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Oliver S, Douglas J, Winkler D, Pearce C, Minter E, Jarman HK, Topping M. The healthcare needs and general practice utilization of people with acquired neurological disability and complex needs: A scoping review. Health Expect 2022; 25:2726-2745. [DOI: 10.1111/hex.13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/13/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Stacey Oliver
- Department of Research and Innovation Summer Foundation Limited Victoria Blackburn Australia
- School of Allied Health, Human Services & Sport, Living with Disability Research Centre La Trobe University Melbourne Victoria Australia
| | - Jacinta Douglas
- Department of Research and Innovation Summer Foundation Limited Victoria Blackburn Australia
- School of Allied Health, Human Services & Sport, Living with Disability Research Centre La Trobe University Melbourne Victoria Australia
| | - Dianne Winkler
- Department of Research and Innovation Summer Foundation Limited Victoria Blackburn Australia
- School of Allied Health, Human Services & Sport, Living with Disability Research Centre La Trobe University Melbourne Victoria Australia
| | | | - Ella‐Rose Minter
- Department of Research and Innovation Summer Foundation Limited Victoria Blackburn Australia
- School of Allied Health, Human Services & Sport, Living with Disability Research Centre La Trobe University Melbourne Victoria Australia
| | - Hannah K. Jarman
- Department of Research and Innovation Summer Foundation Limited Victoria Blackburn Australia
| | - Megan Topping
- Department of Research and Innovation Summer Foundation Limited Victoria Blackburn Australia
- School of Allied Health, Human Services & Sport, Living with Disability Research Centre La Trobe University Melbourne Victoria Australia
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Gharizadeh N, Ghojazadeh M, Naseri A, Dolati S, Tarighat F, Soleimanpour H. Hypertonic saline for traumatic brain injury: a systematic review and meta-analysis. Eur J Med Res 2022; 27:254. [PMID: 36404350 PMCID: PMC9677698 DOI: 10.1186/s40001-022-00897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) causes mortality and long-term disability among young adults and imposes a notable cost on the healthcare system. In addition to the first physical hit, secondary injury, which is associated with increased intracranial pressure (ICP), is defined as biochemical, cellular, and physiological changes after the physical injury. Mannitol and Hypertonic saline (HTS) are the treatment bases for elevated ICP in TBI. This systematic review and meta-analysis evaluates the effectiveness of HTS in the management of patients with TBI. METHODS This study was conducted following the Joanna Briggs Institute (JBI) methods and PRISMA statement. A systematic search was performed through six databases in February 2022, to find studies that evaluated the effects of HTS, on increased ICP. Meta-analysis was performed using comprehensive meta-analysis (CMA). RESULTS Out of 1321 results, 8 studies were included in the systematic review, and 3 of them were included in the quantitative synthesis. The results of the meta-analysis reached a 35.9% (95% CI 15.0-56.9) reduction in ICP in TBI patients receiving HTS, with no significant risk of publication bias (t-value = 0.38, df = 2, p-value = 0.73). The most common source of bias in our included studies was the transparency of blinding methods for both patients and outcome assessors. CONCLUSION HTS can significantly reduce the ICP, which may prevent secondary injury. Also, based on the available evidence, HTS has relatively similar efficacy to Mannitol, which is considered the gold standard therapy for TBI, in boosting patients' neurological condition and reducing mortality rates.
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Affiliation(s)
- Nafiseh Gharizadeh
- grid.412888.f0000 0001 2174 8913Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- grid.412888.f0000 0001 2174 8913Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Naseri
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Dolati
- grid.412888.f0000 0001 2174 8913Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Faezeh Tarighat
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Soleimanpour
- grid.412888.f0000 0001 2174 8913Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, Iran
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3
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The Brain–Gut Axis in Traumatic Brain Injury: Implications for Nutrition Support. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00325-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Purpose of Review
Early enteral nutrition improves outcomes following traumatic brain injury (TBI). This can prove difficult due to TBI-induced feeding intolerance secondary to disruption of the brain-gut axis, a network composed of central nervous system (CNS) input, autonomic signaling, and immunologic regulation that controls gut and CNS homeostasis. Here, we discuss the pathophysiology of brain–gut axis dysregulation and outline nutrition strategies in patients with TBI.
Recent Findings
Feeding intolerance following TBI is multifactorial; complex signaling between the CNS, sympathetic nervous system, parasympathetic nervous system, and enteric nervous system that controls gut homeostasis is disrupted within hours post-injury. This has profound effects on the immune system and gut microbiome, further complicating post-TBI recovery. Despite this disruption, calorie and protein requirements increase considerably following TBI, and early nutritional supplementation improves survival following TBI. Enteral nutrition has proven more efficacious than parenteral nutrition in TBI patients and should be initiated within 48 hours following admission. Immune-fortified nutrition reduces CNS and gut inflammation and may improve outcomes in TBI patients.
Summary
Although autonomic dysregulation of the brain–gut axis results in feeding intolerance following TBI, early enteral nutrition is of paramount importance. Enteral nutrition reduces post-TBI inflammation and enhances immunologic and gut function. When feasible, enteral nutrition should be initiated within 48 hours following injury.
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Santiago-Castañeda C, Huerta de la Cruz S, Martínez-Aguirre C, Orozco-Suárez SA, Rocha L. Cannabidiol Reduces Short- and Long-Term High Glutamate Release after Severe Traumatic Brain Injury and Improves Functional Recovery. Pharmaceutics 2022; 14:pharmaceutics14081609. [PMID: 36015236 PMCID: PMC9414526 DOI: 10.3390/pharmaceutics14081609] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/16/2022] [Accepted: 07/29/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to determine if orally administered cannabidiol (CBD) lessens the cortical over-release of glutamate induced by a severe traumatic brain injury (TBI) and facilitates functional recovery. The short-term experiment focused on identifying the optimal oral pretreatment of CBD. Male Wistar rats were pretreated with oral administration of CBD (50, 100, or 200 mg/kg) daily for 7 days. Then, extracellular glutamate concentration was estimated by cortical microdialysis before and immediately after a severe TBI. The long-term experiment focused on evaluating the effect of the optimal treatment of CBD (pre- vs. pre- and post-TBI) 30 days after trauma. Sensorimotor function, body weight, and mortality rate were evaluated. In the short term, TBI induced a high release of glutamate (738% ± 173%; p < 0.001 vs. basal). Oral pretreatment with CBD at all doses tested reduced glutamate concentration but with higher potency at when animals received 100 mg/kg (222 ± 33%, p < 0.01 vs. TBI), an effect associated with a lower mortality rate (22%, p < 0.001 vs. TBI). In the long-term experiment, the TBI group showed a high glutamate concentration (149% p < 0.01 vs. SHAM). In contrast, animals receiving the optimal treatment of CBD (pre- and pre/post-TBI) showed glutamate concentrations like the SHAM group (p > 0.05). This effect was associated with high sensorimotor function improvement. CBD pretreatment, but not pre-/post-treatment, induced a higher body weight gain (39% ± 2.7%, p < 0.01 vs. TBI) and lower mortality rate (22%, p < 0.01 vs. TBI). These results support that orally administered CBD reduces short- and long-term TBI-induced excitotoxicity and facilitated functional recovery. Indeed, pretreatment with CBD was sufficient to lessen the adverse sequelae of TBI.
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Affiliation(s)
- Cindy Santiago-Castañeda
- Department of Pharmacobiology, Center for Research and Advanced Studies (CINVESTAV), Mexico City 14330, Mexico; (C.S.-C.); (S.H.d.l.C.); (C.M.-A.)
| | - Saúl Huerta de la Cruz
- Department of Pharmacobiology, Center for Research and Advanced Studies (CINVESTAV), Mexico City 14330, Mexico; (C.S.-C.); (S.H.d.l.C.); (C.M.-A.)
| | - Christopher Martínez-Aguirre
- Department of Pharmacobiology, Center for Research and Advanced Studies (CINVESTAV), Mexico City 14330, Mexico; (C.S.-C.); (S.H.d.l.C.); (C.M.-A.)
| | - Sandra Adela Orozco-Suárez
- Unit for Medical Research in Neurological Diseases, Specialties Hospital, National Medical Center SXXI (CMN-SXXI), Mexico City 06720, Mexico;
| | - Luisa Rocha
- Department of Pharmacobiology, Center for Research and Advanced Studies (CINVESTAV), Mexico City 14330, Mexico; (C.S.-C.); (S.H.d.l.C.); (C.M.-A.)
- Correspondence: ; Tel.: +52-55-5483-2800
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Svingos AM, Robicsek SA, Hayes RL, Wang KK, Robertson CS, Brophy GM, Papa L, Gabrielli A, Hannay HJ, Bauer RM, Heaton SC. Predicting Clinical Outcomes 7-10 Years after Severe Traumatic Brain Injury: Exploring the Prognostic Utility of the IMPACT Lab Model and Cerebrospinal Fluid UCH-L1 and MAP-2. Neurocrit Care 2022; 37:172-183. [PMID: 35229233 DOI: 10.1007/s12028-022-01461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is a major contributor to disability and mortality in the industrialized world. Outcomes of severe TBI are profoundly heterogeneous, complicating outcome prognostication. Several prognostic models have been validated for acute prediction of 6-month global outcomes following TBI (e.g., morbidity/mortality). In this preliminary observational prognostic study, we assess the utility of the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) Lab model in predicting longer term global and cognitive outcomes (7-10 years post injury) and the extent to which cerebrospinal fluid (CSF) biomarkers enhance outcome prediction. METHODS Very long-term global outcome was assessed in a total of 59 participants (41 of whom did not survive their injuries) using the Glasgow Outcome Scale-Extended and Disability Rating Scale. More detailed outcome information regarding cognitive functioning in daily life was collected from 18 participants surviving to 7-10 years post injury using the Cognitive Subscale of the Functional Independence Measure. A subset (n = 10) of these participants also completed performance-based cognitive testing (Digit Span Test) by telephone. The IMPACT lab model was applied to determine its prognostic value in relation to very long-term outcomes as well as the additive effects of acute CSF ubiquitin C-terminal hydrolase-L1 (UCH-L1) and microtubule associated protein 2 (MAP-2) concentrations. RESULTS The IMPACT lab model discriminated favorable versus unfavorable 7- to 10-year outcome with an area under the receiver operating characteristic curve of 0.80. Higher IMPACT lab model risk scores predicted greater extent of very long-term morbidity (β = 0.488 p = 0.000) as well as reduced cognitive independence (β = - 0.515, p = 0.034). Acute elevations in UCH-L1 levels were also predictive of lesser independence in cognitive activities in daily life at very long-term follow-up (β = 0.286, p = 0.048). Addition of two CSF biomarkers significantly improved prediction of very long-term neuropsychological performance among survivors, with the overall model (including IMPACT lab score, UCH-L1, and MAP-2) explaining 89.6% of variance in cognitive performance 7-10 years post injury (p = 0.008). Higher acute UCH-L1 concentrations were predictive of poorer cognitive performance (β = - 0.496, p = 0.029), whereas higher acute MAP-2 concentrations demonstrated a strong cognitive protective effect (β = 0.679, p = 0.010). CONCLUSIONS Although preliminary, results suggest that existing prognostic models, including models with incorporation of CSF markers, may be applied to predict outcome of severe TBI years after injury. Continued research is needed examining early predictors of longer-term outcomes following TBI to identify potential targets for clinical trials that could impact long-ranging functional and cognitive outcomes.
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Affiliation(s)
- Adrian M Svingos
- Brain Injury Clinical Research Center, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven A Robicsek
- Departments of Anesthesiology, Neurosurgery, and Neuroscience, University of Florida, Gainesville, FL, USA
| | | | - Kevin K Wang
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, FL, USA
| | | | - Gretchen M Brophy
- Pharmacotherapy and Outcomes Science and Neurosurgery, Virginia Commonwealth University Medical College of Virginia Campus, Richmond, VA, USA
| | - Linda Papa
- Department of Emergency Medicine, Orlando Health Orlando Regional Medical Center, Orlando, FL, USA
| | - Andrea Gabrielli
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA
| | - H Julia Hannay
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Russell M Bauer
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, FL, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shelley C Heaton
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
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Eliacin J, Fortney SK, Rattray NA, Kean J. Patients' and caregivers' perspectives on healthcare navigation in Central Indiana, USA after brain injury. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:988-997. [PMID: 33471969 DOI: 10.1111/hsc.13275] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Little research has documented the experiences of patients with traumatic brain injury (TBI) and their caregivers in navigating health systems for TBI care. In this qualitative study, we conducted semi-structured interviews with 62 participants (34 patients with moderate or severe TBI and 28 caregivers) from Central Indiana. Data were collected from January to September 2016 and analysed using a constructivist grounded theory approach. Participants discussed three significant challenges about navigating health services for TBI care: lack of support for care navigation, financial barriers, and communication barriers. Participants described how navigating outpatient healthcare services for TBI remains complex and emphasised the need for ongoing care navigation support throughout the care continuum. They detailed the long-term financial burden of TBI including high treatment costs, limited insurance coverage, and the emotional toll that financial stress has on their ability to navigate healthcare services for ongoing TBI-related needs. They also discussed how ineffective patient-provider communication and lack of reliable, timely and comprehensive health information about TBI limited their engagement in and navigation of TBI health services. Findings suggest that persons with TBI and their caregivers need ongoing support to manage the long-term impacts of TBI. Efforts to provide care coordination and navigation to patients with TBI and their families are urgently needed to facilitate greater access to care, effective healthcare navigation and improved health outcomes.
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Affiliation(s)
- Johanne Eliacin
- Richard L. Roudebush Department of Veterans Affairs Medical Center, Center for Health Information and Communication, Health Services Research and Development, Indianapolis, IN, USA
- Departments of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
- Regenstrief Institute, Inc. Indianapolis, IN, USA
- Act Center of Indiana, Indianapolis, IN, USA
| | - Sarah K Fortney
- Departments of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Nicholas A Rattray
- Richard L. Roudebush Department of Veterans Affairs Medical Center, Center for Health Information and Communication, Health Services Research and Development, Indianapolis, IN, USA
- Department of Anthropology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Jacob Kean
- Informatics, Decision-Enhancement and Analytic Sciences Center, Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah School of Medicine, Salt Lake City, UT, USA
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Robinson BD, Isbell CL, Melge AR, Lomas AM, Shaji CA, Mohan CG, Huang JH, Tharakan B. Doxycycline prevents blood-brain barrier dysfunction and microvascular hyperpermeability after traumatic brain injury. Sci Rep 2022; 12:5415. [PMID: 35354869 PMCID: PMC8967830 DOI: 10.1038/s41598-022-09394-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
The main objective of this study was to determine the cellular and molecular effects of doxycycline on the blood–brain barrier (BBB) and protection against secondary injuries following traumatic brain injury (TBI). Microvascular hyperpermeability and cerebral edema resulting from BBB dysfunction after TBI leads to elevation of intracranial pressure, secondary brain ischemia, herniation, and brain death. There are currently no effective therapies to modulate the underlying pathophysiology responsible for TBI-induced BBB dysfunction and hyperpermeability. The loss of BBB integrity by the proteolytic enzyme matrix metalloproteinase-9 (MMP-9) is critical to TBI-induced BBB hyperpermeability, and doxycycline possesses anti-MMP-9 effect. In this study, the effect of doxycycline on BBB hyperpermeability was studied utilizing molecular modeling (using Glide) in silico, cell culture-based models in vitro, and a mouse model of TBI in vivo. Brain microvascular endothelial cell assays of tight junction protein immunofluorescence and barrier permeability were performed. Adult C57BL/6 mice were subjected to sham versus TBI with or without doxycycline treatment and immediate intravital microscopic analysis for evaluating BBB integrity. Postmortem mouse brain tissue was collected to measure MMP-9 enzyme activity. It was found that doxycycline binding to the MMP-9 active sites have binding affinity of −7.07 kcal/mol. Doxycycline treated cell monolayers were protected from microvascular hyperpermeability and retained tight junction integrity (p < 0.05). Doxycycline treatment decreased BBB hyperpermeability following TBI in mice by 25% (p < 0.05). MMP-9 enzyme activity in brain tissue decreased with doxycycline treatment following TBI (p < 0.05). Doxycycline preserves BBB tight junction integrity following TBI via inhibiting MMP-9 activity. When established in human subjects, doxycycline, may provide readily accessible medical treatment after TBI to attenuate secondary injury.
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Affiliation(s)
- Bobby D Robinson
- Department of Surgery, Baylor Scott and White Medical Center, Baylor Scott and White Research Institute, Temple, TX, USA.,Texas A&M University Health Science Center College of Medicine, Temple, TX, USA
| | - Claire L Isbell
- Department of Surgery, Baylor Scott and White Medical Center, Baylor Scott and White Research Institute, Temple, TX, USA.,Texas A&M University Health Science Center College of Medicine, Temple, TX, USA
| | - Anu R Melge
- Amrita Center for Nanosciences and Molecular Medicine, Kochi, Kerala, India
| | - Angela M Lomas
- Department of Surgery, Baylor Scott and White Medical Center, Baylor Scott and White Research Institute, Temple, TX, USA.,Texas A&M University Health Science Center College of Medicine, Temple, TX, USA
| | - Chinchusha Anasooya Shaji
- Department of Surgery, Baylor Scott and White Medical Center, Baylor Scott and White Research Institute, Temple, TX, USA
| | - C Gopi Mohan
- Amrita Center for Nanosciences and Molecular Medicine, Kochi, Kerala, India
| | - Jason H Huang
- Department of Neurosurgery, Texas A&M University Health Science Center College of Medicine, Temple, TX, USA
| | - Binu Tharakan
- Department of Surgery, Baylor Scott and White Medical Center, Baylor Scott and White Research Institute, Temple, TX, USA. .,Texas A&M University Health Science Center College of Medicine, Temple, TX, USA. .,Department of Surgery, Morehouse School of Medicine, 720 Westview Dr, Atlanta, GA, 30310, USA.
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A Review of Family Environment and Neurobehavioral Outcomes Following Pediatric Traumatic Brain Injury: Implications of Early Adverse Experiences, Family Stress, and Limbic Development. Biol Psychiatry 2022; 91:488-497. [PMID: 34772505 DOI: 10.1016/j.biopsych.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022]
Abstract
Pediatric traumatic brain injury (TBI) is a public health crisis, with neurobehavioral morbidity observed years after an injury associated with changes in related brain structures. A substantial literature base has established family environment as a significant predictor of neurobehavioral outcomes following pediatric TBI. The neural mechanisms linking family environment to neurobehavioral outcomes have, however, received less empiric study in this population. In contrast, limbic structural differences as well as challenges with emotional adjustment and behavioral regulation in non-TBI populations have been linked to a multitude of family environmental factors, including family stress, parenting style, and adverse childhood experiences. In this article, we systematically review the more comprehensive literature on family environment and neurobehavioral outcomes in pediatric TBI and leverage the work in both TBI and non-TBI populations to expand our understanding of the underlying neural mechanisms. Thus, we summarize the extant literature on the family environment's role in neurobehavioral sequelae in children with TBI and explore potential neural correlates by synthesizing the wealth of literature on family environment and limbic development, specifically related to the amygdala. This review underscores the critical role of environmental factors, especially those predating the injury, in modeling recovery outcomes post-TBI in childhood, and discusses clinical and research implications across pediatric populations. Given the public health crisis of pediatric TBI, along with the context of sparse available medical interventions, a broader understanding of factors contributing to outcomes is warranted to expand the range of intervention targets.
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Levochkina M, McQuillan L, Awan N, Barton D, Maczuzak J, Bianchine C, Trombley S, Kotes E, Wiener J, Wagner A, Calcagno J, Maza A, Nierstedt R, Ferimer S, Wagner A. Neutrophil-to-Lymphocyte Ratios and Infections after Traumatic Brain Injury: Associations with Hospital Resource Utilization and Long-Term Outcome. J Clin Med 2021; 10:jcm10194365. [PMID: 34640381 PMCID: PMC8509449 DOI: 10.3390/jcm10194365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 12/30/2022] Open
Abstract
Traumatic brain injury (TBI) induces immune dysfunction that can be captured clinically by an increase in the neutrophil-to-lymphocyte ratio (NLR). However, few studies have characterized the temporal dynamics of NLR post-TBI and its relationship with hospital-acquired infections (HAI), resource utilization, or outcome. We assessed NLR and HAI over the first 21 days post-injury in adults with moderate-to-severe TBI (n = 196) using group-based trajectory (TRAJ), changepoint, and mixed-effects multivariable regression analysis to characterize temporal dynamics. We identified two groups with unique NLR profiles: a high (n = 67) versus a low (n = 129) TRAJ group. High NLR TRAJ had higher rates (76.12% vs. 55.04%, p = 0.004) and earlier time to infection (p = 0.003). In changepoint-derived day 0–5 and 6–20 epochs, low lymphocyte TRAJ, early in recovery, resulted in more frequent HAIs (p = 0.042), subsequently increasing later NLR levels (p ≤ 0.0001). Both high NLR TRAJ and HAIs increased hospital length of stay (LOS) and days on ventilation (p ≤ 0.05 all), while only high NLR TRAJ significantly increased odds of unfavorable six-month outcome as measured by the Glasgow Outcome Scale (GOS) (p = 0.046) in multivariable regression. These findings provide insight into the temporal dynamics and interrelatedness of immune factors which collectively impact susceptibility to infection and greater hospital resource utilization, as well as influence recovery.
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Affiliation(s)
- Marina Levochkina
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
- Department of Infectious Diseases & Microbiology, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Leah McQuillan
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Nabil Awan
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - David Barton
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - John Maczuzak
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Claudia Bianchine
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Shannon Trombley
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Emma Kotes
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Joshua Wiener
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Audrey Wagner
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Jason Calcagno
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Andrew Maza
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Ryan Nierstedt
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
| | - Stephanie Ferimer
- Division of Pediatric Rehabilitation Medicine, Department of Orthopaedics, West Virginia University, Morgantown, WV 26506, USA;
| | - Amy Wagner
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA 15213, USA; (M.L.); (L.M.); (N.A.); (J.M.); (C.B.); (S.T.); (E.K.); (J.W.); (A.W.); (J.C.); (A.M.); (R.N.)
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Correspondence:
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10
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Hardy MS, Kennedy JE, Cooper DB. Patient Attribution of Posttraumatic Symptoms to Brain Injury Versus PTSD in Military-Related Mild TBI. J Neuropsychiatry Clin Neurosci 2021; 32:252-258. [PMID: 32054399 DOI: 10.1176/appi.neuropsych.19090202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Persistent cognitive, somatic, and neuropsychiatric symptoms following mild traumatic brain injury (TBI) are influenced by posttraumatic stress disorder (PTSD), particularly in military patients. The authors evaluated the degree to which military service members with a history of mild TBI attributed posttraumatic symptoms to TBI versus PTSD. METHODS Service members (N=372) with mild TBI were surveyed about the severity of posttraumatic symptoms across four symptom clusters (cognitive, affective, somatosensory, and vestibular) with the Neurobehavioral Symptom Inventory (NSI). Participants rated the degree to which they believed TBI, PTSD, or other conditions contributed to their symptoms. Differences in cognitive, affective, somatosensory, and vestibular symptom severity were evaluated across participants with TBI, PTSD, or combined TBI-PTSD attribution. Logistic regression was used to evaluate the association between symptom profiles and attribution. RESULTS Participants attributed symptoms mostly to TBI, followed by insufficient sleep, PTSD, chronic pain, depression, and deployment-readjustment stress. PTSD and combined TBI-PTSD attribution were associated with higher total NSI scores (39.5 and 51.6, respectively), compared with TBI attribution only (31.4) (F=29.08, df=3, 358, p<0.01), as well as higher scores in every symptom category. More severe affective symptoms were associated with decreased odds of TBI attribution (odds ratio=0.90, 95% CI=0.83-0.97) and increased odds of PTSD attribution (odds ratio=1.14, 95% CI=1.03-1.26). A PTSD diagnosis was highly associated with PTSD attribution (odds ratio=2.44, 95% CI=1.07-5.58). CONCLUSIONS The nature and severity of posttraumatic symptoms appear to play a role in patient beliefs about the causes of symptoms, whether from TBI or PTSD.
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Affiliation(s)
- Morgan S Hardy
- 59th Medical Wing, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Tex. (Hardy); the Department of Psychiatry, University of Texas Health San Antonio, San Antonio, Tex. (Hardy, Cooper); the Defense and Veterans Brain Injury Center, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Tex. (Kennedy); General Dynamics Information Technology, Falls Church, Va. (Kennedy, Cooper); and the Defense and Veterans Brain Injury Center, San Antonio Polytrauma Rehabilitation Center, Audie L. Murphy Memorial VA Hospital, San Antonio, Tex. (Cooper)
| | - Jan E Kennedy
- 59th Medical Wing, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Tex. (Hardy); the Department of Psychiatry, University of Texas Health San Antonio, San Antonio, Tex. (Hardy, Cooper); the Defense and Veterans Brain Injury Center, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Tex. (Kennedy); General Dynamics Information Technology, Falls Church, Va. (Kennedy, Cooper); and the Defense and Veterans Brain Injury Center, San Antonio Polytrauma Rehabilitation Center, Audie L. Murphy Memorial VA Hospital, San Antonio, Tex. (Cooper)
| | - Douglas B Cooper
- 59th Medical Wing, Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Tex. (Hardy); the Department of Psychiatry, University of Texas Health San Antonio, San Antonio, Tex. (Hardy, Cooper); the Defense and Veterans Brain Injury Center, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Tex. (Kennedy); General Dynamics Information Technology, Falls Church, Va. (Kennedy, Cooper); and the Defense and Veterans Brain Injury Center, San Antonio Polytrauma Rehabilitation Center, Audie L. Murphy Memorial VA Hospital, San Antonio, Tex. (Cooper)
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11
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Abstract
BACKGROUND Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, TBIs substantially contribute to health care costs, which vary by severity. This is important to consider given the variability in recovery time by severity. RESEARCH DESIGN This study quantifies the annual incremental health care costs of nonfatal TBI in 2016 for the US population covered by a private health insurance, Medicaid, or Medicare health plan. This study uses MarketScan and defines severity with the abbreviated injury scale for the head and neck region. Nonfatal health care costs were compared by severity. RESULTS The estimated 2016 overall health care cost attributable to nonfatal TBI among MarketScan enrollees was $40.6 billion. Total estimated annual health care cost attributable to TBI for low severity TBIs during the first year postinjury were substantially higher than costs for middle and high severity TBIs among those with private health insurance and Medicaid. CONCLUSIONS This study presents economic burden estimates for TBI that underscore the importance of developing strategies to prevent TBIs, regardless of severity. Although middle and high severity TBIs were more costly at the individual level, low severity TBIs, and head injuries diagnosed as "head injury unspecified" resulted in higher total estimated annual health care costs attributable to TBI.
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Affiliation(s)
| | - Lara DePadilla
- Overdose Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA
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12
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Roldán M, Kyriacou PA. Near-Infrared Spectroscopy (NIRS) in Traumatic Brain Injury (TBI). SENSORS (BASEL, SWITZERLAND) 2021; 21:1586. [PMID: 33668311 PMCID: PMC7956674 DOI: 10.3390/s21051586] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 01/03/2023]
Abstract
Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently impacts an object or when an object pierces the skull and enters brain tissue. Secondary injuries after traumatic brain injury (TBI) can lead to impairments on cerebral oxygenation and autoregulation. Considering that secondary brain injuries often take place within the first hours after the trauma, noninvasive monitoring might be helpful in providing early information on the brain's condition. Near-infrared spectroscopy (NIRS) is an emerging noninvasive monitoring modality based on chromophore absorption of infrared light with the capability of monitoring perfusion of the brain. This review investigates the main applications of NIRS in TBI monitoring and presents a thorough revision of those applications on oxygenation and autoregulation monitoring. Databases such as PubMed, EMBASE, Web of Science, Scopus, and Cochrane library were utilized in identifying 72 publications spanning between 1977 and 2020 which were directly relevant to this review. The majority of the evidence found used NIRS for diagnosis applications, especially in oxygenation and autoregulation monitoring (59%). It was not surprising that nearly all the patients were male adults with severe trauma who were monitored mostly with continue wave NIRS or spatially resolved spectroscopy NIRS and an invasive monitoring device. In general, a high proportion of the assessed papers have concluded that NIRS could be a potential noninvasive technique for assessing TBI, despite the various methodological and technological limitations of NIRS.
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Affiliation(s)
| | - Panayiotis A. Kyriacou
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences and Engineering, University of London, London EC1V 0HB, UK;
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13
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Lu HY, Huang APH, Kuo LT. Prognostic value of variables derived from heart rate variability in patients with traumatic brain injury after decompressive surgery. PLoS One 2021; 16:e0245792. [PMID: 33539419 PMCID: PMC7861407 DOI: 10.1371/journal.pone.0245792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/07/2021] [Indexed: 11/18/2022] Open
Abstract
Measurement of heart rate variability can reveal autonomic nervous system function. Changes in heart rate variability can be associated with disease severity, risk of complications, and prognosis. We aimed to investigate the prognostic value of heart rate variability measurements in patients with moderate-to-severe traumatic brain injury after decompression surgery. We conducted a prospective study of 80 patients with traumatic brain injury after decompression surgery using a noninvasive electrocardiography device for data collection. Assessment of heart rate variability parameters included the time and frequency domains. The correlations between heart rate variability parameters and one-year mortality and functional outcomes were analyzed. Time domain measures of heart rate variability, using the standard deviation of the RR intervals and the square root of the mean squared differences of successive RR intervals, were statistically significantly lower in the group of patients with unfavorable outcomes and those that died. In frequency domain analysis, very low-frequency and total power were significantly higher in patients with favorable functional outcomes. High-frequency, low-frequency, and total power were statistically significantly higher in patients who survived for more than one year. Multivariate analysis using a model combining age and the Glasgow Coma Scale score with variables derived from heart rate variability substantially improved the prognostic value for predicting long-term outcome. These findings reinforced the concept that traumatic brain injury impacts the brain-heart axis and cardiac autonomic modulation even after decompression surgery, and variables derived from heart rate variability may be useful predictors of outcome.
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Affiliation(s)
- Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliou, Yunlin County, Taiwan
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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14
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Norup A, Kruse M, Soendergaard PL, Rasmussen KW, Biering-Sørensen F. Socioeconomic Consequences of Traumatic Brain Injury: A Danish Nationwide Register-Based Study. J Neurotrauma 2020; 37:2694-2702. [PMID: 32808586 DOI: 10.1089/neu.2020.7064] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined if acquiring a traumatic brain injury (TBI) increases utilization of health care costs, increases risk of job loss for the patient and the closest relatives, and increases the risk of divorce 1 to 5 years following the injury. The study was conducted as a Danish national population-based register study with follow-up. Participants included a cohort of patients with TBI (n = 18,328) admitted to a hospital or treated in an emergency room (ER) and a matching control group (n = 89,155). For both the TBI group and the matching controls, relatives were identified, using national registers (TBI relatives: n = 25,708 and control relatives: n = 135,325). The outcome measures were utilization of health care costs (including hospital services, use of general practitioner and practicing specialists, and prescribed medication), risk of job loss, and risk of divorce among the TBI group and the control group and their relatives. Patients with TBI had significantly increased health care costs at baseline (i.e., the year before the injury) and during the following 4 years. Further, TBI relatives had a significantly higher utilization of health care costs the first and the third year after injury. The TBI group had a significant increased risk of job loss (odds ratio [OR] = 2.88; confidence interval [CI]: 2.70-3.07) and divorce (OR = 1.44; CI: 1.27-1.64) during the first 3 years following injury. In conclusion, the TBI group had significantly higher utilization of health care costs, both pre-morbidly and post-injury. Further, increased risk of job loss and divorce were found, emphasizing that the socioeconomic consequences of TBI last for years post-injury.
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Affiliation(s)
- Anne Norup
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Marie Kruse
- DaCHE - Danish Center for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Pernille Langer Soendergaard
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Katrine Winther Rasmussen
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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15
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Castillo-Angeles M, Seshadri AJ, Benedict LA, Patel N, Ramsis R, Askari R, Salim A, Nehra D. Traumatic Brain Injury: Does Admission Service Matter? J Surg Res 2020; 259:211-216. [PMID: 33310498 DOI: 10.1016/j.jss.2020.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/13/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is common, and significant institutional variation exists with regards to structure and processes of care. Affected patients may be admitted to one of several different services, and this may drive differential care and outcomes. We sought to evaluate differential care and outcomes for patients with isolated mild-to-moderate traumatic brain injury based on admission service. MATERIALS AND METHODS This is a single-institution retrospective study of all adult (≥18 y old) patients admitted with isolated TBI (AIS ≤1 in all other body regions) over a 3-year period (6/2015-6/2018). Patients who underwent neurosurgical intervention (craniectomy/craniotomy) and those with a head AIS ≥4 were excluded. Patients were assigned to one of three groups based upon admission service: Trauma Surgery, Neurology/Medicine or Neurosurgery. Outcomes evaluated included in-hospital mortality and markers of differential care. We performed multivariate analyses adjusting for patient demographics and clinical characteristics. RESULTS A total of 401 isolated mild-to-moderate TBI patients were identified. Overall mortality was 1.7%. Adjusted multivariate logistic regression analysis demonstrated no difference in mortality. Patients admitted to Neurosurgery underwent more repeat head CTs and were more likely to receive antiseizure medication in the absence of seizure activity, and those admitted to Neurology/Medicine were less likely to receive venous thromboembolism chemoprophylaxis compared to those admitted to Trauma Surgery. CONCLUSIONS We identify several important metrics of variation in care received by patients with an isolated mild-to-moderate TBI based upon admission service. These findings deserve further study, and this study may lay the foundation for future efforts at protocolizing care in an evidence-based fashion for this patient cohort.
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Affiliation(s)
- Manuel Castillo-Angeles
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women''s Hospital, Boston, Massachusetts; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anupamaa J Seshadri
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Leo A Benedict
- Department of Surgery, Saint Luke's Hospital, Kansas City, Missouri
| | - Nikita Patel
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women''s Hospital, Boston, Massachusetts
| | | | - Reza Askari
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women''s Hospital, Boston, Massachusetts
| | - Ali Salim
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women''s Hospital, Boston, Massachusetts; Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Deepika Nehra
- Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington.
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16
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Roldán M, Abay TY, Kyriacou PA. Non-Invasive Techniques for Multimodal Monitoring in Traumatic Brain Injury: Systematic Review and Meta-Analysis. J Neurotrauma 2020; 37:2445-2453. [DOI: 10.1089/neu.2020.7266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- María Roldán
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences, and Engineering, City University of London, London, United Kingdom
| | - Tomas Ysehak Abay
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences, and Engineering, City University of London, London, United Kingdom
| | - Panayiotis A. Kyriacou
- Research Centre for Biomedical Engineering, School of Mathematics, Computer Sciences, and Engineering, City University of London, London, United Kingdom
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17
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Fatuki TA, Zvonarev V, Rodas AW. Prevention of Traumatic Brain Injury in the United States: Significance, New Findings, and Practical Applications. Cureus 2020; 12:e11225. [PMID: 33269153 PMCID: PMC7704169 DOI: 10.7759/cureus.11225] [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] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
Traumatic brain injury (TBI) prevention programs aim to reduce trauma-related head injuries across the United States. In addition to epidemiological challenges, patients with TBI have a greater burden of disease and worse health outcomes than the general population. In these circumstances, the prevention of TBI is an important element in reducing the occurrence of post-traumatic health consequences in all settings and beyond. We completed a high-quality overview of TBI prevention programs using the public health approach to identify the most compelling risks to individuals through surveillance, data analysis, and field assessment. We explored the evidence-based programs that are proven to help individuals reduce the risk of TBI. To date, TBI programs have been very efficient, as evidenced by a sustained downturn in TBI incidence. However, recent socioeconomic and epidemiological challenges in the United States are affecting state and local TBI prevention efforts. This article is focused on strategies and solutions to reduce risks and/or consequences associated with head injuries from motor vehicle accidents in New York City. We believe this report is essential to guide the design and implementation of adequate preventive strategies and providing safe and high-quality patient care across all settings where healthcare is delivered.
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Affiliation(s)
- Tolulope A Fatuki
- Psychiatry/Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | - Valeriy Zvonarev
- Psychiatry, University of Missouri-Kansas City, Hospital Hills Campus, Kansas City, USA
| | - Aaron W Rodas
- Internal Medicine, Lower Bucks Hospital, Bristol, USA
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18
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Cherian I, Burhan H, Dashevskiy G, Motta SJH, Parthiban J, Wang Y, Tong H, Torregrossa F, Grasso G. Cisternostomy: A Timely Intervention in Moderate to Severe Traumatic Brain Injuries: Rationale, Indications, and Prospects. World Neurosurg 2019; 131:385-390. [DOI: 10.1016/j.wneu.2019.07.082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 01/11/2023]
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19
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Zarshenas S, Horn SD, Colantonio A, Jaglal S, Cullen N. Content of inpatient rehabilitation for patients with traumatic brain injury: A comparison of Canadian and American facilities. Brain Inj 2019; 33:1503-1512. [PMID: 31446781 DOI: 10.1080/02699052.2019.1658224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To compare components of inpatient rehabilitation (IR) for patients with traumatic brain injury (TBI) between Canada and the US facilities. Design: Secondary analysis of the TBI-practice-based evidence dataset. Participants: Patients with TBI who had a higher Functional Independence Measure (FIMTM) cognitive function score (≥21) that were admitted to 1 IR facility in Canada (n = 103) and 9 IR facilities in the US (n = 401). Main measures: demographic and clinical characteristics, type and intensity of activities by discipline, discharge location, FIM-Rasch score, social participation and quality of life. Results: Time from injury to rehabilitation admission was significantly longer in the Canadian cohort and they experienced a longer rehabilitation length of stay (p < .001, Cohen's d > .8). Patients in Canada received a greater total time of individual therapy and lower intensity of interventions per week from all disciplines. They also showed a higher score at discharge in FIM components, while US patients had better cognitive recovery and community participation long-term post-discharge. Conclusions: This study informs stakeholders of the large variation in service provision for patients who were treated in these two countries. These findings suggest the need for robust analyzes to investigate predictors of short and long-term outcomes considering the variation in health-care delivery. List of abbreviations: TBI: traumatic brain injury, CSI: comprehensive severity index, LoS: length of stay, OT: occupational therapy, PT: physical therapy, SLP: speech language pathology, IR: inpatient rehabilitation.
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Affiliation(s)
- Sareh Zarshenas
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada
| | - Susan D Horn
- Department of Population Health Sciences, University of Utah School of Medicine , Salt Lake City , UT , USA
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada.,Occupational Science and Occupational Therapy, University of Toronto , Toronto , Ontario , Canada.,Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
| | - Susan Jaglal
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada.,Department of Physical Therapy, University of Toronto , Toronto , Ontario , Canada
| | - Nora Cullen
- Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,University Centre, University Health Network, Toronto Rehabilitation Institute , Toronto , Ontario , Canada
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20
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Disparities in Health Care Utilization of Adults With Traumatic Brain Injuries Are Related to Insurance, Race, and Ethnicity: A Systematic Review. J Head Trauma Rehabil 2019; 33:E40-E50. [PMID: 28926481 DOI: 10.1097/htr.0000000000000338] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To characterize racial/ethnic and insurance disparities in the utilization of healthcare services among US adults with traumatic brain injury (TBI). METHODS The PubMed database was used to search for articles that directly examined the association between race/ethnicity and insurance disparities and healthcare utilization among patients with TBI. Eleven articles that met the criteria and were published between June 2011 and June 2016 were finally included in the review. RESULTS Lack of insurance was significantly associated with decreased use of inhospital and posthospital healthcare services among patients with TBI. However, mixed results were reported for the associations between insurance types and healthcare utilization. The majority of studies reported that racial/ethnic minorities were less likely to use inhospital and posthospital healthcare services, while some studies did not indicate any significant relation between race/ethnicity and healthcare utilization among patients with TBI. CONCLUSIONS This review provides evidence of a relation between insurance status and healthcare utilization among US adults with TBI. Insurance status may also account for some portion of the relation between race/ethnicity and healthcare utilization.
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21
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Van Deynse H, Van Belleghem G, Lauwaert D, Moens M, Pien K, Devos S, Hubloue I, Putman K. The incremental cost of traumatic brain injury during the first year after a road traffic accident. Brain Inj 2019; 33:1234-1244. [DOI: 10.1080/02699052.2019.1641224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Helena Van Deynse
- Department of Public Health, Interuniversity Centre of Health Economics Research, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Griet Van Belleghem
- Department of Public Health, Interuniversity Centre of Health Economics Research, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Door Lauwaert
- Emergency and Disaster Medicine, Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Karen Pien
- Department of Medical Registration, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Stefanie Devos
- Department of Public Health, Interuniversity Centre of Health Economics Research, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ives Hubloue
- Emergency and Disaster Medicine, Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Koen Putman
- Department of Public Health, Interuniversity Centre of Health Economics Research, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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22
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Driver S, Juengst S, Reynolds M, McShan E, Kew CL, Vega M, Bell K, Dubiel R. Healthy lifestyle after traumatic brain injury: a brief narrative. Brain Inj 2019; 33:1299-1307. [DOI: 10.1080/02699052.2019.1641623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Simon Driver
- North Texas TBI Model System, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Shannon Juengst
- North Texas TBI Model System, University of Texas at Southwestern, Dallas, TX, USA
| | - Megan Reynolds
- North Texas TBI Model System, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Evan McShan
- North Texas TBI Model System, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Chung Lin Kew
- North Texas TBI Model System, University of Texas at Southwestern, Dallas, TX, USA
| | - Marlene Vega
- North Texas TBI Model System, University of Texas at Southwestern, Dallas, TX, USA
| | - Kathleen Bell
- North Texas TBI Model System, University of Texas at Southwestern, Dallas, TX, USA
| | - Randi Dubiel
- North Texas TBI Model System, Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
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23
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Five-Year Trends in Marital Stability, Academic Achievement, and Socioeconomic Indicators After Concussion: A National Register Study. J Head Trauma Rehabil 2019; 35:E86-E94. [PMID: 31246879 DOI: 10.1097/htr.0000000000000501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine long-term trends in marital stability, academic achievement, income, and socioeconomic status in patients with concussion. DESIGN AND SETTING Danish national register-based cohort study with 5 years of follow-up. PARTICIPANTS A total of 23 549 hospital-admitted or emergency-treated patients between 18 and 60 years of age with concussion (International Classification of Diseases, Tenth Revision [ICD-10] diagnosis S06.0) and 22 228 matching controls. MAIN MEASURES Outcomes were the differences between patients with concussion and controls in the change from injury date to 5 years postinjury in the dichotomized outcomes-martial stability, academic achievement, income, and socioeconomic status. RESULTS Fewer patients had high education (19.43%) compared with controls (23.96%) and the adjusted odds ratio (OR) of high education beyond the difference in prevalence at baseline became even lower at 5 years of follow-up (OR: 0.93, 95% confidence interval [CI]: 0.90-0.95). Patients were to a lesser extent gainfully employed (67.05%) compared with controls (77.32%) and had lower odds of being gainfully employed (OR: 0.83, 95% CI: 0.79-0.88), self-employed, leaders, or managers (OR: 0.89, 95% CI: 0.84-0.95) at 5 years postinjury, beyond differences at baseline. CONCLUSIONS Academic achievement and socioeconomic status are affected by concussion. There is no evidence that marital stability and income are affected. Supporting interventions should be considered those at risk of persistent symptoms.
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24
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van Dijck JTJM, Dijkman MD, Ophuis RH, de Ruiter GCW, Peul WC, Polinder S. In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment. PLoS One 2019; 14:e0216743. [PMID: 31071199 PMCID: PMC6508680 DOI: 10.1371/journal.pone.0216743] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/28/2019] [Indexed: 12/19/2022] Open
Abstract
Background The in-hospital treatment of patients with traumatic brain injury (TBI) is considered to be expensive, especially in patients with severe TBI (s-TBI). To improve future treatment decision-making, resource allocation and research initiatives, this study reviewed the in-hospital costs for patients with s-TBI and the quality of study methodology. Methods A systematic search was performed using the following databases: PubMed, MEDLINE, Embase, Web of Science, Cochrane library, CENTRAL, Emcare, PsychINFO, Academic Search Premier and Google Scholar. Articles published before August 2018 reporting in-hospital acute care costs for patients with s-TBI were included. Quality was assessed by using a 19-item checklist based on the CHEERS statement. Results Twenty-five out of 2372 articles were included. In-hospital costs per patient were generally high and ranged from $2,130 to $401,808. Variation between study results was primarily caused by methodological heterogeneity and variable patient and treatment characteristics. The quality assessment showed variable study quality with a mean total score of 71% (range 48% - 96%). Especially items concerning cost data scored poorly (49%) because data source, cost calculation methodology and outcome reporting were regularly unmentioned or inadequately reported. Conclusions Healthcare consumption and in-hospital costs for patients with s-TBI were high and varied widely between studies. Costs were primarily driven by the length of stay and surgical intervention and increased with higher TBI severity. However, drawing firm conclusions on the actual in-hospital costs of patients sustaining s-TBI was complicated due to variation and inadequate quality of the included studies. Future economic evaluations should focus on the long-term cost-effectiveness of treatment strategies and use guideline recommendations and common data elements to improve study quality.
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Affiliation(s)
- Jeroen T. J. M. van Dijck
- Department of Neurosurgery, Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Neurosurgical Center Holland, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Neurosurgical Center Holland, Haga Teaching Hospital, The Hague, The Netherlands
- * E-mail:
| | - Mark D. Dijkman
- Department of Neurosurgery, Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Neurosurgical Center Holland, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Neurosurgical Center Holland, Haga Teaching Hospital, The Hague, The Netherlands
| | - Robbin H. Ophuis
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Godard C. W. de Ruiter
- Department of Neurosurgery, Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Neurosurgical Center Holland, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Neurosurgical Center Holland, Haga Teaching Hospital, The Hague, The Netherlands
| | - Wilco C. Peul
- Department of Neurosurgery, Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Neurosurgical Center Holland, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Neurosurgery, Neurosurgical Center Holland, Haga Teaching Hospital, The Hague, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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Differences in Posttraumatic Stress Disorder, Depression, and Attribution of Symptoms in Service Members With Combat Versus Noncombat Mild Traumatic Brain Injury. J Head Trauma Rehabil 2019; 35:37-45. [PMID: 31033746 DOI: 10.1097/htr.0000000000000486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study compares combat-related mild traumatic brain injury (mTBI) to non-combat-related mTBI in rates of posttraumatic stress disorder (PTSD) and depression after injury, severity of postconcussive symptoms (PCSs), and attribution of those symptoms to mTBI versus PTSD. PARTICIPANTS A total of 371 active duty service members (SMs) with documented history of mTBI, divided into combat and non-combat-related cohorts. DESIGN Retrospective cohort study. MAIN MEASURES Diagnoses of PTSD and depression based on medical record review and self-report. PCSs measured using Neurobehavioral Symptom Index. Attribution of symptoms based on a rating scale asking how much mTBI, PTSD, depression, deployment, or readjustment stress contributed to current symptoms. RESULTS Prevalence of PTSD was significantly higher after a combat-related mTBI, compared with a noncombat mTBI (P = .001). Prevalence of depression did not differ between the 2 groups. PCSs were high in both combat and noncombat mTBIs, with no statistical difference between groups. SMs with PTSD reported higher PCS, regardless of combat status. SMs without PTSD attributed symptoms mainly to mTBI, whereas SMs with PTSD, regardless of combat status, were much more likely to attribute symptoms to PTSD, depression, and deployment/readjustment stress. CONCLUSIONS This research contributes to our understanding of the complex interplay between mTBI and PTSD in both combat and noncombat injuries within the military population and the importance of addressing both simultaneously.
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26
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Graves JM, Mackelprang JL, Moore M, Abshire DA, Rivara FP, Jimenez N, Fuentes M, Vavilala MS. Rural-urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury. Health Serv Res 2019; 54:337-345. [PMID: 30507042 PMCID: PMC6407359 DOI: 10.1111/1475-6773.13096] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To compare health care costs and service utilization associated with mild traumatic brain injury (mTBI) in rural and urban commercially insured children. DATA SOURCE MarketScan Commercial Claims and Encounters Data, 2007-2011. STUDY DESIGN We compared health care costs and outpatient encounters for physical/occupational therapy, speech therapy, and psychiatry/psychology encounters 180 days after mTBI among rural versus urban children (<18 years). PRINCIPAL FINDINGS A total of 387 846 children had mTBI, with 13 percent residing in rural areas. Adjusted mean total health care costs in the 180 days after mTBI were $2778 (95% CI: 2660-2897) among rural children, compared to $2499 (95% CI: 2471-2528) among urban children (adjusted cost ratio 1.11, 95% CI 1.06-1.16). Rural-urban differences in utilization for specific services were also found. CONCLUSIONS Total health care costs were higher for rural compared to urban children despite lower utilization of certain services. Differences in health service utilization may exacerbate geographic disparities in adverse outcomes associated with mTBI.
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Affiliation(s)
- Janessa M. Graves
- College of NursingHealth Sciences CampusWashington State UniversitySpokaneWashington
| | - Jessica L. Mackelprang
- Department of Psychological SciencesSchool of Health SciencesSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Megan Moore
- School of Social WorkUniversity of WashingtonHarborview Injury Prevention and Research Center (HIPRC)SeattleWashington
| | | | - Frederick P. Rivara
- Department of PediatricsSchool of MedicineUniversity of WashingtonHarborview Injury Prevention and Research Center (HIPRC)SeattleWashington
| | - Nathalia Jimenez
- Department of Anesthesiology and Pain MedicineSchool of MedicineUniversity of WashingtonSeattle Children's Research InstituteHarborview Injury Prevention and Research Center (HIPRC)SeattleWashington
| | - Molly Fuentes
- Department of Rehabilitation MedicineSchool of MedicineUniversity of WashingtonHarborview Injury Prevention and Research Center (HIPRC)Seattle Children's Research InstituteSeattleWashington
| | - Monica S. Vavilala
- Departments of Anesthesiology & Pain Medicine and PediatricsSchool of MedicineUniversity of WashingtonHarborview Injury Prevention and Research Center (HIPRC)SeattleWashington
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27
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Sahbaie P, Tajerian M, Yang P, Irvine KA, Huang TT, Luo J, Wyss-Coray T, Clark JD. Nociceptive and Cognitive Changes in a Murine Model of Polytrauma. THE JOURNAL OF PAIN 2018; 19:1392-1405. [DOI: 10.1016/j.jpain.2018.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 12/27/2022]
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28
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Dismuke-Greer CE, Gebregziabher M, Ritchwood T, Pugh MJ, Walker RJ, Uchendu US, Egede LE. Geographic Disparities in Mortality Risk Within a Racially Diverse Sample of U.S. Veterans with Traumatic Brain Injury. Health Equity 2018; 2:304-312. [PMID: 30374469 PMCID: PMC6203888 DOI: 10.1089/heq.2018.0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Traumatic brain injury (TBI) is a signature injury among the U.S. veterans. Hispanic U.S. veterans diagnosed with TBI have been found to have higher risk-adjusted mortality. This study examined the adjusted association of geographic location with all-cause mortality in 114,593 veterans diagnosed with TBI between January 1, 2000 and December 31, 2010, and followed through December 31, 2014. Methods: National Veterans Health Administration (VHA) databases containing administrative data including International Classification of Diseases, 9th Revision (ICD-9) codes, sociodemographic characteristics, and survival were linked. TBI was identified based on ICD-9 codes. Cox proportional hazards regression methods were used to examine the association of time from first TBI ICD-9 code to death with geographic location, after adjustment for TBI severity, race/ethnicity, other sociodemographic characteristics, military factors, and Elixhauser comorbidities. Results: Relative to urban mainland veterans with a median survival of 76.4 months, veterans living in the U.S. territories had a median survival of 69.1 months, whereas rural mainland veterans had a median survival of 77.1 months, and highly rural mainland veterans had a mean survival of 77.6 months. The final model adjusted for race/ethnicity, TBI severity, sociodemographic, military, and comorbidity covariates showed that residing in the U.S. territories was associated with a higher risk of death (hazard ratios=1.24; 95% confidence interval 1.15-1.34) relative to residing on the U.S. mainland. The race/ethnicity disparity previously found for the U.S. veterans diagnosed with TBI seems to be accounted for by living in the U.S. territories. Conclusion: The study shows that among veterans with TBI, mortality rates were higher in those who reside in the U.S. territories, even after adjustment. Previous documented higher mortality among Hispanic veterans seems to be explained by residing in the U.S. territories. The VA has a mission of ensuring equitable treatment of all veterans, and should investigate targeted policies and interventions to improve the survival of the U.S. territory veterans diagnosed with TBI.
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Affiliation(s)
- Clara E Dismuke-Greer
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Division of Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mulugeta Gebregziabher
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Tiarney Ritchwood
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Mary Jo Pugh
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.,IDEAS Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Uche S Uchendu
- Chief Officer for Health Equity, US Department of Veterans Affairs, Washington, DC.,Principal, Health Management Associates, Washington, DC
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
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Wagner AK, Kumar RG. TBI Rehabilomics Research: Conceptualizing a humoral triad for designing effective rehabilitation interventions. Neuropharmacology 2018; 145:133-144. [PMID: 30222984 DOI: 10.1016/j.neuropharm.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/14/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022]
Abstract
Most areas of medicine use biomarkers in some capacity to aid in understanding how personal biology informs clinical care. This article draws upon the Rehabilomics research model as a translational framework for programs of precision rehabilitation and intervention research focused on linking personal biology to treatment response using biopsychosocial constructs that broadly represent function and that can be applied to many clinical populations with disability. The summary applies the Rehabilomics research framework to the population with traumatic brain injury (TBI) and emphasizes a broad vision for biomarker inclusion, beyond typical brain-derived biomarkers, to capture and/or reflect important neurological and non-neurological pathology associated with TBI as a chronic condition. Humoral signaling molecules are explored as important signaling and regulatory drivers of these chronic conditions and their impact on function. Importantly, secondary injury cascades involved in the humoral triad are influenced by the systemic response to TBI and the development of non-neurological organ dysfunction (NNOD). Biomarkers have been successfully leveraged in other medical fields to inform pre-randomization patient selection for clinical trials, however, this practice largely has not been utilized in TBI research. As such, the applicability of the Rehabilomics research model to contemporary clinical trials and comparative effectiveness research designs for neurological and rehabilitation populations is emphasized. Potential points of intervention to modify inflammation, hormonal, or neurotrophic support through rehabilitation interventions are discussed. This article is part of the Special Issue entitled "Novel Treatments for Traumatic Brain Injury".
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Affiliation(s)
- A K Wagner
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, USA; Safar Center for Resuscitation Research, University of Pittsburgh, USA; Department of Neuroscience, University of Pittsburgh, USA; Center for Neuroscience, University of Pittsburgh, USA.
| | - R G Kumar
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, USA; Safar Center for Resuscitation Research, University of Pittsburgh, USA; Department of Epidemiology, University of Pittsburgh, USA
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30
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Effect of Modafinil Administration on the Level of Consciousness in Patients with Brain Injuries of Moderate Severity. Trauma Mon 2018. [DOI: 10.5812/traumamon.61505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Eliacin J, Fortney S, Rattray NA, Kean J. Access to health services for moderate to severe TBI in Indiana: patient and caregiver perspectives. Brain Inj 2018; 32:1510-1517. [DOI: 10.1080/02699052.2018.1499964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Johanne Eliacin
- Department of Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush Department of Veterans Affairs Medical Center, Indianapolis, IN, USA
- Departments of Psychology, Indiana University Purdue University, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Inc. Indianapolis, IN, USA
- Act Center of Indiana, Indianapolis, IN, USA
| | - Sarah Fortney
- Department of Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush Department of Veterans Affairs Medical Center, Indianapolis, IN, USA
- Departments of Psychology, Indiana University Purdue University, Indianapolis, IN, USA
| | - Nicholas A. Rattray
- Department of Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush Department of Veterans Affairs Medical Center, Indianapolis, IN, USA
- Department of Anthropology, Indiana University Purdue University, Indianapolis, IN, USA
| | - Jacob Kean
- Department of Health Services Research and Development, Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah School of Medicine, Salt Lake City, UT, USA
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32
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Lifetime History of Traumatic Brain Injury and Current Disability Among Ohio Adults. J Head Trauma Rehabil 2018; 33:E24-E32. [DOI: 10.1097/htr.0000000000000352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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33
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Timmons SD. Editorial. The challenges of estimating the cost of traumatic brain injury worldwide. Neurosurg Focus 2018; 44:E8. [DOI: 10.3171/2018.2.focus1888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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34
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Norrara B, Doerl JG, Guzen FP, Cavalcanti JRLP, Freire MAM. Commentary: Localized vs. Systematic Neurodegeneration: A Paradigm Shift in Understanding Neurodegenerative Diseases. Front Syst Neurosci 2017; 11:91. [PMID: 29270113 PMCID: PMC5725474 DOI: 10.3389/fnsys.2017.00091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 11/22/2017] [Indexed: 01/21/2023] Open
Affiliation(s)
- Bianca Norrara
- Laboratory of Experimental Neurology, Department of Biomedical Sciences, Faculty of Healthy Sciences, University of the State of Rio Grande do Norte (UERN), Mossoró, Brazil
| | - Jhulimar G Doerl
- Laboratory of Experimental Neurology, Department of Biomedical Sciences, Faculty of Healthy Sciences, University of the State of Rio Grande do Norte (UERN), Mossoró, Brazil
| | - Fausto P Guzen
- Laboratory of Experimental Neurology, Department of Biomedical Sciences, Faculty of Healthy Sciences, University of the State of Rio Grande do Norte (UERN), Mossoró, Brazil
| | - Jose Rodolfo Lopes P Cavalcanti
- Laboratory of Experimental Neurology, Department of Biomedical Sciences, Faculty of Healthy Sciences, University of the State of Rio Grande do Norte (UERN), Mossoró, Brazil
| | - Marco Aurelio M Freire
- Laboratory of Experimental Neurology, Department of Biomedical Sciences, Faculty of Healthy Sciences, University of the State of Rio Grande do Norte (UERN), Mossoró, Brazil
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Raghava N, Das BC, Ray SK. Neuroprotective effects of estrogen in CNS injuries: insights from animal models. ACTA ACUST UNITED AC 2017; 6:15-29. [PMID: 28845391 PMCID: PMC5567743 DOI: 10.2147/nan.s105134] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Among the estrogens that are biosynthesized in the human body, 17β-estradiol (estradiol or E2) is the most common and the best estrogen for neuroprotection in animal models of the central nervous system (CNS) injuries such as spinal cord injury (SCI), traumatic brain injury (TBI), and ischemic brain injury (IBI). These CNS injuries are not only serious health problems, but also enormous economic burden on the patients, their families, and the society at large. Studies from animal models of these CNS injuries provide insights into the multiple neuroprotective mechanisms of E2 and also suggest the possibility of translating the therapeutic efficacy of E2 in the treatment SCI, TBI, and IBI in humans in the near future. The pathophysiology of these injuries includes loss of motor function in the limbs, arms and their extremities, cognitive deficit, and many other serious consequences including life-threatening paralysis, infection, and even death. The potential application of E2 therapy to treat the CNS injuries may become a trend as the results are showing significant therapeutic benefits of E2 for neuroprotection when administered into the animal models of SCI, TBI, and IBI. This article describes the plausible mechanisms how E2 works with or without the involvement of estrogen receptors and provides an overview of the known neuroprotective effects of E2 in these three CNS injuries in different animal models. Because activation of estrogen receptors has profound implications in maintaining and also affecting normal physiology, there are notable impediments in translating E2 therapy to the clinics for neuroprotection in CNS injuries in humans. While E2 may not yet be the sole molecule for the treatment of CNS injuries due to the controversies surrounding it, the neuroprotective effects of its metabolite and derivative or combination of E2 with another therapeutic agent are showing significant impacts in animal models that can potentially shape the new treatment strategies for these CNS injuries in humans.
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Affiliation(s)
- Narayan Raghava
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Bhaskar C Das
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Swapan K Ray
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA
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36
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The American Telemedicine Association ATA 2017 Telehealth 2.0 Conference Abstracts. Telemed J E Health 2017; 23:A1-A78. [PMID: 28410061 DOI: 10.1089/tmj.2017.29005-a.abstracts] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Near-Infrared Spectroscopy: A Promising Prehospital Tool for Management of Traumatic Brain Injury. Prehosp Disaster Med 2017; 32:414-418. [DOI: 10.1017/s1049023x17006367] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroductionEarly identification of traumatic brain injury (TBI) is essential. Near-infrared spectroscopy (NIRS) can be used in prehospital settings for non-invasive monitoring and the diagnosis of patients who may require surgical intervention.MethodsThe handheld NIRS Infrascanner (InfraScan Inc.; Philadelphia, Pennsylvania USA) uses eight symmetrical scan points to detect intracranial bleeding. A scanner was tested in a physician-staffed helicopter Emergency Medical Service (HEMS). The results were compared with those obtained using in-hospital computed tomography (CT) scans. Scan time, ease-of-use, and change in treatment were scored.ResultsA total of 25 patients were included. Complete scans were performed in 60% of patients. In 15 patients, the scan was abnormal, and in one patient, the scan resulted in a treatment change. Compared with the results of CT scanning, the Infrascanner obtained a sensitivity of 93.3% and a specificity of 78.6%. Most patients had severe TBI with indication for transport to a trauma center prior to scanning. In one patient, the scan resulted in a treatment change. Evaluation of patients with less severe TBI is needed to support the usefulness of the Infrascanner as a prehospital triage tool.ConclusionPromising results were obtained using the InfraScan NIRS device in prehospital screening for intracranial hematomas in TBI patients. High sensitivity and good specificity were found. Further research is necessary to determine the beneficial effects of enhanced prehospital screening on triage, survival, and quality of life in TBI patients.PetersJ,
Van WageningenB,
HoogerwerfN,
TanE. Near-infrared spectroscopy: a promising prehospital tool for management of traumatic brain injury. Prehosp Disaster Med. 2017;32(4):414–418.
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Velikonja D, Oakes J, Brum C, Sachdeva M. Assessing the validity of Task Analysis as a quantitative tool to measure the efficacy of rehabilitation in brain injury. Brain Inj 2016; 31:68-74. [DOI: 10.1080/02699052.2016.1212090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Diana Velikonja
- Hamilton Health Sciences Acquired Brain Injury Program, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jill Oakes
- Hamilton Health Sciences Acquired Brain Injury Program, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christine Brum
- Hamilton Health Sciences Acquired Brain Injury Program, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Muskaan Sachdeva
- McMaster University Health Sciences Program, Hamilton, Ontario, Canada
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