scholarly journals Developing an instrument for an early prediction model of long-term functional outcomes in people with acquired injuries of the central nervous system: protocol and methodological aspects

2020 ◽  
Author(s):  
Stefano Masiero ◽  
Humberto Antonio Cerrel Bazo ◽  
Marcello Rattazzi ◽  
Laura Bernardi ◽  
Marina Munari ◽  
...  
Keyword(s):  
Brain Injury ◽  
Prediction Model ◽  
Prediction Models ◽  
Acquired Brain Injury ◽  
Acute Stage ◽  
Cognitive Outcomes ◽  
Cognitive Outcome ◽  
Teaching Hospitals ◽  
Severe Acquired Brain Injury

Abstract Severe acquired brain injury (ABI) is a major cause of long-term disability and is the main determinant of health and societal costs. Early identification of favourable long-term recovery would allow personalized rehabilitative programs and better health care resources allocation. In light of the higher survival rate from intensive care units (ICU) in recent years, there is a growing need for early prognostication markers of functional recovery; to date, these data have been mainly collected at rehabilitation unit admission and not during the acute phase. We present the protocol and methodology to develop prediction models in people with severe acquired brain injury (GCS at admission to ICU < 8) for the functional and cognitive outcome at 12 months from the event. Predictors will be collected during the acute stage. Participants will be recruited within the first 72 h from the event in the ICUs of two teaching hospitals (Padova and Treviso). Participants will be followed up at discharge from ICU, admission and discharge from Neurorehabilitation and after 12 months from the event. Clinical and functional scales, electroencephalography, evoked potentials, magnetic resonance imaging and serological markers will be entered into a digital registry. Survival will be estimated using the Cox proportional hazard model. A multivariate prediction model will be developed for each of the functional and cognitive outcomes at 12 months from the event.

306 GCS Does Not Predict Cognitive Outcome 30 Years After Severe Traumatic Brain Injury

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 264-265
Author(s):  
Molly E Hubbard ◽  
Abdullah Bin Zahid ◽  
Gabrielle Meyer ◽  
Kathleen Vonderhaar ◽  
David Y Balser ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Assessment Tool ◽  
Cognitive Status ◽  
Cognitive Outcomes ◽  
Cognitive Outcome ◽  
Symptom Severity Score ◽  
History Of ◽  
Severe Tbi

Abstract INTRODUCTION Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US. The effects of TBI on quality of life may not become apparent for years after the injury. There are conflicting reports in the literature regarding long term outcomes. Physicians are often asked to predict long term functional and cognitive outcomes, with limited data available. METHODS Patients with severe TBI (GCS = 9) who previously participated in a clinical trial during the 1980s were followed up with and compared to healthy controls without history of TBI. A health questionnaire, sports concussion assessment tool version 3 (SCAT3) and the Telephone Interview for Cognitive Status-modified (TICS-m) were completed over the phone and compared with controls using t-test. GCS at admission and 12-month GRS were used to predict to TICS-M at 30 years using linear regression. RESULTS >45 of the initial 168 subjects were confirmed alive, and 37 (13 females; mean age: 52.43 years S.D. 10.7) consented. Controls (n = 58; 23 females; mean age = 54 years, S.D. 11.5) had lower symptom severity score (6.7 S.D. 12.6 versus 20.6 S.D. 25.3; P = 0.005), lower total number of symptoms (3.4 S.D. 4.7 versus 7.12 S.D. 6.5; P = 0.006), higher standardized assessment of concussion score (25.6 S.D. 2.8 versus 21.2 S.D. 6.9; P = 0.001), and lower corrected MPAI-4 (22.3 S.D. 17.0 versus 43.7 S.D. 12.8; P < 0.001). GCS at admission did not predict cognitive status at 30-years assessed using TICS-M (P = 0.345). The Glasgow Outcome Scale score at 12-months was correlated to TICS-M at 30 years (R = 0.548, P < 0.001); each point decrease in GOS decreasing the score at TICS-M by 5.6 points. CONCLUSION Remote history of TBI disrupts the lives of survivors long after injury. Admission GCS does not predict cognitive status 30 years after TBI. The GOS at 12-months predicted the cognitive status assessed using TICS-M score at 30 years.

Matching early arterial oxygenation to long-term outcome in severe traumatic brain injury: target values

2020 ◽  
Vol 132 (2) ◽  
pp. 537-544 ◽  
Author(s):  
Aziz S. Alali ◽  
Nancy Temkin ◽  
Monica S. Vavilala ◽  
Abhijit V. Lele ◽  
Jason Barber ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Neuropsychological Tests ◽  
Cognitive Outcomes ◽  
Cognitive Outcome ◽  
Arterial Oxygenation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Relationship

OBJECTIVEThe aim of this study was to examine the relationship between early arterial oxygenation thresholds and long-term outcome after severe traumatic brain injury (TBI).METHODSIn a post hoc analysis of a randomized trial, adults with severe TBI were classified based on exposure to different levels of arterial oxygenation as measured using the average of arterial partial pressure of oxygen (PaO2) values obtained within 24 hours of admission. Potentially important PaO2 thresholds were defined a priori. The primary outcome was Glasgow Outcome Scale–Extended (GOSE) score at 6 months. Secondary outcomes were cognitive outcomes measured using a battery of 9 neuropsychological tests administered at 6 months, and 6-month mortality.RESULTSIn adjusted analyses, oxygenation thresholds of 150 and 200 mm Hg were associated with better functional outcome at 6 months (adjusted OR for better functional outcome on GOSE 1.82 [95% CI 1.12–2.94] and 1.59 [95% CI 1.06–2.37], respectively) and improved cognitive outcome at 6 months (adjusted beta coefficients for better cognitive percentile across 9 neuropsychological tests: 6.9 [95% CI 1.3–12.5] and 6.8 [95% CI 2.4–11.3], respectively). There was no significant association between oxygenation level and 6-month mortality except at a PaO2 threshold of 200 mm Hg (OR for death 0.36, 95% CI 0.18–0.71). Higher or lower oxygenation thresholds were not associated with functional or cognitive outcome.CONCLUSIONSIn this observational study, the relationship between early arterial oxygenation and long-term functional and cognitive TBI outcomes appears to be U-shaped. Mild levels of hyperoxemia within the first 24 hours after injury were associated with better long-term functional and cognitive outcomes. These findings highlight the importance of examining balanced oxygen supplementation as a potential strategy to improve TBI outcomes in future research.

scholarly journals Perceptions of Long-term Community-based Support Following Severe Acquired Brain Injury

2004 ◽  
Vol 5 (1) ◽  
pp. 53-66 ◽  
Author(s):  
Tamara Ownsworth ◽  
Merrill Turpin ◽  
Glenys Carlson ◽  
Julie-Anne Brennan
Keyword(s):  
Brain Injury ◽  
Acquired Brain Injury ◽  
Well Being ◽  
Effective Area ◽  
Structured Interview ◽  
Support Needs ◽  
Individual Choice ◽  
Community Based ◽  
Severe Acquired Brain Injury

AbstractMany individuals require long-term community-based support following acquired brain injury (ABI). However, very few studies have examined individuals' perceptions of these support needs. The present exploratory study examined individuals' perceptions of community-based support following severe ABI. Participants included eight individuals (aged 20–48 years) with severe ABI, seven relatives and three case managers. The individuals were receiving long-term specialised lifestyle support ranging from 3–70 hours per week. A structured interview with open and closed questions was developed to explore perceptions of individuals' support needs across the areas of personal and home-based activities, community-based activities, self-organisation and vocational activities and social and psychological well-being. The questions investigated whether support was needed, the importance of support, the sources of support, the effectiveness of support and the need for change. A comparison of the three respondent groups' perceptions of support indicated a general consensus that community-based activities were the most important and most effective area of support. When the issues raised by the three respondent groups were compared and contrasted two main themes emerged from the data, which were labelled “relationships” and “individual choice versus support needs”. These themes are discussed in relation to the provision of long-term community-based support services following ABI.

Cognitive reserve index and functional and cognitive outcomes in severe acquired brain injury: A pilot study

2020 ◽  
pp. 1-11
Author(s):  
Debora Bertoni ◽  
Federica Petraglia ◽  
Benedetta Basagni ◽  
Giuseppe Pedrazzi ◽  
Katia De Gaetano ◽  
...  
Keyword(s):  
Brain Injury ◽  
Pilot Study ◽  
Cognitive Reserve ◽  
Acquired Brain Injury ◽  
Cognitive Outcomes ◽  
Severe Acquired Brain Injury

scholarly journals External Validation and Calibration of the DecaPreT Prediction Model for Decannulation in Patients with Acquired Brain Injury

2021 ◽  
Vol 11 (6) ◽  
pp. 799
Author(s):  
Elio Leto ◽  
Danilo Lofaro ◽  
Lucia Francesca Lucca ◽  
Maria Ursino ◽  
Stefania Rogano ◽  
...  
Keyword(s):  
Brain Injury ◽  
Prediction Model ◽  
External Validation ◽  
Acquired Brain Injury ◽  
Operating Characteristics ◽  
Logistic Regression Models ◽  
Clinical Variables ◽  
Receiver Operating Characteristics Curve ◽  
Severe Acquired Brain Injury ◽  
Acute Rehabilitation

We propose a new set of clinical variables for a more accurate early prediction of safe decannulation in patients with severe acquired brain injury (ABI), during a post-acute rehabilitation course. Starting from the already validated DecaPreT scale, we tested the accuracy of new logistic regression models where the coefficients of the original predictors were reestimated. Patients with tracheostomy were retrospectively selected from the database of the neurorehabilitation unit at the S. Anna Institute of Crotone, Italy. New potential predictors of decannulation were screened from variables collected on admission during clinical examination, including (a) age at injury, (b) coma recovery scale-revised (CRS-r) scores, and c) length of ICU period. Of 273 patients with ABI (mean age 53.01 years; 34% female; median DecaPreT = 0.61), 61.5% were safely decannulated before discharge. In the validation phase, the linear logistic prediction model, created with the new multivariable predictors, obtained an area under the receiver operating characteristics curve of 0.901. Our model improves the reliability of simple clinical variables detected at the admission of the post-acute phase in predicting decannulation of ABI patients, thus helping clinicians to plan better rehabilitation.

Clinical course of SARS-CoV-2 infection in patients with severe acquired brain injury and a disorder of consciousness: an observational study

Brain Injury ◽  
2021 ◽  
Vol 35 (5) ◽  
pp. 520-529
Author(s):  
Antonio Caronni ◽  
Emanuele Liaci ◽  
Anna Bianchi ◽  
Alessandro Viganò ◽  
Francesco Marenco ◽  
...  
Keyword(s):  
Brain Injury ◽  
Observational Study ◽  
Clinical Course ◽  
Acquired Brain Injury ◽  
Disorder Of Consciousness ◽  
Severe Acquired Brain Injury
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