Cognitive recovery and predictors of functional outcome 1 year after traumatic brain injury

2009 ◽  
Vol 15 (5) ◽  
pp. 740-750 ◽  
Author(s):  
SOLRUN SIGURDARDOTTIR ◽  
NADA ANDELIC ◽  
CECILIE ROE ◽  
ANNE-KRISTINE SCHANKE
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcome ◽  
Injury Severity ◽  
Cognitive Measures ◽  
Related Factors ◽  
Predictive Values ◽  
Neuropsychological Measures ◽  
Cognitive Components ◽  
One Year

AbstractOutcome studies on traumatic brain injury (TBI) have shown that functional status can be predicted by demographic, injury severity, and trauma-related factors. Concurrent cognitive functions as one of the determinants of functional outcome is less documented. This study evaluated the effects of concurrent neuropsychological measures on functional outcome 1 year after injury. Neuropsychological data, employment status, self-reported fatigue, and the Glasgow Outcome Scale-Extended (GOSE) were collected from 115 persons with TBI (ranging from mild to severe) at 3 and 12 months postinjury. Principal components analysis was conducted with the neuropsychological measures and three components emerged. Multiple regression analysis, controlling for demographic and injury severity related factors, was used to test the effects of cognitive components at 12 months on functional outcome (GOSE). One year after injury, 64% were categorized as “good recovery” and 36% as “moderate disability” according to GOSE. Good functional recovery depended on shorter duration of posttraumatic amnesia, less fatigue, absence of intracranial pathology, higher education, and better performance on cognitive measures. The predictive values of Verbal/Reasoning and Visual/Perception components are supported; each added significantly and improved prediction of functional outcome. The Memory/Speed component showed a near-significant relationship to outcome. (JINS, 2009, 15, 740–750)

One-year costs of intensive care in pediatric patients with traumatic brain injury

2021 ◽  
Vol 27 (1) ◽  
pp. 79-86
Author(s):  
Era D. Mikkonen ◽  
Markus B. Skrifvars ◽  
Matti Reinikainen ◽  
Stepani Bendel ◽  
Ruut Laitio ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Social Security ◽  
Functional Outcome ◽  
Injury Severity ◽  
Pediatric Population ◽  
Favorable Outcome ◽  
Index Hospitalization ◽  
Pediatric Tbi

OBJECTIVETraumatic brain injury (TBI) is a major cause of death and disability in the pediatric population. The authors assessed 1-year costs of intensive care in pediatric TBI patients.METHODSIn this retrospective multicenter cohort study of four academic ICUs in Finland, the authors used the Finnish Intensive Care Consortium database to identify children aged 0–17 years treated for TBI in ICUs between 2003 and 2013. The authors reviewed all patient health records and head CT scans for admission, treatment, and follow-up data. Patient outcomes included functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4–5) and death within 6 months. Costs included those for the index hospitalization, rehabilitation, and social security up to 1 year after injury. To assess costs, the authors calculated the effective cost per favorable outcome (ECPFO).RESULTSIn total, 293 patients were included, of whom 61% had moderate to severe TBI (Glasgow Coma Scale [GCS] score 3–12) and 40% were ≥ 13 years of age. Of all patients, 82% had a favorable outcome and 9% died within 6 months of injury. The mean cost per patient was €48,719 ($54,557) (95% CI €41,326–€56,112). The index hospitalization accounted for 66%, rehabilitation costs for 27%, and social security costs for 7% of total healthcare costs. The ECPFO was €59,727 ($66,884) (95% CI €52,335–€67,120). A higher ECPFO was observed among patients with clinical and treatment-related variables indicative of parenchymal swelling and high intracranial pressure. Lower ECPFO was observed among patients with higher admission GCS scores and those who had epidural hematomas.CONCLUSIONSGreater injury severity increases ECPFO and is associated with higher postdischarge costs in pediatric TBI patients. In this pediatric cohort, over two-thirds of all resources were spent on patients with favorable functional outcome, indicating appropriate resource allocation.

scholarly journals Early Predictors of Employment Status One Year Post Injury in Individuals with Traumatic Brain Injury in Europe

2020 ◽  
Vol 9 (6) ◽  
pp. 2007
Author(s):  
Juan Arango-Lasprilla ◽  
Marina Zeldovich ◽  
Laiene Olabarrieta-Landa ◽  
Marit Forslund ◽  
Silvia Núñez-Fernández ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Employment Status ◽  
Injury Severity ◽  
European Countries ◽  
Post Injury ◽  
Early Predictors ◽  
One Year ◽  
Prospective Longitudinal ◽  
Psychiatric Problems

Sustaining a traumatic brain injury (TBI) often affects the individual’s ability to work, reducing employment rates post-injury across all severities of TBI. The objective of this multi-country study was to assess the most relevant early predictors of employment status in individuals after TBI at one-year post-injury in European countries. Using a prospective longitudinal non-randomized observational cohort (The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project), data was collected between December 2014–2019 from 63 trauma centers in 18 European countries. The 1015 individuals who took part in this study were potential labor market participants, admitted to a hospital and enrolled within 24 h of injury with a clinical TBI diagnosis and indication for a computed tomography (CT) scan, and followed up at one year. Results from a binomial logistic regression showed that older age, status of part-time employment or unemployment at time of injury, premorbid psychiatric problems, and higher injury severity (as measured with higher Injury severity score (ISS), lower Glasgow Coma Scale (GCS), and longer length of stay (LOS) in hospital) were associated with higher unemployment probability at one-year after injury. The study strengthens evidence for age, employment at time of injury, premorbid psychiatric problems, ISS, GCS, and LOS as important predictors for employment status one-year post-TBI across Europe.

scholarly journals Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study

2020 ◽  
Vol 34 (9) ◽  
pp. 814-830
Author(s):  
Louis Jacob ◽  
Mélanie Cogné ◽  
Olli Tenovuo ◽  
Cecilie Røe ◽  
Nada Andelic ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multicenter Study ◽  
Western Europe ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Significant Proportion ◽  
Sociodemographic Factors ◽  
Related Factors ◽  
Direct Discharge

Background Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. Objective Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. Methods Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. Results In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). Conclusions Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.

scholarly journals Role of Cisternal Drainage in Patients with Traumatic Brain Injury Undergoing Decompressive Craniectomy

2019 ◽  
Vol 15 (3) ◽  
pp. 14-20
Author(s):  
Amit Thapa ◽  
Rupendra Bahadur Adhikari ◽  
Bidur KC ◽  
Bikram Shakya
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcome ◽  
Decompressive Craniectomy ◽  
Brain Injuries ◽  
Injury Severity ◽  
Absolute Risk ◽  
Group 2 ◽  
Cisternal Drainage ◽  
Group 1

The effect of decompressive craniectomy (DC) on survival and functional outcome in traumatic brain injuries (TBI) is far from satisfactory. Additional modalities including cisternal drainage (CD) that provides good control of refractory intracranial pressure (ICP) intraoperatively need careful scrutiny. Two centre retrospective superiority study with one centre offering only standard decompressive craniectomy (DC) i.e. Group 1 and the other centre supplementing cisternal drainage (CD) to standard DC i.e. Group 2 was conducted. Consecutive patients with traumatic brain injury with signs of brain herniation or CT scan showing mass lesion or diffuse brain edema or midline shift or with GCS less than 9 or rapid fall in GCS over 2 points with persistently raised ICP of 25 mmHg over 15 minutes between August 2012 and July 2017 were included. The primary outcome was rating on Glasgow Outcome Scale (GOS) at 6 months post operatively, with GOS (1-3) categorized as ‘Unfavorable’ and GOS (4,5) as ‘Favorable’. Patients either received DC alone (Group 1=73 patients, 48.7%) or DC with CD (Group 2=77 patients, 51.3%). 107 (71.3%) severe, 36 (24%) moderate, and 7 (4.7%) mild head injuries cases received 72 unilateral and 78 bilateral DC. GOS 1 was observed in 32 DC only group (43.8%) and 22 DC plus CD group (28.6%) (p=0.052), an absolute risk reduction of 15.2% was found. Outcome (favorable sun favorable) against all strata of head injury severity, predominant radiological feature, laterality of surgery, and patient characteristics across the two groups were statistically not significant, however the groups were statistically significantly different on age and GCS at presentation (p=0.016 & 0.034 consecutively). Distinct survival benefit in patients with traumatic brain injury receiving cisternal drainage during decompressive craniectomy did not translate to better functional outcome.

scholarly journals Neurofilament light as a biomarker in traumatic brain injury

Neurology ◽  
2020 ◽  
Vol 95 (6) ◽  
pp. e610-e622 ◽  
Author(s):  
Pashtun Shahim ◽  
Adam Politis ◽  
Andre van der Merwe ◽  
Brian Moore ◽  
Yi-Yu Chou ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcome ◽  
Injury Severity ◽  
Diffusion Tensor ◽  
Characteristic Curve ◽  
The United States ◽  
Class Iii ◽  
Neurofilament Light ◽  
Postconcussive Symptoms

ObjectiveTo determine whether serum neurofilament light (NfL) correlates with CSF NfL, traumatic brain injury (TBI) diagnosis, injury severity, brain volume, and diffusion tensor imaging (DTI) estimates of traumatic axonal injury (TAI).MethodsParticipants were prospectively enrolled in Sweden and the United States between 2011 and 2019. The Swedish cohort included 45 hockey players with acute concussion sampled at 6 days, 31 with repetitive concussion with persistent postconcussive symptoms (PCS) assessed with paired CSF and serum (median 1.3 years after concussion), 28 preseason controls, and 14 nonathletic controls. Our second cohort included 230 clinic-based participants (162 with TBI and 68 controls). Patients with TBI also underwent serum, functional outcome, and imaging assessments at 30 (n = 30), 90 (n = 48), and 180 (n = 59) days and 1 (n = 84), 2 (n = 57), 3 (n = 46), 4 (n = 38), and 5 (n = 29) years after injury.ResultsIn athletes with paired specimens, CSF NfL and serum NfL were correlated (r = 0.71, p < 0.0001). CSF and serum NfL distinguished players with PCS >1 year from PCS ≤1 year (area under the receiver operating characteristic curve [AUROC] 0.81 and 0.80). The AUROC for PCS >1 year vs preseason controls was 0.97. In the clinic-based cohort, NfL at enrollment distinguished patients with mild from those with moderate and severe TBI (p < 0.001 and p = 0.048). Serum NfL decreased over the course of 5 years (ß = −0.09 log pg/mL, p < 0.0001) but remained significantly elevated compared to controls. Serum NfL correlated with measures of functional outcome, MRI brain atrophy, and DTI estimates of TAI.ConclusionsSerum NfL shows promise as a biomarker for acute and repetitive sports-related concussion and patients with subacute and chronic TBI.Classification of evidenceThis study provides Class III evidence that increased concentrations of NfL distinguish patients with TBI from controls.

scholarly journals The subcortical basis of outcome and cognitive impairment in TBI

Neurology ◽  
2020 ◽  
Vol 95 (17) ◽  
pp. e2398-e2408 ◽  
Author(s):  
Evan S. Lutkenhoff ◽  
Matthew J. Wright ◽  
Vikesh Shrestha ◽  
Courtney Real ◽  
David L. McArthur ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Episodic Memory ◽  
Executive Functions ◽  
Cognitive Functioning ◽  
Functional Outcome ◽  
Common Denominator ◽  
Neuropsychological Measures ◽  
Acute Event

ObjectiveTo understand how, biologically, the acute event of traumatic brain injury gives rise to a long-term disease, we address the relationship between evolving cortical and subcortical brain damage and measures of functional outcome and cognitive functioning at 6 months after injury.MethodsFor this longitudinal analysis, clinical and MRI data were collected in a tertiary neurointensive care setting in a continuous sample of 157 patients surviving moderate to severe traumatic brain injury between 2000 and 2018. For each patient, we collected T1- and T2-weighted MRI data acutely and at the 6-month follow-up, as well as acute measures of injury severity (Glasgow Coma Scale), follow-up measures of functional impairment (Glasgow Outcome Scale–extended), and, in a subset of patients, neuropsychological measures of attention, executive functions, and episodic memory.ResultsIn the final cohort of 113 subcortical and 92 cortical datasets that survived (blind) quality control, extensive atrophy was observed over the first 6 months after injury across the brain. However, only atrophy within subcortical regions, particularly in the left thalamus, was associated with functional outcome and neuropsychological measures of attention, executive functions, and episodic memory. Furthermore, when brought together in an analytical model, longitudinal brain measurements could distinguish good from bad outcome with 90% accuracy, whereas acute brain and clinical measurements alone could achieve only 20% accuracy.ConclusionDespite great injury heterogeneity, secondary thalamic pathology is a measurable minimum common denominator mechanism directly relating biology to clinical measures of outcome and cognitive functioning, potentially linking the acute event and the longer-term disease of traumatic brain injury.

scholarly journals Assessing the Severity of Traumatic Brain Injury—Time for a Change?

2021 ◽  
Vol 10 (1) ◽  
pp. 148
Author(s):  
Olli Tenovuo ◽  
Ramon Diaz-Arrastia ◽  
Lee E. Goldstein ◽  
David J. Sharp ◽  
Joukje van der Naalt ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Imaging ◽  
Complex Disease ◽  
Injury Severity ◽  
Prediction Models ◽  
Predictive Values ◽  
New Approach ◽  
Imaging Results ◽  
The Many

Traumatic brain injury (TBI) has been described to be man’s most complex disease, in man’s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures. Current classifications are primarily based on clinical evaluations, which are non-specific and poorly predictive of long-term disability. Brain imaging results have also been used, yet there are multiple ways of doing brain imaging, at different timepoints in this very dynamic injury. Severity itself is a vague concept. All prediction models based on combining variables that can be assessed during the acute phase have reached only modest predictive values for later outcome. Yet, these early labels of severity often determine how the patient is treated by the healthcare system at large. This opinion paper examines the problems and provides caveats regarding the use of current severity labels and the many practical and scientific issues that arise from doing so. The objective of this paper is to show the causes and consequences of current practice and propose a new approach based on risk classification. A new approach based on multimodal quantifiable data (including imaging and biomarkers) and risk-labels would be of benefit both for the patients and for TBI clinical research and should be a priority for international efforts in the field.

Measurement and prediction of subjective fatigue following traumatic brain injury

2005 ◽  
Vol 11 (4) ◽  
pp. 416-425 ◽  
Author(s):  
CARLO ZIINO ◽  
JENNIE PONSFORD
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Post Injury ◽  
Related Factors ◽  
Significant Group ◽  
Subjective Fatigue ◽  
Education Levels ◽  
Fatigue Severity ◽  
Gcs Score

Numerous outcome studies have found fatigue to be a common problem following traumatic brain injury (TBI). This study examined the magnitude, causes and impact of fatigue following TBI using three subjective fatigue scales, and investigated its relationship with demographic and injury-related factors, and mood. Forty-nine controls and 49 TBI participants (36.2% with GCS score of 13–15, 29.8% with GCS score of 9–12, and 34% with GCS score of 3–8) were seen at a mean of approximately 8 months post injury. All participants completed three subjective fatigue measures, including the Fatigue Severity Scale (FSS), Visual Analogue Scale–Fatigue (VAS–F) and Causes of Fatigue Questionnaire (COF). TBI participants reported a significantly greater impact of fatigue on their lifestyle on the FSS relative to controls, and reported activities requiring physical and mental effort as more frequent causes of fatigue on the COF. There were, however, no significant group differences on subscales of the VAS–F. Greater time since injury and higher education levels were associated with higher fatigue levels, independent of the effects of mood. Injury severity and age were not found to be significant predictors of subjective fatigue severity in TBI participants. (JINS, 2005,11, 416–425.)

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