scholarly journals The contribution of injury severity, executive and implicit functions to awareness of deficits after traumatic brain injury (TBI)

2010 ◽  
Vol 16 (6) ◽  
pp. 1089-1098 ◽  
Author(s):  
NICHOLAS MORTON ◽  
LYNNE BARKER
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Mood State ◽  
Hierarchical Regression ◽  
Implicit Measures ◽  
Implicit Functions ◽  
Severe Injuries ◽  
Severity Of Injury ◽  
Head Injured

AbstractDeficits in self-awareness are commonly seen after Traumatic Brain Injury (TBI) and adversely affect rehabilitative efforts, independence and quality of life (Ponsford, 2004). Awareness models predict that executive and implicit functions are important cognitive components of awareness though the putative relationship between implicit and awareness processes has not been subject to empirical investigation (Crosson et al., 1989; Ownsworth, Clare, & Morris, 2006; Toglia & Kirk, 2000). Severity of injury, also thought to be a crucial determinant of awareness outcome post-insult, is under-explored in awareness studies (Sherer, Boake, Levin, Silver, Ringholz, & Walter, 1998). The present study measured the contribution of injury severity, IQ, mood state, executive and implicit functions to awareness in head-injured patients assigned to moderate/severe head-injured groups using several awareness, executive, and implicit measures. Severe injuries resulted in greater impairments across most awareness, executive and implicit measures compared with moderate injuries, although deficits were still seen in the moderate group. Hierarchical regression results showed that severity of injury, IQ, mood state, executive and implicit functions made significant unique contributions to selective aspects of awareness. Future models of awareness should account for both implicit and executive contributions to awareness and the possibility that both are vulnerable to disruption after neuropathology. (JINS, 2010,16, 1089–1098.)

scholarly journals Bypassing nearest hospital for more distant neuroscience care in head-injured adults with suspected traumatic brain injury: findings of the head injury transportation straight to neurosurgery (HITS-NS) pilot cluster randomised trial

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016355 ◽  
Author(s):  
Fiona Elizabeth Lecky ◽  
Wanda Russell ◽  
Graham McClelland ◽  
Elspeth Pennington ◽  
Gordon Fuller ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Measurable Effect ◽  
Cluster Randomised ◽  
Head Injured ◽  
Secondary Transfer

ObjectiveReconfiguration of trauma services, with direct transport of patients with traumatic brain injury (TBI) to specialist neuroscience centres (SNCs)—bypassing non-specialist acute hospitals (NSAHs), could improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) may worsen outcomes when compared with selective secondary transfer from nearest NSAH to SNC. We conducted a pilot cluster randomised controlled trial to determine the feasibility and plausibility of bypassing suspected patients with TBI —directly into SNCs—producing a measurable effect.SettingTwo English Ambulance Services.Participants74 clusters (ambulance stations) were randomised within pairs after matching for important characteristics. Clusters enrolled head-injured adults—injured nearest to an NSAH—with internationally accepted TBI risk factors and stable ABC. We excluded participants attended by Helicopter Emergency Medical Services or who were injured more than 1 hour by road from nearest SNC.InterventionsIntervention cluster participants were transported directly to an SNC bypassing nearest NSAH; control cluster participants were transported to nearest NSAH with selective secondary transfer to SNC.OutcomesTrial recruitment rate (target n=700 per annum) and percentage with TBI on CT scan (target 80%) were the primary feasibility outcomes. 30-day mortality, 6-month Extended Glasgow Outcome Scale and quality of life were secondary outcomes.Results56 ambulance station clusters recruited 293 patients in 12 months. The trial arms were similar in terms of age, conscious level and injury severity. Less than 25% of recruited patients had TBI on CT (n=70) with 7% (n=20) requiring neurosurgery. Complete case analysis showed similar 30-day mortality in the two trial arms (control=8.8 (2.7–14.0)% vs intervention=9.4(2.3–14.0)%).ConclusionBypassing patients with suspected TBI to SNCs gives an overtriage (false positive) ratio of 13:1 for neurosurgical intervention and 4:1 for TBI. A measurable effect from a full trial of early neuroscience care following bypass is therefore unlikely.Trial registration numberISRCTN68087745.

Association of traumatic brain injury severity and time to definitive care in three low-middle-income European countries

2021 ◽  
pp. injuryprev-2020-044049
Author(s):  
Corinne Peek-Asa ◽  
Madalina Adina Coman ◽  
Alison Zorn ◽  
Nino Chikhladze ◽  
Serghei Cebanu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Road Traffic ◽  
Severe Injury ◽  
Severe Injuries ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Traumatic Brain Injury Severity

BackgroundLow-middle-income countries experience among the highest rates of traumatic brain injury in the world. Much of this burden may be preventable with faster intervention, including reducing the time to definitive care. This study examines the relationship between traumatic brain injury severity and time to definitive care in major trauma hospitals in three low-middle-income countries.MethodsA prospective traumatic brain injury registry was implemented in six trauma hospitals in Armenia, Georgia and the Republic of Moldova for 6 months in 2019. Brain injury severity was measured using the Glasgow Coma Scale (GCS) at admission. Time to definitive care was the time from injury until arrival at the hospital. Cox proportionate hazards models predicted time to care by severity, controlling for age, sex, mechanism, mode of transportation, location of injury and country.ResultsAmong 1135 patients, 749 (66.0%) were paediatric and 386 (34.0%) were adults. Falls and road traffic were the most common mechanisms. A higher proportion of adult (23.6%) than paediatric (5.4%) patients had GCS scores indicating moderate (GCS 9–11) or severe injury (GCS 0–8) (p<0.001). Less severe injury was associated with shorter times to care, while more severe injury was associated with longer times to care (HR=1.05, 95% CI 1.01 to 1.09). Age interacted with time to care, with paediatric cases receiving faster care.ConclusionsImplementation of standard triage and transport protocols may reduce mortality and improve outcomes from traumatic brain injury, and trauma systems should focus on the most severe injuries.

scholarly journals Linked Records of Children with Traumatic Brain Injury

2015 ◽  
Vol 54 (04) ◽  
pp. 328-337 ◽  
Author(s):  
T. D. Bennett ◽  
J. M. Dean ◽  
H. T. Keenan ◽  
M. H. McGlincy ◽  
A. M. Thomas ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Health Information ◽  
Record Linkage ◽  
Comparative Effectiveness ◽  
Injury Severity ◽  
Data Bank ◽  
Severe Injuries ◽  
Effectiveness Studies ◽  
The Impact

SummaryObjective: Record linkage may create powerful datasets with which investigators can conduct comparative effectiveness studies evaluating the impact of tests or interventions on health. All linkages of health care data files to date have used protected health information (PHI) in their linkage variables. A technique to link datasets without using PHI would be advantageous both to preserve privacy and to increase the number of potential linkages.Methods: We applied probabilistic linkage to records of injured children in the National Trauma Data Bank (NTDB, N = 156,357) and the Pediatric Health Information Systems (PHIS, N = 104,049) databases from 2007 to 2010. 49 match variables without PHI were used, many of them administrative variables and indicators for procedures recorded as International Classification of Diseases, 9th revision, Clinical Modification codes. We validated the accuracy of the linkage using identified data from a single center that submits to both databases.Results: We accurately linked the PHIS and NTDB records for 69% of children with any injury, and 88% of those with severe traumatic brain injury eligible for a study of intervention effectiveness (positive predictive value of 98%, specificity of 99.99%). Accurate linkage was associated with longer lengths of stay, more severe injuries, and multiple injuries.Conclusion: In populations with substantial illness or injury severity, accurate record linkage may be possible in the absence of PHI. This methodology may enable linkages and, in turn, comparative effectiveness studies that would be unlikely or impossible otherwise.

Thromboelastogram-Guided Resuscitation for Patients with Traumatic Brain Injury on Novel Anticoagulants

2019 ◽  
Vol 85 (8) ◽  
pp. 861-864 ◽  
Author(s):  
Salini Hota ◽  
Matthew Ng ◽  
Dashaunda Hilliard ◽  
Jessica Burgess
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Blood Product ◽  
Retrospective Chart Review ◽  
Control Group ◽  
Severe Injuries ◽  
Novel Anticoagulants ◽  
Severity Of Injury ◽  
Overall Mortality

Traumatic brain injuries in patients on antithrombotic agents carry significant morbidity. Initial therapy is centered around reversal of these agents. The thromboelastogram (TEG) maps the clotting cascade to guide reversal. A retrospective chart review was conducted for 118 patients presenting with a traumatic brain injury while on antithrombotics. Patients were divided between those who received a TEG on arrival and those who did not. The primary endpoint was overall mortality. Secondary endpoints included blood product utilization, and outcomes associated with specific novel anticoagulants. Mortality in the control group was 20.3 per cent compared with 18.5 per cent in the TEG group ( P = 0.81). For less severe injuries, the control group mortality was 3.8 per cent and the TEG group mortality was 8.7 per cent ( P = 0.64). For more severe injuries, mortality in the control versus TEG groups were 31.6 per cent and 25.8 per cent, respectively ( P = 0.73). Blood product utilization was significantly lower in the TEG group ( P = 0.002). Overall mortality was not significantly different between the groups. However, when stratified by severity of injury, mortality was reduced in the TEG-guided group in severely injured patients. Blood product utilization was significantly reduced with TEG-guided reversal. Trauma centers can improve the utilization of blood products in reversal of antithrombotics with the use of TEG.

Measuring the effects of institutional pediatric traumatic brain injury volume on outcomes for rural-dwelling children

2021 ◽  
pp. 1-9
Author(s):  
Pious D. Patel ◽  
Katherine A. Kelly ◽  
Heidi Chen ◽  
Amber Greeno ◽  
Chevis N. Shannon ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Diagnosis Related Groups ◽  
Univariate Analysis ◽  
Medical Complications ◽  
Pediatric Traumatic Brain Injury ◽  
United States Census ◽  
Rural And Urban ◽  
Severity Of Injury

OBJECTIVE Rural-dwelling children may suffer worse pediatric traumatic brain injury (TBI) outcomes due to distance from and accessibility to high-volume trauma centers. This study aimed to compare the impacts of institutional TBI volume and sociodemographics on outcomes between rural- and urban-dwelling children. METHODS This retrospective study identified patients 0–19 years of age with ICD-9 codes for TBI in the 2012–2015 National Inpatient Sample database. Patients were characterized as rural- or urban-dwelling using United States Census classification. Logistic and linear (in log scale) regressions were performed to measure the effects of institutional characteristics, patient sociodemographics, and mechanism/severity of injury on occurrence of medical complications, mortality, length of stay (LOS), and costs. Separate models were built for rural- and urban-dwelling patients. RESULTS A total of 19,736 patients were identified (median age 11 years, interquartile range [IQR] 2–16 years, 66% male, 55% Caucasian). Overall, rural-dwelling patients had higher All Patient Refined Diagnosis Related Groups injury severity (median 2 [IQR 1–3] vs 1 [IQR 1–2], p < 0.001) and more intracranial monitoring (6% vs 4%, p < 0.001). Univariate analysis showed that overall, rural-dwelling patients suffered increased medical complications (6% vs 4%, p < 0.001), mortality (6% vs 4%, p < 0.001), and LOS (median 2 days [IQR 1–4 days ] vs 2 days [IQR 1–3 days], p < 0.001), but multivariate analysis showed rural-dwelling status was not associated with these outcomes after adjusting for injury severity, mechanism, and hospital characteristics. Institutional TBI volume was not associated with medical complications, disposition, or mortality for either population but was associated with LOS for urban-dwelling patients (nonlinear beta, p = 0.008) and cost for both rural-dwelling (nonlinear beta, p < 0.001) and urban-dwelling (nonlinear beta, p < 0.001) patients. CONCLUSIONS Overall, rural-dwelling pediatric patients with TBI have worsened injury severity, mortality, and in-hospital complications, but these disparities disappear after adjusting for injury severity and mechanism. Institutional TBI volume does not impact clinical outcomes for rural- or urban-dwelling children after adjusting for these covariates. Addressing the root causes of the increased injury severity at hospital arrival may be a useful path to improve TBI outcomes for rural-dwelling children.

Predicting Fatigue 12 Months after Child Traumatic Brain Injury: Child Factors and Postinjury Symptoms

2017 ◽  
Vol 24 (3) ◽  
pp. 224-236 ◽  
Author(s):  
Alison Crichton ◽  
Ed Oakley ◽  
Franz E Babl ◽  
Mardee Greenham ◽  
Stephen Hearps ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Motor Function ◽  
Psychological Functioning ◽  
Injury Severity ◽  
Psychological Symptoms ◽  
Hierarchical Regression ◽  
Motor Symptoms ◽  
Mood Symptoms ◽  
Severe Tbi

AbstractObjectives:Fatigue is a common and persisting symptom after childhood brain injury. This study examined whether child characteristics and symptomatology preinjury or 6 months postinjury (pain, sleep, and mood, inattention) predicted fatigue at 12months postinjury.Methods:Parents of 79 children (0–18 years) rated fatigue at 12 months after injury on a multidimensional scale (general, sleep/rest, and cognitive). Demographic and clinical data were collected at injury. Parents rated child sleep, pain, physical/motor function, mood, and inattention at injury (preinjury description), and 6 months postinjury. Children were divided into two traumatic brain injury severity groups:mild TBI(n=57) andmoderate/severe TBI(n=27). Hierarchical regression models were used to examine (i) preinjury factors and (ii) symptoms 6 months postinjury predictive of fatigue (general, sleep/rest, and cognitive) at 12 months postinjury.Results:Sleep/rest fatigue was predicted by preinjury fatigue (7% of variance) and psychological symptoms preinjury (10% of variance). General fatigue was predicted by physical/motor symptoms (27%), sleep (10%) and mood symptoms (9%) 6 months postinjury. Sleep/rest fatigue was predicted by physical/motor symptoms (10%), sleep symptoms (13%) and mood symptoms (9%) 6 months postinjury. Cognitive fatigue was predicted by physical/motor symptoms (17%) 6 months postinjury.Conclusions:Preinjury fatigue and psychological functioning identified those at greatest risk of fatigue 12 months post-TBI. Predictors of specific fatigue domains at 12 months differed across each of the domains, although consistently included physical/motor function as well as sleep and mood symptoms postinjury. (JINS, 2018,24, 224–236)

scholarly journals Effect of Concomitant Extra cranial Injury in outcome of moderate and severe head injury patients admitted to a tertiary care hospital in western Nepal

2021 ◽  
Vol 3 (01) ◽  
pp. 3-7
Author(s):  
Pradeep Ghimire ◽  
Sushil Mishra ◽  
Balgopal Karmacharya ◽  
Nikunja Yogi
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Injury Severity Score ◽  
Severity Score ◽  
Severe Head Injury ◽  
Injury Severity ◽  
Care Hospital ◽  
Severe Injuries ◽  
Cranial Injury

Background: Polytrauma is a term used to describe the patients those are severely injured associated with other injuries (i.e. two or more severe injuries in at least two areas of the body), less often with a multiple injury (i.e. two or more severe injuries in one body area). More than 40% of the patient of Traumatic Brain Injury (TBI) dies due to extra cranial causes. We hypothesized that extra cranial injuries with polytrauma may alter TBI outcomes and perform the study. Materials and methods: An analytical study was done with the patient of moderate to severe head injury admitted to neurosurgery Intensive Care Unit (ICU) of Manipal Teaching Hospital in between January to December 2019. The objective of the study was to assess the impact of concomitant extra cranial injury (Polytrauma) in the outcome of Moderate to severe head injury. Results: In our study it is seen that, those individuals who have presented delayed in emergency department from the time of incidence under the influence of alcohol, likewise with mean Glasgow Coma Scale (GCS) below 8.16+/-3.22 and abnormal pupils, high injury severity score (ISS), and with polytrauma have poorer outcomes. Conclusion: Concomitant extra cranial injuries, injury severity score(ISS),injuries associated under the influence  of alcohol, delayed presentation in emergency after incident, GCS below 9  during presentation in ER and abnormal pupils during examinations are the strong predicting factors for the poor outcome of patient with traumatic brain injury.

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.

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