An inpatient neurobehavioural rehabilitation programme for persons with traumatic brain injury: overview of and outcome data for the Minnesota Neurorehabilitation Hospital

Abstract Background We aimed to systematically review the efficacy of mannitol (MTL) on patients with acute severe traumatic brain injury (TBI). Methods Databases such as PubMed (US National Library of Medicine), CENTRAL (The Cochrane Library 2014, Issue 3), ISI (Web of Science: Science Citation Index Expanded), Chinese Biomedicine Database (CBM), and China Knowledge Resource Integrated Database (CNKI) have been searched for relevant studies published between 1 January 2003 and 1 October 2014. We have established inclusion and exclusion criteria to identify RCTs, which were suitable to be enrolled in the systematic review. The comparison group could be hypertonic saline (HS), hydroxyethyl starch, or others. The quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 and modified Jadad score scale. The major outcome was mortality, followed by the secondary outcomes such as neurological outcome, days on intensive care unit (ICU), and ventilator day. In addition, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and mean arterial pressure (MAP) were used as the surrogate endpoints. Data synthesis and meta-analysis was conducted by using R (version 3.7-0.). Results When 176 potential relevant literatures and abstracts have been screened, four RCTs met all the inclusion criteria and were enrolled for the meta-analysis. Amongst all the enrolled studies, two trials have provided the primary outcome data. There was no heterogeneity between two studies (I2 = 0 %) and a fixed model was used for meta-analysis (n = 53), pooled result indicated that the mortality was similar in mannitol intervention and control treatment, OR = 0.80, 95 % CI [0.27, 2.37], P = 0.38. We found that both mannitol and HS were efficient in decreasing the ICP. Furthermore, the effect of the HS on the ICP appeared to be more effective in the patients with diffuse brain injuries than mannitol did. Conclusions As a conclusion, the mannitol therapy cannot reduce the mortality risk of acute severe traumatic brain injury. Current evidence does not support the mannitol as an effective treatment of acute severe traumatic brain injury. The well-designed randomized controlled trials are in urgent need to demonstrate the adoption of mannitol to acute severe traumatic brain injury.

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An Overview of the Attention Improvement Management (AIM) Program With Outcomes for Three Pilot Participants

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld22.3.90 ◽

2012 ◽

Vol 22 (3) ◽

pp. 90-105 ◽

Cited By ~ 4

Author(s):

Jaime Lee ◽

Beth Harn ◽

McKay Moore Sohlberg ◽

Shari L. Wade

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Brain Injuries ◽

Strategy Instruction ◽

Daily Practice ◽

Evidence Base ◽

Outcome Data ◽

Social Settings ◽

Program Components ◽

Pediatric Tbi

Direct attention training (DAT) and metacognitive strategy instruction have been employed to treat the cognitive deficits associated with traumatic brain injury (TBI) in children and are supported by an emerging evidence base (e.g., Butler et al., 2008; Galbiati et al., 2009; Luton, Reed-Knight, Loiselle, O’Toole, & Blount, 2011; van’t Hooft et al., 2007). The importance of treatment intensity is well established for DAT (Sohlberg et al., 2003), yet restrictions in the delivery and funding of rehabilitation services, the availability of well-trained interventionists, and access by geographic locale remain critical barriers to the provision of intensive services. Computer-delivered treatments that incorporate a home practice component address the gulf between the intensive, daily practice suggested by the efficacy research and these clinical delivery constraints. The purpose of this paper is to (a) review the literature evaluating the integration of DAT and metacognitive facilitation to treat children and adolescents with traumatic brain injury (TBI); (b) present the rationale and description of a computerized program, Attention Improvement Management (AIM); (c) detail the program components; and (d) present outcome data from three pilot participants who completed the intervention. A specific and growing subset of children with TBI have attention impairments following mild brain injuries or concussions (Schatz & Scolaro Moser, 2011) and served as the pilot participants in this study. Pilot participants demonstrated clinically meaningful improvements on attention outcome measures and generalization of the metacognitive strategies trained within the program to contexts outside of therapy, including both academic and social settings. Though initial results are promising, further research is needed to evaluate the efficacy of the AIM intervention to treat the attention and executive function impairments associated with pediatric TBI.

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Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations

Neurosurgery ◽

10.1093/neuros/nyaa278 ◽

2020 ◽

Vol 87 (3) ◽

pp. 427-434 ◽

Cited By ~ 3

Author(s):

Gregory W J Hawryluk ◽

Andres M Rubiano ◽

Annette M Totten ◽

Cindy O’Reilly ◽

Jamie S Ullman ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Decompressive Craniectomy ◽

Severe Traumatic Brain Injury ◽

Controlled Trial ◽

Outcome Data ◽

The Body ◽

Severe Tbi ◽

Key Issues ◽

New Evidence

Abstract When the fourth edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury were finalized in late 2016, it was known that the results of the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) randomized controlled trial of decompressive craniectomy would be public after the guidelines were released. The guideline authors decided to proceed with publication but to update the decompressive craniectomy recommendations later in the spirit of “living guidelines,” whereby topics are updated more frequently, and between new editions, when important new evidence is published. The update to the decompressive craniectomy chapter presented here integrates the findings of the RESCUEicp study as well as the recently published 12-mo outcome data from the DECRA (Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury) trial. Incorporation of these publications into the body of evidence led to the generation of 3 new level-IIA recommendations; a fourth previously presented level-IIA recommendation remains valid and has been restated. To increase the utility of the recommendations, we added a new section entitled Incorporating the Evidence into Practice. This summary of expert opinion provides important context and addresses key issues for practitioners, which are intended to help the clinician utilize the available evidence and these recommendations. The full guideline can be found at: https://braintrauma.org/guidelines/guidelines-for-the-management-of-severe-tbi-4th-ed#/.

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Outcome in Patients with Isolated Moderate to Severe Traumatic Brain Injury

Critical Care Research and Practice ◽

10.1155/2018/3769418 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

D. Jochems ◽

K. J. P. van Wessem ◽

R. M. Houwert ◽

H. B. Brouwers ◽

J. W. Dankbaar ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Cause Of Death ◽

Outcome Data ◽

Unresponsive Wakefulness Syndrome ◽

Exclusion Criteria ◽

Good Functional Outcome ◽

Cord Injury ◽

Life Sustaining Treatment

Introduction. Traumatic brain injury (TBI) remains a major cause of death. Withdrawal of life-sustaining treatment (WLST) can be initiated if there is little anticipated chance of recovery to an acceptable quality of life. The aim of this study was firstly to investigate WLST rates in patients with moderate to severe isolated TBI and secondly to assess outcome data in the survivor group. Material and Methods. A retrospective cohort study was performed. Patients aged ≥ 18 years with moderate or severe isolated TBI admitted to the ICU of a single academic hospital between 2011 and 2015 were included. Exclusion criteria were isolated spinal cord injury and referrals to and from other hospitals. Gathered data included demographics, mortality, cause of death, WLST, and Glasgow Outcome Scale (GOS) score after three months. Good functional outcome was defined as GOS > 3. Results. Of 367 patients, 179 patients were included after applying inclusion and exclusion criteria. 55 died during admission (33%), of whom 45 (82%) after WLST. Patients undergoing WLST were older, had worse neurological performance at presentation, and had more radiological abnormalities than patients without WLST. The decision to withdraw life-sustaining treatment was made on the day of admission in 40% of patients. In 33% of these patients, this decision was made while the patient was in the Emergency Department. 71% of survivors had a good functional outcome after three months. No patient left hospital with an unresponsive wakefulness syndrome (UWS) or suffered from UWS after three months. One patient died within three months of discharge. Conclusion. In-hospital mortality in isolated brain injured patients was 33%. The vast majority died after a decision to withdraw life-sustaining treatment. None of the patients were discharged with an unresponsive wakefulness syndrome.

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A simulation study evaluating approaches to the analysis of ordinal outcome data in randomized controlled trials in traumatic brain injury: results from the IMPACT Project

Clinical Trials ◽

10.1177/1740774509356580 ◽

2010 ◽

Vol 7 (1) ◽

pp. 44-57 ◽

Cited By ~ 64

Author(s):

Gillian S McHugh ◽

Isabella Butcher ◽

Ewout W Steyerberg ◽

Anthony Marmarou ◽

Juan Lu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Controlled Trials ◽

Simulation Study ◽

Outcome Data ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact ◽

Ordinal Outcome

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Paediatric Brain Monitoring with Information Technology (KidsBrainIT) - ERA-NET NEURON Grant

Romanian Neurosurgery ◽

10.2478/romneu-2018-0024 ◽

2018 ◽

Vol 32 (2) ◽

pp. 183-186

Author(s):

C.A. Apetrei ◽

C. Gheorghita ◽

A. Tascu ◽

A.St. Iencean ◽

Tsz-Yan Milly Lo ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Information Technology ◽

Intensive Care ◽

Brain Injury ◽

Perfusion Pressure ◽

Outcome Data ◽

University Hospital ◽

University Hospitals ◽

Project Proposal ◽

Brain Monitoring

Abstract The complete name of this ERA-NET NEURON Grant is “Paediatric Brain Monitoring with Information Technology (KidsBrainIT). Using IT Innovations to Improve Childhood Traumatic Brain Injury Intensive Care Management, Outcome, and Patient Safety”. The Project Coordinators are Ms. Dr. Tsz-Yan Milly Lo (Consultant Paediatric Intensivist and Research Lead in Paediatric Critical Care Medicine ) and Ian Piper from University of Edinburgh, UK and the partners are: Prof. Bart Depreitere and his team from Neurosurgery & Intensive Care Research Group, University Hospitals Leuven, Belgium; Prof. Juan Sahuquillo and his team from Department of Neurosurgery, Vall d’Hebron University Hospital, Barcelona, Spain and the Romanian team with doctors CA Apetrei, C Gheorghita and A Tascu as principal investigators in three different hospitals. This material is based on the scientific project proposal with the basic project data. The aim of this grant is to test two clinically relevant hypotheses: after sustaining traumatic brain injury (TBI), paediatric patients with a longer period of measured cerebral perfusion pressure (CPP) maintained within the calculated optimal CPP (CPPopt) have an improved global clinical outcome and better tolerance against raised intracranial pressure (ICP). Paediatric TBI patients requiring intensive care are recruited from more contributing centres in 4 different countries. Their anonymised routinely collected bedside physiological monitoring data in minute-resolutions linking with anonmyised clinical and outcome data are exported and archived in the central KidsBrainIT data-bank. CPPopt is calculated and ICP dose-response analyses are performed on the KidsBrainIT dataset and their correlations with global outcome at 6 months are determined. The final aim of this study is to improve the treatments of the abnormal physiology insults: increase pressure from brain swelling (raised ICP) and brain perfusion pressure (CPP).

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