Progesterone treatment does not decrease serum levels of biomarkers of glial and neuronal cell injury in moderate and severe TBI subjects: A secondary analysis of the Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment (ProTECT) III trial.

2020 ◽  
Author(s):  
Frederick Kofi Korley ◽  
Qi Pauls ◽  
Sharon D Yeatts ◽  
Courtney Jones ◽  
Emily Corbett-Valade ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cell Injury ◽  
Secondary Analysis ◽  
Neuronal Cell ◽  
Serum Levels ◽  
Clinical Treatment ◽  
Progesterone Treatment ◽  
Severe Tbi

scholarly journals Serum Neurofilament Light as a Biomarker of Traumatic Brain Injury in the Presence of Concomitant Peripheral Injury

2021 ◽  
Vol 16 ◽  
pp. 117727192110534
Author(s):  
Ker Rui Wong ◽  
William T O’Brien ◽  
Mujun Sun ◽  
Glenn Yamakawa ◽  
Terence J O’Brien ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Elevated Serum ◽  
Serum Levels ◽  
Long Bone ◽  
Post Injury ◽  
Neurofilament Light ◽  
Peripheral Injury ◽  
Long Bone Fracture ◽  
Severe Tbi

Introduction: Serum neurofilament light (NfL) is an emerging biomarker of traumatic brain injury (TBI). However, the effect of peripheral injuries such as long bone fracture and skeletal muscle injury on serum NfL levels is unknown. Therefore, the aim of this study was to determine whether serum NfL levels can be used as a biomarker of TBI in the presence of concomitant peripheral injuries. Methods: Rats were randomly assigned to one of four injury groups: polytrauma (muscle crush + fracture + TBI; n = 11); peripheral injuries (muscle crush + fracture + sham-TBI; n = 12); TBI-only (sham-muscle crush + sham-fracture + TBI; n = 13); and triple-sham (n = 7). At 2-days post-injury, serum levels of NfL were quantified using a Simoa HD-X Analyzer. Results: Compared to triple-sham rats, serum NfL concentrations were higher in rats with peripheral injuries-only, TBI-only, and polytrauma. When compared to peripheral injury-only rats, serum NfL levels were higher in TBI-only and polytrauma rats. No differences were found between TBI-only and polytrauma rats. Conclusion: Serum NfL levels did not differ between TBI-only and polytrauma rats, indicating that significant peripheral injuries did not affect the sensitivity and specificity of serum NfL as a biomarker of moderate TBI. However, the finding of elevated serum NfL levels in rats with peripheral injuries in the absence of a TBI suggests that the presence of such injuries may limit the utility of NfL as a biomarker of less severe TBI (eg, concussion).

A-102 Performance Validity Testing in Telehealth Research: A VA Traumatic Brain Injury Model Systems Study

2021 ◽  
Vol 36 (6) ◽  
pp. 1151-1151
Author(s):  
Justin O'Rourke ◽  
Robert J Kanser ◽  
Marc A Silva
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Digit Span ◽  
Secondary Analysis ◽  
Primary Objective ◽  
Model Systems ◽  
Performance Validity ◽  
Cut Scores ◽  
Chi Square ◽  
Severe Tbi

Abstract Objective Studies on Performance Validity Tests (PVTs) for tele-neuropsychology (TeleNP) are sparse. Verbal PVTs appear to better translate to TeleNP, so the primary objective of this study was to provide initial data on two well-established, verbal PVTs administered via TeleNP for research participants with traumatic brain injury (TBI). Methods This secondary analysis of the Veterans Affairs TBI Model Systems data included 53 participants enrolled in a PVT module study (3/01/2020–09/20/2020) with documented moderate-to-severe TBI per Glasgow Coma Score (M = 6.5, SD = 4.4), posttraumatic amnesia duration (M = 42.7 days, SD = 47.1), and/or time to follow commands (M = 10.5 days, SD = 16.3). Participants completed two PVTs—Reliable Digit Span (RDS) and the 21-Item Test (21-IT)—alongside telephone-based cognitive assessment 1–7 years after TBI. Descriptive analyses were performed to compare PVT performances to previously established cut scores. Chi square analyses were employed to examine 21-IT and RDS as dichotomous outcomes (pass/fail) at selected cutoffs. Results RDS ranged from 5 to 16 (M = 10.5, SD = 2.4). 21-IT ranged from 7 to 21 (M = 16.4, SD = 3.1). For RDS, 9.8% were invalid with a cutscore of ≤7 and 19.6% using a cutscore of ≤8. For the 21-IT, 7.8% were in invalid using a cutscore of ≤11, and 13.7% using a cutscore of ≤12. Conclusion(s) Using previously established cut scores, telephone-administered RDS and 21-IT resulted in relatively low rates of invalid performance among individuals with moderate-to-severe TBI. These findings provide preliminary support for the RDS and 21-IT in TeleNP.

Perfil epidemiológico, clínico e desfecho de pacientes com traumatismo cranioencefálico / Epidemiological, clinical profile and outcome of patients with traumatic brain injury

2021 ◽  
Vol 66 (1u) ◽  
pp. 1
Author(s):  
Jeniffer Araújo Valentim da Silva ◽  
Marcele Pescuma Capeletti Padula ◽  
Camila Waters
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Stay ◽  
Clinical Treatment ◽  
Clinical Profile ◽  
Average Hospital Stay ◽  
Mild Tbi ◽  
Average Hospital ◽  
Firearm Injury ◽  
Severe Tbi

Objetivo: Identificar o perfil epidemiológico, clínico e o desfecho dos pacientes com Traumatismo Cranioencefálico (TCE). Métodos: Pesquisa retrospectiva realizada com pacientes com idade maior ou igual a 18 anos, que estiveram internados na Instituição no ano de 2017, vítimas de TCE por qualquer etiologia. Resultados: Analisados 268 prontuários, sendo 78,7% do sexo masculino, com uma média de idade de 51 anos e maior incidência na faixa etária dos 31 a 50 anos (38,4%). A maioria (76,1%) chegou ao Pronto Socorro (PS) pelo Serviço de Atendimento Móvel de Urgência (SAMU), com uma média da Escala de Coma de Glasgow de 12 pontos, sendo que 78,0% apresentavam TCE leve (13 a 15 pontos), 14,2% apresentavam TCE grave (3 a 8 pontos) e 7,8% apresentavam TCE moderado (9 a 12 pontos). A maioria (57,5%) apresentou o TCE por queda, seguido de 16,0% por atropelamento, 12,0% por agressão, 5,9% por politrauma de mecanismos desconhecidos, 5,6% por acidente de moto, 1,9% por acidente automobilístico e 1,1% por ferimento por arma de fogo. A maioria (84,3%) ficou internada no hospital por até 10 dias, com uma média de internação hospitalar de seis dias, 92,9% receberam tratamento clínico (conservador) e 85,8% receberam alta hospitalar. Conclusões: Prevaleceram indivíduos do sexo masculino, com uma média de idade de 51 anos, encaminhados ao PS pelo SAMU, vítimas de TCE leve, ocasionado por queda, com uma média de internação hospitalar de seis dias, recebendo tratamento clínico e com desfecho de alta hospitalar.Palavras chave: Perfil de saúde, Lesões encefálicas traumáticas, Traumatismo cerebrovascularABSTRACTObjective: To identify the epidemiological, clinical profile and outcome of patients with Traumatic Brain Injury (TBI). Methods: Retrospective research conducted with patients aged 18 years or older, who were admitted to the Institution in 2017, victims of TBI due to any etiology. Results: 268 medical records were analyzed, of wich 78,7% were male, with an average age of 51 years and a higher incidence in the age group from 31 to 50 years (38,4%). The majority (76,1%) arrived at the Emergency Room (ER) through the Mobile Emergency Service (SAMU), with an average of the Glasgow Coma Scale of 12 points, with 78,0% having mild TBI (13 at 15 points), 14,2% had severe TBI (3 to 8 points) and 7,8% had moderate TBI (9 to 12 points). The majority (57,5%) presented TBI due a fall, followed by 16,0% due to being run over, 12,0% due to aggression, 5,9% due to polytrauma of unknown mechanisms, 5,6% due to motorcycle accident, 1,9% due to automobile accident and 1,1% due to firearm injury. The majority (84,3%) stayed in the hospital for up to 10 days, with an average hospital stay of six days, 92,9% received clinical treatment and 85,8% were discharged. Conclusions: Male individuals prevailed, with an average age of 51 years, referred to ER by SAMU, victims of mild TBI, caused by a fall, with an average hospital stay of six days, receiving clinical treatment and with outcome of discharge hospital.Keywords: Health profile, Traumatic brain injury, Cerebrovascular trauma

scholarly journals Microparticles Impair Hypotensive Cerebrovasodilation and Cause Hippocampal Neuronal Cell Injury after Traumatic Brain Injury

2016 ◽  
Vol 33 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Leif-Erik Bohman ◽  
John Riley ◽  
Tatyana N. Milovanova ◽  
Matthew R. Sanborn ◽  
Stephen R. Thom ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cell Injury ◽  
Neuronal Cell

Traumatic Brain Injury

2019 ◽  
pp. 503-525
Author(s):  
Irene Cristofori ◽  
Jordan Grafman
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Deficits ◽  
Neuronal Cell Death ◽  
Neuronal Cell ◽  
Future Research ◽  
Important Health ◽  
Behavioral Treatments ◽  
Severe Tbi ◽  
External Forces

Traumatic brain injury (TBI) is an alteration in brain structure or function caused by external forces that result in vascular and axonal damage, edema, and neuronal cell death. This chapter examines the spectrum of TBI. TBI is a major cause of death and disability and, therefore, an important health and socioeconomic problem for societies. Individuals surviving a moderate to severe TBI frequently suffer from long-lasting cognitive deficits. Such deficits include different aspects of cognition, such as memory, attention, executive functions, social behavior, and awareness. Protective factors, well-detailed diagnostic criteria, and available pharmacological and behavioral treatments are described. Final considerations on current controversies, knowledge gaps, and future research targets are provided.

scholarly journals Effects of probiotics combined with early enteral nutrition on endothelin-1 and C-reactive protein levels and prognosis in patients with severe traumatic brain injury

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051988811
Author(s):  
Guohua Wan ◽  
Linlin Wang ◽  
Guanhong Zhang ◽  
Jian Zhang ◽  
Yanli Lu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Enteral Nutrition ◽  
Serum Levels ◽  
Inflammatory Factors ◽  
Early Enteral Nutrition ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Tnf Α ◽  
Severe Tbi

Objective To investigate the effects of probiotics combined with early enteral nutrition on levels of endothelin-1 (ET-1), C-reactive protein (CRP), and inflammatory factors, and on the prognosis of patients with severe traumatic brain injury (TBI). Methods We enrolled 76 adults with severe TBI. The patients were divided randomly into two equal groups administered enteral nutrition with and without probiotics, respectively. Demographic and clinical data including age, sex, Glasgow Coma Scale score, Sequential Organ Failure Score, Acute Physiology, Chronic Health Score, hospitalization, mortality, and infections were recorded. Results Serum levels of inflammatory factors gradually decreased with increasing treatment time in both groups. However, ET-1 at 15 days, and interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α, and CRP at 7 and 15 days decreased significantly more in the combined treatment group. Hospitalization duration and pulmonary infection rates were also significantly reduced in the combined compared with the enteral nutrition alone group. GCS scores at 15 days were significantly lower in the combined compared with the enteral nutrition group. Conclusion Probiotics combined with early enteral nutrition could reduce serum levels of ET-1, CRP, and IL-6, IL-10, and TNF-α, and could thus improve the recovery of patients with severe TBI.

scholarly journals Clinical Utility of Serum Levels of Ubiquitin C-Terminal Hydrolase as a Biomarker for Severe Traumatic Brain Injury

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 666-675 ◽  
Author(s):  
Stefania Mondello ◽  
Akinyi Linnet ◽  
Andras Buki ◽  
Steven Robicsek ◽  
Andrea Gabrielli ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Utility ◽  
Injury Severity ◽  
Sandwich Elisa ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Severe Tbi ◽  
Gcs Score ◽  
And Control

Abstract Background: Brain damage markers released in cerebrospinal fluid (CSF) and blood may provide valuable information about diagnosis and outcome prediction after traumatic brain injury (TBI). Objective: To examine the concentrations of ubiquitin C-terminal hydrolase-L1 (UCH-L1), a novel brain injury biomarker, in CSF and serum of severe TBI patients and their association with clinical characteristics and outcome. Methods: This case-control study enrolled 95 severe TBI subjects (Glasgow Coma Scale [GCS] score, 8). Using sensitive UCH-L1 sandwich ELISA, we studied the temporal profile of CSF and serum UCH-L1 levels over 7 days for severe TBI patients. Results: Comparison of serum and CSF levels of UCH-L1 in TBI patients and control subjects shows a robust and significant elevation of UCH-L1 in the acute phase and over the 7-day study period. Serum and CSF UCH-L1 receiver-operating characteristic curves further confirm strong specificity and selectivity for diagnosing severe TBI vs controls, with area under the curve values in serum and CSF statistically significant at all time points up to 24 hours (P < .001). The first 12-hour levels of both serum and CSF UCH-L1 in patients with GCS score of 3 to 5 were also significantly higher than those with GCS score of 6 to 8. Furthermore, UCH-L1 levels in CSF and serum appear to distinguish severe TBI survivors from nonsurvivors within the study, with nonsurvivors having significantly higher and more persistent levels of serum and CSF UCH-L1. Cumulative serum UCH-L1 levels > 5.22 ng/mL predicted death (odds ratio, 4.8). Conclusion: Serum levels of UCH-L1 appear to have potential clinical utility in diagnosing TBI, including correlating to injury severity and survival outcome.

scholarly journals Evacuation Strategies for U.S. Casualties with Traumatic Brain Injury (TBI) with and without Polytrauma

2022 ◽  
Author(s):  
Patrick C Ng ◽  
Allyson A Araña ◽  
Shelia C Savell ◽  
William T Davis ◽  
Julie Cutright ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Clinical Outcomes ◽  
Secondary Analysis ◽  
Service Members ◽  
Blood Products ◽  
Significant Difference ◽  
Severe Tbi ◽  
Polytrauma Patients ◽  
The Impact

ABSTRACT Introduction According to the Military Health System Traumatic Brain Injury (TBI) Center of Excellence, 51,261 service members suffered moderate to severe TBI in the last 21 years. Moderate to severe TBI in service members is usually related to blast injury in combat operations, which necessitates medical evacuation to higher levels of care. Prevention of secondary insult, and mitigation of the unique challenges associated with the transport of TBI patients in a combat setting are important in reducing the morbidity and mortality associated with this injury. The primary goal of this study was a secondary analysis comparing the impact of time to transport on clinical outcomes for TBI patients without polytrauma versus TBI patients with polytrauma transported out of the combat theater via Critical Care Air Transport Teams (CCATT). Our secondary objective was to describe the occurrence of in-flight events and interventions for TBI patients without polytrauma versus TBI with polytrauma to assist with mission planning for future transports. Materials and Methods We performed a secondary analysis of a retrospective cohort of 438 patients with TBI who were evacuated out of theater by CCATT from January 2007 to May 2014. Polytrauma was defined as abbreviated injury scale (AIS) of at least three to another region in addition to head/neck. Time to transport was defined as the time (in days) from injury to CCATT evacuation out of combat theater. We calculated descriptive statistics and examined the associations between time to transport and preflight characteristics, in-flight interventions and events, and clinical outcomes for TBI patients with and without polytrauma. Results We categorized patients into two groups, those who had a TBI without polytrauma (n = 179) and those with polytrauma (n = 259). Within each group, we further divided those that were transported within 1 day of injury, in 2 days, and 3 or more days. Patients with TBI without polytrauma transported in 1 or 2 days were more likely to have a penetrating injury, an open head injury, a preflight Glascow Coma Score (GCS) of 8 or lower, and be mechanically ventilated compared to those transported later. Patients without polytrauma who were evacuated in 1 or 2 days required more in-flight interventions compared to patients without polytrauma evacuated later. Patients with polytrauma who were transported in 2 days were more likely to receive blood products, and patients with polytrauma who were evacuated within 1 day were more likely to have had at least one episode of hypotension en route. Polytrauma patients who were evacuated in 2–3 days had higher hospital days compared to polytrauma with earlier evacuations. There was no significant difference in mortality between any of the groups. Conclusions In patients with moderate to severe TBI transported via CCATT, early evacuation was associated with a higher rate of in-flight hypotension in polytrauma patients. Furthermore, those who had TBI without polytrauma that were evacuated in 1–2 days received more in-flight supplementary oxygen, blood products, sedatives, and paralytics. Given the importance of minimizing secondary insults in patients with TBI, recognizing this in this subset of the population may help systematize ways to minimize such events. Traumatic Brain Injury patients with polytrauma may benefit from further treatment and stabilization in theater prior to CCATT evacuation.

Early posttraumatic seizures in pediatric traumatic brain injury: a multicenter analysis

2021 ◽  
pp. 1-7
Author(s):  
Shu-Ling Chong ◽  
Suyun Qian ◽  
Sarah Hui Wen Yao ◽  
John Carson Allen ◽  
Hongxing Dang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcomes ◽  
Cerebral Performance Category ◽  
Secondary Analysis ◽  
Pediatric Intensive Care ◽  
Risk Of Death ◽  
Severe Tbi ◽  
Gcs Score ◽  
Posttraumatic Seizures

OBJECTIVE Early posttraumatic seizures (EPTSs) in children after traumatic brain injury (TBI) increase metabolic stress on the injured brain. The authors sought to study the demographic and radiographic predictors for EPTS, and to investigate the association between EPTS and death, and between EPTS and poor functional outcomes among children with moderate to severe TBI in Asia. METHODS A secondary analysis of a retrospective TBI cohort among participating centers of the Pediatric Acute & Critical Care Medicine Asian Network was performed. Children < 16 years of age with a Glasgow Coma Scale (GCS) score ≤ 13 who were admitted to pediatric intensive care units between January 2014 and October 2017 were included. Logistic regression analysis was performed to study risk factors for EPTS and to investigate the association between EPTS and death, and between EPTS and poor functional outcomes. Poor functional outcomes were defined as moderate disability, severe disability, and coma as defined by the Pediatric Cerebral Performance Category scale. RESULTS Overall, 313 children were analyzed, with a median age of 4.3 years (IQR 1.8–8.9 years); 162 children (51.8%) had severe TBI (GCS score < 8), and 76 children (24.3%) had EPTS. After adjusting for age, sex, and the presence of nonaccidental trauma (NAT), only younger age was significantly associated with EPTS (adjusted odds ratio [aOR] 0.85, 95% CI 0.78–0.92; p < 0.001). Forty-nine children (15.6%) in the cohort died, and 87 (32.9%) of the 264 surviving patients had poor functional outcomes. EPTS did not increase the risk of death. After adjusting for age, sex, TBI due to NAT, multiple traumas, and a GCS score < 8, the presence of EPTS was associated with poor functional outcomes (aOR 2.08, 95% CI 1.05–4.10; p = 0.036). CONCLUSIONS EPTSs were common among children with moderate to severe TBI in Asia and were associated with poor functional outcomes among children who survived TBI.

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