Firearm-Related Traumatic Brain Injury Homicides in the United States, 2000-2019

Disparities in traumatic brain injury-related deaths-the United States, 2021

OBJECTIVES

This manuscript describes traumatic brain injury (TBI)-related mortality in the United States during 2021, by geography, sociodemographic characteristics, mechanism of injury, and injury intent.

METHOD

Multivariable modeling of TBI mortality was performed to assess the simultaneous effect of multiple factors (geographic region, sex, race and ethnicity, and age) included in the model. Authors analyzed multiple-cause-of-death data from the National Vital Statistics System and included records when an International Classification of Diseases, Tenth Revision (ICD-10) underlying cause of death injury code, and a TBI-related ICD-10 diagnosis code were both listed.

RESULTS

During 2021, there were 69,473 TBI-related deaths. Rates were highest among older adults, males, and non-Hispanic American Indian/Alaska Native persons. A large proportion of all TBI-related deaths were attributed to unintentional falls and suicides. Model-based rates of TBI mortality revealed a divergent pattern with increasing rates by age group, while rate ratios simultaneously declined with age among specific racial/ethnic groups when compared with non-Hispanic White persons.

CONCLUSION

Findings indicate unintentional falls and suicides remain a common cause of fatal TBI and specific groups are disproportionally affected by such injuries. Health care providers can play a role by assessing patients at increased risk for TBI and providing referrals for care and culturally tailored interventions when warranted.

Comparative Analysis of Clinical Severity and Outcomes in Penetrating Versus Blunt Traumatic Brain Injury Propensity Matched Cohorts

Traumatic brain injury (TBI) is a global health challenge; however, penetrating brain injury (PBI) remains under-represented in evidence-based knowledge and research efforts. This study utilized data from the Trauma Quality Improvement Program (TQIP) of the National Trauma Data Bank (NTDB) to investigate outcomes of PBI as compared with clinical-severity-matched non-penetrating or blunt TBI. A total of 1765 patients with PBI were 1:1 propensity score-matched for clinical severity with blunt TBI patients. The intent of PBI was self-inflicted in 34.1% of the cases, and the mechanism was firearm-inflicted in 89.1%. Mortality was found to be significantly more common in PBI than in the severity- matched TBI cohort (33.9% vs. 14.3 %, p < 0.001) as was unfavorable outcome. Mortality was mediated by withdrawal of life-sustaining therapies (WOLST) 30% of the time, and WOLST occurred earlier (median 3 days vs. 6 days, p < 0.001) in PBI. Increased rate of mortality was observed with a Glasgow Coma Scale (GCS) of <11 in PBI as compared with <7 in blunt TBI. In conclusion, PBI patients exhibited higher mortality rates and unfavorable outcomes; one third of excess mortality was mediated by WOLST. The study also brings into question the applicability of the conventional TBI classification, based on GCS, in PBI. We emphasize the need to address the observed disparities and better understand the distinctive characteristics and mechanisms underlying PBI outcomes to improve patient care and reduce mortality.

Dopamine enhances recovery after traumatic brain injury through ubiquitylation and autophagic degradation of RIPK1

BACKGROUND

Although the neurotransmitter dopamine (DA) plays a crucial pathophysiologic role after traumatic brain injury (TBI), its function and specific underlying mechanisms of action remain unclear.

METHODS

Adult male mice underwent controlled cortical impact (CCI). We administered DA intraperitoneally to mice for 14 consecutive days, starting 8 h before CCI. On day 3 after brain injury, cortical lesion volume and brain water content were measured. On days 7-13, behavioral tests were performed.

RESULTS

Herein we report that DA inhibits neural death after injury, which is mediated via the dopamine D1 receptor (DRD1). Our results also showed that DRD1 signaling promotes RIPK1 ubiquitination via the E3 ubiquitin ligase Chip and then degradation through autophagy. Importantly, in vivo data revealed that DRD1 signaling prevented neural death, suppressed neuroinflammation, and restored many TBI-related functional sequelae.

CONCLUSIONS

These data reveal a novel mechanism involving dopamine, and suggest that DRD1 activation positively regulates Chip-mediated ubiquitylation of RIPK1-leading to its autophagic degradation.

Penetrating Firearm-Inflicted Injury-The Neglected Traumatic Brain Injury

This Viewpoint discusses penetrating firearm-inflicted brain injury and the current collaborative efforts to perform more penetrating brain injury–specific randomized clinical trials and comparative effectiveness research to identify effective management guidelines.