scholarly journals A-126 Clinical Utility of Risk Factors to Predict Self-reported Neurobehavioral Outcome Following Traumatic Brain Injury: PTSD, Sleep, Resilience, and Lifetime Blast Exposure

2020 ◽  
Vol 35 (6) ◽  
pp. 919-919
Author(s):  
Lange R ◽  
Lippa S ◽  
Hungerford L ◽  
Bailie J ◽  
French L ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Risk Factor ◽  
Brain Injury ◽  
Clinical Utility ◽  
Poor Sleep ◽  
Post Injury ◽  
Poor Outcome ◽  
Blast Exposure ◽  
Neurobehavioral Outcome

Abstract Objective To examine the clinical utility of PTSD, Sleep, Resilience, and Lifetime Blast Exposure as ‘Risk Factors’ for predicting poor neurobehavioral outcome following traumatic brain injury (TBI). Methods Participants were 993 service members/veterans evaluated following an uncomplicated mild TBI (MTBI), moderate–severe TBI (ModSevTBI), or injury without TBI (Injured Controls; IC); divided into three cohorts: (1) < 12 months post-injury, n = 237 [107 MTBI, 71 ModSevTBI, 59 IC]; (2) 3-years post-injury, n = 370 [162 MTBI, 80 ModSevTBI, 128 IC]; and (3) 10-years post-injury, n = 386 [182 MTBI, 85 ModSevTBI, 119 IC]. Participants completed a 2-hour neurobehavioral test battery. Odds Ratios (OR) were calculated to determine whether the ‘Risk Factors’ could predict ‘Poor Outcome’ in each cohort separately. Sixteen Risk Factors were examined using all possible combinations of the four risk factor variables. Poor Outcome was defined as three or more low scores (< 1SD) on five TBI-QOL scales (e.g., Fatigue, Depression). Results In all cohorts, the vast majority of risk factor combinations resulted in ORs that were ‘clinically meaningful’ (ORs > 3.00; range = 3.15 to 32.63, all p’s < .001). Risk factor combinations with the highest ORs in each cohort were PTSD (Cohort 1 & 2, ORs = 17.76 and 25.31), PTSD+Sleep (Cohort 1 & 2, ORs = 18.44 and 21.18), PTSD+Sleep+Resilience (Cohort 1, 2, & 3, ORs = 13.56, 14.04, and 20.08), Resilience (Cohort 3, OR = 32.63), and PTSD+Resilience (Cohort 3, OR = 24.74). Conclusions Singularly, or in combination, PTSD, Poor Sleep, and Low Resilience were strong predictors of poor outcome following TBI of all severities and injury without TBI. These variables may be valuable risk factors for targeted early interventions following injury.

scholarly journals Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury

2020 ◽  
Vol 21 (16) ◽  
pp. 5613
Author(s):  
Ryuta Nakae ◽  
Yu Fujiki ◽  
Yasuhiro Takayama ◽  
Takahiro Kanaya ◽  
Yutaka Igarashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Propensity Score ◽  
Older Patients ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Elderly Group ◽  
Post Injury ◽  
D Dimer

Coagulopathy and older age are common and well-recognized risk factors for poorer outcomes in traumatic brain injury (TBI) patients; however, the relationships between coagulopathy and age remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more pronounced in older patients and may be a factor in poorer outcomes. We retrospectively evaluated severe TBI cases in which fibrinogen and D-dimer were measured on arrival and 3–6 h after injury. Propensity score-matched analyses were performed to adjust baseline characteristics between older patients (the “elderly group,” aged ≥75 y) and younger patients (the “non-elderly group,” aged 16–74 y). A total of 1294 cases (elderly group: 395, non-elderly group: 899) were assessed, and propensity score matching created a matched cohort of 324 pairs. Fibrinogen on admission, the degree of reduction in fibrinogen between admission and 3–6 h post-injury, and D-dimer levels between admission and 3–6 h post-injury were significantly more abnormal in the elderly group than in the non-elderly group. On multivariate logistic regression analysis, independent risk factors for poor prognosis included low fibrinogen and high D-dimer levels on admission. Posttraumatic coagulation and fibrinolytic abnormalities are more severe in older patients, and fibrinogen and D-dimer abnormalities are negative predictive factors.

A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury

2016 ◽  
Vol 46 (6) ◽  
pp. 1331-1341 ◽  
Author(s):  
Y. Alway ◽  
K. R. Gould ◽  
L. Johnston ◽  
D. McKenzie ◽  
J. Ponsford
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Substance Use ◽  
Brain Injury ◽  
Anxiety Disorders ◽  
Psychiatric Disorders ◽  
Substance Use Disorders ◽  
First Year ◽  
Post Injury ◽  
Over Time

BackgroundPsychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI.MethodParticipants were 161 individuals (78.3% male) with moderate (31.2%) or severe (68.8%) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors.ResultsIn the first 5 years post-injury, 75.2% received a psychiatric diagnosis, commonly emerging within the first year (77.7%). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5%) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6% over time, decreasing by 27% [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.65–0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95% CI 0.63–0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95% CI 1.41–4.25) and accident-related limb injury (OR 1.78, 95% CI 1.03–3.07).ConclusionsFindings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders.

scholarly journals A Levee to the Flood: Pre-injury Neuroinflammation and Immune Stress Influence Traumatic Brain Injury Outcome

2022 ◽  
Vol 13 ◽  
Author(s):  
Samuel Houle ◽  
Olga N. Kokiko-Cochran
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Inflammatory Response ◽  
Genetic Risk ◽  
Traumatic Injury ◽  
Genetic Risk Factors ◽  
Post Injury ◽  
Immune Stress ◽  
Age Related

Increasing evidence demonstrates that aging influences the brain's response to traumatic brain injury (TBI), setting the stage for neurodegenerative pathology like Alzheimer's disease (AD). This topic is often dominated by discussions of post-injury aging and inflammation, which can diminish the consideration of those same factors before TBI. In fact, pre-TBI aging and inflammation may be just as critical in mediating outcomes. For example, elderly individuals suffer from the highest rates of TBI of all severities. Additionally, pre-injury immune challenges or stressors may alter pathology and outcome independent of age. The inflammatory response to TBI is malleable and influenced by previous, coincident, and subsequent immune insults. Therefore, pre-existing conditions that elicit or include an inflammatory response could substantially influence the brain's ability to respond to traumatic injury and ultimately affect chronic outcome. The purpose of this review is to detail how age-related cellular and molecular changes, as well as genetic risk variants for AD affect the neuroinflammatory response to TBI. First, we will review the sources and pathology of neuroinflammation following TBI. Then, we will highlight the significance of age-related, endogenous sources of inflammation, including changes in cytokine expression, reactive oxygen species processing, and mitochondrial function. Heightened focus is placed on the mitochondria as an integral link between inflammation and various genetic risk factors for AD. Together, this review will compile current clinical and experimental research to highlight how pre-existing inflammatory changes associated with infection and stress, aging, and genetic risk factors can alter response to TBI.

Executive Functions and Their Relation to Sleep Following Mild Traumatic Brain Injury in Preschoolers

2018 ◽  
Vol 24 (8) ◽  
pp. 769-780 ◽  
Author(s):  
Catherine Landry-Roy ◽  
Annie Bernier ◽  
Jocelyn Gravel ◽  
Miriam H. Beauchamp
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functioning ◽  
Executive Functions ◽  
Sleep Disturbances ◽  
Sleep Problems ◽  
Poor Sleep ◽  
Healthy Children ◽  
Post Injury ◽  
Mild Tbi

AbstractObjectives:Traumatic brain injury (TBI) sustained during childhood is known to impact children’s executive functioning. However, few studies have focused specifically on executive functioning after preschool TBI. TBI has also been associated with sleep disturbances, which are known to impair executive functions in healthy children. The aim of this study was to investigate executive functions in preschoolers with mild TBI, and to determine the role of sleep in the links between TBI and executive functioning.Methods:The sample was drawn from a longitudinal study and included 167 children, aged 18 to 60 months, divided into 2 groups: children with accidental mild TBI (n=84) and typically developing children (n=83). Children were assessed 6 months post-injury on executive function measures (inhibition and cognitive flexibility) and sleep measures (actigraphy data and parental rating of sleep problems).Results:The two groups did not differ in their executive abilities. However, relative to controls, children with mild TBI and shorter nighttime sleep duration or increased sleep problems exhibited poorer executive functions.Conclusions:These results support a “double hazard” effect, whereby the combination of sleep disturbances and mild TBI results in poorer executive functions. The findings highlight the importance of assessing and monitoring the quality of sleep even after mild head injuries. Poor sleep may place children at risk for increased cognitive difficulties. (JINS, 2018,24, 769–780)

scholarly journals Longitudinal Analyses of the Reciprocity of Depression and Anxiety after Traumatic Brain Injury and Its Clinical Implications

2021 ◽  
Vol 10 (23) ◽  
pp. 5597
Author(s):  
Biyao Wang ◽  
Marina Zeldovich ◽  
Katrin Rauen ◽  
Yi-Jhen Wu ◽  
Amra Covic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
First Year ◽  
Depression And Anxiety ◽  
Post Injury ◽  
Related Factors ◽  
Cross Domain ◽  
Psychiatric Disturbances ◽  
Patient Reported

Depression and anxiety are common following traumatic brain injury (TBI). Understanding their prevalence and interplay within the first year after TBI with differing severities may improve patients’ outcomes after TBI. Individuals with a clinical diagnosis of TBI recruited for the large European collaborative longitudinal study CENTER-TBI were screened for patient-reported major depression (MD) and generalized anxiety disorder (GAD) at three, six, and twelve months post-injury (N = 1683). Data were analyzed using autoregressive cross-lagged models. Sociodemographic, premorbid and injury-related factors were examined as risk factors. 14.1–15.5% of TBI patients reported moderate to severe MD at three to twelve months after TBI, 7.9–9.5% reported GAD. Depression and anxiety after TBI presented high within-domain persistency and cross-domain concurrent associations. MD at three months post-TBI had a significant impact on GAD at six months post-TBI, while both acted bidirectionally at six to twelve months post-TBI. Being more severely disabled, having experienced major extracranial injuries, an intensive care unit stay, and being female were risk factors for more severe MD and GAD. Major trauma and the level of consciousness after TBI were additionally associated with more severe MD, whereas being younger was related to more severe GAD. Individuals after TBI should be screened and treated for MD and GAD early on, as both psychiatric disturbances are highly persistent and bi-directional in their impact. More severely disabled patients are particularly vulnerable, and thus warrant timely screening and intensive follow-up treatment.

scholarly journals Augmented Renal Clearance in Chinese Intensive Care Unit Patients After Traumatic Brain Injury: Identifying Estimate Glomerular Filtration Rate Cut-off Value as a Risk Factor

2020 ◽  
Author(s):  
Zilong Dang ◽  
Hong Guo ◽  
Bin Li ◽  
Maohua Zhen ◽  
Jian Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Risk Factor ◽  
Glomerular Filtration Rate ◽  
Brain Injury ◽  
Serum Creatinine ◽  
Filtration Rate ◽  
Augmented Renal Clearance ◽  
History Of ◽  
Estimate Glomerular Filtration Rate

Abstract BackgroundAugmented renal clearance (ARC) is common in trauma patients and associated with subtherapeutic antimicrobial concentrations. China has more patients with traumatic brain injury (TBI) than most other countries in the world. However, there were no studies that focus on the ARC in Chinese TBI patients. In this study, we report the incidence of ARC in patients with TBI as well as risk factors for ARC. Besides, we evaluated the ability of four commonly used estimate glomerular filtration rate (eGFR) formulas and other covariates to predict the presence of ARC.MethodsThe prospective observational study was conducted in a 24-bed tertiary level, university-affiliated hospital, and 54 TBI patients with normal serum creatinine enrolled. We measured 24-h creatinine clearance after admission, and ARC defined as measured creatinine clearance ≥ 130 ml/min/1.73 m2. Demographic variables were then compared, and multivariate analysis was performed. Receiver operating curve, bias, and precision analyses were conducted to examine eGFR and ARCTIC score accuracy in predicting ARC. Multiple logistic regression analysis was performed to estimate the risk factors contributing to ARC. ResultsThe incidence of ARC was 50%. A moderate correlation was shown between measured Crcl and four eGFR (rs/r was 0.590, 0.499, 0.404, and 0.518, respectively). All of the equations significantly underestimated the measured Crcl, especially in the ARC group. Neither had excellent precision for clinical application in this setting. ARCTIC score can't accurately distinguish ARC either. Multivariable analysis displayed that four factors independently correlated to ARC: male, larger BMI, lower serum creatinine, and without a history of hypertension. Further investigation found eGFR higher than the threshold, without a history of hypertension, and/or bigger BMI were independent risk factors for ARC, and they had good accuracy in predicting the occurrence of ARC.ConclusionsARC was frequently observed in Chinese TBI patients. The estimated methods of GFR and ARCTIC score inaccurate and couldn't be directly used as a screening tool to identify ARC in Chinese TBI patients. But if we take the cut-off values of different formulas into account, the estimated GFR could be used as a decisive risk factor in helping to screen the ARC.

scholarly journals APOE4 genetic polymorphism results in impaired recovery in a repeated mild traumatic brain injury model and treatment with Bryostatin-1 improves outcomes

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Anna O. Giarratana ◽  
Cynthia Zheng ◽  
Sahithi Reddi ◽  
Shavonne L. Teng ◽  
David Berger ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Risk Factor ◽  
Brain Injury ◽  
Genetically Engineered ◽  
Nucleotide Polymorphisms ◽  
Bryostatin 1 ◽  
Post Injury ◽  
Injury Model ◽  
Personalized Approach ◽  
Poor Outcomes

AbstractAfter traumatic brain injury (TBI), some people have worse recovery than others. Single nucleotide polymorphisms (SNPs) in Apolipoprotein E (APOE) are known to increase risk for developing Alzheimer’s disease, however there is controversy from human and rodent studies as to whether ApoE4 is a risk factor for worse outcomes after brain trauma. To resolve these conflicting studies we have explored the effect of the human APOE4 gene in a reproducible mouse model that mimics common human injuries. We have investigated cellular and behavioral outcomes in genetically engineered human APOE targeted replacement (TR) mice following repeated mild TBI (rmTBI) using a lateral fluid percussion injury model. Relative to injured APOE3 TR mice, injured APOE4 TR mice had more inflammation, neurodegeneration, apoptosis, p-tau, and activated microglia and less total brain-derived neurotrophic factor (BDNF) in the cortex and/or hippocampus at 1 and/or 21 days post-injury. We utilized a novel personalized approach to treating APOE4 susceptible mice by administering Bryostatin-1, which improved cellular as well as motor and cognitive behavior outcomes at 1 DPI in the APOE4 injured mice. This study demonstrates that APOE4 is a risk factor for poor outcomes after rmTBI and highlights how personalized therapeutics can be a powerful treatment option.

Suicidality after traumatic brain injury: demographic, injury and clinical correlates

2002 ◽  
Vol 32 (4) ◽  
pp. 687-697 ◽  
Author(s):  
GRAHAME SIMPSON ◽  
ROBYN TATE
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Suicidal Ideation ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
Post Injury ◽  
Psychiatric Disturbance ◽  
Clinical Correlates ◽  
High Level

Background. In spite of the high frequency of emotional distress after traumatic brain injury (TBI), few investigations have examined the extreme of such distress, namely, suicidality, and no large scale surveys have been conducted. The current study examined both the prevalence and demographic, injury, and clinical correlates of hopelessness, suicidal ideation and suicide attempts after TBI.Methods. Out-patients (N = 172) with TBI were screened for suicidal ideation and hopelessness using the Beck Scale for Suicide Ideation and the Beck Hopelessness Scale. Data were also collected on demographic, injury, pre-morbid and post-injury psychosocial variables and included known risk factors for suicide.Results. A substantial proportion of participants had clinically significant levels of hopelessness (35%) and suicide ideation (23%), and 18% had made a suicide attempt post-injury. There was a high degree of co-morbidity between suicide attempts and emotional/psychiatric disturbance. Results from regression analyses indicated that a high level of hopelessness was the most significant association of suicide ideation and a high level of suicide ideation, along with occurrence of post-injury emotional/psychiatric disturbance, were the most significant associations of post-injury suicide attempts. Neither injury severity nor the presence of pre-morbid suicide risk factors contributed to elevated levels of suicidality post-injury.Conclusions. Suicidality is a common psychological reaction to TBI among out-patient populations. Management should involve careful history taking of previous post-injury suicidal behaviour, assessment of post-injury adjustment to TBI with particular focus on the degree of emotional/psychiatric disturbance, and close monitoring of those individuals with high levels of hopelessness and suicide ideation.

Prognostic value of leukocytosis in pediatric traumatic brain injury

2020 ◽  
pp. 1-11
Author(s):  
Soumya Mukherjee ◽  
Gnanamurthy Sivakumar ◽  
John R. Goodden ◽  
Atul K. Tyagi ◽  
Paul D. Chumas
Keyword(s):  
Traumatic Brain Injury ◽  
Risk Factor ◽  
Brain Injury ◽  
Hospital Stay ◽  
Neutrophil Count ◽  
Prognostic Value ◽  
Independent Risk Factor ◽  
Leukocyte Count ◽  
Poor Outcome ◽  
Gcs Score

OBJECTIVEThe purpose of this study was to assess leukocytosis and its prognostic value in pediatric isolated traumatic brain injury (TBI).METHODSTwo hundred one children with isolated TBI admitted to the authors’ institution between June 2006 and June 2018 were prospectively followed and their data retrospectively analyzed. Initial blood leukocyte count (i.e., white cell count [WCC]), Glasgow Coma Scale (GCS) score, CT scans, duration of hospital stay, and Pediatric Cerebral Performance Category Scale (PCPCS) scores were analyzed.RESULTSThe mean age was 4.2 years (range 0.2–16 years). Seventy-four, 70, and 57 patients had severe (GCS score 3–8), moderate (GCS score 9–13), and mild (GCS score 14–15) TBI, respectively, with associated WCC of 20, 15.9, and 10.7 × 109/L and neutrophil counts of 15.6, 11.3, and 6.1 × 109/L, respectively (p < 0.01). Higher WCC and neutrophil counts were demonstrated in patients with increased intracranial mass effect on CT, longer hospital stay, and worse 6-month PCPCS score (p < 0.05). Multivariate regression revealed a cutoff leukocyte count of 16.1 × 109/L, neutrophil count of 11.9 × 109/L, and neutrophil-to-lymphocyte ratio (NLR) of 5.2, above which length of hospital stay and PCPCS scores were less favorable. Furthermore, NLR was the second most important independent risk factor for a poor outcome (after GCS score). The IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) adult TBI prediction model applied to this pediatric cohort demonstrated increased accuracy when WCC was incorporated as a risk factor.CONCLUSIONSIn the largest and first prospective study of isolated pediatric head injury to date, the authors have demonstrated that WCC > 16.1 × 109/L, neutrophil count > 11.9 × 109/L and NLR > 5.2 each have predictive value for lengthy hospital stay and poor PCPCS scores, and NLR is an independent risk factor for poor outcome. Incorporating the initial leukocyte count into TBI prediction models may improve prognostication.

scholarly journals A-117 Sleep Disruption has a Stronger Influence on Self-reported Neurobehavioral Status than Traumatic Brain Injury in U.S. Military Service Members and Veterans

2020 ◽  
Vol 35 (6) ◽  
pp. 910-910
Author(s):  
Lange R ◽  
French L ◽  
Bailie J ◽  
Hungerford L ◽  
Lippa S ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Military Service ◽  
Service Members ◽  
Sleep Disruption ◽  
Poor Sleep ◽  
Mild Tbi ◽  
Military Service Members ◽  
Good Sleep ◽  
Neurobehavioral Outcome

Abstract Objective To examine the relation between sleep disruption and neurobehavioral outcome following mild, moderate, and severe traumatic brain injury (TBI). Methods Participants were 509 U.S. military service members/veterans divided into four groups: uncomplicated mild TBI (n = 183; MTBI); complicated mild TBI and moderate–severe TBI (n = 96; STBI); injured controls (n = 138; IC); and non-injured controls (n = 92; NIC). Participants completed a 2-hour neurobehavioral test battery 12 or more months post-injury that included the PTSD Checklist and 13 scales from the TBI-Quality of Life (TBI-QOL). Using the TBI-QOL Sleep Disturbance scale, participants were classified into two ‘Sleep’ subgroups: Poor Sleep (55 T or higher) or Good Sleep (50 T or lower). Results A higher proportion of the MTBI group was classified as having Poor Sleep (79.2%) compared to the IC (64.5%) and STBI (58.3%) groups; and all were higher than the NIC group (40.2%). In each group separately, participants with Poor Sleep had significantly worse scores on all TBI-QOL scales compared to those with Good Sleep (all p’s &lt; .001, d = .68 to d = 1.98). Participants with Poor Sleep consistently had worse TBI-QOL scores regardless of TBI severity or the presence/absence of TBI (all p’s &lt; .05). Additionally, there was a significant interaction between Sleep and PTSD. Both factors combined resulted in worse outcome than either factor alone (p’s &lt; .05). Conclusions Poor Sleep had a very strong influence on self-reported neurobehavioral outcome, and a greater influence on outcome than TBI severity or the presence/absence of TBI. Poor Sleep may be a useful ‘risk factor’ that can be used clinically to identify individuals in need of early intervention.

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