either ischemic ( n = 6) and/or hemorrhagic ( n = 6) cerebrovascular complications. All underwent computed tomographic angiography prior to early valve reconstructive surgery to identify potentially actionable neurological findings. Early valve surgery was performed for ongoing sepsis or persistent emboli. Neurologic risk and outcome were assessed pre- and postoperatively using the National Institutes of Health Stroke Scale and the Glasgow Outcome Scale, respectively. Results All 12 patients underwent surgical treatment within 10 days of the diagnosis of stroke. Mortality in the immediate postoperative period was 8%. Eleven of the 12 patients exhibited good neurological recovery in the immediate postoperative period, with a Glasgow Outcome Scale score ≥ 3. There was no correlation between duration of cardiopulmonary bypass and neurological outcomes. Conclusion Early cardiac surgery in patients with infective endocarditis and stroke maybe lifesaving with a low neurological risk. Comprehensive neurovascular imaging may help in identifying patient-related risk factors.
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Affiliation(s)
- Jai Raman
- Division of Cardiac Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Bala Hota
- Department of Medicine, Rush University Medical Center, Chicago, IL Illinois, USA
| | - Sara Mirza
- Department of Medicine, Rush University Medical Center, Chicago, IL Illinois, USA
| | - David Lai
- National University of Singapore, Singapore
| | - Thomas Bleck
- Department of Medicine, Rush University Medical Center, Chicago, IL Illinois, USA
| | - Omar Lateef
- Department of Medicine, Rush University Medical Center, Chicago, IL Illinois, USA
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Khalin I, Jamari NLA, Razak NBA, Hasain ZB, Nor MABM, Zainudin MHBA, Omar AB, Alyautdin R. A mouse model of weight-drop closed head injury: emphasis on cognitive and neurological deficiency. Neural Regen Res 2016; 11:630-5. [PMID: 27212925 PMCID: PMC4870921 DOI: 10.4103/1673-5374.180749] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in individuals worldwide. Producing a clinically relevant TBI model in small-sized animals remains fairly challenging. For good screening of potential therapeutics, which are effective in the treatment of TBI, animal models of TBI should be established and standardized. In this study, we established mouse models of closed head injury using the Shohami weight-drop method with some modifications concerning cognitive deficiency assessment and provided a detailed description of the severe TBI animal model. We found that 250 g falling weight from 2 cm height produced severe closed head injury in C57BL/6 male mice. Cognitive disorders in mice with severe closed head injury could be detected using passive avoidance test on day 7 after injury. Findings from this study indicate that weight-drop injury animal models are suitable for further screening of brain neuroprotectants and potentially are similar to those seen in human TBI.
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Affiliation(s)
- Igor Khalin
- Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur, Malaysia
| | - Nor Laili Azua Jamari
- Chemistry Department, Centre for Defence Foundation Studies, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur, Malaysia
| | - Nadiawati Bt Abdul Razak
- Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur, Malaysia
| | - Zubaidah Bt Hasain
- Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur, Malaysia
| | - Mohd Asri Bin Mohd Nor
- Department of Civil Engineering, Faculty of Engineering, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur, Malaysia
| | - Mohd Hakimi Bin Ahmad Zainudin
- Centre for Research and Innovation Management, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur, Malaysia
| | - Ainsah Bt Omar
- Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur, Malaysia
| | - Renad Alyautdin
- Scientific Centre for Expertise of Medical Application Products, Petrovsky Blvd, Moscow, Russia
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Qu W, Liu NK, Xie XMS, Li R, Xu XM. Automated monitoring of early neurobehavioral changes in mice following traumatic brain injury. Neural Regen Res 2016; 11:248-56. [PMID: 27073377 PMCID: PMC4810988 DOI: 10.4103/1673-5374.177732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury often causes a variety of behavioral and emotional impairments that can develop into chronic disorders. Therefore, there is a need to shift towards identifying early symptoms that can aid in the prediction of traumatic brain injury outcomes and behavioral endpoints in patients with traumatic brain injury after early interventions. In this study, we used the SmartCage system, an automated quantitative approach to assess behavior alterations in mice during an early phase of traumatic brain injury in their home cages. Female C57BL/6 adult mice were subjected to moderate controlled cortical impact (CCI) injury. The mice then received a battery of behavioral assessments including neurological score, locomotor activity, sleep/wake states, and anxiety-like behaviors on days 1, 2, and 7 after CCI. Histological analysis was performed on day 7 after the last assessment. Spontaneous activities on days 1 and 2 after injury were significantly decreased in the CCI group. The average percentage of sleep time spent in both dark and light cycles were significantly higher in the CCI group than in the sham group. For anxiety-like behaviors, the time spent in a light compartment and the number of transitions between the dark/light compartments were all significantly reduced in the CCI group than in the sham group. In addition, the mice suffering from CCI exhibited a preference of staying in the dark compartment of a dark/light cage. The CCI mice showed reduced neurological score and histological abnormalities, which are well correlated to the automated behavioral assessments. Our findings demonstrate that the automated SmartCage system provides sensitive and objective measures for early behavior changes in mice following traumatic brain injury.
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Affiliation(s)
- Wenrui Qu
- Hand & Foot Surgery and Reparative & Reconstructive Surgery Center, Orthopaedic Hospital of the Second Hospital of Jilin University, Changchun, Jilin Province, China; Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA; Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | - Nai-Kui Liu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA; Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | | | - Rui Li
- Hand & Foot Surgery and Reparative & Reconstructive Surgery Center, Orthopaedic Hospital of the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xiao-Ming Xu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA; Goodman Campbell Brain and Spine, Indianapolis, IN, USA
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Fulkerson DH, White IK, Rees JM, Baumanis MM, Smith JL, Ackerman LL, Boaz JC, Luerssen TG. Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4. J Neurosurg Pediatr 2015; 16:410-9. [PMID: 26140392 DOI: 10.3171/2015.3.peds14679] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Patients with traumatic brain injury (TBI) with low presenting Glasgow Coma Scale (GCS) scores have very high morbidity and mortality rates. Neurosurgeons may be faced with difficult decisions in managing the most severely injured (GCS scores of 3 or 4) patients. The situation may be considered hopeless, with little chance of a functional recovery. Long-term data are limited regarding the clinical outcome of children with severe head injury. The authors evaluate predictor variables and the clinical outcomes at discharge, 1 year, and long term (median 10.5 years) in a cohort of children with TBI presenting with postresuscitation GCS scores of 3 and 4. METHODS A review of a prospectively collected trauma database was performed. Patients treated at Riley Hospital for Children (Indianapolis, Indiana) from 1988 to 2004 were reviewed. All children with initial GCS (modified for pediatric patients) scores of 3 or 4 were identified. Patients with a GCS score of 3 were compared with those with a GCS score of 4. The outcomes of all patients at the time of death or discharge and at 1-year and long-term follow-up were measured with a modified Glasgow Outcome Scale (GOS) that included a "normal" outcome. Long-term outcomes were evaluated by contacting surviving patients. Statistical "classification trees" were formed for survival and outcome, based on predictor variables. RESULTS Sixty-seven patients with a GCS score of 3 or 4 were identified in a database of 1636 patients (4.1%). Three of the presenting factors differed between the GCS 3 patients (n = 44) and the GCS 4 patients (n = 23): presence of hypoxia, single seizure, and open basilar cisterns on CT scan. The clinical outcomes were statistically similar between the 2 groups. In total, 48 (71.6%) of 67 patients died, remained vegetative, or were severely disabled by 1 year. Eight patients (11.9%) were normal at 1 year. Ten of the 22 patients with long-term follow-up were either normal or had a GOS score of 5. Multiple clinical, historical, and radiological factors were analyzed for correlation with survival and clinical outcome. Classification trees were formed to stratify predictive factors. The pupillary response was the factor most predictive of both survival and outcome. Other factors that either positively or negatively correlated with survival included hypothermia, mechanism of injury (abuse), hypotension, major concurrent symptoms, and midline shift on CT scan. Other factors that either positively or negatively predicted long-term outcome included hypothermia, mechanism of injury, and the assessment of the fontanelle. CONCLUSIONS In this cohort of 67 TBI patients with a presenting GCS score of 3 or 4, 56.6% died within 1 year. However, approximately 15% of patients had a good outcome at 10 or more years. Factors that correlated with survival and outcome included the pupillary response, hypothermia, and mechanism. The authors discuss factors that may help surgeons make critical decisions regarding their most serious pediatric trauma patients.
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Affiliation(s)
- Daniel H Fulkerson
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine
| | - Ian K White
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Jacqueline M Rees
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Maraya M Baumanis
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Jodi L Smith
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine
| | - Laurie L Ackerman
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine
| | - Joel C Boaz
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Goodman Campbell Brain and Spine
| | - Thomas G Luerssen
- Department of Neurological Surgery, Baylor College of Medicine, Texas Children's Hospital, Pediatric Neurosurgery, Houston, Texas
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Mathias JL, Wheaton P. Contribution of brain or biological reserve and cognitive or neural reserve to outcome after TBI: A meta-analysis (prior to 2015). Neurosci Biobehav Rev 2015; 55:573-93. [PMID: 26054792 DOI: 10.1016/j.neubiorev.2015.06.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 05/22/2015] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Jane L Mathias
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
| | - Patricia Wheaton
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Functional Recovery and Life Satisfaction in the First Year After Severe Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:E38-49. [DOI: 10.1097/htr.0000000000000080] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel MB, Wilson LD, Bregman JA, Leath TC, Humble SS, Davidson MA, de Riesthal MR, Guillamondegui OD. Neurologic Functional and Quality of Life Outcomes after TBI: Clinic Attendees versus Non-Attendees. J Neurotrauma 2015; 32:984-9. [PMID: 25683481 DOI: 10.1089/neu.2014.3652] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This investigation describes the relationship between TBI patient demographics, quality of life outcome, and functional status outcome among clinic attendees and non-attendees. Of adult TBI survivors with intracranial hemorrhage, 63 attended our TBI clinic and 167 did not attend. All were telephone surveyed using the Extended-Glasgow Outcome Scale (GOSE), the Quality of Life after Brain Injury (QOLIBRI) scale, and a post-discharge therapy questionnaire. To determine risk factors for GOSE and QOLIBRI outcomes, we created multivariable regression models employing covariates of age, injury characteristics, clinic attendance, insurance status, post-discharge rehabilitation, and time from injury. Compared with those with severe TBI, higher GOSE scores were identified in individuals with both mild (odds ratio [OR]=2.0; 95% confidence interval [CI]: 1.1-3.6) and moderate (OR=4.7; 95% CI: 1.6-14.1) TBIs. In addition, survivors with private insurance had higher GOSE scores, compared with those with public insurance (OR=2.0; 95% CI: 1.1-3.6), workers' compensation (OR=8.4; 95% CI: 2.6-26.9), and no insurance (OR=3.1; 95% CI: 1.6-6.2). Compared with those with severe TBI, QOLIBRI scores were 11.7 points (95% CI: 3.7-19.7) higher in survivors with mild TBI and 17.3 points (95% CI: 3.2-31.5) higher in survivors with moderate TBI. In addition, survivors who received post-discharge rehabilitation had higher QOLIBRI scores by 11.4 points (95% CI: 3.7-19.1) than those who did not. Survivors with private insurance had QOLIBRI scores that were 25.5 points higher (95% CI: 11.3-39.7) than those with workers' compensation and 16.8 points higher (95% CI: 7.4-26.2) than those without insurance. Because neurologic injury severity, insurance status, and receipt of rehabilitation or therapy are independent risk factors for functional and quality of life outcomes, future directions will include improving earlier access to post-TBI rehabilitation, social work services, affordable insurance, and community resources.
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Affiliation(s)
- Mayur B Patel
- 1 Veterans Affairs (VA) Tennessee Valley Healthcare System , Nashville VA, Nashville, Tennessee.,2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Laura D Wilson
- 3 Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Jana A Bregman
- 2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Taylor C Leath
- 2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Stephen S Humble
- 2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Mario A Davidson
- 4 Department of Biostatistics, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Michael R de Riesthal
- 3 Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Oscar D Guillamondegui
- 2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee
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Motorcycle-Related Traumatic Brain Injuries: Helmet Use and Treatment Outcome. NEUROSCIENCE JOURNAL 2015; 2015:696787. [PMID: 26317112 PMCID: PMC4437263 DOI: 10.1155/2015/696787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 03/02/2015] [Accepted: 03/05/2015] [Indexed: 11/17/2022]
Abstract
Summary. With increasing use of motorcycle as means of transport in developing countries, traumatic brain injuries from motorcycle crashes have been increasing. The only single gadget that protects riders from traumatic brain injury is crash helmet. Objective. The objectives were to determine the treatment outcome among traumatic brain injury patients from motorcycle crashes and the rate of helmet use among them. Methods. It was a prospective, cross-sectional study of motorcycle-related traumatic brain injury patients managed in our center from 2010 to 2014. Patients were managed using our unit protocol for traumatic brain injuries. Data for the study were collected in accident and emergency, intensive care unit, wards, and outpatient clinic. The data were analyzed using Environmental Performance Index (EPI) info 7 software. Results. Ninety-six patients were studied. There were 87 males. Drivers were 65. Only one patient wore helmet. Majority of them were between 20 and 40 years. Fifty-three patients had mild head injuries. Favorable outcome among them was 84.35% while mortality was 12.5%. Severity of the injury affected the outcome significantly. Conclusion. Our study showed that the helmet use by motorcycle riders was close to zero despite the existing laws making its use compulsory in Nigeria. The outcome was related to severity of injuries.
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Kushner DS, Johnson-Greene D. Changes in cognition and continence as predictors of rehabilitation outcomes in individuals with severe traumatic brain injury. ACTA ACUST UNITED AC 2014; 51:1057-68. [DOI: 10.1682/jrrd.2014.01.0002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/06/2014] [Indexed: 11/05/2022]
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Intraoperative intracranial pressure and cerebral perfusion pressure for predicting surgical outcome in severe traumatic brain injury. Kaohsiung J Med Sci 2013; 29:540-6. [DOI: 10.1016/j.kjms.2013.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/26/2012] [Indexed: 11/21/2022] Open
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McMillan TM, Weir CJ, Ireland A, Stewart E. The Glasgow Outcome at Discharge Scale: an inpatient assessment of disability after brain injury. J Neurotrauma 2013; 30:970-4. [PMID: 23230909 DOI: 10.1089/neu.2012.2703] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study assesses the validity and reliability of the Glasgow Outcome at Discharge Scale (GODS), which is a tool that is designed to assess disability after brain injury in an inpatient setting. It is derived from the Glasgow Outcome Scale-Extended (GOS-E), which assesses disability in the community after brain injury. Inter-rater reliability on the GODS is high (quadratic-weighted kappa 0.982; 95% confidence interval [CI] 0.968, 0.996) as is concurrent validity with the Disability Rating Scale (DRS) (Spearman correlation -0.728; 95% CI -0.819, -0.601). The GODS is significantly associated with physical and fatigue subscales of the short form (SF)-36 in hospital. In terms of predictive validity the GODS is highly associated with the GOS-E after discharge (Spearman correlation 0.512; 95% CI 0.281, 0.687), with the DRS, and with physical, fatigue, and social subscales of the SF-36. The GODS is recommended as an assessment tool for disability after brain injury pre-discharge and can be used in conjunction with the GOS-E to monitor disability between hospital and the community.
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Affiliation(s)
- Thomas M McMillan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
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Leitgeb J, Mauritz W, Brazinova A, Majdan M, Janciak I, Wilbacher I, Rusnak M. Glasgow Coma Scale score at intensive care unit discharge predicts the 1-year outcome of patients with severe traumatic brain injury. Eur J Trauma Emerg Surg 2013; 39:285-92. [PMID: 23762202 PMCID: PMC3675268 DOI: 10.1007/s00068-013-0269-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 02/10/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the association between the Glasgow Coma Scale (GCS) score at intensive care unit (ICU) discharge and the 1-year outcome of patients with severe traumatic brain injury (TBI). DESIGN Retrospective analysis of prospectively collected observational data. PATIENTS Between 01/2001 and 12/2005, 13 European centres enrolled 1,172 patients with severe TBI. Data on accident, treatment and outcomes were collected. According to the GCS score at ICU discharge, survivors were classified into four groups: GCS scores 3-6, 7-9, 10-12 and 13-15. Using the Glasgow Outcome Scale (GOS), 1-year outcomes were classified as "favourable" (scores 5, 4) or "unfavourable" (scores <4). Factors that may have contributed to outcomes were compared between groups and for favourable versus unfavourable outcomes within each group. MAIN RESULTS Of the 538 patients analysed, 308 (57 %) had GCS scores 13-15, 101 (19 %) had scores 10-12, 46 (9 %) had scores 7-9 and 83 (15 %) had scores 3-6 at ICU discharge. Factors significantly associated with these GCS scores included age, severity of trauma, neurological status (GCS, pupils) at admission and patency of the basal cisterns on the first computed tomography (CT) scan. Favourable outcome was achieved in 74 % of all patients; the rates were significantly different between GCS groups (93, 83, 37 and 10 %, respectively). Within each of the GCS groups, significant differences regarding age and trauma severity were found between patients with favourable versus unfavourable outcomes; neurological status at admission and CT findings were not relevant. CONCLUSION The GCS score at ICU discharge is a good predictor of 1-year outcome. Patients with a GCS score <10 at ICU discharge have a poor chance of favourable outcome.
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Affiliation(s)
- J Leitgeb
- Department of Traumatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Abstract
BACKGROUND Age is an important prognostic indicator of outcomes following traumatic brain injuries. This study examines how outcomes for traumatic brain injuries in the acute care setting have changed during a recent 10-year period. METHODS Population-level data broken down by age group was obtained from the Agency for Healthcare Research and Quality Web site for the years 2000 to 2009. Linear regression was used to determine trends in age-specific discharge volume, mortality rate, discharge disposition, and cost. Population and cost estimates were adjusted using census data and consumer price index. RESULTS It was found that discharges for intracranial injuries have been increasing, with the most marked increase in the population older than 65 years, which cannot be accounted for by population age distribution changes. There were overall improvements in outcomes including decreased in-hospital mortality rates for all age groups and increased home discharges for those 18 to 44 years and older than 85 years. This came at an average annual cost increase of $1,071 dollars per patient. CONCLUSION Acute care outcomes for intracranial injuries have been improving at a cost of $1,071 per patient per year. LEVEL OF EVIDENCE Economic and decision analysis, level IV.
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de Guise E, LeBlanc J, Abouassaly M, Lin H, Lamoureux J, Champoux MC, Couturier C, Maleki M, Roger EP, Feyz M. The Relationship between Acute Functional Status and Long-Term Ambulation after Severe Traumatic Brain Injury. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/534856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective. To correlate long-term physical impairments of patients with severe traumatic brain injury (sTBI) based on their functional status in an acute care setting. Methods. 46 patients with sTBI participated in this prospective study. The Extended Glasgow Outcome Scale (GOSE) and the FIM instrument were rated at discharge from the acute care setting and at followup. The Functional Ambulation Classification (FAC), the Five-Meter Gait Speed, a quantified measure of negotiating stairs (Stair Climbing Speed and Rails used), and the functional reach test were rated at followup. Results. The subject with a score of 6 on the GOSE at discharge remained nonfunctional ambulator at followup. None of the subjects with a GOSE score of 5 became independent ambulators. Fifty percent of the subjects with a GOSE score of 4 were dependent ambulators. 100% of the subjects with a GOSE score of 2 or 3 at discharge were independent ambulators. A higher FIM score at discharge was associated with a greater chance of ambulating independently at 2 to 5 years after TBI (χKW22df). Conclusions. These data will allow physical health professionals in acute rehabilitation settings to provide more precise long-term physical outcome information to patients and families.
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Affiliation(s)
- Elaine de Guise
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada H3A 0G4
| | - Joanne LeBlanc
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Michel Abouassaly
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Howell Lin
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Julie Lamoureux
- Social and Preventive Medicine Department, University of Montreal, Montreal, QC, Canada H3C 3J7
| | - Marie-Claude Champoux
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Céline Couturier
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Mohammed Maleki
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada H3A 0G4
| | - Eric P. Roger
- Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, NY 14260-1660, USA
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
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Hilario A, Ramos A, Millan JM, Salvador E, Gomez PA, Cicuendez M, Diez-Lobato R, Lagares A. Severe traumatic head injury: prognostic value of brain stem injuries detected at MRI. AJNR Am J Neuroradiol 2012; 33:1925-31. [PMID: 22576887 DOI: 10.3174/ajnr.a3092] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Traumatic brain injuries represent an important cause of death for young people. The main objectives of this work are to correlate brain stem injuries detected at MR imaging with outcome at 6 months in patients with severe TBI, and to determine which MR imaging findings could be related to a worse prognosis. MATERIALS AND METHODS One hundred and eight patients with severe TBI were studied by MR imaging in the first 30 days after trauma. Brain stem injury was categorized as anterior or posterior, hemorrhagic or nonhemorrhagic, and unilateral or bilateral. Outcome measures were GOSE and Barthel Index 6 months postinjury. The relationship between MR imaging findings of brain stem injuries, outcome, and disability was explored by univariate analysis. Prognostic capability of MR imaging findings was also explored by calculation of sensitivity, specificity, and area under the ROC curve for poor and good outcome. RESULTS Brain stem lesions were detected in 51 patients, of whom 66% showed a poor outcome, as expressed by the GOSE scale. Bilateral involvement was strongly associated with poor outcome (P < .05). Posterior location showed the best discriminatory capability in terms of outcome (OR 6.8, P < .05) and disability (OR 4.8, P < .01). The addition of nonhemorrhagic and anterior lesions or unilateral injuries showed the highest odds and best discriminatory capacity for good outcome. CONCLUSIONS The prognosis worsens in direct relationship to the extent of traumatic injury. Posterior and bilateral brain stem injuries detected at MR imaging are poor prognostic signs. Nonhemorrhagic injuries showed the highest positive predictive value for good outcome.
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Affiliation(s)
- A Hilario
- Department of Radiology, Hospital 12 de Octubre, Madrid, Spain.
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Abstract
The purpose of this review is to look at the most recent work carried out on predicting outcome after traumatic brain injury (TBI). TBI is a leading cause of death and disability but prediction of long-term outcome for individual patients is difficult. In particular, predicting outcome in the first few hours or days after injury is limited by the paucity of scoring systems or clinical models available. Many clinical variables have been studied to determine if they may play a role in outcome prediction, including age, admission Glasgow Coma Score and pupillary reactivity. Newer variables being studied include serum biomarkers, abnormalities seen on magnetic resonance imaging and data obtained from evoked potentials and electroencephalography studies. There are many factors that impact on outcome and a perfect model is yet to be developed. Models must take into account the economic status of the country in which the trauma occurs. It is important that less affluent nations are not left behind in the search for accurate prognostic modelling.
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Affiliation(s)
- Sandra Reynolds
- Specialist Registrar in Anaesthetics & ICM, Royal London Hospital, Whitechapel
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Crandon IW, Harding HE, Cawich SO, Webster D. Complicated head trauma from machete wounds: the experience from a tertiary referral hospital in Jamaica. Int J Inj Contr Saf Promot 2011; 18:293-7. [PMID: 21547816 DOI: 10.1080/17457300.2011.569890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There have been limited reports on machete wounds to the cranium. This study was carried out to document the injury profile in a series of patients who have sustained cranial injuries from machete wounds in this setting. Between 1 January 1998 and 1 January 2008, demographic and clinical data were retrospectively collected from all patients treated with complicated head injuries from machete wounds with at least one of the following clinical or radiological features: a recorded Glasgow Coma Score < 8 at any point during admission; compound skull fractures; protruding brain matter; cerebrospinal fluid (CSF) leaks; intra-cranial bleeding; parenchymal contusions; lacerations and/or oedema. The data were analysed using the SPSS version 12.0. Of the 40 patients with complex injuries to the cranium, there was a 6:1 male preponderance with a mean age of 32.5 ± 13.7 years (Mean ± SD). The injuries included open skull fractures in all the 40 (100%) patients, depressed skull fractures in 20 (50%) patients, CSF leaks in 4 (10%) patients, protruding brain matter in 4 (10%) patients, cerebral contusions in 3 (7.5%) patients and extra cranial injuries in 16 (40%) patients. Tetanus prophylaxis and intravenous antibiotics were administered to all patients, and phenytoin was required in 16 (40%) cases. There were 37 (92%) patients requiring operative intervention at a mean of 10.4 h after presentation (SD ± 18.1; Median 6). The operative procedures included elevation of depressed fractures in 20 (54.1%) patients, dural repair in 10 (27.0%) patients and intra-cranial debridement in 7 (18.9%) patients. There were three deaths (7.5%), and seizures were recorded in 5 (12.5%) cases with no reports of infectious morbidity. Eighty percent of patients had a normal Glasgow outcome score on discharge. Complicated machete head trauma is uncommon at this health care facility in Jamaica. We achieved a satisfactory outcome with aggressive management consisting of prompt assessment of the extent of injury, appropriate antibiotics, anticonvulsants for those with seizures or cortical injury and early operation to decrease the risk of complications.
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Affiliation(s)
- I W Crandon
- Department of Surgery, Radiology and Anaesthesia, University of the West Indies, Kingston 7, Jamaica
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Liesemer K, Bratton SL, Zebrack CM, Brockmeyer D, Statler KD. Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features. J Neurotrauma 2011; 28:755-62. [PMID: 21381863 DOI: 10.1089/neu.2010.1518] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We performed a retrospective, observational study at a level I pediatric trauma center of children with moderate-to-severe traumatic brain injury (TBI) from January 2002 to September 2006 to identify clinical and radiographic risk factors for early post-traumatic seizures (EPTS). Two hundred and ninety-nine children ages 0-15 years were evaluated, with 24 excluded because they died before the initial head computed tomography (CT) was obtained (n=20), or because their medical records were missing (n=4). Records were reviewed for accident characteristics, pre-hospital hypoxia or hypotension, initial non-contrast head CT characteristics, seizure occurrence, antiepileptic drug (AED) administration, and outcome. All care was at the discretion of the treating physicians, including the use of AEDs and continuous electroencephalogram (EEG) monitoring in patients receiving neuromuscular blocking agents. The primary outcome was seizure activity during the first 7 days as determined by clinician observation or EEG analysis. Of the 275 patients included in the study, 34 had identified EPTS (12%). Risk factors identified on bivariable analysis included pre-hospital hypoxia, young age, non-accidental trauma (NAT), severe TBI, impact seizure, and subdural hemorrhage, while receiving an AED was protective. Independent risk factors identified by multivariable analysis were age <2 years (OR 3.0 [95% CI 1.0,8.6]), Glasgow Coma Scale (GCS) score ≤8 (OR 8.7 [95% CI 1.1,67.6]), and NAT as a mechanism of injury (OR 3.4 [95% CI 1.0,11.3]). AED treatment was protective against EPTS (OR 0.2 [95% CI 0.07,0.5]). Twenty-three (68%) patients developed EPTS within the first 12 h post-injury. This early peak in EPTS activity and demonstrated protective effect of AED administration in this cohort suggests that to evaluate the maximal potential benefit among patients at increased risk for EPTS, future research should be randomized and prospective, and should intervene during pre-trauma center care with initiation of continuous EEG monitoring as soon as possible.
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Affiliation(s)
- Kate Liesemer
- University of Utah School of Medicine & Primary Children's Medical Center Department of Pediatrics, Division of Critical Care Medicine, Salt Lake City, Utah 84118, USA.
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Ramanathan DM, Wardecker BM, Slocomb JE, Hillary FG. Dispositional optimism and outcome following traumatic brain injury. Brain Inj 2011; 25:328-37. [PMID: 21314277 DOI: 10.3109/02699052.2011.554336] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Despite vast literature examining the predictors of patient outcome following traumatic brain injury (TBI), the complicated relationship between personality and psychological, cognitive and functional outcomes remains poorly understood. The present study examined the relationship between the personality trait of dispositional optimism (DO) and outcome after moderate and severe TBI in the context of a proposed theoretical model. METHODS Forty-five individuals who had sustained moderate-to-severe TBI were recruited through mailings and completed the Symptom Checklist Questionnaire-90 Revised (SCL-90-R), the Telephone Interview for Cognitive Status (TICS), the Craig Handicap Assessment Reporting Technique (CHART) and the Life Orientation Test-Revised (LOT-R). Analyses were conducted to test a model predicting the relationship between personality and patient outcome after TBI. RESULTS DO was significantly correlated with psychological distress, but did not predict functional outcome. In addition, two significant mediating relationships were demonstrated: (1) psychological distress was shown to mediate the relationship between dispositional optimism and cognitive ability and (2) cognitive ability mediated the relationship between psychological distress and functional outcome. CONCLUSION These findings illustrate that higher levels of DO in individuals sustaining moderate-to-severe TBI are related to better psychological functioning which in turn predicts improved cognitive and functional outcomes.
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Affiliation(s)
- Deepa M Ramanathan
- Psychology Department, The Pennsylvania State University, University Park, PA 16802, USA.
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Wilde EA, Whiteneck GG, Bogner J, Bushnik T, Cifu DX, Dikmen S, French L, Giacino JT, Hart T, Malec JF, Millis SR, Novack TA, Sherer M, Tulsky DS, Vanderploeg RD, von Steinbuechel N. Recommendations for the use of common outcome measures in traumatic brain injury research. Arch Phys Med Rehabil 2010; 91:1650-1660.e17. [PMID: 21044708 DOI: 10.1016/j.apmr.2010.06.033] [Citation(s) in RCA: 342] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 06/09/2010] [Accepted: 06/11/2010] [Indexed: 11/28/2022]
Abstract
This article summarizes the selection of outcome measures by the interagency Traumatic Brain Injury (TBI) Outcomes Workgroup to address primary clinical research objectives, including documentation of the natural course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements Workgroups, the TBI Outcomes Workgroup adopted the standard 3-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in TBI from each identified domain, including global level of function, neuropsychological impairment, psychological status, TBI-related symptoms, executive functions, cognitive and physical activity limitations, social role participation, and perceived health-related quality of life. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to some older ("legacy") measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges.
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Affiliation(s)
- Elisabeth A Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
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One-year outcome and course of recovery after severe traumatic brain injury. Eur J Trauma Emerg Surg 2010; 37:387-95. [DOI: 10.1007/s00068-010-0053-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 09/09/2010] [Indexed: 11/25/2022]
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Chastain CA, Oyoyo UE, Zipperman M, Joo E, Ashwal S, Shutter LA, Tong KA. Predicting outcomes of traumatic brain injury by imaging modality and injury distribution. J Neurotrauma 2010; 26:1183-96. [PMID: 19317591 DOI: 10.1089/neu.2008.0650] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Early prediction of outcomes after traumatic brain injury (TBI) is often difficult. To improve prognostic accuracy soon after trauma, we compared different radiological modalities and anatomical injury distribution in a group of adult TBI patients. The four methods studied were computed tomography (CT), magnetic resonance imaging (MRI) with T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR) imaging, and susceptibility weighted imaging (SWI). The objective of this study was to identify which modality and anatomic model best predict outcome. The patient population consisted of 38 adults admitted between February 2001 and May 2003. Early CT, T2WI, FLAIR, and SWI were obtained for each patient as well as a Glasgow Outcome Score (GOS) between 0.1 and 22 months (mean 9.2 months) after injury. Using a semi-automated computer method, intraparenchymal lesions were traced, measured, and converted to lesion volumes based on slice thickness and pixel size. Lesions were assigned to zones and regions. Outcomes were dichotomized into good (GOS 4-5) and poor (GOS 1-3) outcome groups. Brain injury detected by imaging was analyzed by median total lesion volume, median volume per lesion, and median number of lesions per outcome group. T2WI and FLAIR imaging most consistently discriminated between good and poor outcomes by median total lesion volume, median volume per lesion, and median number of lesions. In addition, T2WI and FLAIR imaging most consistently discriminated between good and poor outcomes by zonal distribution. While SWI rarely discriminated by outcome, it was very sensitive to intraparenchymal injury and its optimal use in evaluating TBI is unclear. SWI and other new imaging modalities should be further studied to fully evaluate their prognostic utility in TBI evaluation.
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Affiliation(s)
- Cody A Chastain
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Colgan NC, Cronin MM, Gobbo OL, O'Mara SM, O'Connor WT, Gilchrist MD. Quantitative MRI Analysis of Brain Volume Changes due to Controlled Cortical Impact. J Neurotrauma 2010; 27:1265-74. [DOI: 10.1089/neu.2009.1267] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Niall C. Colgan
- School of Electrical, Electronic & Mechanical Engineering, University College Dublin, Belfield, Dublin, Ireland
| | | | | | | | - William T. O'Connor
- Conway Institute, University College Dublin, Belfield, Dublin, Ireland
- Graduate Entry Medical School, University of Limerick, Castletroy, County Limerick, Ireland
| | - Michael D. Gilchrist
- School of Electrical, Electronic & Mechanical Engineering, University College Dublin, Belfield, Dublin, Ireland
- School of Human Kinetics, University of Ottawa, Ontario, Canada
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Chauhan NB, Gatto R, Chauhan MB. Neuroanatomical correlation of behavioral deficits in the CCI model of TBI. J Neurosci Methods 2010; 190:1-9. [PMID: 20385166 DOI: 10.1016/j.jneumeth.2010.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 04/03/2010] [Accepted: 04/05/2010] [Indexed: 01/05/2023]
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability both in combat and civilian situations with limited treatment options including surgical removal of hematoma, ventricular drainage and use of hyperosmotic agents that restrict secondary injury following TBI. Availability of appropriate model system with full-range characterization of anatomical and behavioral components correlative with brain injury provides a pre-clinical platform to test candidate therapies for clinical translation. Modeling of TBI using controlled cortical impact injury (CCI) is largely considered to be close to clinical TBI and hence CCI models have been widely used in pre-clinical TBI research. Most studies reported so far using CCI models were presented with a limited behavioral characterization and lacked its correlation with the signature histopathology of TBI. Current investigation validated a detailed sensomotor and cognitive behavioral characterization correlative with diffuse axonal injury-the signature histopathology of TBI, in the CCI mouse model of TBI. Present study offers a comprehensively characterized model of TBI that can be used to investigate cellular and molecular mechanisms underlying TBI and to test candidate therapies in developing novel and effective treatments for TBI.
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Affiliation(s)
- Neelima B Chauhan
- Research & Development, Jesse Brown VA Medical Center Chicago, IL 60612, USA.
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Crandon IW, Harding HE, Cawich SO, McDonald AH, Fearron-Boothe D. Motorcycle accident injury profiles in Jamaica: an audit from the University Hospital of the West Indies. Int J Inj Contr Saf Promot 2009; 16:175-8. [PMID: 19941216 DOI: 10.1080/17457300903024236] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is little data available on the prevalence of motorcycle accidents, their resultant injuries and the demand on the health care services in Jamaica. We performed a descriptive, analytical study to evaluate the extent of this problem and the need for preventative national policy measures. Between 1 January 2000 and 1 January 2007, demographic and clinical data on all motorcycle accident victims admitted to the University Hospital of the West Indies were collected in a prospective database. The data were analysed using the SPSS version 12.0. Of 270 motorcycle accident victims, there were 257 (95.2%) males and 13 (4.8%) females. Overall, 134 (49.6%) victims wore helmets at the time of their accident. The more common injuries were as follows: soft tissue trauma 270 (100%); head injuries 143 (53.0%); long bone fractures 126 (46.7%); abdominal injuries 38 (14.1%); thoracic injuries 71 (26.3%); vascular injuries 11 (4.1%). The mean injury severity score was 9.0 (SD 9.4; Median 8; Mode 4). There were 195 patients needing surgical intervention in the form of orthopaedic operations (94), neurosurgical operations (43), abdominal operations (49) and vascular operations (14). The mean duration of hospitalisation was 10 days (SD 11.2; Range 0-115; Median 6; Mode 3). There were 12 (4.4%) deaths, 9 (75%) due to traumatic brain injuries. Fatal injuries were more common in males (11) and un-helmeted patients (10). Motorcycle accidents take a heavy toll on this health care facility in Jamaica. Measures to prevent motorcycle accidents and reduce consequent injuries may be one way in which legislators can preserve precious resources that are spent during these incidents. This can be achieved through active measures such as educational campaigns, adherence to traffic regulations and enforcement of helmet laws.
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Affiliation(s)
- I W Crandon
- Section of Surgery, Department of Surgery, Radiology and Anaesthesia, University of the West Indies, Jamaica
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50
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A Colloquium on the Congress “A Gift for Life. Considerations on Organ Donation”. Transplantation 2009; 88:S108-58. [DOI: 10.1097/tp.0b013e3181b66576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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