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Huang Q, Lindgren N, Zhou Z, Li X, Kleiven S. A method for generating case-specific vehicle models from a single-view vehicle image for accurate pedestrian injury reconstructions. Accid Anal Prev 2024; 200:107555. [PMID: 38531282 DOI: 10.1016/j.aap.2024.107555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/20/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
Developing vehicle finite element (FE) models that match real accident-involved vehicles is challenging. This is related to the intricate variety of geometric features and components. The current study proposes a novel method to efficiently and accurately generate case-specific buck models for car-to-pedestrian simulations. To achieve this, we implemented the vehicle side-view images to detect the horizontal position and roundness of two wheels to rectify distortions and deviations and then extracted the mid-section profiles for comparative calculations against baseline vehicle models to obtain the transformation matrices. Based on the generic buck model which consists of six key components and corresponding matrices, the case-specific buck model was generated semi-automatically based on the transformation metrics. Utilizing this image-based method, a total of 12 vehicle models representing four vehicle categories including family car (FCR), Roadster (RDS), small Sport Utility Vehicle (SUV), and large SUV were generated for car-to-pedestrian collision FE simulations in this study. The pedestrian head trajectories, total contact forces, head injury criterion (HIC), and brain injury criterion (BrIC) were analyzed comparatively. We found that, even within the same vehicle category and initial conditions, the variation in wrap around distance (WAD) spans 84-165 mm, in HIC ranges from 98 to 336, and in BrIC fluctuates between 1.25 and 1.46. These findings highlight the significant influence of vehicle frontal shape and underscore the necessity of using case-specific vehicle models in crash simulations. The proposed method provides a new approach for further vehicle structure optimization aiming at reducing pedestrian head injury and increasing traffic safety.
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Affiliation(s)
- Qi Huang
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Natalia Lindgren
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Zhou Zhou
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Xiaogai Li
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Svein Kleiven
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
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Cáceres E, Divani AA, Rubinos CA, Olivella-Gómez J, Viñan Garcés AE, González A, Alvarado Arias A, Bhatia K, Samadani U, Reyes LF. PaCO 2 Association with Outcomes of Patients with Traumatic Brain Injury at High Altitude: A Prospective Single-Center Cohort Study. Neurocrit Care 2024:10.1007/s12028-024-01982-8. [PMID: 38740704 DOI: 10.1007/s12028-024-01982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/12/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Partial pressure of carbon dioxide (PaCO2) is generally known to influence outcome in patients with traumatic brain injury (TBI) at normal altitudes. Less is known about specific relationships of PaCO2 levels and clinical outcomes at high altitudes. METHODS This is a prospective single-center cohort of consecutive patients with TBI admitted to a trauma center located at 2600 m above sea level. An unfavorable outcome was defined as a Glasgow Outcome Scale-Extended (GOSE) score < 4 at the 6-month follow-up. RESULTS We had a total of 81 patients with complete data, 80% (65/81) were men, and the median (interquartile range) age was 36 (25-50) years. Median Glasgow Coma Scale (GCS) score on admission was 9 (6-14); 49% (40/81) of patients had severe TBI (GCS 3-8), 32% (26/81) had moderate TBI (GCS 12-9), and 18% (15/81) had mild TBI (GCS 13-15). The median (interquartile range) Abbreviated Injury Score of the head (AISh) was 3 (2-4). The frequency of an unfavorable outcome (GOSE < 4) was 30% (25/81), the median GOSE was 4 (2-5), and the median 6-month mortality rate was 24% (20/81). Comparison between patients with favorable and unfavorable outcomes revealed that those with unfavorable outcome were older, (median age 49 [30-72] vs. 29 [22-41] years, P < 0.01), had lower admission GCS scores (6 [4-8] vs. 13 [8-15], P < 0.01), had higher AISh scores (4 [4-4] vs. 3 [2-4], P < 0.01), had higher Acute Physiology and Chronic Health disease Classification System II scores (17 [15-23] vs. 10 [6-14], P < 0.01), had higher Charlson scores (0 [0-2] vs. 0 [0-0], P < 0.01), and had higher PaCO2 levels (mean 35 ± 8 vs. 32 ± 6 mm Hg, P < 0.01). In a multivariate analysis, age (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.1-1.30, P < 0.01), AISh (OR 4.7, 95% CI 1.55-21.0, P < 0.05), and PaCO2 levels (OR 1.23, 95% CI 1.10-1.53, P < 0.05) were significantly associated with the unfavorable outcomes. When applying the same analysis to the subgroup on mechanical ventilation, AISh (OR 5.4, 95% CI 1.61-28.5, P = 0.017) and PaCO2 levels (OR 1.36, 95% CI 1.13-1.78, P = 0.015) remained significantly associated with the unfavorable outcome. CONCLUSIONS Higher PaCO2 levels are associated with an unfavorable outcome in ventilated patients with TBI. These results underscore the importance of PaCO2 levels in patients with TBI and whether it should be adjusted for populations living at higher altitudes.
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Affiliation(s)
- Eder Cáceres
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chía, Colombia.
- Department of Bioscience, School of Engineering, Universidad de La Sabana, Chía, Colombia.
- Department of Critical Care, Clínica Universidad de La Sabana, Chía, Colombia.
| | - Afshin A Divani
- Department of Neurology, The University of New Mexico, Albuquerque, NM, USA
| | - Clio A Rubinos
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
| | - Juan Olivella-Gómez
- Department of Critical Care, Clínica Universidad de La Sabana, Chía, Colombia
| | | | - Angélica González
- Department of Critical Care, Clínica Universidad de La Sabana, Chía, Colombia
| | | | - Kunal Bhatia
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Uzma Samadani
- Department of Neurosurgery, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Luis F Reyes
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chía, Colombia
- Department of Critical Care, Clínica Universidad de La Sabana, Chía, Colombia
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
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Lorente AI, Maza-Peón S, Hidalgo-García C, López-de-Celis C, Rodríguez-Sanz J, Pérez-Bellmunt A, Maza-Frechín M. Skull fractures by glass bottles tested on cadaveric heads. Int J Legal Med 2024; 138:1165-1171. [PMID: 38112757 PMCID: PMC11003884 DOI: 10.1007/s00414-023-03133-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/11/2023] [Indexed: 12/21/2023]
Abstract
Head trauma is frequently related to the misuse of drinking vessels as weapons. Forensic reports usually evaluate these blunt injuries as having occurred in scenarios where the alcohol intake is high. Fatal consequences are seen in blows with glass bottles aiming at the head. To prove the outcome that a glass bottle thrown to the head could cause, three intact human cadaver heads were impacted with 1-liter glass bottles at 9.5 m/s using a drop-tower. The impact location covered the left temporal bone, sphenoid bone, and zygomatic arch. The contact between the head and the bottle was produced at an angle of 90° with (1) the valve of the bottle, (2) the bottom of the bottle, and (3) with the head rotated 20° in the frontal plane touching again with the bottom of the bottle. The three bottles remained intact after the impact, and the injury outcomes were determined by computed tomography (CT). The alterations were highly dependent on the impact orientation. The outcome varied from no injury to severe bone fractures. In the most injurious case (#3), fractures were identified in the cranial base, sphenoid bone, and zygomatic bone. These testing conditions were selected to replicate one specific legal case, as required by the plaintiff. Physical disputes with bar glassware can lead to complex combinations of blunt and sharp-force injuries. Controlled biomechanical studies can benefit forensic analyses of violence involving glassware by providing a better understanding of the underlying injury mechanisms.
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Affiliation(s)
- Ana I Lorente
- Instituto Universitario de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain.
- Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Drive, Charlottesville, VA, 22911, USA.
| | - Samuel Maza-Peón
- Instituto Universitario de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain
| | - César Hidalgo-García
- Researching Unit of Physiotherapy, University of Zaragoza, c/Domingo Miral s/n, 50009, Zaragoza, Spain
| | - Carlos López-de-Celis
- Universitat Internacional de Catalunya, Actium Functional Anatomy Group, Faculty of Medicine and Health Sciences, C/Josep Trueta, s/n, 08195, Sant Cugat del Valles (Barcelona), Spain
| | - Jacobo Rodríguez-Sanz
- Universitat Internacional de Catalunya, Actium Functional Anatomy Group, Faculty of Medicine and Health Sciences, C/Josep Trueta, s/n, 08195, Sant Cugat del Valles (Barcelona), Spain
| | - Albert Pérez-Bellmunt
- Universitat Internacional de Catalunya, Actium Functional Anatomy Group, Faculty of Medicine and Health Sciences, C/Josep Trueta, s/n, 08195, Sant Cugat del Valles (Barcelona), Spain
| | - Mario Maza-Frechín
- Instituto Universitario de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, C/Mariano Esquillor s/n, 50018, Zaragoza, Spain
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Saboori M, Riazi A, Taji M, Yadegarfar G. Traumatic brain injury and stem cell treatments: A review of recent 10 years clinical trials. Clin Neurol Neurosurg 2024; 239:108219. [PMID: 38471197 DOI: 10.1016/j.clineuro.2024.108219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
Traumatic brain injury (TBI) is damage to the brain by an external physical force. It may result in cognitive and physical dysfunction. It is one of the main causes of disability and death all around the world. In 2016, the worldwide incidence of acute TBI was nearly 27 million cases. Therapeutic interventions currently in use provide poor outcomes. So recent research has focused on stem cells as a potential treatment. The major objective of this study was to conduct a systematic review of the recent clinical trials in the field of stem cell transplantation for patients with TBI. The Cochrane Library, Web of Science, SCOPUS, PubMed and also Google Scholar were searched for relevant terms such as "traumatic brain injury", " brain trauma", "brain injury", "head injury", "TBI", "stem cell", and "cell transplantation" and for publications from January 2013 to June 2023. Clinical trials and case series which utilized stem cells for TBI treatment were included. The data about case selection and sample size, mechanism of injury, time between primary injury and cell transplantation, type of stem cells transplanted, route of stem cell administration, number of cells transplanted, episodes of transplantation, follow-up time, outcome measures and results, and adverse events were extracted. Finally, 11 studies met the defined criteria and were included in the review. The total sample size of all studies was 402, consisting of 249 cases of stem cell transplantation and 153 control subjects. The most commonly used cells were BMMNCs, the preferred route of transplantation was intrathecal transplantation, and all studies reported improvement in clinical, radiologic, or biochemical markers after transplantation. No serious adverse events were reported. Stem cell therapy is safe and logistically feasible and leads to neurological improvement in patients with traumatic brain injury. However, further controlled, randomized, multicenter studies with large sample sizes are needed to determine the optimal cell and dose, timing of transplantation in acute or chronic phases of TBI, and the optimal route and number of transplants.
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Affiliation(s)
- Masih Saboori
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of Iran
| | - Ali Riazi
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of Iran
| | - Mohammadreza Taji
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of Iran.
| | - Ghasem Yadegarfar
- Department of Epidemiology and Biostatistics, Health School, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of Iran
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Heinonen A, Rauhala M, Isokuortti H, Raj R, Kataja A, Nikula M, Öhman J, Iverson GL, Luoto T. Incidence of surgically treated chronic subdural hematoma after head injury with normal initial computed tomography. Acta Neurochir (Wien) 2024; 166:144. [PMID: 38514587 PMCID: PMC10957655 DOI: 10.1007/s00701-024-06040-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The objective was to determine the incidence of surgically treated chronic subdural hematoma (cSDH) within six months after head trauma in a consecutive series of head injury patients with a normal initial computed tomography (CT). METHODS A total of 1941 adult patients with head injuries who underwent head CT within 48 h after injury and were treated at the Tampere University Hospital's emergency department were retrospectively evaluated from medical records (median age = 59 years, IQR = 39-79 years, males = 58%, patients using antithrombotic medication = 26%). Patients with no signs of acute traumatic intracranial pathology or any type of subdural collection on initial head CT were regarded as CT negative (n = 1573, 81%). RESULTS Two (n = 2) of the 1573 CT negative patients received surgical treatment for cSDH. Consequently, the incidence of surgically treated cSDH after a normal initial head CT during a six-month follow-up was 0.13%. Both patients sustained mild traumatic brain injuries initially. One of the two patients was on antithrombotic medication (warfarin) at the time of trauma, hence incidence of surgically treated cSDH among patients with antithrombotic medication in CT negative patients (n = 376, 23.9%) was 0.27%. Additionally, within CT negative patients, one subdural hygroma was operated shortly after trauma. CONCLUSION The extremely low incidence of surgically treated cSDH after a normal initial head CT, even in patients on antithrombotic medication, supports the notion that routine follow-up imaging after an initial normal head CT is not indicated to exclude the development of cSDH. Additionally, our findings support the concept of cSDH not being a purely head trauma-related disease.
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Affiliation(s)
- Aaro Heinonen
- The Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Minna Rauhala
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anneli Kataja
- Department of Radiology, Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Milaja Nikula
- The Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
| | - Juha Öhman
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
| | - Teemu Luoto
- The Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
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Galteland P, Døving M, Næss I, Sehic A, Utheim TP, Eken T, Skaga NO, Helseth E, Ramm-Pettersen J. The association between head injury and facial fracture treatment: an observational study of hospitalized bicyclists from a level 1 trauma centre. Acta Neurochir (Wien) 2024; 166:132. [PMID: 38472419 PMCID: PMC10933183 DOI: 10.1007/s00701-024-06019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury. METHODS Retrospective analysis of data from bicycle-related injuries in the period 2005-2016 extracted from the Oslo University Hospital trauma registry. RESULTS A total of 967 bicyclists with head injuries classified according to the Abbreviated Injury Scale (AIS) were included. The group suffering minor-moderate head injury (AIS Head 1-2) included 518 bicyclists, while 449 bicyclists had major head injury (AIS Head 3-6). The mean patient age was 40.2 years (range 3-91 years) and 701 patients (72%) were men. A total of 521 facial fractures were registered in 262 patients (on average 2 facial fractures per bicyclist). Bicyclists with major head injury exhibited increased odds for facial fractures compared to bicyclists with minor-moderate head injury (sex and age adjusted odds ratio (OR) 2.75, 95% confidence interval (CI) 2.03-3.72, p < 0.001. More specifically, there was increased odds for all midface fractures, but no difference for mandible fractures. There was also increased odds for orbital reconstruction in cyclist with major head injury compared to bicyclist with minor-moderate head injury (adjusted OR 3.34, 95% CI 1.30-8.60, p = 0.012). CONCLUSION Bicyclists with more severe head injuries had increased odds for midface fractures and surgical correction of orbital fractures. During trauma triage, the head and the face should be considered as one unit.
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Affiliation(s)
- Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway
- Faculty of Dentistry, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Ingar Næss
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Amer Sehic
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway
- Faculty of Dentistry, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway
- Faculty of Dentistry, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Torsten Eken
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Jon Ramm-Pettersen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
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Ranson R, Esper GW, Woodruff R, Solasz SJ, Egol KA, Konda SR. The effect of traumatic head injuries on the outcome of middle-aged and geriatric orthopedic trauma patients. Injury 2024; 55:111299. [PMID: 38199073 DOI: 10.1016/j.injury.2023.111299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The purpose of this study is to characterize the effects of head injuries amongst the middle-aged and geriatric populations on hospital quality measures, costs, and outcomes in an orthopedic trauma setting. METHODS Patients with head and orthopedic injuries aged >55 treated at an academic medical center from October 2014-April 2021 were reviewed for their Abbreviated Injury Score for Head and Neck (AIS-H), baseline demographics, injury characteristics, hospital quality measures and outcomes. Univariate comparative analyses were conducted across AIS-H groups with additional regression analyses controlling for confounding variables. All statistical analyses were conducted with a Bonferroni adjusted alpha. RESULTS A total of 1,051 patients were included. The mean age was 74 years, and median AIS-H score was 2 (range 1-6). While outcomes worsened and costs increased as AIS-H scores increased, the most drastic (and clinically relevant) rise occurs between scores 2-3. Patients who sustained a head injury warranting an AIS-H score of 3 experienced a significantly higher rate of major complications, need for ICU admission, inpatient and 1-year mortality with longer lengths of stay and higher total costs despite no differences in demographics or injury characteristics. Regression analysis found a higher AIS-H score was independently associated with greater mortality risk. CONCLUSION AIS-H scores >2 correlate with significantly worse outcomes and higher hospital costs. Concomitant head injuries impact both outcomes and direct variable costs for middle-aged and geriatric orthopedic trauma patients. Clinicians, hospitals, and payers should consider the significant effect of head injuries on the hospitalization of these patients.
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Affiliation(s)
- Rachel Ranson
- NYU Langone Orthopaedic Hospital, New York, NY, United States; The George Washington University Hospital, Washington, DC, United States.
| | - Garrett W Esper
- NYU Langone Orthopaedic Hospital, New York, NY, United States
| | - Robert Woodruff
- Campbell University School of Osteopathic Medicine, Lillington, NC, United States
| | - Sara J Solasz
- NYU Langone Orthopaedic Hospital, New York, NY, United States
| | - Kenneth A Egol
- NYU Langone Orthopaedic Hospital, New York, NY, United States; Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Queens, NY 11418, United States
| | - Sanjit R Konda
- NYU Langone Orthopaedic Hospital, New York, NY, United States; Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Queens, NY 11418, United States
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O'Connor S, Reilly R, Hegedus A, Whyte E, Moran K, Porter L. Current Concussion Knowledge, Beliefs, Education, and Management Practices Among Irish Post-Primary PE Teachers. Res Q Exerc Sport 2024; 95:118-126. [PMID: 36731859 DOI: 10.1080/02701367.2022.2158999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/08/2022] [Indexed: 06/18/2023]
Abstract
Purpose: Physical education (PE) teachers play an important role in concussion recognition and management in schools both in an academic and activity based setting. This study aimed to identify Irish post-primary PE teachers' concussion knowledge, beliefs, education and management practices. Methods: An anonymous online survey, adapted to the Irish context from the validated BAKPAC-TEACH, was completed by 128 PE teachers (female = 74/123; 60.2%; male = 49/123; 39.8%, 36.1 ± 10.9 years), representing 4% of registered PE teachers in Ireland. Results: PE teachers reported 3.5 ± 4.7 students suffer with a sports-related concussion in their classroom annually and 43.9% previously had a student sustain a concussion during their PE class. Most received concussion education (58.6%), largely provided by sporting bodies. They frequently identified dizziness (93.0%) and headaches (92.2%) as concussion symptoms, but less commonly emotional (more emotional = 36.5%, nervous or anxious = 33.6%, sadness = 28.9%) or sleep (35.2%) symptoms. All PE teachers knew that a concussion requires immediate removal from a game/practice. PE teachers demonstrated less perceived knowledge and confidence relating to academic adjustments and return to learn criteria. Just 31.3% reported their school facilitates academic adjustments. Conclusion: Tailored concussion education addressing knowledge gaps highlighted in this study should be developed. A concussion policy and an academic support team in each school should be established and widely publicised to enhance the support of concussed students in returning to school.
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Bosch L, Rittersma SZH, van der Worp BH, Kraaijeveld AO, Vlachojannis G, van der Harst P, Voskuil M. The value of computed tomography for head trauma in patients presenting with out-of-hospital cardiac arrest before emergency percutaneous coronary intervention. Neth Heart J 2024; 32:125-129. [PMID: 37615827 PMCID: PMC10883901 DOI: 10.1007/s12471-023-01807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) caused by an ST-elevation myocardial infarction (STEMI) is often accompanied by a sudden loss of consciousness that may cause the patient to collapse with resulting head trauma, leading to a suspicion of possible intracranial haemorrhage. To rule out intracranial haemorrhage before emergency percutaneous coronary intervention (PCI), emergency computed tomography (CT) of the head might be useful but also causes a delay in percutaneous STEMI treatment. METHODS The medical records of all adult patients that presented with OHCA to the emergency department (ED) of the University Medical Centre Utrecht (UMCU), the Netherlands between 16 February 2020 and 16 February 2022 were reviewed. RESULTS A total of 263 patients presented to the ED with an OHCA; 50 presented with a STEMI requiring emergency PCI. Thirty-nine (78%) patients with a STEMI were immediately referred to the catheterisation laboratory and 11 (22%) STEMI patients underwent a CT scan prior to emergency angiography; in no case was PCI deferred on the basis of the CT findings. The dominant indication for CT of the head was collapse, reported by 10 patients and resulting in a visible traumatic head injury in 7 patients. In none of the patients was intracranial haemorrhage detected. However, there was a delay between presentation to the ED and arrival at the catheterisation laboratory in patients who underwent CT of the head (mean 63 ± 25 min) before emergency PCI compared to patients without a CT scan (mean 37 ± 21 min). CONCLUSION CT of the head did not result in a diagnosis of intracranial haemorrhage or deferral of PCI but did delay PCI treatment for STEMI in patients presenting with OHCA.
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Affiliation(s)
- Lena Bosch
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Saskia Z H Rittersma
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Bart H van der Worp
- Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - George Vlachojannis
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Saxena S, Zutrauen S, McFaull SR. Assault-related traumatic brain injury hospitalizations in Canada from 2010 to 2021: rates, trends and comorbidity. Inj Epidemiol 2024; 11:4. [PMID: 38326885 PMCID: PMC10851460 DOI: 10.1186/s40621-024-00486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major cause of morbidity and mortality globally. TBI is often associated with other physical or psychological issues resulting in high hospitalization costs. TBI incidence and recovery can vary with the external cause being intentional or unintentional. It is important to monitor the rates of TBI hospitalizations related to different external causes. This study examined the annual rate, comorbidity and length of stay associated with assault-related TBI hospitalizations and compare it with other external causes, by age and sex in Canada from 2010 to 2021. METHODS Discharge Abstract Database was used to extract cases of TBI (2010-2021). ICD-10-CA codes were used to classify all cases with TBI as per assault and other external causes (falls; transport; sport, physical activity and recreation; struck by). Additional variables, including age, sex, comorbidity and length of stay, were examined. Time trends were quantified using Joinpoint regression. RESULTS The average annual percent increase for all TBI hospitalizations from 2010 to 2021 was not significant at 0.1%. Females accounted for 35.8% of these TBI hospitalizations. From 2010 to 2021, assault-related TBI hospitalizations showed a significant annual decline of 4.1% for males and a significant increase of 1.2% for females. Increase in TBI hospitalizations related to falls showed an average annual percent increase of 1.4% for males and 2.2% for females. A significant decrease was observed for TBI hospitalizations related to the other three (transport, SPAR and struck by) external causes for both sexes from 2010 to 2021. Infants and children under 10 years of age had higher percentages of cases with comorbidities and higher length of stay for assault-related TBI hospitalizations. CONCLUSIONS Assault-related TBI hospitalization rates decreased overall and among males, rates among females increased from 2010 to 2021. These results underscore the importance of targeted prevention efforts for TBI related to different external causes, age and sex, and continued surveillance to monitor the epidemiology of assault-related TBI.
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11
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Carr HR, Hall JE, Eisenbarth H, Brandt VC. The bidirectional relationship between head injuries and conduct problems: longitudinal modelling of a population-based birth cohort study. Eur Child Adolesc Psychiatry 2024; 33:411-420. [PMID: 36826528 PMCID: PMC10869410 DOI: 10.1007/s00787-023-02175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
Childhood head injuries and conduct problems increase the risk of aggression and criminality and are well-known correlates. However, the direction and timing of their association and the role of their demographic risk factors remain unclear. This study investigates the bidirectional links between both from 3 to 17 years while revealing common and unique demographic risks. A total of 8,603 participants (50.2% female; 83% White ethnicity) from the Millennium Cohort Study were analysed at 6 timepoints from age 3 to 17. Conduct problems were parent-reported for ages 3 to 17 using the Strengths and Difficulties Questionnaire (SDQ) and head injuries at ages 3 to 14. A cross-lagged path model estimated the longitudinal bidirectional effects between the two whilst salient demographic risks were modelled cumulatively at three ecological levels (child, mother, and household). Conduct problems at age 5 promoted head injuries between 5 and 7 (Z = 0.07; SE = 0.03; 95% CI, 0.02-0.13), and head injuries at ages 7 to 11 promoted conduct problems at age 14 (ß = .0.06; SE = .0.03; 95% CI, 0.01-0.12). Head injuries were associated with direct child-level risk at age 3, whereas conduct problems were associated with direct risks from all ecological levels until 17 years. The findings suggest a sensitive period at 5-11 years for the bidirectional relationship shared between head injuries and conduct problems. They suggest that demographic risks for increased head injuries play an earlier role than they do for conduct problems. Both findings have implications for intervention timing.
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Affiliation(s)
- Hannah R Carr
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, University Road, Highfield Campus, Building 44, Southampton, SO17 1PS, UK.
| | - James E Hall
- Southampton Education School, University of Southampton, Southampton, SO17 1BJ, UK
| | - Hedwig Eisenbarth
- School of Psychology, Victoria University of Wellington, Wellington, 6140, New Zealand
| | - Valerie C Brandt
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, University Road, Highfield Campus, Building 44, Southampton, SO17 1PS, UK
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12
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Amulya T, Babu A, Kuriachan M, Vasan TC. "Sealing the Gap" : CSF Leakage Demystified-A Comprehensive Analysis of our Experience in CSF Rhinorrhea Management. Indian J Otolaryngol Head Neck Surg 2024; 76:653-657. [PMID: 38440596 PMCID: PMC10908997 DOI: 10.1007/s12070-023-04240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 03/06/2024] Open
Abstract
CSF (Cerebro Spinal Fluid) rhinorrhoea occurs when the fluid leaks from subarachnoid space into the nasal cavity. The study aims to find out the prevalence and demographic distribution of CSF leak and to describe the site of the CSF leak along with the management. We did a prospective study on 180 patients admitted with head injury in neurosurgery department, along with the patients who came to ENT department with unilateral nasal discharge during the time period from March 2017 to March 2021. A total of 36 cases of CSF leak were obtained during the time period. The etiology in 18 cases was head injury & the other 18 cases were either due to infectious or nontraumatic causes. In our study, 26(72.22%) patients were aged less than 50 years. Incidence was more among males compared to females. The most common etiology was head injury - 18(50%) patients followed by the spontaneous leak- 16 (44.44%) patients with the most common site as the cribriform plate. Endoscopic repair using a hadad flap was done in most of the patients. Trauma due to head injury is the most common etiology in CSF rhinorrhea with more number of patients aged less than 50 years. Most of the leaks can be repaired successfully with the use of endoscope with excellent illumination & localizing the exact site of the leak.
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Affiliation(s)
- T.M Amulya
- Department of ENT, Head and Neck surgery, JSS Academy of Higher Education and Research(JSSAHER), Mysuru, Karnataka 570004 India
| | - A.R Babu
- Department of ENT, Head and Neck surgery, JSS Academy of Higher Education and Research(JSSAHER), Mysuru, Karnataka 570004 India
| | - Merin Kuriachan
- Department of ENT, Head and Neck surgery, JSS Academy of Higher Education and Research(JSSAHER), Mysuru, Karnataka 570004 India
| | - T.S. Col. Vasan
- Department of Neurosurgery, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka 570004 India
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13
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Schiff ND, Diringer M, Diserens K, Edlow BL, Gosseries O, Hill NJ, Hochberg LR, Ismail FY, Meyer IA, Mikell CB, Mofakham S, Molteni E, Polizzotto L, Shah SA, Stevens RD, Thengone D. Brain-Computer Interfaces for Communication in Patients with Disorders of Consciousness: A Gap Analysis and Scientific Roadmap. Neurocrit Care 2024:10.1007/s12028-023-01924-w. [PMID: 38286946 DOI: 10.1007/s12028-023-01924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND We developed a gap analysis that examines the role of brain-computer interfaces (BCI) in patients with disorders of consciousness (DoC), focusing on their assessment, establishment of communication, and engagement with their environment. METHODS The Curing Coma Campaign convened a Coma Science work group that included 16 clinicians and neuroscientists with expertise in DoC. The work group met online biweekly and performed a gap analysis of the primary question. RESULTS We outline a roadmap for assessing BCI readiness in patients with DoC and for advancing the use of BCI devices in patients with DoC. Additionally, we discuss preliminary studies that inform development of BCI solutions for communication and assessment of readiness for use of BCIs in DoC study participants. Special emphasis is placed on the challenges posed by the complex pathophysiologies caused by heterogeneous brain injuries and their impact on neuronal signaling. The differences between one-way and two-way communication are specifically considered. Possible implanted and noninvasive BCI solutions for acute and chronic DoC in adult and pediatric populations are also addressed. CONCLUSIONS We identify clinical and technical gaps hindering the use of BCI in patients with DoC in each of these contexts and provide a roadmap for research aimed at improving communication for adults and children with DoC, spanning the clinical spectrum from intensive care unit to chronic care.
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Affiliation(s)
- Nicholas D Schiff
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.
| | - Michael Diringer
- Departments of Neurology and Neurosurgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Karin Diserens
- Neurology and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, Centre du Cerveau, University Hospital of Liège, University of Liège & Centre du Cerveau, Liège, Belgium
| | - N Jeremy Hill
- National Center for Adaptive Neurotechnologies, Stratton VA Medical Center, Albany, NY, USA
- Electrical & Computer Engineering Department, State University of New York at Albany, Albany, NY, USA
| | - Leigh R Hochberg
- Veterans Affairs Rehabilitation Research & Development Center for Neurorestoration and Neurotechnology, Rehabilitation Research & Development Service, Providence VA Medical Center, Providence, RI, USA
- School of Engineering and Carney Institute for Brain Science, Brown University, Providence, RI, USA
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Fatima Y Ismail
- Department of Pediatrics, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Neurology, Adjunct Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivo A Meyer
- Neurology and Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Centre for Advanced Research in Sleep Medicine and Integrated Trauma Centre, Integrated University Health and Social Services Centre (CIUSSS) du Nord-de-L'Île-de-Montréal, Montreal, QC, Canada
| | - Charles B Mikell
- Department of Neurosurgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Sima Mofakham
- Department of Neurosurgery, Stony Brook University Hospital, Stony Brook, NY, USA
- Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, and Centre for Medical Engineering, King's College London, London, UK
| | - Leonard Polizzotto
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Sudhin A Shah
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Robert D Stevens
- Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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14
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Kalagara R, Hrabarchuk EI, Hannah TC, Downes MH, Li T, Vasan V, Li AY, Asfaw ZK, Quinones A, McCarthy L, Schupper AJ, Gometz A, Lovell MR, Choudhri TF. The effect of age on baseline neurocognitive performance. Brain Inj 2024; 38:136-141. [PMID: 38328998 DOI: 10.1080/02699052.2024.2307968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Evaluate the independent effect of age on baseline neurocognitive performance. STUDY DESIGN Baseline ImPACT scores from tests taken by 7454 athletes aged 12-22 from 2009 to 2019 were split into three age cohorts: 12-14 years (3244), 15-17 years (3732), and 18-22 years (477). Linear regression analyses were used to evaluate the effect of age on ImPACT composite scores while controlling for demographic differences, medication-use, and symptom burden. Significance values have been set at p < 0.05. RESULTS Linear regression analyses demonstrated that increased age does not significantly affect symptom score (β = 0.06, p = 0.54) but does improve impulse control (β = -0.45, p < 0.0001), verbal memory (β = 0.23, p = 0.03), visualmotor (β = 0.77, p < 0.0001), and reaction time (β = -0.008, p < 0.0001) scores. However, age did not have an effect on visual memory scores (β = -0.25, p = 0.07). CONCLUSIONS Age was shown to be an independent modifier of impulse control, verbal memory, visual motor, and reaction time scores but not visual memory or symptom scores. This underscores the previous literature showing developmental differences as age increases among the adolescent athlete population. This data also indicates the need for repeat neurocognitive baseline testing every other year as baseline scoring is likely to change as athletes become older.
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Affiliation(s)
- Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Eugene I Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Theodore C Hannah
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Margaret H Downes
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Troy Li
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
| | - Alex Gometz
- Concussion Management of New York, New York, USA
| | - Mark R Lovell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine, at Mount Sinai, New York, USA
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15
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Quigley KG, Fenner M, Pavilionis P, Constantino NL, Moran RN, Murray NG. Minimal Detectable Change for the ImPACT Subtests at Baseline. Arch Clin Neuropsychol 2024:acae002. [PMID: 38273670 DOI: 10.1093/arclin/acae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE To establish the minimal detectable change (MDC) of the subtests that comprise the composite scores from remotely administered Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baselines. METHOD Remote ImPACT baseline data from 172 (male = 45, female = 127) National Collegiate Athletic Association Division I student-athletes from the 2020 and 2021 athletic preseasons were used to calculate the MDC at the 95%, 90%, and 80% confidence intervals (CIs) for all subtest scores used to generate the four core composite scores and the impulse control composite. RESULTS The MDCs for the verbal memory subtests at the 95% CI were 10.31 for word memory percent correct, 4.68 for symbol match total correct hidden, and 18.25 for three letters percentage correct. Visual memory subtest MDCs were 19.03 for design memory total percent correct and 4.90 for XO total correct memory. Visual motor speed subtest MDCs were 18.89 for XO total correct interference and 5.40 for three letters average counted correctly. Reaction time (RT) MDCs were 0.12 for XO average correct, 0.95 for symbol match average correct RT, and 0.28 for color match average correct. Impulse control MDCs were 5.97 for XO total incorrect and 1.15 for color match total commissions. One-way repeated measures MANOVA, repeated measures ANOVAs, and Wilcoxon signed-ranks test all suggested no significant difference between any subtests across two remote ImPACT baselines. CONCLUSIONS The ImPACT subtest scores did not significantly change between athletic seasons. Our study suggests the subtests be evaluated in conjunction with the composite scores to provide additional metrics for clinical interpretation.
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Affiliation(s)
- Kristen G Quigley
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
| | - Madison Fenner
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
| | - Philip Pavilionis
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
| | - Nora L Constantino
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
| | - Ryan N Moran
- Athletic Training Research Laboratory, Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA
| | - Nicholas G Murray
- Department of Kinesiology, School of Public Health, University of Nevada, Reno, NV, USA
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16
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Foster MA, Collins MR, Wertin TM, Azurdia AR, Lettieri SC, Feiz-Erfan I. Management of epidural hematomas of the posterior Cranial Fossa. World Neurosurg X 2024; 21:100263. [PMID: 38187504 PMCID: PMC10770538 DOI: 10.1016/j.wnsx.2023.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/29/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Michael A. Foster
- Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- University of Arizona, College of Science, Tucson, AZ, USA
| | - Michael R. Collins
- Department of Radiology, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Thomas M. Wertin
- Division of Trauma, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Adrienne R. Azurdia
- Department of Emergency Medicine, Valleywise Health Medical Center, Phoenix, AZ, USA
- Department of Emergency Medicine, Honor Health Osborn, Scottsdale, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Salvatore C. Lettieri
- Division of Plastic Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Division of Plastic Surgery, Mayo Clinic, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Iman Feiz-Erfan
- Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
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17
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Moore S, Musgrave C, Sandler J, Bradley B, Jones JRA. Early intervention treatment in the first 2 weeks following concussion in adults: A systematic review of randomised controlled trials. Phys Ther Sport 2024; 65:59-73. [PMID: 38065015 DOI: 10.1016/j.ptsp.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE International guidelines support a repertoire of therapeutic interventions that may assist recovery following concussion. We aimed to systematically review the efficacy of early pharmacological and non-pharmacological interventions initiated within two weeks of injury on symptoms and functional recovery of adults with concussion. METHODS We conducted a Systematic Review (SR) of Randomised Controlled Trials (RCTs) without meta-analysis utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed of four databases. Study inclusion criteria were adult participants diagnosed with concussion and commencing active intervention within 14 days of injury. RESULTS AND CONCLUSIONS Of 7531 studies identified, 11 were included in the final review. Six studies were rated as high-risk of bias, three with some concerns and two as low-risk of bias. We found no evidence to support specific pharmacotherapeutic management to hasten the natural recovery time-course. Two studies reported significant improvement in selected concussion symptoms following manual therapy (at 48-72 hours post-treatment) or telephone counselling interventions (at 6 months post-injury). No high quality RCTs demonstrate superior effects of early therapeutic interventions on concussion recovery in the first 2 weeks. We advocate future research to examine impacts of health-clinician contact points aligned with symptom-specific interventions.
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Affiliation(s)
- Sonya Moore
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia.
| | - Chris Musgrave
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan Sandler
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Ben Bradley
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer R A Jones
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia; Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia; Institute of Breathing and Sleep, Heidelberg, Victoria, Australia
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18
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Carr HR, Hall JE, Brandt VC. Adolescent delinquency following co-occurring childhood head injuries and conduct problem symptoms: findings from a UK longitudinal birth cohort. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02335-0. [PMID: 38153523 DOI: 10.1007/s00787-023-02335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023]
Abstract
Childhood conduct problems and head injuries share a bidirectional association, but how this affects the risk of adolescent delinquency is unknown. Due to their similar underlying mechanisms (i.e. increased impulsivity), this study aims to identify whether their co-occurrence increases the risk of adolescent delinquency. Data was obtained from 11,272 children at age 14 and 10,244 at age 17 years enrolled in the UK Millennium Cohort Study. Conduct problem symptoms (via the Strengths and Difficulties Questionnaire) and head injuries were parent reported from ages 3 to 14 years. Delinquency was self-reported at ages 14 and 17 including substance use, criminality, and antisocial behaviour. Incident rate ratios (IRR) were estimated for delinquency at ages 14 and 17 by childhood conduct problem and head injury status. Co-occurring head injuries and high conduct problem symptoms presented the greatest risk for overall delinquency and substance use at age 14 compared to those with the presence of one or neither (IRRs from 1.20 to 1.60). At age 17, conduct problems (with or without co-occurring head injuries) presented the greatest risk for overall delinquency, substance use, and antisocial behaviour. There was no evidence for an increased risk of delinquency at ages 14 or 17 following a head injury only. Whilst these findings suggest childhood head injuries alone do not increase the risk of adolescent delinquency, when co-occurring alongside high conduct problem symptoms there is a heightened earlier risk. These results provide further insight into adolescent delinquency and the outcomes of co-occurring childhood head injury and conduct problem symptoms.
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Affiliation(s)
- Hannah R Carr
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, University Road, Highfield Campus, Building 44, Southampton, SO17 1PS, UK.
| | - James E Hall
- Southampton Education School, University of Southampton, Southampton, UK
| | - Valerie C Brandt
- School of Psychology, Centre for Innovation in Mental Health, University of Southampton, University Road, Highfield Campus, Building 44, Southampton, SO17 1PS, UK
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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19
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Quang H, Wearne T, Filipcikova M, Pham N, Nguyen N, McDonald S. A Biopsychosocial Framework for Apathy Following Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-analysis. Neuropsychol Rev 2023:10.1007/s11065-023-09620-4. [PMID: 38112938 DOI: 10.1007/s11065-023-09620-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 09/19/2023] [Indexed: 12/21/2023]
Abstract
Apathy, the deficit of goal-directed behaviour, is well recognised as one of the most debilitating syndromes after moderate-to-severe traumatic brain injury (TBI). However, mechanisms underlying apathy, or at least factors associated with apathy, are sporadically reported. Based on a biopsychosocial framework, this systematic review and meta-analysis synthesised evidence regarding neurobiological, socio-environmental and individual factors associated with apathy. Our searches identified 21 studies satisfying inclusion and exclusion criteria. Results showed that the majority of work has focused on cognitive dysfunction, TBI-related factors, demographic variables and psychological correlates of apathy, while evidence for neural substrates and socio-cultural and premorbid aspects is scant. Overall, the current literature suggests that TBI-related and patient demographic factors did not contribute to apathy after TBI, whereas complex neurocognitive alterations, socio-environmental and cultural factors as well as patients' self-related factors may be important components. The evidence points to the multifaceted interplay of certain biopsychosocial contributors to apathy and suggests future investigations of more complex behavioural traits, cultural elements and pre-injury levels to better characterise the aetiology of this detrimental impairment after TBI.
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Affiliation(s)
- Halle Quang
- School of Health Sciences and Brain & Mind Centre, University of Sydney, Sydney, Australia.
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia.
| | | | - Michaela Filipcikova
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia
| | - Nhi Pham
- School of Psychology, Ho Chi Minh City University of Education, Ho Chi Minh City, Vietnam
| | - Nhi Nguyen
- Ho Chi Minh City University of Social Sciences and Humanities, Ho Chi Minh City, Vietnam
| | - Skye McDonald
- School of Psychology, University of New South Wales, High Street, Kensington, NSW, 2033, Australia
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20
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Niang FG, Faye I, Niang I, Diedhiou M, Diop AD, Diop AN. Early stage of cerebral amyloid angiopathy revealed by follow-up of a minimal head injury. Radiol Case Rep 2023; 18:4458-4460. [PMID: 37860781 PMCID: PMC10582288 DOI: 10.1016/j.radcr.2023.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Cerebral amyloid angiopathy (CAA) is an age-related cerebral microangiopathy characterized by the accumulation of amyloid-beta peptide in the wall of leptomeningeal arteries and cortical vessels. Diagnosis of sporadic amyloid angiopathy is most often made in elderly patient with lobar hematoma. We report a case of a 68-year-old female who had minimal head injury. Cerebral CT showed a right cerebellar hematoma. Follow-up MRI after 4 months showed signs of cerebral amyloid angiopathy. Through this observation, we describe the MRI semiology that helps make the diagnosis of cerebral amyloid angiopathy.
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Affiliation(s)
- Fallou Galass Niang
- Department of Radiology, Saint-Louis Regional Hospital, Saint-Louis, Senegal
- Gaston Berger University, Saint-Louis, Senegal
| | - Ibrahima Faye
- Department of Radiology, Saint-Louis Regional Hospital, Saint-Louis, Senegal
| | - Ibrahima Niang
- Department of Radiology, Fann University Hospital, Dakar, Senegal
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21
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Fuchs K, Backhaus R, Jordan MC, Lefering R, Meffert RH, Gilbert F. [The severely injured older cyclist-Evaluation of the TraumaRegister DGU® : Retrospective, multicenter cross-sectional study based on the TraumaRegister DGU®]. Unfallchirurgie (Heidelb) 2023; 126:952-959. [PMID: 36988660 PMCID: PMC10682217 DOI: 10.1007/s00113-022-01286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Contrary to the trend of decreasing traffic fatalities, the number of cyclists killed in Germany has been steadily increasing in recent years. With the increasing popularity of cycling in all age groups, the number of accidents with sometimes serious injuries is rising. In the course of this, the question arises what influence age has on the type and severity of injuries, the probability of survival and the length of hospital stay in seriously injured cyclists. METHODS A retrospective analysis of data from the TraumaRegister DGU® (TR-DGU) from 2010 to 2019 was performed. All severely injured cyclists with a maximum abbreviated injury scale (MAIS) of 3+ (n = 14,651) in the TR-DGU were included in this study and the available parameters were evaluated. A subdivision into three age groups (60-69, 70-79, and ≥ 80 years) and a control group (20-59 years) was carried out. RESULTS Injuries to the head were by far the most common, accounting for 64.2%. There was a marked increase in severe head injuries in the 60-plus years age group. Furthermore, with increasing age, the probability of prehospital intubation, catecholamine requirement, intensive care and hospital length of stay, and mortality increased. CONCLUSION Head injuries represent the most common serious injury, especially among older cyclists. As helmet wearing was not recorded in the TraumaRegister DGU® during the evaluation period, no conclusion can be drawn about its effect. Furthermore, a higher age correlates with a longer hospital stay and a higher mortality, but does not represent an independent risk factor for death in severely injured patients.
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Affiliation(s)
- Konrad Fuchs
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Roman Backhaus
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Martin C Jordan
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Rolf Lefering
- MUM - Muskuloskelettales Universitätszentrum München, Ludwigs-Maximilians-Universität München, Campus Innenstadt, Ziemssenstr. 5, 80336, München, Deutschland
| | - Rainer H Meffert
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - Fabian Gilbert
- MUM - Muskuloskelettales Universitätszentrum München, Ludwigs-Maximilians-Universität München, Campus Innenstadt, Ziemssenstr. 5, 80336, München, Deutschland.
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22
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Hiskens MI, Mengistu TS, Hovinga B, Thornton N, Smith KB, Mitchell G. Epidemiology and management of traumatic brain injury in a regional Queensland Emergency Department. Australas Emerg Care 2023; 26:314-320. [PMID: 37076417 DOI: 10.1016/j.auec.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND There is a paucity of traumatic brain injury (TBI) data in Australia in the regional and rural context. This study aimed to investigate the epidemiology, severity, causes, and management of TBI in a regional north Queensland population to plan acute care, follow up, and prevention strategies. METHODS This retrospective study analysed TBI patients presenting to Mackay Base Hospital Emergency Department (ED) in 2021. We identified patients using head injury SNOMED codes, and analysed patient characteristics with descriptive and multivariable regression analysis. RESULTS There were 1120 head injury presentations, with an overall incidence of 909 per 100,000 people per year. The median (IQR) age was 18 (6-46) years. Falls were the most common injury mechanism (52.4% of presentations). 41.1% of patients had a Computed Tomography (CT) scan, while 16.5% of patients who met criteria had post traumatic amnesia (PTA) testing. Age, being male and Indigenous status were associated with higher odds of moderate to severe TBI. CONCLUSION TBI incidence in this regional population was higher than metropolitan locations. CT scan was undertaken less frequently than in comparative literature, and low rates of PTA testing were undertaken. These data provide insight to assist in planning prevention and TBI-care services.
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Affiliation(s)
- Matthew I Hiskens
- Mackay Institute of Research and Innovation (MIRI), Mackay Hospital and Health Service, Mackay, QLD 4740, Australia.
| | - Tesfaye S Mengistu
- Mackay Institute of Research and Innovation (MIRI), Mackay Hospital and Health Service, Mackay, QLD 4740, Australia; University of Queensland, School of Public Health, Herston, QLD 4006, Australia
| | - Bauke Hovinga
- Emergency Department, Mackay Hospital and Health Service, Mackay, QLD 4740, Australia
| | - Neale Thornton
- Emergency Department, Mackay Hospital and Health Service, Mackay, QLD 4740, Australia
| | - Karen B Smith
- Mackay Institute of Research and Innovation (MIRI), Mackay Hospital and Health Service, Mackay, QLD 4740, Australia
| | - Gary Mitchell
- Royal Brisbane and Women's Hospital Emergency and Trauma Centre, Herston, QLD 4006, Australia
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23
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Ichwan K, Gazali S, Suherman S, Desiana D, Nurjannah N. Plasma interleukin 6 as an outcome predictor of traumatic brain injury patients. Narra J 2023; 3:e234. [PMID: 38455629 PMCID: PMC10919736 DOI: 10.52225/narra.v3i3.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/26/2023] [Indexed: 03/09/2024]
Abstract
Traumatic brain injury is one of the leading causes of death and disability in young adults. Previous studies have suggested that neuroinflammatory process involves the overexpression of interleukin 6 (IL-6); however, data on the predictive ability of IL-6 is limited and conflicting in traumatic head injury patients. The aim of this study was to assess the ability of plasma IL-6 as a predictor of outcome in head injury patients. A cross-sectional study was conducted between June and December 2020 among traumatic head injury patients admitted to Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Demographic, clinical data, and IL-6 level were collected and measured on admission. The outcome was assessed by the Glasgow outcome scale extended (GOSE) in the first- and third-month of post-injury. A total of 50 traumatic brain injury patients were recruited of which 54% were male, 64% had mild head injury, 82% had leukocytosis, and 60% had non-bleeding head CT scan. The mean of IL-6 level was 79.32 pg/mL while the GOSE scores ranged from 1 (death) to 8 (upper good recovery). Early IL-6 level (<24 hours post-injury) was significantly correlated with worse outcome in traumatic head injury, though the correlation strength was moderate (p<0.001; r=-0.42). As a predictor, IL-6 yielded the area under curve (AUC) value of 93.5% (p<0.001) and a cut-off point of 46.33 pg/mL. The sensitivity and specificity of this predictor were 87.5% and 95.24%, respectively. In conclusion, early IL-6 level can be used as a predictor for traumatic head injury. Nevertheless, further multi-center study with a bigger sample size is needed to confirm this finding.
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Affiliation(s)
- Khairunnisa Ichwan
- Department of Neurology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Syahrul Gazali
- Department of Neurology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Suherman Suherman
- Department of Neurology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Desiana Desiana
- Department of Clinical Pathology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Clinical Pathology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Nurjannah Nurjannah
- Department of Public Health, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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24
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Jeffs SB, Nolasco LA, Petroskey KJ. Predicting head injury metrics during low- to moderate-speed frontal collisions using computational simulations. Accid Anal Prev 2023; 193:107303. [PMID: 37769479 DOI: 10.1016/j.aap.2023.107303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/29/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Subjective reports of mild traumatic brain injury (mTBI) are common following low-energy motor-vehicle collisions. Biomechanical analyses are useful in providing a quantitative means for determining the likelihood of sustaining mTBI. While occupant dynamics in low-speed rear impacts have been extensively investigated, peer-reviewed studies on occupant dynamics during low-speed frontal collisions are sparse. The objective of this study is to present a validated computational method to quantify the biomechanical response of the head in low- and moderate-speed frontal collisions. DATA AND METHODS This study used data from a previously-published series of four instrumented in-line front-to-rear staged collisions using 2014 Honda Accord sedans at closing velocities of approximately 7.4 kph (test L1), 12.7 kph (test L2), 21.7 kph (test L3), and 33.6 kph (test L4) kph. A model of the test vehicle occupant compartment was created using the MAthematical DYnamic MOdeling (MADYMO) software using methods previously described. Crash pulse data from L4 were applied to the MADYMO model. Seat belt parameters were optimized to achieve reasonable agreement between simulation results and test data for relevant head injury metrics (linear head acceleration [LHA], angular head acceleration [AHA], and HIC15). Crash pulses from the other tests in the series (L1, L2, and L3) were then applied to the model and peak values for LHA, AHA, and HIC15 were compared to the physical test data to demonstrate validation. RESULTS The optimization of seat belt and seat parameters within the MADYMO model resulted in accurate prediction of ATD dynamics demonstrated in Test L4. The simulation-predicted peak LHA was within 0.2 g of the test value, peak AHA was within 64 rad/s2, and HIC15 was within 0.46. When applied to the remainder of the tests (L1, L2, and L3), the optimized model showed excellent accuracy in predicting peak LHA and HIC15. When compared to the physical test data, the simulation-predicted values for LHA were within 0.4 g or less and the HIC15 values were within 0.4 or less across all tests. The model generally over-predicted AHA, particularly for the lower-severity collisions (L1 and L2). CONCLUSIONS We have demonstrated a reliable methodology for developing a biomechanical computational model to predict head injury metrics in low- to moderate-speed frontal collisions. This approach can be particularly valuable in forensic investigations of real-world crashes. Pre-existing crash test data can be used in conjunction with exemplar vehicle information to validate a MADYMO model. Appropriate crash pulse data from classical accident reconstruction techniques, event data recorders, or simulations can then be applied to the model to accurately predict head dynamics for real-world vehicle occupants without the need for full-scale staged crash tests.
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25
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Tai K, Leland EM, Seal SM, Schneider ALC, Rowan NR, Kamath V. Olfactory Dysfunction Following Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2023; 33:717-732. [PMID: 36070126 PMCID: PMC10040093 DOI: 10.1007/s11065-022-09563-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/30/2022] [Accepted: 07/11/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Reports of smell loss following traumatic brain injury (TBI) are a well-documented but understudied phenomenon. Given the broad consequences of olfactory loss, we characterized psychophysical olfactory dysfunction in individuals with moderate to severe TBI using systematic review and meta-analytic methods. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol, five databases (PubMed, EMBASE, Cochrane Library, Web of Science, Scopus) were reviewed for studies investigating olfactory dysfunction in persons with moderate to severe TBI. Of the 5,223 studies reviewed, 19 met our inclusion criteria for the systematic review and 11 met inclusion criteria for meta-analysis. We calculated effect sizes (Hedges' g) to characterize the degree of olfactory dysfunction between patients with moderate to severe TBI and controls. RESULTS A total of 951 moderate-severe TBI patients from 19 studies were included in the systematic review, which largely demonstrated poorer olfactory psychophysical performances in this patient population. Meta-analysis demonstrated a large effect size for olfactory dysfunction in moderate-severe TBI relative to healthy controls (g=-2.43, 95%CI: -3.16 < δ<-1.69). The magnitude of the effect was moderated by age and patient sex, with larger effect sizes associated with older age (following exclusion of a pediatric population) and larger compositions of women in the patient group. CONCLUSION Moderate to severe TBI is associated with prominent olfactory dysfunction. Significant research gaps remain regarding the mechanism, recovery and natural history of olfactory dysfunction following moderate to severe TBI, which has significant clinical implications for the identification and treatment for those with post-traumatic olfactory dysfunction.
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Affiliation(s)
- Katherine Tai
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Evelyn M Leland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stella M Seal
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurological Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 218, 21287-7218, Baltimore, MD, USA.
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26
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Waltzman D, Sarmiento K, Zhang X, Miller GF. Estimated prevalence of helmet use while bicycling, rollerblading, and skateboarding among middle school students in selected U.S. States- Youth Behavior Risk Survey, 2013-2019. J Safety Res 2023; 87:367-374. [PMID: 38081708 PMCID: PMC10714050 DOI: 10.1016/j.jsr.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/04/2022] [Accepted: 08/09/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Helmet use helps prevent severe and fatal head and brain injuries from bicycle, rollerblade, and skateboard crashes. This study explores the prevalence of self-reported helmet use among middle school students while bicycling, skateboarding, and rollerblading. METHODS Data from the Middle School Youth Risk Behavior Survey (YRBS) for selected states were analyzed. Self-reported prevalence (frequency) of helmet use while bicycling, rollerblading, or skateboarding and other variables (sex, grade level, and race/ethnicity) are reported. RESULTS The overall prevalence of rarely or never wearing a helmet while bicycling among middle school students in selected states was 68.6%; decreasing from 71.7% in 2013 to 67.1% in 2019. The overall prevalence of rarely or never wearing a helmet while rollerblading or skateboarding in middle school students in selected states was 74.6%; decreasing from 76.4% in 2013 to 73.5% in 2019. Students in 7th and 8th grade and students of non-Hispanic race/ethnicity had significantly higher odds of rarely or never wearing a helmet while bicycling or while rollerblading and skateboarding than students in 6th grade and non-Hispanic White students. CONCLUSIONS While helmet use among middle school students improved over time, overall helmet use during bicycling, rollerblading, and skateboarding remained low. These estimates illustrate the continued call for universal implementation of helmet use efforts among kids using established strategies. PRACTICAL APPLICATIONS Future research on helmet use among youth who rollerblade and skateboard, as well as multi-pronged efforts to promote helmet use among middle schoolers who bicycle, skateboard, and rollerblade (inclusive of education, helmet distribution, and social marketing techniques, as well as the provision of helmets at no-cost) may be beneficial for addressing perceived risks for injury and other barriers.
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Affiliation(s)
- Dana Waltzman
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, United States.
| | - Kelly Sarmiento
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, United States
| | - Xinjian Zhang
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, United States
| | - Gabrielle F Miller
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, United States
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Abstract
N-Acetylcysteine (NAC) has shown promise as a putative neurotherapeutic for traumatic brain injury (TBI). Yet, many such promising compounds have limited ability to cross the blood-brain barrier (BBB), achieve therapeutic concentrations in brain, demonstrate target engagement, among other things, that have hampered successful translation. A pharmacologic strategy for overcoming poor BBB permeability and/or efflux out of the brain of organic acid-based, small molecule therapeutics such as NAC is co-administration with a targeted or nonselective membrane transporter inhibitor. Probenecid is a classic ATP-binding cassette and solute carrier inhibitor that blocks transport of organic acids, including NAC. Accordingly, combination therapy using probenecid as an adjuvant with NAC represents a logical neurotherapeutic strategy for treatment of TBI (and other CNS diseases). We have completed a proof-of-concept pilot study using this drug combination in children with severe TBI-the Pro-NAC Trial (ClinicalTrials.gov NCT01322009). In this review, we will discuss the background and rationale for combination therapy with probenecid and NAC in TBI, providing justification for further clinical investigation.
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Affiliation(s)
- Robert S B Clark
- Departments of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
| | - Philip E Empey
- Department of Pharmacy & Therapeutics, Center for Clinical Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Patrick M Kochanek
- Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA
- Departments of Critical Care Medicine, Anesthesiology, and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael J Bell
- Division of Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC, USA
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Thotakura AK, Velivela KC, Marabathina NR, Riyaz AA, Vuddandi SP, Danaboyina AR. S100B and optic nerve sheath diameter correlation in head injury patients with contusions. J Neurosci Rural Pract 2023; 14:599-602. [PMID: 38059225 PMCID: PMC10696316 DOI: 10.25259/jnrp_45_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/14/2023] [Indexed: 12/08/2023] Open
Abstract
S100B is a biochemical marker of head injury and optic nerve sheath diameter (ONSD) is a non-invasive bedside technique to detect intracranial pressure. We aim to demonstrate whether ONSD correlates with S100B protein in head injury patients with contusions and also whether the grade of contusion correlates with S100B protein. This is a prospective study done on head injury patients aged between 18 and 75 years having isolated contusions admitted within 24 h of injury. Patients were assessed neurologically with Glasgow Coma Scale (GCS) and cranial computed tomography study on admission. Ocular sonography was done for ONSD recording, and S100B protein venous samples were collected at 24 h, 48 h, and at discharge. The outcome was evaluated with Glasgow Outcome Scale (GOS) at discharge and 3 months. Out of 42 patients, the mean age was 46.2 years and 27 were males. There were 12 patients with mild, 25 with moderate, and 5 patients with severe head injury. The mean GCS at 24 h was 12.35, the mean ONSD at 24 h was 3.9 mm, and the mean S100B at 24 h was 0.214 µg/L. There was a statistically significant correlation noted between mean S100B and contusion grade. A moderate positive correlation was noted between ONSD and S100B at 48 h in mild and moderate head injury groups. Favorable outcome (GOS 4,5) at 3 months can be predicted by GCS, contusion grade, and S100B values. Better GCS (14 and 15), focal contusion grade, and S100B values (<0.5 µg/L) predict good outcome. Although ONSD and S100B give important information in different scenarios, S100B gives better predictive information in patients with traumatic cerebral contusions. Key message S100 B and ONSD are simple biochemical and radiological investigations that can be done in every neurosurgical setup and can be useful in the management of head injury patients.
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Affiliation(s)
- Amit Kumar Thotakura
- Department of Neurosurgery, NRI Academy of Sciences, Guntur, Andhra Pradesh, India
| | - Kiran Chand Velivela
- Department of Neurosurgery, NRI Academy of Sciences, Guntur, Andhra Pradesh, India
| | | | - Abdul Aziz Riyaz
- Department of Neurosurgery, NRI Academy of Sciences, Guntur, Andhra Pradesh, India
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Bennett R, Sullivan KA. A psychometric evaluation of a new social subscale for the Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire: toward the CM-TBI-II. Brain Inj 2023; 37:1253-1261. [PMID: 37525435 DOI: 10.1080/02699052.2023.2237891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 05/18/2023] [Accepted: 05/27/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Existing TBI misconception measures are critiqued for failing to measure postinjury social experiences. This study developed a social subscale for the Common Misconceptions about TBI (CM-TBI) questionnaire for use in the general public. METHODS Seven experts independently review items drawn from the literature. Shortlisted items were administered online to 158 adults (aged ≥18 years; 51% postschool educated; 60% no TBI experience), the CM-TBI, and a measure of construct validity (a published TBI-adaptation of the Community Attitudes Towards the Mentally Ill; CAMI-TBI). One week later, the new items were redeployed (n = 46). RESULTS Expert review and iterative correlations identified a 10-item social subscale (internal consistency, test-retest reliability, α's>.80). When added to the CM-TBI (ie. CM-TBI-II), the internal consistency was .71. The social subscale was significantly correlated with CAMI-TBI measures (p's <.05, r's > .3). There was no significant difference on the social subscale for education subgroups (school vs post-school, p = 0.056) or previous TBI experience; but there was a difference for the CM-TBI-II (post-school>school; Cohen's d = 7.83, large effect). CONCLUSION This study found strong preliminary psychometric support for a new social subscale, administered as the CM-TBI-II. This subscale shows promise as a measure of misconceptions about social functioning post-TBI. The CM-TBI-II could support evaluations of programs aiming to improve social engagement and community participation for people with TBI.
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Affiliation(s)
- Ryleigh Bennett
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karen A Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
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30
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Fournier M, Bailly N, Schäuble A, Petit Y. Head impact kinematics and injury risks during E-scooter collisions against a curb. Heliyon 2023; 9:e19254. [PMID: 37662814 PMCID: PMC10474420 DOI: 10.1016/j.heliyon.2023.e19254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/02/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
E-scooters as a mode of transportation is rapidly growing in popularity. This study evaluates head impact conditions and injury risk associated with E-scooter crashes. A multibody model of E-scooter falls induced by wheel-curb collision was built and compared with an experimental E-scooter crash test. A total of 162 crash scenarios were simulated to assess the effect of fall conditions (E-scooter initial speed and inclination, obstacle orientation, and user size) on the head impact kinematics. The forehead hit the ground first in 44% of simulations. The average tangential and normal impact speeds were 3.5 m/s and 4.8 m/s respectively. Nearly 100% of simulations identified a risk of concussion (linear acceleration peak >82 g and rotational acceleration peak >6383 rad/s2) and 90% of simulations suggested a risk of severe head injuries (HIC>700). This work provides preliminary data useful for the assessment and design of protective gears.
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Affiliation(s)
- Marion Fournier
- École de technologie supérieure, 1100 Rue Notre Dame O, Montréal, QC, H3C 1K3, Canada
- Research Center, CIUSSS Nord de L’île de Montréal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
- ILab-Spine: International Laboratory on Spine Imaging and Biomechanics, France
| | - Nicolas Bailly
- Univ Gustave Eiffel, LBA, France, Bd Pierre Dramard, 13015, Marseille, France
- ILab-Spine: International Laboratory on Spine Imaging and Biomechanics, France
| | - Andreas Schäuble
- DEKRA Automobil GmbH, AG5 Unfallforschung Accident Research, HQ Stuttgart, Handwerkstraße 15, 70565, Stuttgart, Germany
| | - Yvan Petit
- École de technologie supérieure, 1100 Rue Notre Dame O, Montréal, QC, H3C 1K3, Canada
- Research Center, CIUSSS Nord de L’île de Montréal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
- Univ Gustave Eiffel, LBA, France, Bd Pierre Dramard, 13015, Marseille, France
- ILab-Spine: International Laboratory on Spine Imaging and Biomechanics, France
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31
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Pattnaik L, Mehra L, Pareek D, Panigrahi PK. Unilateral branch retinal vein occlusion with vitreous hemorrhage mimicking Terson's syndrome. Oman J Ophthalmol 2023; 16:552-554. [PMID: 38059082 PMCID: PMC10697244 DOI: 10.4103/ojo.ojo_5_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/11/2023] [Accepted: 06/03/2023] [Indexed: 12/08/2023] Open
Abstract
We report a case of unilateral traumatic vitreous hemorrhage following injury to the anterior cranium. A 55-year-old female presented with gradual loss of vision in her left eye following trauma to the anterior cranium. Funduscopy revealed fresh vitreous hemorrhage. Conservative management was futile with further visual deterioration over the next 2 weeks. During pars plana vitrectomy, fresh retinal hemorrhages were noted along the superotemporal (ST) vein suggesting bleed due to vein rupture. Postoperative fundus fluorescein angiography indicated ST branch retinal vein occlusion. Since trauma can be an inciting factor for both, this case could be a variant of Terson's syndrome.
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Affiliation(s)
- Lolly Pattnaik
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Lipika Mehra
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Deergha Pareek
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Pradeep Kumar Panigrahi
- Department of Ophthalmology, Institute of Medical Sciences and SUM Hospital, Siksha O Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
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Bot GM, Shilong DJ, Philip JA, Dung ED, Shitta AH, Kyesmen NI, Alfin JD, Houlihan LM, Preul MC, Ozoilo KN, Binitie PO. Predictors of Outcome in Management of Paediatric Head Trauma in a Tertiary Healthcare Institution in North-Central Nigeria. J Korean Neurosurg Soc 2023; 66:582-590. [PMID: 37667636 PMCID: PMC10483157 DOI: 10.3340/jkns.2022.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/04/2022] [Accepted: 10/12/2022] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE Trauma is a leading causes of death and disability in all ages. The aim of this study was to describe the demography and characteristics of paediatric head trauma in our institution and examine the predictors of outcome and incidence of injury related mortality. METHODS We examined our institutional Trauma Registry over a 2 year period. RESULTS A total of 1100 trauma patients were seen over the study period. Of the 579 patients who had head injury 99 were in the paediatric age group. Of the paediatric head trauma patients 79 had documented Glasgow coma score (GCS), 38 (48.1%), 17 (21.5%) and 24 (30.4%) had mild, moderate and severe head injury respectively. The percentage mortality of head injury in the paediatric age group was 6.06% (6/99). There is an association between mortality and GCS (p=0.008), necessity for intensive care unit (ICU) admission (p=0.0001), associated burns (p=0.0001) and complications such as aspiration pneumonia (p=0.0001). The significant predictors of outcome are aspiration (p=0.004), the need for ICU admission (p=0.0001) and associated burns (p=0.005) using logistic binary regression. During the study period 46 children underwent surgical intervention with extradural haematoma 16 (34.8%), depressed skull fracture 14 (30.4%) and chronic subdural haematoma five (10.9%) being the commonest indication for surgeries. CONCLUSION Paediatric head injury accounted for 9.0% (99/1100) of all trauma admissions. Majority of patients had mild or moderate injuries. Burns, aspiration pneumonitis and the need for ICU admission were important predictors of outcome in children with traumatic brain injury.
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Affiliation(s)
- Gyang Markus Bot
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Danaan J. Shilong
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Jerry A. Philip
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Ezekiel Dido Dung
- Division of Paediatric Surgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Andrew H. Shitta
- Division of Paediatric Surgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Nanpan Isa Kyesmen
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Jeneral D. Alfin
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Lena Mary Houlihan
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Mark C. Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Kenneth N. Ozoilo
- Division of Trauma Surgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Peter O. Binitie
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
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Strong RW, Grashow R, Roberts AL, Passell E, Scheuer L, Terry DP, Cohan S, Pascual-Leone A, Weisskopf MG, Zafonte RD, Germine LT. Association of Retrospectively Reported Concussion Symptoms with Objective Cognitive Performance in Former American-Style Football Players. Arch Clin Neuropsychol 2023; 38:875-890. [PMID: 36861317 DOI: 10.1093/arclin/acad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Sustaining concussions has been linked to health issues later in life, yet evidence for associations between contact sports exposure and long-term cognitive performance is mixed. This cross-sectional study of former professional American-style football players tested the association of several measures of football exposure with later life cognitive performance, while also comparing the cognitive performance of former players to nonplayers. METHODS In total, 353 former professional football players (Mage = 54.3) completed both (1) an online cognitive test battery measuring objective cognitive performance and (2) a survey querying demographic information, current health conditions, and measures of past football exposure, including recollected concussion symptoms playing professional football, diagnosed concussions, years of professional play, and age of first football exposure. Testing occurred an average of 29 years after former players' final season of professional play. In addition, a comparison sample of 5,086 male participants (nonplayers) completed one or more cognitive tests. RESULTS Former players' cognitive performance was associated with retrospectively reported football concussion symptoms (rp = -0.19, 95% CI -0.09 to -0.29; p < 0.001), but not with diagnosed concussions, years of professional play, or age of first football exposure. This association could be due to differences in pre-concussion cognitive functioning, however, which could not be estimated based on available data. CONCLUSIONS Future investigations of the long-term outcomes of contact sports exposure should include measures of sports-related concussion symptoms, which were more sensitive to objective cognitive performance than other football exposure measures, including self-reported diagnosed concussions.
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Affiliation(s)
- Roger W Strong
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rachel Grashow
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Eliza Passell
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Luke Scheuer
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Douglas P Terry
- Department of Neurologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Cohan
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
| | - Ross D Zafonte
- Football Players Health Study, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Sakamoto MS, Hanson KL, Chanfreau-Coffinier C, Lai MHC, Román CAF, Clark AL, Marquine MJ, Delano-Wood L, Merritt VC. An Examination of Racial/Ethnic Differences on the Neurobehavioral Symptom Inventory Among Veterans Completing the Comprehensive Traumatic Brain Injury Evaluation: A Veterans Affairs Million Veteran Program Study. Arch Clin Neuropsychol 2023; 38:929-943. [PMID: 36702773 PMCID: PMC10656879 DOI: 10.1093/arclin/acad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The purpose of this study was to explore racial/ethnic differences in neurobehavioral symptom reporting and symptom validity testing among military veterans with a history of traumatic brain injury (TBI). METHOD Participants of this observational cross-sectional study (N = 9,646) were post-deployed Iraq-/Afghanistan-era veterans enrolled in the VA's Million Veteran Program with a clinician-confirmed history of TBI on the Comprehensive TBI Evaluation (CTBIE). Racial/ethnic groups included White, Black, Hispanic, Asian, Multiracial, Another Race, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander. Dependent variables included neurobehavioral symptom domains and symptom validity assessed via the Neurobehavioral Symptom Inventory (NSI) and Validity-10, respectively. RESULTS Chi-square analyses showed significant racial/ethnic group differences for vestibular, somatic/sensory, and affective symptoms as well as for all Validity-10 cutoff scores examined (≥33, ≥27, ≥26, >22, ≥22, ≥13, and ≥7). Follow-up analyses compared all racial/ethnic groups to one another, adjusting for sociodemographic- and injury-related characteristics. These analyses revealed that the affective symptom domain and the Validity-10 cutoff of ≥13 revealed the greatest number of racial/ethnic differences. CONCLUSIONS Results showed significant racial/ethnic group differences on neurobehavioral symptom domains and symptom validity testing among veterans who completed the CTBIE. An enhanced understanding of how symptoms vary by race/ethnicity is vital so that clinical care can be appropriately tailored to the unique needs of all veterans. Results highlight the importance of establishing measurement invariance of the NSI across race/ethnicity and underscore the need for ongoing research to determine the most appropriate Validity-10 cutoff score(s) to use across racially/ethnically diverse veterans.
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Affiliation(s)
- McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Karen L Hanson
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Mark H C Lai
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | | | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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Li Y, Vakiel P, Adanty K, Ouellet S, Vette AH, Raboud D, Dennison CR. Evaluating the Intracranial Pressure Biofidelity and Response Repeatability of a Physical Head-Brain Model in Frontal Impacts. Ann Biomed Eng 2023; 51:1816-1833. [PMID: 37095278 DOI: 10.1007/s10439-023-03198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/15/2023] [Indexed: 04/26/2023]
Abstract
Headforms are widely used in head injury research and headgear assessment. Common headforms are limited to replicating global head kinematics, although intracranial responses are crucial to understanding brain injuries. This study aimed to evaluate the biofidelity of intracranial pressure (ICP) and the repeatability of head kinematics and ICP of an advanced headform subjected to frontal impacts. Pendulum impacts were performed on the headform using various impact velocities (1-5 m/s) and impactor surfaces (vinyl nitrile 600 foam, PCM746 urethane, and steel) to simulate a previous cadaveric experiment. Head linear accelerations and angular rates in three axes, cerebrospinal fluid ICP (CSFP), and intraparenchymal ICP (IPP) at the front, side, and back of the head were measured. The head kinematics, CSFP, and IPP demonstrated acceptable repeatability with coefficients of variation generally being less than 10%. The BIPED front CSFP peaks and back negative peaks were within the range of the scaled cadaver data (between the minimum and maximum values reported by Nahum et al.), while side CSFPs were 30.9-92.1% greater than the cadaver data. CORrelation and Analysis (CORA) ratings evaluating the closeness of two time histories demonstrated good biofidelity of the front CSFP (0.68-0.72), while the ratings for the side (0.44-0.70) and back CSFP (0.27-0.66) showed a large variation. The BIPED CSFP at each side was linearly related to head linear accelerations with coefficients of determination greater than 0.96. The slopes for the BIPED front and back CSFP-acceleration linear trendlines were not significantly different from cadaver data, whereas the slope for the side CSFP was significantly greater than cadaver data. This study informs future applications and improvements of a novel head surrogate.
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Affiliation(s)
- Yizhao Li
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada
| | - Paris Vakiel
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, V8P 5C2, Canada.
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada.
| | - Kevin Adanty
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada
| | - Simon Ouellet
- Weapons Effects and Protection Section, Defence R&D Valcartier Research Center, Quebec, Canada
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, T5G 0B7, Canada
| | - Donald Raboud
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada
| | - Christopher R Dennison
- Department of Mechanical Engineering, University of Victoria, Victoria, BC, V8P 5C2, Canada
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Courville E, Kazim SF, Vellek J, Tarawneh O, Stack J, Roster K, Roy J, Schmidt M, Bowers C. Machine learning algorithms for predicting outcomes of traumatic brain injury: A systematic review and meta-analysis. Surg Neurol Int 2023; 14:262. [PMID: 37560584 PMCID: PMC10408617 DOI: 10.25259/sni_312_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. The use of machine learning (ML) has emerged as a key advancement in TBI management. This study aimed to identify ML models with demonstrated effectiveness in predicting TBI outcomes. METHODS We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. In total, 15 articles were identified using the search strategy. Patient demographics, clinical status, ML outcome variables, and predictive characteristics were extracted. A small meta-analysis of mortality prediction was performed, and a meta-analysis of diagnostic accuracy was conducted for ML algorithms used across multiple studies. RESULTS ML algorithms including support vector machine (SVM), artificial neural networks (ANN), random forest, and Naïve Bayes were compared to logistic regression (LR). Thirteen studies found significant improvement in prognostic capability using ML versus LR. The accuracy of the above algorithms was consistently over 80% when predicting mortality and unfavorable outcome measured by Glasgow Outcome Scale. Receiver operating characteristic curves analyzing the sensitivity of ANN, SVM, decision tree, and LR demonstrated consistent findings across studies. Lower admission Glasgow Coma Scale (GCS), older age, elevated serum acid, and abnormal glucose were associated with increased adverse outcomes and had the most significant impact on ML algorithms. CONCLUSION ML algorithms were stronger than traditional regression models in predicting adverse outcomes. Admission GCS, age, and serum metabolites all have strong predictive power when used with ML and should be considered important components of TBI risk stratification.
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Affiliation(s)
- Evan Courville
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
| | - John Vellek
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, New York, United States
| | - Omar Tarawneh
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, New York, United States
| | - Julia Stack
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, New York, United States
| | - Katie Roster
- Department of Neurosurgery, School of Medicine, New York Medical College, Valhalla, New York, United States
| | - Joanna Roy
- Department of Neurosurgery, Topiwala National Medical and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Meic Schmidt
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
| | - Christian Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, United States
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Amadon GK, Goeckner BD, Brett BL, Meier TB. Comparison of Various Metrics of Repetitive Head Impact Exposure And Their Associations With Neurocognition in Collegiate-Aged Athletes. Arch Clin Neuropsychol 2023; 38:714-723. [PMID: 36617242 PMCID: PMC10369361 DOI: 10.1093/arclin/acac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Characterize the levels of various metrics of repetitive head impacts (RHI) in contact (CS) and non-contact (NCS) sport athletes and determine the extent to which they are associated with fluid cognition. METHODS Collegiate-aged athletes (n = 176) completed semi-structured interviews about participation in contact sport. RHI was operationalized based on current sport (CS/NCS), the cumulative number of years of participation, age at first exposure (AFE), and based on recently proposed traumatic encephalopathy syndrome (TES) categories. The NIH Toolbox Cognition Battery assessed fluid cognition. General linear models compared RHI metrics between CS and NCS athletes and tested associations of RHI measures with fluid cognition. RESULTS CS athletes had more years of RHI exposure, higher rates of "extensive" exposure based on TES criteria, and were more likely to have AFE before age 12 relative to NCS (ps < .001). A subset of NCS athletes, however, reported prior RHI at levels categorized as being "extensive" based on TES criteria (5%), while a larger minority had AFE before 12 (34%). No adverse associations of RHI and fluid cognition were observed (ps > .05). Across all RHI metrics, more or earlier RHI was associated with better episodic memory (ps ≤ .05). Secondary analyses showed this effect was driven by women. CONCLUSIONS Current results find no evidence that RHI in collegiate-aged athletes is associated with worse neurocognition. Although there was extensive overlap among RHI measures, results demonstrate that categorizing athletes based on their current sport undercounts the lifetime RHI exposure in many NCS athletes.
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Affiliation(s)
- Grace K Amadon
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Bryna D Goeckner
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
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Rao AL, Song L, Griffin G. Head Injuries and Emergencies in Sports. Clin Sports Med 2023; 42:473-489. [PMID: 37208060 DOI: 10.1016/j.csm.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Head injuries are a common occurrence in sports and can involve injuries to the brain, skull, and superficial soft tissues. The most commonly discussed diagnosis is a concussion. Head and cervical spine injuries must be considered together at times, due to the overlapping nature of symptoms present during on-field evaluation. This article presents a range of head injuries, along with critical steps in evaluation and management.
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Affiliation(s)
- Ashwin L Rao
- Department of Family Medicine, Section of Sports Medicine, University of Washington, Seattle, WA, USA; University of Washington Sports Medicine Center, 3800 Montlake Boulevard NE, Box 354060, Seattle, WA 98195, USA.
| | - Leina'ala Song
- University of Washington Sports Medicine Center, 3800 Montlake Boulevard NE, Box 354060, Seattle, WA 98195, USA; Department of Family Medicine, Section of Sports Medicine, University of Washington, Seattle, WA, USA
| | - Georgia Griffin
- University of Washington Sports Medicine Center, 3800 Montlake Boulevard NE, Box 354060, Seattle, WA 98195, USA; Department of Family Medicine, Section of Sports Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA, USA
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Chakma A, Siddiqui OA, Ali S, Nadeem A. Track your trach: Removal of a fractured tracheostomy tube using a flexible fibreoptic bronchoscope in a patient with severe head injury. Med J Armed Forces India 2023; 79:481-484. [PMID: 37441303 PMCID: PMC10334239 DOI: 10.1016/j.mjafi.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022] Open
Abstract
Tracheostomy is a common airway procedure for life support in critically ill patients with head injuries. This procedure is safe but also associated with early and late complications. Tube fracture and dislodgement into the tracheobronchial tree leading to airway obstruction is a rare but life-threatening complication after prolonged tracheostomy tube placement. There are very few published reports of tracheostomy tube fracture and dislodgement into tracheobronchial tree in a neurologically injured patient. We report a case of a fractured tracheostomy tube which got impacted in the left main bronchus, in a 41-year-old male patient who had been on prolonged tracheostomy tube after craniotomy and evacuation of subdural hematoma. The distal part of the tracheostomy tube fractured and impacted in the left main bronchus. Fibreoptic bronchoscopy was performed through the oral cavity to extract it, and the anaesthetic management during the period is discussed.
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Affiliation(s)
- Avishek Chakma
- Resident, Jawaharlal Nehru Medical College, Aligarh, India
| | | | - Shahna Ali
- Assistant Professor, Jawaharlal Nehru Medical College, Aligarh, India
| | - Abu Nadeem
- Associate Professor, Jawaharlal Nehru Medical College, Aligarh, India
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Takeda K, Oda K, Fukumoto H, Kobayashi H, Morishita T, Takemoto K, Iwaasa M, Abe H. Repeated coil embolization of traumatic basilar artery pseudoaneurysm accompanied by bilateral traumatic internal carotid artery stenosis following severe head injury in a pediatric patient: A case report and literature review. Surg Neurol Int 2023; 14:199. [PMID: 37404524 PMCID: PMC10316180 DOI: 10.25259/sni_267_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Background Few cases of pediatric traumatic intracranial aneurysms (pTICAs) in the posterior circulation involving the basilar artery (BA) following severe head trauma have been reported. Here, we describe a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic internal carotid artery (ICA) stenosis following blunt head trauma. Case Description A 16-year-old boy presented to our emergency department after being hit by a car. The patient was initially diagnosed with multiple skull base fractures underlying traumatic subarachnoid hemorrhage and left acute epidural hematoma. Seven days following emergency craniectomy, magnetic resonance imaging revealed bilateral ICA stenosis, BA stenosis, and BA pseudoaneurysm. We decided to perform coil embolization, resulting in body filling and a volume embolization ratio of 15.7%. Twenty-eight days after coil embolization, digital subtraction angiography revealed aneurysmal rupture. We performed repeated coil embolization, resulting in body filling and a volume embolization ratio of 20.9%. Conclusion We reported a pediatric case of traumatic BA pseudoaneurysm accompanied by bilateral traumatic ICA stenosis following a severe head injury treated with repeated coil embolization. Considering the risk of further brain injury due to high incidence of rupture, early vascular survey and appropriate treatment may be the most important prognostic factors in pTICAs.
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Affiliation(s)
| | - Kazunori Oda
- Corresponding author: Kazunori Oda, Department of Neurosurgery, Fukuoka University, Fukuoka, Japan.
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Patton DA, Maheshwari J, Arbogast KB. Frontal-oblique impact sled tests of a rearward-facing child restraint system with and without a support leg. Accid Anal Prev 2023; 190:107137. [PMID: 37295359 DOI: 10.1016/j.aap.2023.107137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To quantify the head and neck injury metrics of an anthropometric test device (ATD) in a rearward-facing child restraint system (CRS), with and without a support leg, in frontal-oblique impacts. METHODS Sled tests using the Federal Motor Vehicle Safety Standards (FMVSS) 213 frontal crash pulse (48 km/h, 23 g) were performed with a simulated Consumer Reports test buck, which comprised a test bench that mimics the rear outboard vehicle seat of a sport utility vehicle (SUV). The test bench was rigidised to increase durability for repeated testing and the seat springs and cushion were replaced every five tests. A force plate was mounted to the floor of the test buck directly in front of the test bench to measure support leg peak reaction force. The test buck was rotated 30° and 60° relative to the longitudinal axis of the sled deck to represent frontal-oblique impacts. The door surrogate from the FMVSS 213a side impact test was rigidly attached to the sled deck adjacent to the test bench. The 18-month-old Q-Series (Q1.5) ATD was seated in a rearward-facing infant CRS, which was attached to the test bench with either rigid lower anchors or a three-point seatbelt. The rearward-facing infant CRS was tested with and without a support leg. Conductive foil was attached to the upper edge of the door panel and a strip of conductive foil was attached to the top of the ATD head so that a voltage signal quantified contact with the door panel. A new CRS was used for each test. A repeat test was performed for each condition for a total of 16 tests. DATA SOURCES Resultant linear head acceleration 3 ms clip; head injury criterion 15 ms (HIC15); peak neck tensile force; peak neck flexion moment; potential difference between the ATD head and the door panel; support leg peak reaction force. RESULTS The presence of a support leg significantly reduced head injury metrics (p < 0.001) and peak neck tensile force (p = 0.004) compared to tests without a support leg. Rigid lower anchors were associated with significant reductions in head injury metrics and peak neck flexion moment (p < 0.001) compared to tests that attached the CRS with the seatbelt. The 60° frontal-oblique tests had significantly elevated head injury metrics (p < 0.01) compared to the 30° frontal-oblique tests. No ATD head contact with the door was observed for 30° frontal-oblique tests. The ATD head contacted the door panel in the 60° frontal-oblique tests when the CRS was tested without the support leg. Average support leg peak reaction forces ranged from 2167 to 4160 N. The 30° frontal-oblique sled tests had significantly higher support leg peak reaction forces (p < 0.001) compared to the 60° frontal-oblique sled tests. CONCLUSIONS The findings of the current study add to the growing body of evidence regarding the protective benefits of CRS models with a support leg and rigid lower anchors.
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Affiliation(s)
- Declan A Patton
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, United States.
| | - Jalaj Maheshwari
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Pennsylvania, PA, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Dubey YV, Prasad BK. A Study of Difficulty in Decannulation of Tracheostomized Head Injury Patients. Indian J Otolaryngol Head Neck Surg 2023; 75:817-824. [PMID: 37275027 PMCID: PMC10235311 DOI: 10.1007/s12070-023-03504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/14/2023] [Indexed: 02/07/2023] Open
Abstract
A prospective observational study was done with the aim to analyze the difficulties during decannulation of tracheostomized head injury patients and to devise a sound protocol for decannulation. It was done over 2 years in a tertiary care Army Hospital with 40 tracheostomized head injury cases in the age group of 10-70 years. Once the indication of tracheostomy was over, their Glasgow Coma Scale score, airway adequacy, phonation, swallowing, cough reflex, and lung pathology were assessed. Fit patients were decannulated if they tolerated tube capping for 3 days. Data was statistically analyzed. Road traffic accident was the cause of head injury in 90% cases. 45% patients had traumatic brain injury. All the cases required ventilatory support. 80% patients required neurosurgery. Tracheostomy was done between 5th to 10th day. Decannulation could be achieved in 75% patients. Factors like neurological status, duration of ventilatory need, number of days on T piece, cough reflex, suction requirement, phonation, consistency of tracheal secretion, lung condition, and three days? capping of tracheostomy tube were significantly associated with outcome of decannulation trial (p <0.05). Factors like mode of injury, neurosurgical intervention, absence of phonation, and downsizing of tube did not affect the outcome significantly (p >0.05). The factors like strong cough reflex, thin minimal tracheal secretion, aspiration free swallowing, better GCS score, early weaning from ventilator and younger age favour early successful decannulation. Gradual downsizing of tube or presence of phonation are not essential prerequisites for decannulation. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03504-y.
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Ritter M. Evidence-Based Pearls: Traumatic Brain Injury. Crit Care Nurs Clin North Am 2023; 35:171-178. [PMID: 37127374 DOI: 10.1016/j.cnc.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in the United States, predominantly impacting men. The highest risk for the development of a TBI includes athletes, construction workers, military personnel, and law enforcement. TBI is classified as mild, moderate, or severe. The degree of TBI will determine the severity of clinical manifestations. Management of TBI may be a combination of operative and non-operative interventions. Nursing considerations and management include frequent assessment of vital signs and neurologic status, maintaining hemodynamic stability, early identification of worsening clinical manifestations, and psychosocial support to the TBI patient and family.
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Affiliation(s)
- Mary Ritter
- Southeastern Louisiana University, Hammond, LA, USA; Urgent Care, Premier Health, Baton Rouge, LA, USA.
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Schaffert J, Didehbani N, LoBue C, Hart J, Wilmoth K, Cullum CM. No association between age beginning tackle football, or years played and neurocognitive performance later-in-life among older National Football League retirees. Arch Clin Neuropsychol 2023; 38:644-649. [PMID: 36533487 PMCID: PMC10202547 DOI: 10.1093/arclin/acac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE In a retrospective cohort, we evaluated whether age beginning tackle football (ABTF) and more total years of playing football (TYPF) were associated with worse later-in-life neuropsychological change among older retired National Football League (NFL) players. METHOD Participants were 19 older NFL retirees aged 54-79, including 12 who returned for follow-up evaluation 15-51 months later. Mixed-linear models evaluated the association between ABTF/TYFP and baseline neuropsychological composite scores (executive functioning/attention/speed, language, memory), and neuropsychological composites over time. RESULTS ABTF and TYPF were not significantly associated with neuropsychological composites at baseline or over time (all p's > .05). There were no significant differences in neuropsychological performance between those ABTF <12 and ≥ 12 years old (all p's ≥ .475) or between those with TYPF <19 or ≥ 19 years played (median split; all p's ≥ .208). CONCLUSIONS Preliminary findings suggest that ABTF and TYPF does not worsen neurocognitive decline later-in-life among older NFL retirees.
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Affiliation(s)
- Jeff Schaffert
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Callier Center, School of Behavioral and Brain Sciences, UT Dallas, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristin Wilmoth
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Liu Y, Wang C, Pi Z, Wang T, Zhang C, Cai J. Research on the Potential Biomarkers of Mild Traumatic Brain Injury: a Systematic Review and Bibliometric Analysis. Mol Neurobiol 2023:10.1007/s12035-023-03350-7. [PMID: 37103686 DOI: 10.1007/s12035-023-03350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
Reliable diagnostic methods for mild traumatic brain injury (mTBI) are lacking, and many researchers continue to search for objective biomarkers that can both define and detect mTBI. Although much research has been conducted in this field, there have not been many bibliometric studies. In this study, we aim to analyze the development over the last two decades in scientific output relating to the diagnosis of mTBI. To do this, we extracted documents from Web of Science, PubMed, and Embase and performed descriptive analysis (number of publications, primary journals, authors, and countries/regions), trend topics analysis, and citation analysis for papers across the globe, with a particular focus on molecular markers. One thousand twenty-three publications spanning 390 journals were identified on Web of Science, PubMed, and Embase for the period from 2000 to 2022. The number of publications increased every year (from 2 in 2000 to 137 in 2022). Of all the publications we analyzed, 58.7% had authors from the USA. Our analysis shows that molecular markers are the most studied markers in the field of mTBI diagnostics, accounting for 28.4% of all publications, and that the number of studies focused on this specific aspect has increased sharply in the past 5 years, indicating that molecular markers may become a research trend in the future.
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Affiliation(s)
- Yishu Liu
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, 410013, Hunan, China
| | - Chudong Wang
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, 410013, Hunan, China
| | - Zhiyun Pi
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, 410013, Hunan, China
| | - Tingting Wang
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, 410013, Hunan, China
| | - Changquan Zhang
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, 410013, Hunan, China.
| | - Jifeng Cai
- Department of Forensic Science, School of Basic Medical Science, Central South University, Changsha, 410013, Hunan, China.
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Lin YP, Ku CH, Chang CC, Chang ST. Effects of intravascular photobiomodulation on cognitive impairment and crossed cerebellar diaschisis in patients with traumatic brain injury: a longitudinal study. Lasers Med Sci 2023; 38:108. [PMID: 37076743 PMCID: PMC10115718 DOI: 10.1007/s10103-023-03764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
The association between intravascular photobiomodulation (iPBM) and crossed cerebellar diaschisis (CCD) and cognitive dysfunction in patients with traumatic brain injury (TBI) remains unknown. We postulate that iPBM might enable greater neurologic improvements. The objective of this study was to evaluate the clinical impact of iPBM on the prognosis of patients with TBI. In this longitudinal study, patients who were diagnosed with TBI were recruited. CCD was identified from brain perfusion images when the uptake difference of both cerebella was > 20%. Thus, two groups were identified: CCD( +) and CCD( -). All patients received general traditional physical therapy and three courses of iPBM (helium-neon laser illuminator, 632.8 nm). Treatment assemblies were conducted on weekdays for 2 consecutive weeks as a solitary treatment course. Three courses of iPBM were performed over 2-3 months, with 1-3 weeks of rest between each course. The outcomes were measured using the Rancho Los Amigos Levels of Cognitive Functioning (LCF) tool. The chi-square test was used to compare categorical variables. Generalized estimating equations were used to verify the associations of various effects between the two groups. p < 0.05 indicated a statistically significant difference. Thirty patients were included and classified into the CCD( +) and CCD( -) groups (n = 15, each group). Statistics showed that before iPBM, CCD in the CCD( +) group was 2.74 (exp 1.0081) times higher than that of CCD( -) group (p = 0.1632). After iPBM, the CCD was 0.64 (exp-0.4436) times lower in the CCD( +) group than in the CCD( -) group (p < 0.0001). Cognitive assessment revealed that, before iPBM, the CCD( +) group had a non-significantly 0.1030 lower LCF score than that of CCD( -) group (p = 0.1632). Similarly, the CCD( +) group had a non-significantly 0.0013 higher score than that of CCD( -) after iPBM treatment (p = 0.7041), indicating no significant differences between the CCD( +) or CCD( -) following iPBM and general physical therapy. CCD was less likely to appear in iPBM-treated patients. Additionally, iPBM was not associated with LCF score. Administration of iPBM could be applied in TBI patients to reduce the occurrence of CCD. The study failed to show differences in cognitive function after iPBM, which still serves as an alternative non-pharmacological intervention.
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Affiliation(s)
- Yen-Po Lin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Education and Research, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chih-Hung Ku
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Chiang Chang
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Neihu District, # 161, Section 6, Minquan East Road, Taipei, 114201, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, Neihu District, # 161, Section 6, Minquan East Road, Taipei, 114201, Taiwan.
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Zuoying Dist., # 386, Dazhong 1st Rd., 813414, Kaohsiung, Taiwan.
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Race MK, Hahn-Ketter AE, Spielman LA, Selmanovic E, Sy KLT, Wellington R, Dams-O'Connor K. Traumatic brain injury history and baseline symptoms outweigh sex differences for risk of concussion in a sample of collegiate athletes. Brain Inj 2023:1-6. [PMID: 37074262 DOI: 10.1080/02699052.2023.2203521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To test the hypothesis that a history of traumatic brain injury (TBI) prior to the collegiate pre-season is associated with risk for re-injury. We also investigate sex differences, cognitive functioning, and self-reported concussion symptoms and their associations with concussion risk. METHODS A longitudinal cohort study consisting of collegiate athletes (n = 212) who completed consecutive preseason evaluations (P1 and P2) between 2012 and 2015, averaging 12.9 (SD = 4.2) months apart. RESULTS There were 40 new concussions recorded between P1 and P2, 21 (53%) of which were among athletes who reported a lifetime history of mild TBI/concussion at P1. New P1-P2 concussions occurred in 24% of female athletes (n = 23) and 15% of male athletes (n = 17). History of TBI and female sex were significant predictors of new concussion between P1 and P2; however, in adjusted models, the inclusion of Impulse Control and PCSS Total symptom scores attenuated the effect of sex on the risk for new injury. CONCLUSION Collegiate athletes with a lifetime history of TBI had a significantly higher risk of sustaining a subsequent concussion. Pre-season emotional and somatic symptomology may contribute to incident concussion risk. The findings highlight the importance of considering lifetime head injury exposure and baseline symptomatology when interpreting sex differences and evaluating concussion risk.
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Affiliation(s)
- Meaghan K Race
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Sochet AA, Nakagawa TA. Anticoagulation for pediatric head-injury-related cerebral sinovenous thrombosis. A call for trial-derived evidence to standardize anticoagulant management. Eur J Paediatr Neurol 2023; 43:A2-A3. [PMID: 36990950 DOI: 10.1016/j.ejpn.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Affiliation(s)
- Anthony A Sochet
- The Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Department of Anesthesiology and Critical Care Medicine, St. Petersburg, Florida, USA
| | - Thomas A Nakagawa
- University of Florida College of Medicine-Jacksonville, Department of Pediatrics, Division of Critical Care Medicine, Jacksonville, Florida, USA.
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Lystad RP. Changes in sport-related concussion and traumatic brain injury in New Zealand during the first two years of the COVID-19 pandemic. J Sci Med Sport 2023:S1440-2440(23)00044-0. [PMID: 36948906 PMCID: PMC10028426 DOI: 10.1016/j.jsams.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/19/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES To quantify changes in sport-related concussion and traumatic brain injury claims in New Zealand during the first two years of the COVID-19 pandemic (i.e., 2020 and 2021). DESIGN Population-based cohort study. METHODS This study included all new sport-related concussion and traumatic brain injury claims that were registered with the Accident Compensation Corporation in New Zealand during 1 January 2010 to 31 December 2021. Annual sport-related concussion and traumatic brain injury claim rates per 100,000 population from 2010 to 2019 were used to fit autoregressive integrated moving average models, from which forecast estimates with 95 % prediction intervals for 2020 and 2021 were derived and compared against corresponding observed values to obtain estimates of absolute and relative forecast errors. RESULTS Sport-related concussion and traumatic brain injury claim rates were 30 % and 10 % lower than forecasted in 2020 and 2021, respectively, equating to an estimated total of 2410 fewer sport-related concussion and traumatic brain injury claims during the two-year period. CONCLUSIONS There was a large reduction in sport-related concussion and traumatic brain injury claims in New Zealand during the first two years of the COVID-19 pandemic. These findings highlight the need for future epidemiological studies examining temporal trends of sport-related concussion and traumatic brain injury to account for the impact of the COVID-19 pandemic.
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Affiliation(s)
- Reidar P Lystad
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Australia.
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Wei W, Petit Y, Arnoux PJ, Bailly N. Head-ground impact conditions and helmet performance in E-scooter falls. Accid Anal Prev 2023; 181:106935. [PMID: 36571970 DOI: 10.1016/j.aap.2022.106935] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Head injuries are common injuries in E-scooter accidents which have dramatically increased in recent years. The head impact conditions and helmet performance during E-scooter accidents are barely investigated. This study aims to characterize the head-ground impact biomechanics and evaluate bicycle helmet protection in typical E-scooter falls. METHOD The finite element (FE) model of a hybrid III dummy riding an E-scooter was developed and validated. The FE model with and without a bicycle helmet was used to reproduce twenty-seven E-scooter falls caused by the collision with a curb, in which different riding speeds (10, 20, and 30 km/h), curb orientations (30, 60, and 90°), and E-scooter orientations (-15, 0, and 15°) were simulated. Head-ground impact velocities and locations were evaluated for the unhelmeted configurations while the helmet performance was evaluated with the reduction of head injury metrics. RESULTS E-scooter falls always resulted in an oblique head-ground impact, with 78 % on the forehead. The mean vertical and tangential head-ground impact velocities were respectively 5.7 ± 1.5 m/s and 3.7 ± 2.0 m/s. The helmet significantly (p < 0.1) reduced the head linear acceleration, angular velocity, HIC_36, and BrIC, but not the angular acceleration. However, even with the helmet, the head injury metrics were mostly above the thresholds of severe head injuries. CONCLUSION Typical E-scooter falls might cause severe head injuries. The bicycle helmet was efficient to reduce head injury metrics but not to prevent severe head injuries. Future helmet standard evaluations should involve higher impact energy and the angular acceleration assessment in oblique impacts.
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Affiliation(s)
- Wei Wei
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France.
| | - Yvan Petit
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France; École de technologie supérieure, Canada
| | - Pierre-Jean Arnoux
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Nicolas Bailly
- LBA UMRT24, Aix Marseille Université/Université Gustave Eiffel, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
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