Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis

Abstract Background Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood. Methods This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis. Results Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to − 6, hypothermia and hypotension increased risk significantly. Conclusion Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management.

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Traumatic brain injury among female veterans: a review of sex differences in military neurosurgery

Neurosurgical FOCUS ◽

10.3171/2018.9.focus18369 ◽

2018 ◽

Vol 45 (6) ◽

pp. E16 ◽

Cited By ~ 4

Author(s):

Lily H. Kim ◽

Jennifer L. Quon ◽

Felicia W. Sun ◽

Kristen M. Wortman ◽

Maheen M. Adamson ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Sex Differences ◽

Brain Injury ◽

Mortality Data ◽

Female Veterans ◽

Female Representation ◽

Social Challenges ◽

Increased Risk ◽

The Face ◽

The Impact

The impact of traumatic brain injury (TBI) has been demonstrated in various studies with respect to prevalence, morbidity, and mortality data. Many of the patients burdened with long-term sequelae of TBI are veterans. Although fewer in number, female veterans with TBI have been suggested to suffer from unique physical, mental, and social challenges. However, there remains a significant knowledge gap in the sex differences in TBI. Increased female representation in the military heralds an increased risk of TBI for female soldiers, and medical professionals must be prepared to address the unique health challenges in the face of changing demographics among the veteran TBI population. In this review, the authors aimed to present the current understanding of sex differences in TBI in the veteran population and suggest directions for future investigations.

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The Impact of Neurocognitive Functioning on the Course of Posttraumatic Stress Symptoms following Civilian Traumatic Brain Injury

Journal of Clinical Medicine ◽

10.3390/jcm10215109 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5109

Author(s):

Dominique L. G. Van Praag ◽

Filip Van Den Eede ◽

Kristien Wouters ◽

Lindsay Wilson ◽

Andrew I. R. Maas ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Posttraumatic Stress ◽

Visual Information ◽

Verbal Learning ◽

Neurocognitive Functioning ◽

Ptsd Symptoms ◽

Post Injury ◽

Change Scores ◽

The Impact

Background: One out of seven individuals who have suffered a traumatic brain injury (TBI) develops a posttraumatic stress disorder (PTSD), which is often associated with neurocognitive impairment. The present study explores the impact of neurocognitive functioning after mild, moderate, and severe TBI on the course of PTSD symptoms. Methods: The data of 671 adults admitted to hospital for a TBI was drawn from the Collaborative European Neurotrauma Effectiveness Research (CENTER-TBI) study. After six- and 12-months post-injury, participants completed the PTSD Checklist-5 (PCL-5), from which change scores were calculated. At six months, participants also completed a neurocognitive assessment including the Rey Auditory Verbal Learning Test, the Trail Making Test, and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Linear regressions were performed to identify associations between cognitive functioning and PCL-5 change scores. Results: Overall, mean PCL-5 change scores showed no clear change (−0.20 ± 9.88), but 87 improved and 80 deteriorated by a change score of 10 or more. CANTAB Rapid Visual Information Processing scores were significantly associated with PCL-5 change scores. Conclusions: Strong sustained attention was associated with improvement in PTSD symptoms. Assessing cognitive performance may help identify individuals at risk of developing (persisting) PTSD post-TBI and offer opportunities for informing treatment strategies.

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Examining the Prospective Relationship between Family Affective Responsiveness and Theory of Mind in Chronic Paediatric Traumatic Brain Injury

Brain Impairment ◽

10.1017/brimp.2016.20 ◽

2016 ◽

Vol 18 (1) ◽

pp. 88-101 ◽

Cited By ~ 5

Author(s):

Nicholas P. Ryan ◽

Kim Mihaljevic ◽

Miriam H. Beauchamp ◽

Cathy Catroppa ◽

Louise Crossley ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Theory Of Mind ◽

Childhood And Adolescence ◽

Post Injury ◽

Related Factors ◽

Lesion Location ◽

Severe Tbi ◽

The Impact ◽

Affective Responsiveness

Childhood and adolescence coincide with rapid structural and functional maturation of brain networks implicated in Theory of Mind (ToM); however, the impact of paediatric traumatic brain injury (TBI) on the development of these higher order skills is not well understood. ToM can be partitioned intoconative ToM, defined as the ability to understand how indirect speech acts involving irony and empathy are used to influence the mental or affective state of the listener; andaffective ToM, concerned with understanding that facial expressions are often used for social purposes to convey emotions that we want people to think we feel. In a sample of 84 children with mild-severe TBI and 40 typically developing controls, this study examined the effect of paediatric TBI on affective and conative ToM; and evaluated the respective contributions of injury-related factors (injury severity/lesion location) and non-injury-related environmental variables (socio-economic status (SES)/family functioning) to long-term ToM outcomes. Results showed that the poorest ToM outcomes were documented in association with mild-complicated and moderate TBI, rather than severe TBI. Lesion location and SES did not significantly contribute to conative or affective ToM. Post-injury family affective responsiveness was the strongest and most significant predictor of conative ToM. Results suggest that clinicians should exercise caution when prognosticating based on early clinical indicators, and that group and individual-level outcome prediction should incorporate assessment of a range of injury- and non-injury-related factors. Moreover, the affective quality of post-injury family interactions represents a potentially modifiable risk factor, and might be a useful target for family-centred interventions designed to optimise social cognitive outcomes after paediatric TBI.

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A-125 The Impact of Bilingualism on Symbol Digit Modalities Test Performance Following Traumatic Brain Injury

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab062.143 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1175-1175

Author(s):

Raelynn Munoz ◽

Daniel W Lopez-Hernandez ◽

Rachel A Rugh-Fraser ◽

Jasman Sidhu ◽

Pavel Y Litvin ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Deficits ◽

Test Performance ◽

Oral Performance ◽

Neurocognitive Performance ◽

Post Injury ◽

Cognitive Speed ◽

The Impact ◽

Larger Sample

Abstract Objective Traumatic brain injury (TBI) survivors exhibit cognitive deficits. Research suggests that multilingualism can influence neurocognitive performance. We examined the effects of TBI and bilingualism/monolingualism on a test of attention and cognitive speed (i.e., Symbol Digit Modalities Test; SDMT). Method The sample consisted of 55 healthy comparison (27 Spanish-English bilinguals; 28 English-monolinguals), 34 acute TBI (14 Spanish-English bilinguals; 23 English-monolinguals), and 27 chronic TBI (13 Spanish-English bilinguals; 12 English-monolinguals) participants. Acute TBI participants were tested 6 months post-injury; chronic TBI participants were tested 12 months or more post-injury. A series of 3X2 ANOVAs were conducted to determine the effect of TBI and language on SDMT written and oral performance. Results ANOVAs revealed the healthy comparison group outperformed both TBI groups on SDMT written, p = 0.000, ηp2 = 0.21. Also, the healthy comparison and chronic TBI groups outperformed the acute TBI group on SDMT oral, p = 0.000, ηp2 = 0.13. Interaction effects emerged between TBI and bilingualism/monolingualism. On SDMT written and oral, acute TBI English-monolinguals outperformed acute TBI Spanish-English bilinguals; meanwhile, chronic TBI Spanish-English bilinguals outperformed chronic TBI English-monolinguals, p < 0.05, ηp2 = 0.09–0.10. Conclusion The acute TBI group performed worse than healthy comparison adults on both SDMT tasks. Furthermore, the chronic TBI group demonstrated better SDMT oral abilities compared to the acute TBI group. Relative to monolinguals with TBI, our findings suggest better cognitive recovery of attention and cognitive speed in bilingual TBI participants. Future studies with larger sample sizes should examine if learning English first or second impacts Spanish-English bilingual TBI survivors’ SDMT performance compared to English-monolingual TBI survivors.

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The impact of deployment and traumatic brain injury on the health and behavior of children of US military service members and veterans

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104517740405 ◽

2017 ◽

Vol 23 (3) ◽

pp. 425-441

Author(s):

Tracey A Brickell ◽

Louis M French ◽

Sara M Lippa ◽

Rael T Lange

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Military Service ◽

Emotional Health ◽

Post Injury ◽

Number Of Children ◽

Us Military ◽

Combat Deployment ◽

And Behavior ◽

The Impact

This study examined the impact of service member/veteran (SMV) combat deployment and traumatic brain injury (TBI) on the health and behavior of his or her children. Participants were 104 female spouse caregivers of US SMVs who had sustained a mild, severe, or penetrating TBI. Participants completed the Children’s Health and Behavior Questionnaire (CHBQ; r = .758 to .881) that evaluates school grades, behavior, medical health, emotional health, and social participation: (a) prior to the first combat deployment, (b) in the month prior to the TBI, (c) within 2 years after the TBI, and (d) 2 or more years after the TBI. A substantial number of children experienced a decline in health and behavior following the TBI (41.7%–79.1%). Of those who declined (a) 68.8%–75.5% declined within the first 2 years post-injury, followed by improvement or stabilization; (b) 6.7%–15.6% declined only after 2 or more years post-injury; (c) 15.6%–25.0% declined within the first 2 years post-injury and then again 2 or more years post-injury; and (d) 16.9%–26.5% experienced a decline as a result of deployment, followed by an additional decline after the SMV’s TBI. Services are required for children of SMVs following TBI and deployment, particularly children at risk for poor outcome.

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Beta blocker use in traumatic brain injury based on the high-sensitive troponin status (BBTBBT): methodology and protocol implementation of a double-blind randomized controlled clinical trial

Trials ◽

10.1186/s13063-021-05872-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ayman El-Menyar ◽

Mohammad Asim ◽

Ahmed Abdel-Aziz Bahey ◽

Talat Chughtai ◽

Abdulnasser Alyafai ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Calcium Binding ◽

Troponin T ◽

Controlled Clinical Trial ◽

Post Injury ◽

Double Blind ◽

Severity Of Injury ◽

The Impact ◽

High Sensitive Troponin

Abstract Background Beta-adrenergic receptor blockers (BB) play an important role in the protection of organs that are susceptible for secondary injury due to stress-induced adrenergic surge. However, the use of BB in traumatic brain injury (TBI) patients is not yet the standard of care which necessitates clear scientific evidence to be used. The BBTBBT study aims to determine whether early administration of propranolol based on the high-sensitive troponin T(HsTnT) status will improve the outcome of TBI patients. We hypothesized that early propranolol use is effective in reducing 10- and 30-day mortality in TBI patients. Secondary outcomes will include correlation between serum biomarkers (troponin, epinephrine, cytokines, enolase, S100 calcium binding protein B) and the severity of injury and the impact of BB use on the duration of hospital stay and functional status at a 3-month period. Methods The BBTBBT study is a prospective, randomized, double-blinded, placebo-controlled three-arm trial of BB use in mild-to-severe TBI patients based on the HsTnT status. All enrolled patients will be tested for HsTnT at the first 4 and 6 h post-injury. Patients with positive HsTnT will receive BB if there is no contraindication (group 1). Patients with negative HsTnT will be randomized to receive either propranolol (group 2) or placebo (group 3). The time widow for receiving the study treatment is the first 24 h post-injury. Discussion Early BB use may reduce the catecholamine storm and subsequently the cascade of immune and inflammatory changes associated with TBI. HsTnT could be a useful fast diagnostic and prognostic tool in TBI patients. This study will be of great clinical interest to improve survival and functional outcomes of TBI patients. Trial registration ClinicalTrials.gov NCT04508244. Registered on 7 August 2020. Recruitment started on 29 December 2020 and is ongoing.

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P.090 A systematic review of the risks and benefits of venous thromboembolism prophylaxis in traumatic brain injury

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.192 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S41-S41

Author(s):

C Dandurand ◽

J Margolick ◽

D Evans ◽

M Sekhon ◽

N Garraway ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Venous Thromboembolism ◽

Brain Injury ◽

Hematoma Expansion ◽

Time Interval ◽

Thromboembolism Prophylaxis ◽

Post Injury ◽

Increased Risk ◽

Hemorrhagic Risk

Background: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of chemoprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the post-injury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. Methods: MEDLINE and EMBASE databases were searched. Inclusion criteria were: studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation. Two investigators extracted data and graded the papers based on levels of evidence. Results: A total of 408 studies were screened. Forty-five studies were reviewed in-entirety and 21 were included in the systematic review. There were 2 prospective randomized trials and 19 comparative studies. Eighteen total studies demonstrated that VTEp post injury in patients with stable head computed tomography scan does not lead to TBI progression. Fourteen studies demonstrated that VTEp administration specifically 24–72 hours post injury is safe in patients with stable injury. Four studies suggested that administering VTEp within 24 hours of injury in patients with stable TBI does not lead to progressive ICH. Conclusions: Literature suggests that administering VTEp 48 hours post-injury may be safe for patients with low-hemorrhagic risk TBIs and stable injury on repeat imaging.

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Comparison of amateur boxing before and after the 2013 rules change and the impact on boxers’ safety

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-097667 ◽

2017 ◽

Vol 52 (11) ◽

pp. 741-746 ◽

Cited By ~ 5

Author(s):

Philip Davis ◽

Robert Waldock ◽

Andrew Connorton ◽

Sonny Driver ◽

Sean Anderson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Long Range ◽

The Body ◽

Video Footage ◽

Increased Risk ◽

Before And After ◽

Elite Level ◽

Amateur Boxing ◽

The Impact

ObjectivesThe effect of the rules change in 2013 on amateur boxing strategy, technique and safety in comparison with pre-2013 is unknown.MethodsPre-2013 and post-2013 3×3 min elite level amateur boxing was compared from video footage of 29 Olympic (pre-2013) and 50 World Championship bouts (post-2013) totalling 99 male boxers (mean±SD) age: 24.3±3.2 years, height: 177.3±11.3 cm and body mass: 70.7±16.4 kg.ResultMany techniques that were dominant pre-2013 were used less post-2013, including: total punches thrown, rear hand punches, hook rear hand, punches landed, uppercut punches, total punches to the body (all <0.05), while movement around the ring and defensive movements were higher post-2013 (both p<0.004). Post-2013 boxers have increased their foot movement by 20% to move in and then away from their opponent, combined with long-range punches and deliberate defensive movements. The percentage of rounds where standing counts were issued changed from 9% to 3% pre-2013 to post-2013. However, pre-2013, 1.7% of bouts did not last the full duration due to referee stoppage, while post-2013, this increased to 4.2% as a result of two knockouts and eight technical knockouts.Discussion and conclusionBoxers should be aware of the large changes in technical demands of boxing. An increased risk of concussive or traumatic brain injury post-2013 is equivocal. However, an increase in skin splits and technical knockouts is apparent. It is likely that boxers believe head guard removal has made them more prone to knockouts.

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LO87: Influence of co-injuries on post-concussion symptoms after a mild traumatic brain injury

CJEM ◽

10.1017/cem.2020.141 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S39-S39

Author(s):

V. Ouellet ◽

V. Boucher ◽

F. Beauchamp ◽

X. Neveu ◽

P. Archambault ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Post Injury ◽

Adjusted Risk ◽

Multicenter Prospective Cohort Study ◽

Improve Patient Management ◽

Specific Symptoms ◽

The Impact

Introduction: Each year, 3/1000 Canadians sustain a mild traumatic brain injury (mTBI). Many of those mTBI are accompanied by various co-injuries such as dislocations, sprains, fractures or internal injuries. A number of those patients, with or without co-injuries will suffer from persistent post-concussive symptoms (PPCS) more than 90 days post injury. However, little is known about the impact of co-injuries on mTBI outcome. This study aims to describe the impact of co-injuries on PPCS and on patient return to normal activities. Methods: This multicenter prospective cohort study took place in seven large Canadian Emergency Departments (ED). Inclusion criteria: patients aged ≥ 14 who had a documented mTBI that occurred within 24 hours of ED visit, with a Glasgow Coma Scale score of 13-15. Patients who were admitted following their ED visit or unable to consent were excluded. Clinical and sociodemographic information was collected during the initial ED visit. A research nurse then conducted three follow-up phone interviews at 7, 30 and 90 days post-injury, in which they assessed symptom evolution using the validated Rivermead Post-concussion Symptoms Questionnaire (RPQ). Adjusted risk ratios (RR) were calculated to estimate the influence of co-injuries. Results: A total of 1674 patients were included, of which 1023 (61.1%) had at least one co-injury. At 90 days, patients with co-injuries seemed to be at higher risk of having 3 symptoms ≥2 points according to the RPQ (RR: 1.28 95% CI 1.02-1.61) and of experiencing the following symptoms: dizziness (RR: 1.50 95% CI 1.03-2.20), fatigue (RR: 1.35 95% CI 1.05-1.74), headaches (RR: 1.53 95% CI 1.10-2.13), taking longer to think (RR: 1.50 95% CI 1.07-2.11) and feeling frustrated (RR: 1.45 95% CI 1.01-2.07). We also observed that patients with co-injuries were at higher risk of non-return to their normal activities (RR: 2.31 95% CI 1.37-3.90). Conclusion: Patients with co-injuries could be at higher risk of suffering from specific symptoms at 90 days post-injury and to be unable to return to normal activities 90 days post-injury. A better understanding of the impact of co-injuries on mTBI could improve patient management. However, further research is needed to determine if the differences shown in this study are due to the impact of co-injuries on mTBI recovery or to the co-injuries themselves.

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P23 Investigating synaptopathy following traumatic brain injury in a preclinical model

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.99 ◽

2019 ◽

Vol 90 (3) ◽

pp. e31.3-e31

Author(s):

AAB Jamjoom ◽

Z Qui ◽

J Rhodes ◽

PJD Andrews ◽

SGN Grant

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pearson Correlation ◽

Brain Regions ◽

Machine Learning Algorithms ◽

Preclinical Model ◽

Strong Positive Correlation ◽

Post Injury ◽

Positive Correlation ◽

The Impact

ObjectivesThe impact of Traumatic Brain Injury (TBI) on the synapse is poorly understood. We examined the impact of TBI on the distribution of two postsynaptic density proteins (PSD95 and SAP102) at single-synapse resolution.Subjects44 male transgenic knock-in mice, aged 8–16 weeks, expressing fluorescently labelled PSD95 and SAP102.MethodsMice were randomised to a mild lateral fluid percussion injury (LFPI) or sham treatment and brain sections were examined at 7 and 28 days. Using high resolution confocal microscopy and machine learning algorithms, the synaptic puncta density, size and intensity were mapped across 222 brain regions. Microglia and presynaptic changes were indexed using Iba1 and SV2A immunostaining. Pearson correlation and t-tests were used (significance p<0.05).ResultsWe found a significant reduction in synaptic puncta density at 28 days post-injury in brain regions distal to the injury site including the hippocampus. PSD95 and SAP102 density changes had a strong positive correlation at 28 days (r=0.8; p<0.0001). We also observed evidence of synapse recovery in the ipsilateral cortex between 7 and 28 days. Puncta density had a positive correlation with SV2A (r=0.7; p<0.01) and a negative correlation with (r=−0.6; p<0.001) Iba1 count.ConclusionsFocal LFPI induced progressive region-specific loss of synapses for which microglia may play a role. Our study highlights the value of brain-wide synaptome mapping technology and suggests a capacity for synaptic recovery which could be a therapeutic target.

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