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Gabbe BJ, Keeves J, McKimmie A, Gadowski AM, Holland AJ, Semple BD, Young JT, Crowe L, Ownsworth T, Bagg MK, Antonic-Baker A, Hicks AJ, Hill R, Curtis K, Romero L, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Systematic Review and Consensus Process to Determine the Predictive Value of Demographic, Injury Event, and Social Characteristics on Outcomes for People With Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38115598 DOI: 10.1089/neu.2023.0461] [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: 12/21/2023] Open
Abstract
The objective of the Australian Traumatic Brain Injury (AUS-TBI) Initiative is to develop a data dictionary to inform data collection and facilitate prediction of outcomes of people who experience moderate-severe TBI in Australia. The aim of this systematic review was to summarize the evidence of the association between demographic, injury event, and social characteristics with outcomes, in people with moderate-severe TBI, to identify potentially predictive indicators. Standardized searches were implemented across bibliographic databases to March 31, 2022. English-language reports, excluding case series, which evaluated the association between demographic, injury event, and social characteristics, and any clinical outcome in at least 10 patients with moderate-severe TBI were included. Abstracts and full text records were independently screened by at least two reviewers in Covidence. A pre-defined algorithm was used to assign a judgement of predictive value to each observed association. The review findings were discussed with an expert panel to determine the feasibility of incorporation of routine measurement into standard care. The search strategy retrieved 16,685 records; 867 full-length records were screened, and 111 studies included. Twenty-two predictors of 32 different outcomes were identified; 7 were classified as high-level (age, sex, ethnicity, employment, insurance, education, and living situation at the time of injury). After discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous predictors capable of enabling early identification of those at risk for poor outcomes and improved personalization of care through inclusion in routine data collection.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Jemma Keeves
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Ancelin McKimmie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adelle M Gadowski
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew J Holland
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney School of Medicine, Westmead, Australia
| | - Bridgette D Semple
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Jesse T Young
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Clinical Sciences Murdoch Children's Research Institute, Parkville, VIC, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Justice Health Group, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Louise Crowe
- Clinical Sciences Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and the Hopkins Centre, Griffith University, Brisbane, Australia
| | - Matthew K Bagg
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Regina Hill
- Regina Hill Effective Consulting Pty. Ltd., Melbourne, VIC, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Illawarra Shoalhaven LHD, Wollongong, NSW, Australia
- George Institute for Global Health, Newtown, NSW, Australia
| | | | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | | | - Melinda Fitzgerald
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
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Dresch Vascouto H, Melo HM, de Oliveira Thais MER, Schwarzbold ML, Lin K, Pizzol FD, Kupek E, Walz R. Cognitive Performance of Brazilian Patients With Favorable Outcomes After Severe Traumatic Brain Injury: A Prospective Study. Am J Phys Med Rehabil 2023; 102:1070-1075. [PMID: 37204939 DOI: 10.1097/phm.0000000000002279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the cognitive performance of patients with favorable outcomes, determined by the Glasgow Outcome Scale, 1 yr after hospital discharge due to severe traumatic brain injury. DESIGN This was a prospective case-control study. From 163 consecutive adult patients with severe traumatic brain injury included in the study, 73 patients had a favorable outcome (Glasgow Outcome Scale score of 4 or 5) 1 yr after hospital discharge and were eligible for the cognitive evaluation, of which 28 completed the evaluations. The latter were compared with 44 healthy controls. RESULTS The average loss of cognitive performance among participants with traumatic brain injury varied between 13.35% and 43.49% compared with the control group. Between 21.4% and 32% of the patients performed below the 10th percentile on three language tests and two verbal memory tests, whereas 39% to 50% performed below this threshold on one language test and three memory tests. Longer hospital stay, older age, and lower education were the most important predictors of worse cognitive performance. CONCLUSION One year after a severe traumatic brain injury, a significant proportion of Brazilian patients with the favorable outcome determined by Glasgow Outcome Scale still showed significant cognitive impairment in verbal memory and language domains.
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Affiliation(s)
- Helena Dresch Vascouto
- From the Center for Applied Neuroscience (CeNAp), Department of Clinical Medicine, University Hospital-UFSC (HU-UFSC) (HDV, HMM, MLS, KL, RW), Graduate Program in Neuroscience (HDV, HMM, MERdOT, RW), Graduate Program in Medical Sciences (MERdOT, MLS, KL, RW), Psychiatry Unit, Department of Internal Medicine, University Hospital (HU) (MLS), Neurology Unit, Department of Internal Medicine, University Hospital-UFSC (HU-UFSC) (KL, RW), and Department of Public Health (EK), Federal University of Santa Catarina (UFSC), FlorianĂłpolis/SC; and Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, Health Sciences Unit, University of South Santa Catarina, Santa Catarina, Brazil (FDP)
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Abstract
PURPOSE OF REVIEW Evaluating longer term mortality, morbidity, and quality of life in survivors of critical illness is a research priority. This review details the challenges of long-term follow-up studies of critically ill patients and highlights recently proposed methodological solutions. RECENT FINDINGS Barriers to long-term follow-up studies of critical care survivors include high rates of study attrition because of death or loss to follow-up, data missingness from experienced morbidity, and lack of standardized outcome as well as reporting of key covariates. A number of recent methods have been proposed to reduce study patients attrition, including minimum data set selection and visits to transitional care or home settings, yet these have significant downsides as well. Conducting long-term follow-up even in the absence of such models carries a high expense, as personnel are very costly, and patients/families require reimbursement for their time and inconvenience. SUMMARY There is a reason why many research groups do not conduct long-term outcomes in critical care: it is very difficult. Challenges of long-term follow-up require careful consideration by study investigators to ensure our collective success in data integration and a better understanding of underlying mechanisms of mortality and morbidity seen in critical care survivorship.
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Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine (Critical Care Medicine), Division of Respirology, University Health Network, Toronto, Canada
- Interdepartment Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - E. Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine and Center for Health Services Research, Department of Medicine, and the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
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Fraser EE, Downing MG, Biernacki K, McKenzie DP, Ponsford JL. Cognitive Reserve and Age Predict Cognitive Recovery after Mild to Severe Traumatic Brain Injury. J Neurotrauma 2019; 36:2753-2761. [DOI: 10.1089/neu.2019.6430] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Elinor E. Fraser
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
| | - Marina G. Downing
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
| | - Kathryn Biernacki
- Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, New Jersey
| | - Dean P. McKenzie
- Epworth HealthCare, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennie L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
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Areas FZ, Schwarzbold ML, Diaz AP, Rodrigues IK, Sousa DS, Ferreira CL, Quevedo J, Lin K, Kupek E, Ritter C, Dal Pizzol F, Walz R. Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil. Front Neurol 2019; 10:432. [PMID: 31105642 PMCID: PMC6494964 DOI: 10.3389/fneur.2019.00432] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/09/2019] [Indexed: 01/08/2023] Open
Abstract
Traumatic brain injury (TBI) is a worldwide social, economic, and health problem related to premature death and long-term disabilities. There were no prospective and multicentric studies analyzing the predictors of TBI related mortality and estimating the burden of TBI in Brazil. To address this gap, we investigated prospectively: (1) the hospital mortality and its determinants in patients admitted with severe TBI we analyzed in three reference centers; (2) the burden of TBI estimated by the years of life lost (YLLs) due to premature death based on the hospital mortality considering the hospital mortality. Between April 2014 and January 2016 (22 months), all the 266 patients admitted with Glasgow coma scale (GCS), ≤ 8 admitted in three TBI reference centers were included in the study. These centers cover a population of 1,527,378 population of the Santa Catarina state, Southern Brazil. Most patients were male (n = 230, 86.5%), with a mean (SD) age of 38 (17) years. Hospital mortality was 31.1% (n = 83) and independently associated with older age, worse cranial CT injury by the Marshall classification, the presence of subarachnoid hemorrhage in the CT, lower GCS scores and abnormal pupils at admission. The final multiple logistic regression model including these variables showed an overall accuracy for hospital mortality of 77.9% (specificity 88.6%, sensitivity 53.8%, PPV 67.7%, and NPV 81.1%). The estimated annual incidence of hospitalizations and mortality due to severe TBI were 9.5 cases and 5.43 per 100,000 inhabitants, respectively. The estimated YLLs in 22 months, in the 2 metropolitan areas were 2,841, corresponding to 1,550 YLLs per year and 101.5 YLLs per 100,000 people every year. The hospital mortality did not change significantly since the end of the 1990s and was similar to other centers in Brazil and Latin America. Significant predictors of hospital mortality were the same as those of studies worldwide, but their strength of association seemed to differ according to countries income. Present study results question the extrapolation of TBI hospital mortality models for high income to lower- and middle-income countries and therefore have implications for TBI multicentric trials including countries with different income levels.
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Affiliation(s)
- Fernando Zanela Areas
- Centro de Neurociências Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, Florianópolis, Brazil.,Programa de Pós-Graduação em Neurociências, UFSC, Florianópolis, Brazil
| | - Marcelo Liborio Schwarzbold
- Centro de NeurociĂŞncias Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, FlorianĂłpolis, Brazil.,Programa de PĂłs-Graduação em NeurociĂŞncias, UFSC, FlorianĂłpolis, Brazil.,Programa de PĂłs-Graduação em CiĂŞncias MĂ©dicas, UFSC, FlorianĂłpolis, Brazil.,Serviço de Psiquiatria, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil
| | - Alexandre Paim Diaz
- Centro de NeurociĂŞncias Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, FlorianĂłpolis, Brazil.,Serviço de Psiquiatria, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil
| | - Igor Kunze Rodrigues
- Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Serviço de Neurocirurgia, HU, UFSC, Florianópolis, Brazil.,Serviço de Neurocirurgia, Hospital Regional de São José Homero de Miranda Gomes, São José, Brazil
| | - Daniel Santos Sousa
- Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Serviço de Neurocirurgia, Hospital Governado Celso Ramos, Florianópolis, Brazil
| | - Camila Leite Ferreira
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
| | - JoĂŁo Quevedo
- Laboratório de Neurociências, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil.,Department of Psychiatry and Behavioral Sciences McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Katia Lin
- Centro de NeurociĂŞncias Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, FlorianĂłpolis, Brazil.,Programa de PĂłs-Graduação em CiĂŞncias MĂ©dicas, UFSC, FlorianĂłpolis, Brazil.,Serviço de Neurologia, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil
| | - Emil Kupek
- Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Departmento de Saúde Pública, UFSC, Florianópolis, Brazil
| | - Cristiane Ritter
- Hospital São José, Criciúma, Brazil.,Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, UNESC, Criciúma, Brazil
| | - Felipe Dal Pizzol
- Programa de Pós-Graduação em Ciências Médicas, UFSC, Florianópolis, Brazil.,Hospital São José, Criciúma, Brazil.,Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, UNESC, Criciúma, Brazil
| | - Roger Walz
- Centro de NeurociĂŞncias Aplicadas, Universidade Federal de Santa Catarina, Hospital Universitário, FlorianĂłpolis, Brazil.,Programa de PĂłs-Graduação em NeurociĂŞncias, UFSC, FlorianĂłpolis, Brazil.,Programa de PĂłs-Graduação em CiĂŞncias MĂ©dicas, UFSC, FlorianĂłpolis, Brazil.,Serviço de Neurologia, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil
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6
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Ashley JG, Ashley MJ, Masel BE, Randle K, Kreber LA, Singh C, Harrington D, Griesbach GS. The influence of post-acute rehabilitation length of stay on traumatic brain injury outcome: a retrospective exploratory study. Brain Inj 2018; 32:600-607. [PMID: 29388849 DOI: 10.1080/02699052.2018.1432896] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Data regarding length of stay (LOS) in a rehabilitation programme after traumatic brain injury (TBI) are limited. The goal of this study was to examine the effect of LOS and disability on outcome following TBI. METHODS Records from patients in a multidisciplinary rehabilitation programme at least 3Â months after TBI were analysed retrospectively to study the influence of LOS on functional outcome at different levels of disability. Functional status was determined by the Mayo-Portland Adaptability Inventory (MPAI) and the Community Integration Questionnaire (CIQ). Patients were further grouped by time since injury of 3-12Â months or over 1Â year. RESULTS Those with a mild and moderate disabilities and over 1 year chronicity showed improvements after 90Â days of rehabilitation. Patients with a severe disability and over 1Â year chronicity required at least 180Â days to show improvements. Moderately and severely disabled patients with an injury chronicity of 3-12Â months showed improvements in the MPAI after 90Â days. However, further improvement was observed after 180Â days in the severely disabled group. CONCLUSIONS Results suggest that both, level of disability and injury chronicity, should be considered when determining LOS. Data also show an association between LOS and changes in the MPAI and CIQ.
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Affiliation(s)
- Jessica G Ashley
- a Research Department, Centre for Neuro Skills , Bakersfield , CA , USA
| | - Mark J Ashley
- a Research Department, Centre for Neuro Skills , Bakersfield , CA , USA.,d Rehabilitation Institute of the College of Education, Southern Illinois University , Carbondale , USA
| | - Brent E Masel
- a Research Department, Centre for Neuro Skills , Bakersfield , CA , USA.,c Department of Neurology , University of Texas Medical Branch , Galveston , USA
| | - Kevin Randle
- a Research Department, Centre for Neuro Skills , Bakersfield , CA , USA
| | - Lisa A Kreber
- a Research Department, Centre for Neuro Skills , Bakersfield , CA , USA
| | - Charan Singh
- a Research Department, Centre for Neuro Skills , Bakersfield , CA , USA
| | - David Harrington
- a Research Department, Centre for Neuro Skills , Bakersfield , CA , USA
| | - Grace S Griesbach
- a Research Department, Centre for Neuro Skills , Bakersfield , CA , USA.,b Department of Neurosurgery , David Geffen School of Medicine at UCLA , Los Angeles , USA
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7
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Hohl A, Zanela FA, Ghisi G, Ronsoni MF, Diaz AP, Schwarzbold ML, Dafre AL, Reddi B, Lin K, Pizzol FD, Walz R. Luteinizing Hormone and Testosterone Levels during Acute Phase of Severe Traumatic Brain Injury: Prognostic Implications for Adult Male Patients. Front Endocrinol (Lausanne) 2018; 9:29. [PMID: 29487565 PMCID: PMC5816813 DOI: 10.3389/fendo.2018.00029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/22/2018] [Indexed: 12/28/2022] Open
Abstract
Traumatic brain injury (TBI) is a worldwide core public health problem affecting mostly young male subjects. An alarming increase in incidence has turned TBI into a leading cause of morbidity and mortality in young adults as well as a tremendous resource burden on the health and welfare sector. Hormone dysfunction is highly prevalent during the acute phase of severe TBI. In particular, investigation of the luteinizing hormone (LH) and testosterone levels during the acute phase of severe TBI in male has identified a high incidence of low testosterone levels in male patients (36.5-100%) but the prognostic significance of which remains controversial. Two independent studies showed that normal or elevated levels of LH levels earlier during hospitalization are significantly associated with higher mortality/morbidity. The association between LH levels and prognosis was independent of other predictive variables such as neuroimaging, admission Glasgow coma scale, and pupillary reaction. The possible mechanisms underlying this association and further research directions in this field are discussed. Overall, current data suggest that LH levels during the acute phase of TBI might contribute to accurate prognostication and further prospective multicentric studies are required to develop more sophisticated predictive models incorporating biomarkers such as LH in the quest for accurate outcome prediction following TBI. Moreover, the potential therapeutic benefits of modulating LH during the acute phase of TBI warrant investigation.
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Affiliation(s)
- Alexandre Hohl
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Endocrinologia e Metabologia, Departamento de ClĂnica MĂ©dica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil
| | - Fernando Areas Zanela
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Gabriela Ghisi
- Serviço de Endocrinologia e Metabologia, Departamento de ClĂnica MĂ©dica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil
| | - Marcelo Fernando Ronsoni
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Endocrinologia e Metabologia, Departamento de ClĂnica MĂ©dica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil
| | - Alexandre Paim Diaz
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Psiquiatria, Departamento de ClĂnica MĂ©dica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil
| | - Marcelo Liborio Schwarzbold
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Psiquiatria, Departamento de ClĂnica MĂ©dica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil
| | - Alcir Luiz Dafre
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Departamento de BioquĂmica, Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil
| | - Benjamin Reddi
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Kátia Lin
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Neurologia, Departamento de ClĂnica MĂ©dica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil
| | - Felipe Dal Pizzol
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- LaboratĂłrio de Fisiopatologia Experimental, Universidade do Extremo Sul Catarinense (UNESC), CriciĂşma, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas (CeNAp), Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
- Serviço de Neurologia, Departamento de ClĂnica MĂ©dica, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil
- *Correspondence: Roger Walz,
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8
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Hacker D, Jones CA, Clowes Z, Belli A, Su Z, Sitaraman M, Davies D, Taylor R, Flahive E, Travis C, O'Neil N, Pettigrew Y. The Development and Psychometric Evaluation of a Supplementary Index Score of the Neuropsychological Assessment Battery Screening Module that is Sensitive to Traumatic Brain Injury. Arch Clin Neuropsychol 2016; 32:215-227. [DOI: 10.1093/arclin/acw087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 11/14/2022] Open
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9
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Global Outcome and Late Seizures After Penetrating Versus Closed Traumatic Brain Injury: A NIDRR TBI Model Systems Study. J Head Trauma Rehabil 2016; 30:231-40. [PMID: 25931183 DOI: 10.1097/htr.0000000000000127] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND If and how much dural penetration influences long-term outcome after traumatic brain injury (TBI) is understudied, especially within the civilian population. OBJECTIVES Using the large TBI Model Systems cohort, this study assessed and compared penetrating TBI (PTBI) and closed TBI with respect to global outcome and late seizures 2 years after injury. METHODS After performing unadjusted PTBI versus closed TBI comparisons, multivariate regression models were built and analyzed for both outcomes by including the following additional predictors: length of unconsciousness, posttraumatic amnesia duration, hospital length of stay, age, gender, race, marital status, education level, problem substance abuse, and preinjury employment status. RESULTS The collapsed Glasgow Outcome Scale model (n = 6111) showed significant secondary effects of PTBI with employment status. When employed before injury, individuals with PTBI were 2.62 times more likely (95% confidence interval, 1.92-3.57) to have a lower Glasgow Outcome Scale category. The final model for late seizures (n = 6737) showed a significant main effect for PTBI. Adjusting for other predictors, individuals with PTBI were 2.78 times more likely (95% confidence interval, 1.93-3.99) than those with closed TBI to be rehospitalized for a seizure. CONCLUSION This study empirically demonstrates that penetrating injury mechanism has important prognostic implications.
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Neuropsychological functioning in a national cohort of severe traumatic brain injury: demographic and acute injury-related predictors. J Head Trauma Rehabil 2016; 30:E1-12. [PMID: 24695265 DOI: 10.1097/htr.0000000000000039] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the rates of cognitive impairment 1 year after severe traumatic brain injury (TBI) and to examine the influence of demographic, injury severity, rehabilitation, and subacute functional outcomes on cognitive outcomes 1 year after severe TBI. SETTING National multicenter cohort study over 2 years. PARTICIPANTS Patients (N = 105), aged 16 years or older, with Glasgow Coma Scale score of 3 to 8 and Galveston Orientation and Amnesia Test score of more than 75. MAIN MEASURES Neuropsychological tests representing cognitive domains of Executive Functions, Processing Speed, and Memory. Injury severity included Rotterdam computed tomography score, Glasgow Coma Scale score, and posttraumatic amnesia (PTA) duration, together with length of rehabilitation and Glasgow Outcome Scale-Extended score. RESULTS In total, 67% of patients with severe TBI had cognitive impairment. Executive Functions, Processing Speed, and Memory were impaired in 41%, 58%, and 57% of patients, respectively. Using multiple regression analysis, Processing Speed was significantly related to PTA duration, Glasgow Outcome Scale-Extended score, and length of inpatient rehabilitation (R = 0.30); Memory was significantly related to Glasgow Outcome Scale-Extended score (R = 0.15); and Executive Functions to PTA duration (R = 0.10). Rotterdam computed tomography and Glasgow Coma Scale scores were not associated with cognitive functioning at 1 year postinjury. CONCLUSION Findings highlight cognitive consequences of severe TBI, with nearly two-thirds of patients showing cognitive impairments in at least 1 of 3 cognitive domains. Regarding injury severity predictors, only PTA duration was related to cognitive functioning.
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Janzen EP, Walz R, Lin K. Cross-cultural adaptation of the SCATBI instrument for cognitive-linguistic abilities after traumatic brain injury. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:939-45. [PMID: 26517218 DOI: 10.1590/0004-282x20150146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/30/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To perform the cross-cultural adaptation of the "Scales of Cognitive Ability for Traumatic Brain Injury" (SCATBI). METHOD After the translation and back-translation phases, a multidisciplinary committee judged and elaborated versions in order to maintain its conceptual equivalence, content, comprehensibility and contextual adjustment for Brazilian population. The final version was tested on 55 healthy subjects. RESULTS The individuals' mean age was 41.75 ± 17.40 years (range = 18-81), 69% were women and they had a mean schooling of 12.96 ± 4.55 years. Higher total scores were positively correlated with years of schooling (p < 0.001) and social-economic status (p = 0.001), while older aged individuals performed worse than younger ones (p = 0.001). Both genders performed similarly on all domains of the instrument, except for "organization" ability, where women performed significantly better than men (p = 0.02). CONCLUSION The Brazilian version of SCATBI is a useful tool for the diagnosis and monitoring of cognitive impairments after a traumatic brain injury.
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Affiliation(s)
- Ester Priscila Janzen
- Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Katia Lin
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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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: 42] [Impact Index Per Article: 4.7] [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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Vieira FCDF, Ronsoni MF, Hohl A, Claudino LS, Diaz AP, Schwarzbold ML, Guarnieri R, Nunes JC, Lin K, Walz R. How predictable is the erectile function of patients with epilepsy? Epilepsy Behav 2015; 47:61-5. [PMID: 26043165 DOI: 10.1016/j.yebeh.2015.04.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/23/2015] [Accepted: 04/29/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is often reported by patients with epilepsy and may be related to endocrine system abnormalities, side effects of antiepileptic drugs, psychiatric comorbidities, and family or social difficulties. AIMS This study aimed to identify independent predictor factors for ED in patients with epilepsy. MAIN OUTCOME MEASURES the five-question form of the International Index of Erectile Function (IIEF-5). METHODS Independent predictive factors for ED evaluated by the IIEF-5 questionnaire in 36 patients (mean age: 39 years) with focal epilepsy (mean: 6 seizures/month) were identified by multiple linear regression analysis. RESULTS Eight (21.1%) patients were asymptomatic. Among the symptomatic patients, 11 (28.9%) had mild dysfunction, 10 (26.3%) had moderate dysfunction, and 9 (23.7%) showed severe ED. The multiple linear regression model including family income (B=0.005; p=0.05), education levels in years (B=0.54; p=0.03), depressive symptoms determined by HADS depression subscale (B=-0.49; p=0.03), and prolactin levels (B=-0.45; p=0.07) showed a moderate association (r=0.64) with the IIEF questionnaire and explained 41% (r(2)=0.41) of its variation. CONCLUSIONS Erectile dysfunction is highly prevalent in patients with focal epilepsies. Education, depressive symptoms, and prolactin levels can predict erectile dysfunction in up to 41% of patients with epilepsy. This preliminary report justifies further efforts to make a large sample size study to identify independent biomarkers and therapeutic targets for ED treatment in patients with epilepsy.
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Affiliation(s)
| | - Marcelo Fernando Ronsoni
- Centro de NeurociĂŞncias Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil; Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil
| | - Alexandre Hohl
- Centro de NeurociĂŞncias Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil; Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil
| | - LĂşcia Sukis Claudino
- Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil; Serviço de Neurologia, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil
| | - Alexandre Paim Diaz
- Centro de NeurociĂŞncias Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil; Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil; AmbulatĂłrio de Transtornos Psiquiátricos Resistentes ao Tratamento FarmacolĂłgico (REFRACTA), Serviço de Psiquiatria, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil; Centro de Epilepsia do Estado de Santa Catarina (CEPES), Hospital Governador Celso Ramos, FlorianĂłpolis, Brazil
| | - Marcelo LibĂłrio Schwarzbold
- Centro de NeurociĂŞncias Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil; Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil; AmbulatĂłrio de Transtornos Psiquiátricos Resistentes ao Tratamento FarmacolĂłgico (REFRACTA), Serviço de Psiquiatria, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil
| | - Ricardo Guarnieri
- Centro de NeurociĂŞncias Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil; Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil; AmbulatĂłrio de Transtornos Psiquiátricos Resistentes ao Tratamento FarmacolĂłgico (REFRACTA), Serviço de Psiquiatria, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil; Centro de Epilepsia do Estado de Santa Catarina (CEPES), Hospital Governador Celso Ramos, FlorianĂłpolis, Brazil
| | - Jean Costa Nunes
- Centro de Neurociências Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil; Unidade de Neuropatologia, Serviço de Patologia, HU, UFSC, Florianópolis, Brazil
| | - Kátia Lin
- Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil; Serviço de Neurologia, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil
| | - Roger Walz
- Centro de NeurociĂŞncias Aplicadas, Hospital Universitário, Universidade Federal de Santa Catarina (UFSC), FlorianĂłpolis, Brazil; Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil; Serviço de Neurologia, Departamento de ClĂnica MĂ©dica, HU, UFSC, FlorianĂłpolis, Brazil.
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DE SOUZA RL, THAIS ME, CAVALLAZZI G, PAIM DIAZ A, SCHWARZBOLD ML, NAU AL, RODRIGUES GM, SOUZA DS, HOHL A, WALZ R. Side of pupillary mydriasis predicts the cognitive prognosis in patients with severe traumatic brain injury. Acta Anaesthesiol Scand 2015; 59:392-405. [PMID: 25678229 DOI: 10.1111/aas.12447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 10/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pupils' abnormalities are associated to bad prognosis in traumatic brain injury. We investigated the association between the side of pupil mydriasis and the long-term cognitive performance of patients with severe traumatic brain injury (TBI). METHODS We analyzed the cognitive performance of patients admitted at the intensive care unit with isochoric pupils (IP, n = 28), left mydriasis (LM, n = 10), right mydriasis (RM, n = 9) evaluated in mean 2.5 years after the severe TBI and controls (n = 26) matched for age, sex and education level. RESULTS Patients and controls had similar scores in the four WAIS-III investigated subtests. In comparison with controls, LM patients had lower scores in Letters and Category Fluency and IP patients in Category Fluency. Among the 10 evaluated memory tests, LM patients had lower scores than controls in eight, RM patients in two and IP in three memory tests. IP and RM were 3.5 to nine times more associated to significant impairment (cognitive scores under the percentile 10 of controls) in six of 16 investigated cognitive tests. LM was six to 15 times more associated to significant impairment in 10 of 16 cognitive tests. The association among the pupil abnormalities and cognitive performances remained significant after the multiple linear regression analysis controlling for age, gender, admission coma Glasgow scale and serum glucose, presence of associated trauma, and cranial computed tomography abnormalities. CONCLUSION Side of admission pupil abnormalities may be a useful variable to improve prognostic models for long-term cognitive performance in severe TBI patients.
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Affiliation(s)
- R. L. DE SOUZA
- Centro de Neurociências Aplicadas (CeNAp); Hospital Universitário (HU); Universidade Federal de Santa Catarina (UFSC); Florianópolis SC Brazil
- Unidade de Terapia Intensiva; Hospital Governador Celso Ramos (HGCR); FlorianĂłpolis SC Brazil
- Unidade de Terapia Intensiva; HU; UFSC; FlorianĂłpolis SC Brazil
| | - M. E. THAIS
- Centro de Neurociências Aplicadas (CeNAp); Hospital Universitário (HU); Universidade Federal de Santa Catarina (UFSC); Florianópolis SC Brazil
| | - G. CAVALLAZZI
- Centro de Neurociências Aplicadas (CeNAp); Hospital Universitário (HU); Universidade Federal de Santa Catarina (UFSC); Florianópolis SC Brazil
| | - A. PAIM DIAZ
- Centro de Neurociências Aplicadas (CeNAp); Hospital Universitário (HU); Universidade Federal de Santa Catarina (UFSC); Florianópolis SC Brazil
| | - M. L. SCHWARZBOLD
- Centro de Neurociências Aplicadas (CeNAp); Hospital Universitário (HU); Universidade Federal de Santa Catarina (UFSC); Florianópolis SC Brazil
| | - A. L. NAU
- Centro de Neurociências Aplicadas (CeNAp); Hospital Universitário (HU); Universidade Federal de Santa Catarina (UFSC); Florianópolis SC Brazil
| | - G. M. RODRIGUES
- Centro de Neurociências Aplicadas (CeNAp); Hospital Universitário (HU); Universidade Federal de Santa Catarina (UFSC); Florianópolis SC Brazil
| | - D. S. SOUZA
- Serviço de Neurocirurgia; HGCR; Florianópolis SC Brazil
| | - A. HOHL
- Centro de Neurociências Aplicadas (CeNAp); Hospital Universitário (HU); Universidade Federal de Santa Catarina (UFSC); Florianópolis SC Brazil
| | - R. WALZ
- Centro de Neurociências Aplicadas (CeNAp); Hospital Universitário (HU); Universidade Federal de Santa Catarina (UFSC); Florianópolis SC Brazil
- Departamento de ClĂnica MĂ©dica; HU; UFSC; FlorianĂłpolis SC Brazil
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Mathias JL, Harman-Smith Y, Bowden SC, Rosenfeld JV, Bigler ED. Contribution of psychological trauma to outcomes after traumatic brain injury: assaults versus sporting injuries. J Neurotrauma 2014; 31:658-69. [PMID: 24228916 DOI: 10.1089/neu.2013.3160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clinical research into outcomes after traumatic brain injury (TBI) frequently combines injuries that have been sustained through different causes (e.g., car accidents, assaults, and falls), the effect of which is not well understood. This study examined the contribution of injury-related psychological trauma—which is more commonly associated with specific types of injuries—to outcomes after nonpenetrating TBI in order to determine whether it may be having a differential effect in samples containing mixed injuries. Data from three groups that were prospectively recruited for two larger studies were compared: one that sustained a TBI as a result of physical assaults (i.e., psychologically traumatizing) and another as a result of sporting injuries (i.e., nonpsychologically traumatizing), as well as an orthopedic control group (OC). Psychosocial and emotional (postconcussion symptoms, injury-related stress, and depression), cognitive (memory, abstract reasoning, problem solving, and verbal fluency), and functional (general outcome; resumption of home, social, and work roles) outcomes were all assessed. The TBI(assault) group reported significantly poorer psychosocial and emotional outcomes and higher rates of litigation (criminal rather than civil) than both the TBI(sport) and OC groups approximately 6 months postinjury, but there were no differences in the cognitive or functional outcomes of the three groups. The findings suggest that the cause of a TBI may assist in explaining some of the differences in outcomes of people who have seemingly comparable injuries. Involvement in litigation and the cause of an injury may also be confounded, which may lead to the erroneous conclusion that litigants have poorer outcomes.
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Corrigan JD, Kreider S, Cuthbert J, Whyte J, Dams-O’Connor K, Faul M, Harrison-Felix C, Whiteneck G, Pretz CR. Components of traumatic brain injury severity indices. J Neurotrauma 2014; 31:1000-7. [PMID: 24521197 PMCID: PMC4677389 DOI: 10.1089/neu.2013.3145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The purpose of this study was to determine whether there are underlying dimensions common among traditional traumatic brain injury (TBI) severity indices and, if so, the extent to which they are interchangeable when predicting short-term outcomes. This study had an observational design, and took place in United States trauma centers reporting to the National Trauma Data Bank (NTDB). The sample consisted of 77,470 unweighted adult cases reported to the NTDB from 2007 to 2010, with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) TBI codes. There were no interventions. Severity indices used were the Emergency Department Glasgow Coma Scale (GCS) Total score and each of the subscales for eye opening (four levels), verbal response (five levels), and motor response (six levels); the worst Abbreviated Injury Scale (AIS) severity score for the head (six levels); and the worst Barell index type (three categories). Prediction models were computed for acute care length of stay (days), intensive care unit length of stay (days), hospital discharge status (alive or dead), and, if alive, discharge disposition (home versus institutional). Multiple correspondence analysis (MCA) indicated a two dimensional relationship among items of severity indexes. The primary dimension reflected overall injury severity. The second dimension seemed to capture volitional behavior without the capability for cogent responding. Together, they defined two vectors around which most of the items clustered. A scale that took advantage of the order of items along these vectors proved to be the most consistent index for predicting short-term health outcomes. MCA provided useful insight into the relationships among components of traditional TBI severity indices. The two vector pattern may reflect the impact of injury on different cortical and subcortical networks. Results are discussed in terms of score substitution and the ability to impute missing values.
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Affiliation(s)
- John D. Corrigan
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus Ohio
| | - Scott Kreider
- Research Department, Craig Hospital, Englewood, Colorado
| | | | - John Whyte
- Moss Rehabilitation Research Institute, Albert Einstein Healthcare Network, Elkins Park, Pennsylvania
| | - Kristen Dams-O’Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark Faul
- National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Gale Whiteneck
- Research Department, Craig Hospital, Englewood, Colorado
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