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Lang L, Wang T, Xie L, Yang C, Skudder-Hill L, Jiang J, Gao G, Feng J. An independently validated nomogram for individualised estimation of short-term mortality risk among patients with severe traumatic brain injury: a modelling analysis of the CENTER-TBI China Registry Study. EClinicalMedicine 2023; 59:101975. [PMID: 37180469 PMCID: PMC10173159 DOI: 10.1016/j.eclinm.2023.101975] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/02/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Background Severe traumatic brain injury (sTBI) is extremely disabling and associated with high mortality. Early detection of patients at risk of short-term (≤14 days after injury) death and provision of timely treatment is critical. This study aimed to establish and independently validate a nomogram to estimate individualised short-term mortality for sTBI based on large-scale data from China. Methods The data were from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) China registry (between Dec 22, 2014, and Aug 1, 2017; registered at ClinicalTrials.gov, NCT02210221). This analysis included information of eligible patients with diagnosed sTBI from 52 centres (2631 cases). 1808 cases from 36 centres were enrolled in the training group (used to construct the nomogram) and 823 cases from 16 centres were enrolled in the validation group. Multivariate logistic regression was used to identify independent predictors of short-term mortality and establish the nomogram. The discrimination of the nomogram was evaluated using area under the receiver operating characteristic curves (AUC) and concordance indexes (C-index), the calibration was evaluated using calibration curves and Hosmer-Lemeshow tests (H-L tests). Decision curve analysis (DCA) was used to evaluate the net benefit of the model for patients. Findings In the training group, multivariate logistic regression demonstrated that age (odds ratio [OR] 1.013, 95% confidence interval [CI] 1.003-1.022), Glasgow Coma Scale score (OR 33.997, 95% CI 14.657-78.856), Injury Severity Score (OR 1.020, 95% CI 1.009-1.032), abnormal pupil status (OR 1.738, 95% CI 1.178-2.565), midline shift (OR 2.266, 95% CI 1.378-3.727), and pre-hospital intubation (OR 2.059, 95% CI 1.472-2.879) were independent predictors for short-term death in patients with sTBI. A nomogram was built using the logistic regression prediction model. The AUC and C-index were 0.859 (95% CI 0.837-0.880). The calibration curve of the nomogram was close to the ideal reference line, and the H-L test p value was 0.504. DCA curve demonstrated significantly better net benefit with the model. Application of the nomogram in external validation group still showed good discrimination (AUC and C-index were 0.856, 95% CI 0.827-0.886), calibration, and clinical usefulness. Interpretation A nomogram was developed for predicting the occurrence of short-term (≤14 days after injury) death in patients with sTBI. This can provide clinicians with an effective and accurate tool for the early prediction and timely management of sTBI, as well as support clinical decision-making around the withdrawal of life-sustaining therapy. This nomogram is based on Chinese large-scale data and is especially relevant to low- and middle-income countries. Funding Shanghai Academic Research Leader (21XD1422400), Shanghai Medical and Health Development Foundation (20224Z0012).
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Affiliation(s)
- Lijian Lang
- Brain Injury Centre, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
- Shanghai Institute of Head Trauma, 160 Pujian Road, Shanghai, 200127, China
| | - Tianwei Wang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Dadao, Haizhu District, Guangzhou, 510282, China
| | - Li Xie
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, 227 Chongqing Road, Shanghai, China
| | - Chun Yang
- Shanghai Institute of Head Trauma, 160 Pujian Road, Shanghai, 200127, China
| | - Loren Skudder-Hill
- Department of Neurosurgery, Yuquan Hospital Affiliated to Tsinghua University School of Clinical Medicine, 5 Shijingshan Road, Shijingshan, Beijing, 100049, China
| | - Jiyao Jiang
- Brain Injury Centre, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
- Shanghai Institute of Head Trauma, 160 Pujian Road, Shanghai, 200127, China
| | - Guoyi Gao
- Shanghai Institute of Head Trauma, 160 Pujian Road, Shanghai, 200127, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Corresponding author. Shanghai Institute of Head Trauma, 160 Pujian Road, Shanghai, 200127, China.
| | - Junfeng Feng
- Brain Injury Centre, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
- Shanghai Institute of Head Trauma, 160 Pujian Road, Shanghai, 200127, China
- Corresponding author. Brain Injury Centre, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai, China.
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2
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Rahim S, Laugsand EA, Fyllingen EH, Rao V, Pantelatos RI, Müller TB, Vik A, Skandsen T. Moderate and severe traumatic brain injury in general hospitals: a ten-year population-based retrospective cohort study in central Norway. Scand J Trauma Resusc Emerg Med 2022; 30:68. [PMID: 36494745 PMCID: PMC9733333 DOI: 10.1186/s13049-022-01050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with moderate and severe traumatic brain injury (TBI) are admitted to general hospitals (GHs) without neurosurgical services, but few studies have addressed the management of these patients. This study aimed to describe these patients, the rate of and reasons for managing patients entirely at the GH, and differences between patients managed entirely at the GH (GH group) and patients transferred to the regional trauma centre (RTC group). We specifically examined the characteristics of elderly patients. METHODS Patients with moderate (Glasgow Coma Scale score 9-13) and severe (score ≤ 8) TBIs who were admitted to one of the seven GHs without neurosurgical services in central Norway between 01.10.2004 and 01.10.2014 were retrospectively identified. Demographic, injury-related and outcome data were collected from medical records. Head CT scans were reviewed. RESULTS Among 274 patients admitted to GHs, 137 (50%) were in the GH group. The transferral rate was 58% for severe TBI and 40% for moderate TBI. Compared to the RTC group, patients in the GH group were older (median age: 78 years vs. 54 years, p < 0.001), more often had a preinjury disability (50% vs. 39%, p = 0.037), and more often had moderate TBI (52% vs. 35%, p = 0.005). The six-month case fatality rate was low (8%) in the GH group when transferral was considered unnecessary due to a low risk of further deterioration and high (90%, median age: 87 years) when neurosurgical intervention was considered nonbeneficial. Only 16% of patients ≥ 80 years old were transferred to the RTC. For this age group, the in-hospital case fatality rate was 67% in the GH group and 36% in the RTC group and 84% and 73%, respectively, at 6 months. CONCLUSIONS Half of the patients were managed entirely at a GH, and these were mainly patients considered to have a low risk of further deterioration, patients with moderate TBI, and elderly patients. Less than two of ten patients ≥ 80 years old were transferred, and survival was poor regardless of the transferral status.
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Affiliation(s)
- Shavin Rahim
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Eivor Alette Laugsand
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway ,grid.414625.00000 0004 0627 3093Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600 Levanger, Norway ,grid.52522.320000 0004 0627 3560Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Even Hovig Fyllingen
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, 7491 Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7006 Trondheim, Norway
| | - Vidar Rao
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Rabea Iris Pantelatos
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
| | - Tomm Brostrup Müller
- grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Anne Vik
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Toril Skandsen
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Clinic of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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3
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In the Aftermath of Acute Hospitalization for Traumatic Brain Injury: Factors Associated with the Direct Pathway into Specialized Rehabilitation. J Clin Med 2021; 10:jcm10163577. [PMID: 34441872 PMCID: PMC8397212 DOI: 10.3390/jcm10163577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022] Open
Abstract
Previous research has demonstrated that early initiation of rehabilitation and direct care pathways improve outcomes for patients with severe traumatic brain injury (TBI). Despite this knowledge, there is a concern that a number of patients are still not included in the direct care pathway. The study aim was to provide an updated overview of discharge to rehabilitation following acute care and identify factors associated with the direct pathway. We analyzed data from the Oslo TBI Registry—Neurosurgery over a five-year period (2015–2019) and included 1724 adults with intracranial injuries. We described the patient population and applied multivariable logistic regression to investigate factors associated with the probability of entering the direct pathway. In total, 289 patients followed the direct pathway. For patients with moderate–severe TBI, the proportion increased from 22% to 35% during the study period. Significant predictors were younger age, low preinjury comorbidities, moderate–severe TBI and disability due to TBI at the time of discharge. In patients aged 18–29 years, 53% followed the direct pathway, in contrast to 10% of patients aged 65–79 years (moderate–severe TBI). This study highlights the need for further emphasis on entering the direct pathway to rehabilitation, particularly for patients aged >64 years.
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4
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Brazinova A, Rehorcikova V, Taylor MS, Buckova V, Majdan M, Psota M, Peeters W, Feigin V, Theadom A, Holkovic L, Synnot A. Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review. J Neurotrauma 2021; 38:1411-1440. [PMID: 26537996 PMCID: PMC8082737 DOI: 10.1089/neu.2015.4126] [Citation(s) in RCA: 226] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This systematic review provides a comprehensive, up-to-date summary of traumatic brain injury (TBI) epidemiology in Europe, describing incidence, mortality, age, and sex distribution, plus severity, mechanism of injury, and time trends. PubMed, CINAHL, EMBASE, and Web of Science were searched in January 2015 for observational, descriptive, English language studies reporting incidence, mortality, or case fatality of TBI in Europe. There were no limitations according to date, age, or TBI severity. Methodological quality was assessed using the Methodological Evaluation of Observational Research checklist. Data were presented narratively. Sixty-six studies were included in the review. Country-level data were provided in 22 studies, regional population or treatment center catchment area data were reported by 44 studies. Crude incidence rates varied widely. For all ages and TBI severities, crude incidence rates ranged from 47.3 per 100,000, to 694 per 100,000 population per year (country-level studies) and 83.3 per 100,000, to 849 per 100,000 population per year (regional-level studies). Crude mortality rates ranged from 9 to 28.10 per 100,000 population per year (country-level studies), and 3.3 to 24.4 per 100,000 population per year (regional-level studies.) The most common mechanisms of injury were traffic accidents and falls. Over time, the contribution of traffic accidents to total TBI events may be reducing. Case ascertainment and definitions of TBI are variable. Improved standardization would enable more accurate comparisons.
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Affiliation(s)
- Alexandra Brazinova
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Veronika Rehorcikova
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Mark S Taylor
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Veronika Buckova
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Marek Majdan
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Marek Psota
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Wouter Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- National Institute for Stroke and Applied Neuroscience, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lubomir Holkovic
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Anneliese Synnot
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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5
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Rønning P, Helseth E, Skaansar O, Tverdal C, Andelic N, Bhatnagar R, Melberg M, Skaga NO, Aarhus M, Halvorsen S, Helseth R. Impact of Preinjury Antithrombotic Therapy on 30-Day Mortality in Older Patients Hospitalized With Traumatic Brain Injury (TBI). Front Neurol 2021; 12:650695. [PMID: 34054695 PMCID: PMC8155515 DOI: 10.3389/fneur.2021.650695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
Objective: Elderly patients are frequently in need of antithrombotic therapy for reducing thrombotic events. The association between antithrombotic drugs and survival after traumatic brain injury (TBI) is, nevertheless, unclear. Methods: This retrospective study included patients ≥65 years admitted to a Norwegian Level 1 trauma center with TBI identified on cerebral computed tomography (cerebral-CT) during 2014–2019. Preinjury use of antiplatelets and anticoagulants was compared to the prescription rate in the general Norwegian population. The primary outcome was 30-day mortality. Uni- and multivariate logistic regression analyses estimated the association between the use of antithrombotic drugs and mortality. Results: The study includes 832 consecutive TBI patients ≥65 years. The median age was 76 years, 58% were males, 51% had moderate or severe TBI, and 39% had multiple traumas. Preinjury use of antithrombotics was registered in 471/832 (55.6%) patients; antiplatelet therapy alone in 268, anticoagulant therapy alone in 172, and combined antiplatelet and anticoagulant therapy in 31. Antiplatelet use did not differ between the study cohort and the general Norwegian population ≥65 years (31 vs. 31%, p = 0.87). Anticoagulant therapy was used more commonly in the study cohort than in the general Norwegian population (24 vs. 19%, p = 0.04). Combined use of antiplatelet and anticoagulant therapy was significantly associated with 30-day mortality, while preinjury antiplatelet or anticoagulation treatment alone was not. No difference in 30-day mortality between patients using VKA, DOACs, or LMWH was encountered. Conclusions: In this cohort, neither antiplatelet nor anticoagulant therapy alone was associated with increased 30-day mortality. Anticoagulant use was more prevalent among TBI patients than the general population, suggesting that anticoagulation might contribute to the initiation of intracranial bleeding after blunt head trauma. Combined antiplatelet and anticoagulant therapy posed increased risk of 30-day mortality.
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Affiliation(s)
- Pål Rønning
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Eirik Helseth
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ola Skaansar
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Cathrine Tverdal
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Rahul Bhatnagar
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Mathias Melberg
- Department of Pulmonology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Mads Aarhus
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Sigrun Halvorsen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Ragnhild Helseth
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
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Moe HK, Follestad T, Andelic N, Håberg AK, Flusund AMH, Kvistad KA, Saksvoll EH, Olsen Ø, Abel-Grüner S, Sandrød O, Skandsen T, Vik A, Moen KG. Traumatic axonal injury on clinical MRI: association with the Glasgow Coma Scale score at scene of injury or at admission and prolonged posttraumatic amnesia. J Neurosurg 2020; 135:562-573. [PMID: 33096528 DOI: 10.3171/2020.6.jns20112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim in this study was to investigate if MRI findings of traumatic axonal injury (TAI) after traumatic brain injury (TBI) are related to the admission Glasgow Coma Scale (GCS) score and prolonged duration of posttraumatic amnesia (PTA). METHODS A total of 490 patients with mild to severe TBI underwent brain MRI within 6 weeks of injury (mild TBI: median 2 days; moderate to severe TBI: median 8 days). The location of TAI lesions and measures of total TAI lesion burden (number and volume of lesions on FLAIR and diffusion-weighted imaging and number of lesions on T2*-weighted gradient echo or susceptibility-weighted imaging) were quantified in a blinded manner for clinical information. The volume of contusions on FLAIR was likewise recorded. Associations between GCS score and the location and burden of TAI lesions were examined with multiple linear regression, adjusted for age, Marshall CT score (which includes compression of basal cisterns, midline shift, and mass lesions), and alcohol intoxication. The predictive value of TAI lesion location and burden for duration of PTA > 28 days was analyzed with multiple logistic regression, adjusted for age and Marshall CT score. Complete-case analyses of patients with TAI were used for the regression analyses of GCS scores (n = 268) and PTA (n = 252). RESULTS TAI lesions were observed in 58% of patients: in 7% of mild, 69% of moderate, and 93% of severe TBI cases. The TAI lesion location associated with the lowest GCS scores were bilateral lesions in the brainstem (mean difference in GCS score -2.5), followed by lesions bilaterally in the thalamus, unilaterally in the brainstem, and lesions in the splenium. The volume of TAI on FLAIR was the measure of total lesion burden most strongly associated with the GCS score. Bilateral TAI lesions in the thalamus had the largest predictive value for PTA > 28 days (OR 16.2, 95% CI 3.9-87.4). Of the measures of total TAI lesion burden, the FLAIR volume of TAI predicted PTA > 28 days the best. CONCLUSIONS Bilateral TAI lesions in the brainstem and thalamus, as well as the total volume of TAI lesions on FLAIR, had the strongest association with the GCS score and prolonged PTA. The current study proposes a first step toward a modified classification of TAI, with grades ranked according to their relation to these two measures of clinical TBI severity.
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Affiliation(s)
| | - Turid Follestad
- 2Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim
| | - Nada Andelic
- 3Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo
- 4Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ullevål
| | - Asta Kristine Håberg
- Departments of1Neuromedicine and Movement Science and
- Departments of5Radiology and Nuclear Medicine
| | - Anne-Mari Holte Flusund
- Departments of1Neuromedicine and Movement Science and
- 6Department of Radiology, Molde Hospital, Molde; and
| | | | - Elin Hildrum Saksvoll
- 7Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Øystein Olsen
- 7Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | | | - Toril Skandsen
- Departments of1Neuromedicine and Movement Science and
- 9Physical Medicine and Rehabilitation, and
| | - Anne Vik
- Departments of1Neuromedicine and Movement Science and
- 10Neurosurgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim
| | - Kent Gøran Moen
- Departments of1Neuromedicine and Movement Science and
- 7Department of Radiology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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7
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Skaansar O, Tverdal C, Rønning PA, Skogen K, Brommeland T, Røise O, Aarhus M, Andelic N, Helseth E. Traumatic brain injury-the effects of patient age on treatment intensity and mortality. BMC Neurol 2020; 20:376. [PMID: 33069218 PMCID: PMC7568018 DOI: 10.1186/s12883-020-01943-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background Ageing is associated with worse treatment outcome after traumatic brain injury (TBI). This association may lead to a self-fulfilling prophecy that affects treatment efficacy. The aim of the current study was to evaluate the role of treatment bias in patient outcomes by studying the intensity of diagnostic procedures, treatment, and overall 30-day mortality in different age groups of patients with TBI. Methods Included in this study was consecutively admitted patients with TBI, aged ≥ 15 years, with a cerebral CT showing intracranial signs of trauma, during the time-period between 2015–2018. Data were extracted from our prospective quality control registry for admitted TBI patients. As a measure of management intensity in different age groups, we made a composite score, where placement of intracranial pressure monitor, ventilator treatment, and evacuation of intracranial mass lesion each gave one point. Uni- and multivariate survival analyses were performed using logistic multinomial regression. Results A total of 1,571 patients with TBI fulfilled the inclusion criteria. The median age was 58 years (range 15–98), 70% were men, and 39% were ≥ 65 years. Head injury severity was mild in 706 patients (45%), moderate in 437 (28%), and severe in 428 (27%). Increasing age was associated with less management intensity, as measured using the composite score, irrespective of head injury severity. Multivariate analyses showed that the following parameters had a significant association with an increased risk of death within 30 days of trauma: increasing age, severe comorbidities, severe TBI, Rotterdam CT-score ≥ 3, and low management intensity. Conclusion The present study indicates that the management intensity of hospitalised patients with TBI decreased with advanced age and that low management intensity was associated with an increased risk of 30-day mortality. This suggests that the high mortality among elderly TBI patients may have an element of treatment bias and could in the future be limited with a more aggressive management regime.
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Affiliation(s)
- Ola Skaansar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Cathrine Tverdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | - Karoline Skogen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Tor Brommeland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Olav Røise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Mads Aarhus
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
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8
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Tverdal C, Aarhus M, Andelic N, Skaansar O, Skogen K, Helseth E. Characteristics of traumatic brain injury patients with abnormal neuroimaging in Southeast Norway. Inj Epidemiol 2020; 7:45. [PMID: 32867838 PMCID: PMC7461333 DOI: 10.1186/s40621-020-00269-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background The vast majority of hospital admitted patients with traumatic brain injury (TBI) will have intracranial injury identified by neuroimaging, requiring qualified staff and hospital beds. Moreover, increased pressure in health care services is expected because of an aging population. Thus, a regular evaluation of characteristics of hospital admitted patients with TBI is needed. Oslo TBI Registry – Neurosurgery prospectively register all patients with TBI identified by neuroimaging admitted to a trauma center for southeast part of Norway. The purpose of this study is to describe this patient population with respect to case load, time of admission, age, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival. Methods Data for 5 years was extracted from Oslo TBI Registry – Neurosurgery. Case load, time of admission, age, sex, comorbidity, injury mechanism, injury characteristics, length of stay, and 30-days survival was compiled and compared. Results From January 1st, 2015 to December 31st, 2019, 2153 consecutive patients with TBI identified by neuroimaging were registered. The admission rate of TBI of all severities has been stable year-round since 2015. Mean age was 52 years (standard deviation 25, range 0–99), and 68% were males. Comorbidities were common; 28% with pre-injury ASA score of ≥3 and 25% used antithrombotic medication. The dominating cause of injury in all ages was falls (55%) but increased with age. Upon admission, the head injury was classified as mild TBI in 46%, moderate in 28%, and severe (Glasgow coma score ≤ 8) in 26%. Case load was stable without seasonal variation. Majority of patients (68%) were admitted during evening, night or weekend. 68% was admitted to intensive care unit. Length of hospital stay was 4 days (median, interquartile range 3–9). 30-day survival for mild, moderate and severe TBI was 98, 94 and 69%, respectively. Conclusions The typical TBI patients admitted to hospital with abnormal neuroimaging were aged 50–79 years, often with significant comorbidity, and admitted outside ordinary working hours. This suggests the necessity for all-hour presence of competent health care professionals.
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Affiliation(s)
- Cathrine Tverdal
- Department of Neurosurgery, Ullevål Hospital, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Mads Aarhus
- Department of Neurosurgery, Ullevål Hospital, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ola Skaansar
- Department of Neurosurgery, Ullevål Hospital, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karoline Skogen
- Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Department of Neurosurgery, Ullevål Hospital, Oslo University Hospital, P. O. Box 4956 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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9
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Anke A, Røe C, Sigurdardottir S, Norup A, Soberg HL, Arango-Lasprilla JC, Manskow US. Family needs at one and two years after severe traumatic brain injury: a prospective study of changes and predictors. Brain Inj 2019; 34:89-97. [DOI: 10.1080/02699052.2019.1682191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway
- Faculty of Health Sciences, Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | | | - Anne Norup
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helene L. Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Juan Carlos Arango-Lasprilla
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- IKERBASQUE, Basque Foundation For Science, Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Unn Sollid Manskow
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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10
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Abstract
Objectives: Traumatic brain injury continue to be a public health issue, mainly as a result of road accidents and falls. Current epidemiological studies appear to be necessary for a better understanding and monitoring of this problem. This paper analyzes the evolution of these cases in Portugal from the late 1990s to 2014. Methods: The number of hospital admissions and of total mortality in the country were analyzed regarding 2011 and 2014. The results were compared with values obtained previously, for 1997. Results: Incidence rate decreased, being 137/100 000 in 1997 and 65/100 000 in 2014. The mortality rate has also decreased from 17/100 000 to 10/100 000. However, between 2011 and 2014, there was a trend to increase the total number of cases. The incidence rate by age group also differs, with fewer cases in the young adult population in 2014 contrasting with a very high mortality among people aged 80 or older, of 57/100 000. Men continue to show a greater incidence, presenting more hospitalization cases (1.4:1), and higher mortality (2.3:1). Conclusions: The results are consistent with other studies, revealing a decrease in cases, but a high mortality in the elderly population, and the need of more preventive measures.
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Affiliation(s)
- Maria Emilia Santos
- Universidade Católica Portuguesa Ringgold standard institution, Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences , Lisbon , Portugal
| | - Nicole Agrela
- Universidade Católica Portuguesa Ringgold standard institution, Institute of Health Sciences , Lisbon , Portugal
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11
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Sigurdardottir S, Andelic N, Wehling E, Anke A, Skandsen T, Holthe OO, Manskow US, Roe C. Return to work after severe traumatic brain injury: a national study with a one-year follow-up of neurocognitive and behavioural outcomes. Neuropsychol Rehabil 2018; 30:281-297. [PMID: 29667477 DOI: 10.1080/09602011.2018.1462719] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The objectives were to investigate the frequency of return-to-work (RTW) one year after severe traumatic brain injury (sTBI: Glasgow Coma Scale, GCS 3-8) and to identify which demographic and injury-related characteristics and neurocognitive factors are associated with RTW. This study is part of a prospective national study on sTBI conducted in all four Norwegian Trauma Referral Centres, including patients aged >15 years over a period of three years (n = 378). For the purpose of this study, only pre-employed individuals of working age (16 to 67 years) were investigated for RTW (n = 143), and of these, 104 participants underwent neuropsychological testing. Measures of acute injury severity, neuropsychological composite scores (Memory, Processing Speed, Executive Functions) at the one-year follow-up, and the Behaviour Rating Inventory of Executive Functions (patient- and relative reports) were explored as predictors of RTW. The frequency of RTW was 54.5%. Multivariate logistic regression analyses identified younger age, shorter length of stay in intensive care, better Processing Speed scores, and lower levels of metacognitive difficulties as rated by relatives as significant predictors of RTW. Findings support the importance of neuropsychological measures in predicting long-term RTW and highlight the need to address neurocognitive and behavioural difficulties to improve RTW after sTBI.
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Affiliation(s)
- Solrun Sigurdardottir
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Eike Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway.,Department of Clinical Medicine, University of Tromso, The Arctic University of Norway, Tromso, Norway
| | - Toril Skandsen
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Heath Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oyvor Oistensen Holthe
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Unn Sollid Manskow
- Department of Rehabilitation, University Hospital of North Norway, Tromso, Norway.,Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromso, Tromso, Norway
| | - Cecilie Roe
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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12
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Tollefsen MH, Vik A, Skandsen T, Sandrød O, Deane SF, Rao V, Moen KG. Patients with Moderate and Severe Traumatic Brain Injury: Impact of Preinjury Platelet Inhibitor or Warfarin Treatment. World Neurosurg 2018. [PMID: 29524716 DOI: 10.1016/j.wneu.2018.02.167] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We aimed to examine the effect of preinjury antithrombotic medication on clinical and radiologic neuroworsening in traumatic brain injury (TBI) and study the effect on outcome. METHODS A total of 184 consecutive patients ≥50 years old with moderate and severe TBI admitted to a level 1 trauma center were included. Neuroworsening was assessed clinically by using the Glasgow Coma Scale (GCS) score and radiologically by using the Rotterdam CT score on repeated time points. Functional outcome was assessed with the Glasgow Outcome Scale Extended 6 months after injury. RESULTS The platelet inhibitor group (mean age, 77.3 years; n = 43) and the warfarin group (mean age, 73.2 years; n = 20) were significantly older than the nonuser group (mean age, 63.7 years; n = 121; P ≤ 0.001). In the platelet inhibitor group 74% and in the warfarin group, 85% were injured by falls. Platelet inhibitors were not significantly associated with clinical or radiologic neuroworsening (P = 0.37-1.00), whereas warfarin increased the frequency of worsening in GCS score (P = 0.001-0.028) and Rotterdam CT score (P = 0.004). In-hospital mortality was higher in the platelet inhibitor group (28%; P = 0.030) and the warfarin group (50%; P < 0.001) compared with the nonuser group (13%). Platelet inhibitors did not predict mortality or worse outcome after adjustment for age, preinjury disability, GCS score, and Rotterdam CT score, whereas warfarin predicted both mortality and worse outcome. CONCLUSIONS In this study of patients with moderate and severe TBI, preinjury platelet inhibitors did not cause neuroworsening or predict higher mortality or worse outcome. In contrast, preinjury warfarin caused neuroworsening and was an independent risk factor for mortality and worse outcome at 6 months. Hence, fall prevention and liberal use of computed tomography examinations is important in this patient group.
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Affiliation(s)
- Marie Hexeberg Tollefsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Oddrun Sandrød
- Department of Anesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Susan Frances Deane
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vidar Rao
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kent Gøran Moen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Medical Imaging, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
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13
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Mohamed WRA, Leach MJ, Reda NA, Abd-Ellatif MM, Mohammed MA, Abd-Elaziz MA. The effectiveness of clinical pathway-directed care on hospitalisation-related outcomes in patients with severe traumatic brain injury: A quasi-experimental study. J Clin Nurs 2018; 27:e820-e832. [PMID: 29193516 DOI: 10.1111/jocn.14194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To compare the effectiveness of clinical pathway-directed care to usual care on hospitalisation-related outcomes in patients with severe traumatic brain injury (STBI). BACKGROUND Severe traumatic brain injury is a major cause of disability and mortality in young adults. Clinical pathways endeavour to bring evidence and clinical practice closer together to foster the delivery of best practice and to improve patient outcomes. DESIGN Quasi-experimental study. METHODS The study was conducted in a trauma intensive care unit of a large teaching hospital in Egypt. Patients aged 18-60 years with a diagnosis of STBI, a Glasgow Coma Scale score between 3-8 and a nonpenetrating head injury were consecutively assigned to 15 days of care. The outcomes assessed were complications related to hospitalisation, clinical variances, length of intensive care unit (ICU) stay, ICU readmission rate and patient/family satisfaction. RESULTS Sixty participants completed the study (30 in each arm). Apart from age, there were no significant differences between groups in baseline characteristics. The clinical pathway group demonstrated statistically significantly fewer cases of hospitalisation-related complications on day 15, and a significantly shorter length of ICU stay, lower ICU readmission rate and a high level of patient/family satisfaction when compared with the usual care group. The effect of the intervention on fever, pressure ulceration, hyperglycaemia and readmission to the ICU was no longer statistically significant after controlling for age. CONCLUSIONS The findings of the current study suggest that the implementation of a clinical pathway for patients with severe TBI may be helpful in improving the patient experience as well as some hospitalisation-related outcomes. RELEVANCE TO CLINICAL PRACTICE The provision of clinical pathway-directed care in a trauma ICU may offer benefits to the patient, family and institution beyond that provided by usual care.
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Affiliation(s)
| | - Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, SA, Australia
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14
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Behavior Rating Inventory of Executive Function Adult Version in Patients with Neurological and Neuropsychiatric Conditions: Symptom Levels and Relationship to Emotional Distress. J Int Neuropsychol Soc 2016; 22:682-94. [PMID: 27126218 DOI: 10.1017/s135561771600031x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The present study explored the level of self-and informant reported executive functioning in daily living using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) in a large sample comprising healthy adults and patient cohorts with neurological and neuropsychiatric disorders. The relationship to neuropsychological test performance and self-reported emotional distress was explored, as well as the applicability of U.S. normative data. METHODS Scores on the self- and informant reported BRIEF-A are presented, along with scores on standardized cognitive tests, and on rating scales of self-reported emotional distress in a Norwegian healthy comparison group (n=115), patients with severe traumatic brain injury (n=125), focal frontal lobe damage (n=29), focal cerebellar lesion (n=24), Parkinson's disease (n=42), attention deficit hyperactivity disorder (n=34), type II bipolar disorder (n=21), and borderline personality disorder (n=18). RESULTS Strong associations were observed between the BRIEF-A and emotional distress in both the healthy group and in neurological groups, while no or weak relationships with IQ and performance-based tests of executive function were seen. The relationship between BRIEF-A and emotional distress was weaker in the neuropsychiatric patient groups, despite high symptom load in both domains. Healthy participants tended to have BRIEF-A scores 1/2-3/4 SD below the U.S. normative mean of T score=50. CONCLUSIONS The study demonstrates the need to interpret BRIEF-A results within a broad differential diagnostic context, where measures of psychological distress are included in addition to neuropsychological tests. Uncertainty about the appropriateness of U.S. normative data in non-U.S. countries adds to the need for interpretive caution. (JINS, 2016, 22, 682-694).
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15
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Tuñón-Pitalua MC, Ortiz-Pinto MA. Caracterización epidemiológica del trauma craneoencefálico fatal en Cartagena, Colombia, 2007-2011. COLOMBIA FORENSE 2016. [DOI: 10.16925/cf.v3i1.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Resumen. Introducción: el trauma craneoencefálico fatal es de común ocurrencia en nuestro medio, sin que tengamos estadísticas confiables sobre su frecuencia real. Metodología: se realizó un estudio descriptivo retrospectivo, con base en los registros del Instituto Nacional de Medicina Legal y Ciencias Forenses de la Unidad Básica de Cartagena, Colombia. Resultados: las tasas de mortalidad oscilaron de 7 a 14 por cada 100 000 habitantes por año, durante el período analizado, presentándose con mayor frecuencia en el sexo masculino, en una proporción que varió de 25:1 en el primer año estudiado, a 10:1 al final del período, y en edades desde los 20 a los 35 años. La causa se debió a heridas perforantes por proyectiles de arma de fuego en el 56,8 % de los casos, seguido por lesiones en accidente de tránsito en un 32,4 %, con lesiones de localización supratentorial en el 82,8 % de los casos. El 69,9 % de las víctimas falleció en el lugar de los hechos, afectando individuos entre los 20 y 35 años de edad. La georeferenciación de los casos permitió observar que las comunas en donde hubo mayor número de casos fue en las 1, 4 y 11, correspondientes a las comunas Histórica, Caribe Norte y la localidad la Virgen y Turística. Conclusiones: El trauma craneoencefálico fatal es de frecuente ocurrencia en laciudad, en individuos del sexo masculino, en edades de 20 a 35 años, debido en su mayoría a heridas por arma de fuego, de manera homicida, seguido por accidentes de tránsito. Es necesario ahondar en los hechos relacionados con estos resultados.
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16
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Kumar RG, Rubin JE, Berger RP, Kochanek PM, Wagner AK. Principal components derived from CSF inflammatory profiles predict outcome in survivors after severe traumatic brain injury. Brain Behav Immun 2016; 53:183-193. [PMID: 26705843 PMCID: PMC4783208 DOI: 10.1016/j.bbi.2015.12.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/03/2015] [Accepted: 12/13/2015] [Indexed: 12/31/2022] Open
Abstract
Studies have characterized absolute levels of multiple inflammatory markers as significant risk factors for poor outcomes after traumatic brain injury (TBI). However, inflammatory marker concentrations are highly inter-related, and production of one may result in the production or regulation of another. Therefore, a more comprehensive characterization of the inflammatory response post-TBI should consider relative levels of markers in the inflammatory pathway. We used principal component analysis (PCA) as a dimension-reduction technique to characterize the sets of markers that contribute independently to variability in cerebrospinal (CSF) inflammatory profiles after TBI. Using PCA results, we defined groups (or clusters) of individuals (n=111) with similar patterns of acute CSF inflammation that were then evaluated in the context of outcome and other relevant CSF and serum biomarkers collected days 0-3 and 4-5 post-injury. We identified four significant principal components (PC1-PC4) for CSF inflammation from days 0-3, and PC1 accounted for the greatest (31%) percentage of variance. PC1 was characterized by relatively higher CSF sICAM-1, sFAS, IL-10, IL-6, sVCAM-1, IL-5, and IL-8 levels. Cluster analysis then defined two distinct clusters, such that individuals in cluster 1 had highly positive PC1 scores and relatively higher levels of CSF cortisol, progesterone, estradiol, testosterone, brain derived neurotrophic factor (BDNF), and S100b; this group also had higher serum cortisol and lower serum BDNF. Multinomial logistic regression analyses showed that individuals in cluster 1 had a 10.9 times increased likelihood of GOS scores of 2/3 vs. 4/5 at 6 months compared to cluster 2, after controlling for covariates. Cluster group did not discriminate between mortality compared to GOS scores of 4/5 after controlling for age and other covariates. Cluster groupings also did not discriminate mortality or 12 month outcomes in multivariate models. PCA and cluster analysis establish that a subset of CSF inflammatory markers measured in days 0-3 post-TBI may distinguish individuals with poor 6-month outcome, and future studies should prospectively validate these findings. PCA of inflammatory mediators after TBI could aid in prognostication and in identifying patient subgroups for therapeutic interventions.
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Affiliation(s)
- Raj G Kumar
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan E Rubin
- Department of Mathematics, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Rachel P Berger
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA; Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick M Kochanek
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
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17
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Mortality and One-Year Functional Outcome in Elderly and Very Old Patients with Severe Traumatic Brain Injuries: Observed and Predicted. Behav Neurol 2015; 2015:845491. [PMID: 26688614 PMCID: PMC4672101 DOI: 10.1155/2015/845491] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/29/2015] [Accepted: 11/08/2015] [Indexed: 11/21/2022] Open
Abstract
The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC). Methods. Prospective, national multicenter study including patients with severe TBI ≥65 years. Predicted mortality and outcome were calculated based on clinical information (CRASH basic) (age, GCS score, and pupil reactivity to light), as well as with additional CT findings (CRASH CT). Observed 14-day mortality and favorable/unfavorable outcome according to the Glasgow Outcome Scale at one year was compared to the predicted outcome according to the CRASH models. Results. 97 patients, mean age 75 (SD 7) years, 64% men, were included. Two patients were lost to follow-up; 48 died within 14 days. The predicted versus the observed odds ratio (OR) for mortality was 2.65. Unfavorable outcome (GOSE < 5) was observed at one year follow-up in 72% of patients. The CRASH models predicted unfavorable outcome in all patients. Conclusion. The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI.
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18
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Mahler B, Carlsson S, Andersson T, Adelöw C, Ahlbom A, Tomson T. Unprovoked seizures after traumatic brain injury: A population-based case-control study. Epilepsia 2015; 56:1438-44. [DOI: 10.1111/epi.13096] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Benno Mahler
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Sofia Carlsson
- Epidemiology Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Tomas Andersson
- Center for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - Cecilia Adelöw
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Anders Ahlbom
- Epidemiology Unit; Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - Torbjörn Tomson
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
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19
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20
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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: 59] [Impact Index Per Article: 6.6] [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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21
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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: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Prehospital management of traumatic brain injury patients--a gender perspective. Int Emerg Nurs 2015; 23:250-3. [PMID: 25676258 DOI: 10.1016/j.ienj.2015.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Studies show that there are differences between men and women when it comes to several aspects of health care. But the research on equal care in a prehospital setting for patients with severe traumatic brain injury (TBI) has been sparsely investigated. The aim of this study is to describe prehospital care from a gender perspective. METHOD This is a retrospective study of (n = 651) patients (>15 years) with severe TBI requiring intensive care at a University Hospital in Sweden during the years 2000-2010. Outcome was measured by survival and Glasgow Outcome Scale (GOS) scores at discharge. RESULT Our results show differences, though not significant, in the initial assessments and performed interventions between male and female TBI patients. Female patients received more assessments and performed interventions compared to men during prehospital care. Men received more interventions with I.V. fluid but significantly less airway interventions (endotracheal intubation) compared to female patients. More men were transported directly to neurosurgical specialist care as compared to females. No difference in outcome was found. CONCLUSION Our results show differences, however not significant in the assessments and performed interventions between gender, with female patients receiving more assessments and interventions compared to male patients during prehospital care. Future research should focus on gender differences in initial early signs of TBI to improve early identification.
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23
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Diaz AP, Schwarzbold ML, Thais ME, Cavallazzi GG, Schmoeller R, Nunes JC, Hohl A, Guarnieri R, Linhares MN, Walz R. Personality changes and return to work after severe traumatic brain injury: a prospective study. ACTA ACUST UNITED AC 2014; 36:213-9. [PMID: 24770655 DOI: 10.1590/1516-4446-2013-1303] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/27/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. METHODS Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. RESULTS After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). CONCLUSIONS In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition.
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Affiliation(s)
- Alexandre P Diaz
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Marcelo L Schwarzbold
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Maria E Thais
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Gisele G Cavallazzi
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Roseli Schmoeller
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Jean C Nunes
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Alexandre Hohl
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Ricardo Guarnieri
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Marcelo N Linhares
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
| | - Roger Walz
- Center of Applied Neurosciences (CeNAp), Hospital Universitário da Universidade Federal de Santa Catarina (HU-UFSC), Florianópolis, SC, Brazil
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Cavus UY, Yildirim S, Gurer B, Dibek K, Yilmaz D, Ozturk G, Buyukcam F, Sonmez E. The prognostic value of plasma Δ-copeptin levels in patients with isolated traumatic brain injury. Eur J Trauma Emerg Surg 2013; 40:373-8. [DOI: 10.1007/s00068-013-0357-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 11/14/2013] [Indexed: 12/01/2022]
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