A-133 Understanding Caregiver Anxiety after Traumatic Brain Injury

Abstract Objective After an individual sustains a severe traumatic brain injury (sTBI), the recovery process continues, as there are often long-standing difficulties in cognitive, behavioral, and physical abilities. People who care for individuals living with sTBI experience unique challenges. The term to best explain these challenges is caregiver burden. More often than not in research, caregiver burden combines stress and the emotional toll with the most challenging behaviors they encounter. This systematic review aims to assess anxiety for sTBI caregivers. Methods A search for recent, peer-reviewed publications was conducted using GALILEO, which encompasses PsychINFO and PubMed, with the terms “caregiver burden,” “care recipient,” “caregiver,” “burden,” “anxiety,” “stress,” “strain,” “traumatic brain injury” which resulted in N = 1,013 total articles. After excluding irrelevant studies lacking anxiety and sTBI, N = 8 articles remained. Results A review of relevant studies revealed many psychosocial factors that contribute to anxiety including perceived stress/strain management, coping style, and level of care. When an individual had a dual diagnosis of sTBI and psychiatric disorder (e.g., depression) combined with behavioral disturbances (e.g., anger), caregivers showed increased anxiety. Similarly, caregivers’ anxiety increased depending on military career, gender, and relationship status. Protective factors for caregivers included social support and psychotherapeutic interventions, specifically brief structured psychoeducation. Conclusions The results of this systematic review highlight the specific challenges sTBI caregivers face and subsequent anxiety. Individuals with sTBI experience adjustment phases post-injury, and the caregivers experience the transitions alongside the survivor. Future research should investigate how to increase caregiver protective factors and manage the impact of caregiver anxiety on individuals with sTBI.

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The Impact of Accidental Hypothermia on Mortality in Trauma Patients Overall and Patients with Traumatic Brain Injury Specifically: A Systematic Review and Meta-Analysis

World Journal of Surgery ◽

10.1007/s00268-020-05750-5 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4106-4117

Author(s):

David Rösli ◽

Beat Schnüriger ◽

Daniel Candinas ◽

Tobias Haltmeier

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Mortality ◽

Meta Analysis ◽

Accidental Hypothermia ◽

Trauma Patients ◽

Qualitative Synthesis ◽

Pubmed Database ◽

The Impact

Abstract Background Accidental hypothermia is a known predictor for worse outcomes in trauma patients, but has not been comprehensively assessed in a meta-analysis so far. The aim of this systematic review and meta-analysis was to investigate the impact of accidental hypothermia on mortality in trauma patients overall and patients with traumatic brain injury (TBI) specifically. Methods This is a systematic review and meta-analysis using the Ovid Medline/PubMed database. Scientific articles reporting accidental hypothermia and its impact on outcomes in trauma patients were included in qualitative synthesis. Studies that compared the effect of hypothermia vs. normothermia at hospital admission on in-hospital mortality were included in two meta-analyses on (1) trauma patients overall and (2) patients with TBI specifically. Meta-analysis was performed using a Mantel–Haenszel random-effects model. Results Literature search revealed 264 articles. Of these, 14 studies published 1987–2018 were included in the qualitative synthesis. Seven studies qualified for meta-analysis on trauma patients overall and three studies for meta-analysis on patients with TBI specifically. Accidental hypothermia at admission was associated with significantly higher mortality both in trauma patients overall (OR 5.18 [95% CI 2.61–10.28]) and patients with TBI specifically (OR 2.38 [95% CI 1.53–3.69]). Conclusions In the current meta-analysis, accidental hypothermia was strongly associated with higher in-hospital mortality both in trauma patients overall and patients with TBI specifically. These findings underscore the importance of measures to avoid accidental hypothermia in the prehospital care of trauma patients.

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Burden and Preparedness amongst Informal Caregivers of Adults with Moderate to Severe Traumatic Brain Injury

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176386 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6386

Author(s):

Kirsten Lieshout ◽

Joanne Oates ◽

Anne Baker ◽

Carolyn A. Unsworth ◽

Ian D. Cameron ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Caregiver Burden ◽

Severe Traumatic Brain Injury ◽

Informal Caregivers ◽

Family Care ◽

Care Recipient ◽

Chi Square ◽

Cross Sectional ◽

Reported Data

This study examined the patterns of informal (unpaid) caregiving provided to people after moderate to severe traumatic brain injury (TBI), explore the self-reported burden and preparedness for the caregiving role, and identify factors predictive of caregiver burden and preparedness. A cross-sectional cohort design was used. Informal caregivers completed the Demand and Difficulty subscales of the Caregiving Burden Scale; and the Mutuality, Preparedness, and Global Strain subscales of the Family Care Inventory. Chi-square tests and logistic regression were used to examine the relationships between caregiver and care recipient variables and preparedness for caregiving. Twenty-nine informal caregivers who reported data on themselves and people with a moderate to severe TBI were recruited (referred to as a dyad). Most caregivers were female (n = 21, 72%), lived with the care recipient (n = 20, 69%), and reported high levels of burden on both scales. While most caregivers (n = 21, 72%) felt “pretty well” or “very well” prepared for caregiving, they were least prepared to get help or information from the health system, and to deal with the stress of caregiving. No significant relationships or predictors for caregiver burden or preparedness were identified. While caregivers reported the provision of care as both highly difficult and demanding, further research is required to better understand the reasons for the variability in caregiver experience, and ultimately how to best prepare caregivers for this long-term role.

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The impact of pre-injury anticoagulation therapy in the older adult patient experiencing a traumatic brain injury: a systematic review

International Journal of Evidence-Based Healthcare ◽

10.1097/01258363-201309000-00069 ◽

2013 ◽

Vol 11 (3) ◽

pp. 246

Author(s):

K Smith ◽

S Weeks

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Adult Patient ◽

Older Adult ◽

Anticoagulation Therapy ◽

The Impact

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Comorbidity and outcomes in traumatic brain injury: protocol for a systematic review on functional status and risk of death

BMJ Open ◽

10.1136/bmjopen-2017-018626 ◽

2017 ◽

Vol 7 (10) ◽

pp. e018626 ◽

Cited By ~ 5

Author(s):

Tatyana Mollayeva ◽

Chen Xiong ◽

Sara Hanafy ◽

Vincy Chan ◽

Zheng Jing Hu ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Status ◽

Medical Information ◽

Longitudinal Design ◽

Adverse Outcomes ◽

Current Evidence ◽

Risk Of Death ◽

The Impact

IntroductionReports on the association between comorbidity and functional status and risk of death in patients with traumatic brain injury (TBI) have been inconsistent; it is currently unknown which additional clinical entities (comorbidities) have an adverse influence on the evolution of outcomes across the lifespan of men and women with TBI. The current protocol outlines a strategy for a systematic review of the current evidence examining the impact of comorbidity on functional status and early-term and late-term mortality, taking into account known risk factors of these adverse outcomes (ie, demographic (age and sex) and injury-related characteristics).Methods and analysisA comprehensive search strategy for TBI prognosis, functional (cognitive and physical) status and mortality studies has been developed in collaboration with a medical information specialist of the large rehabilitation teaching hospital. All peer-reviewed English language studies with longitudinal design in adults with TBI of any severity, published from May 1997 to April 2017, found through Medline, Central, Embase, Scopus, PsycINFO and bibliographies of identified articles, will be considered eligible. Study quality will be assessed using published guidelines.Ethics and disseminationThe authors will publish findings from this review in a peer-reviewed scientific journal(s) and present the results at national and international conferences. This work aims to understand how comorbidity may contribute to adverse outcomes in TBI, to inform risk stratification of patients and guide the management of brain injury acutely and at the chronic stages postinjury on a population level.PROSPERO registration numberCRD42017070033.

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The Impact of Traumatic Brain Injury on Neurocognitive Outcomes in Children: a Systematic Review and Meta-Analysis

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-325066 ◽

2021 ◽

pp. jnnp-2020-325066

Author(s):

Mark Sen Liang Goh ◽

Dawn Shu Hui Looi ◽

Jia Ling Goh ◽

Rehena Sultana ◽

Sharon Si Min Goh ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Executive Function ◽

Brain Injury ◽

Learning And Memory ◽

Meta Analysis ◽

Cochrane Central Register ◽

Neurocognitive Outcomes ◽

Severe Tbi ◽

The Impact

ObjectiveTo assess the burden of paediatric traumatic brain injury (TBI) on neurocognition via a systematic review and meta-analysis.MethodsStudies that compared neurocognitive outcomes of paediatric patients with TBI and controls were searched using Medline, Embase, PsycINFO and Cochrane Central Register of Controlled Trials, between January 1988 and August 2019. We presented a random-effects model, stratified by TBI severity, time of assessment post injury and age.ResultsOf 5919 studies, 41 (patients=3717) and 33 (patients=3118) studies were included for the systematic review and meta-analysis, respectively. Studies mostly measured mild TBI (n=26, patients=2888) at 0–3 months postinjury (n=17, patients=2502). At 0–3 months postinjury, standardised mean differences between TBI and controls for executive function were −0.04 (95% CI −0.14 to 0.07; I2=0.00%), −0.18 (95% CI −0.29 to –0.06; I2=26.1%) and −0.95 (95% CI −1.12 to –0.77; I2=10.1%) for mild, moderate and severe TBI, respectively; a similar effect was demonstrated for learning and memory. Severe TBI had the worst outcomes across all domains and persisted >24 months postinjury. Commonly used domains differed largely from workgroup recommendations. Risk of bias was acceptable for all included studies.ConclusionA dose-dependent relationship between TBI severity and neurocognitive outcomes was evident in executive function and in learning and memory. Cognitive deficits were present for TBIs of all severity but persisted among children with severe TBI. The heterogeneity of neurocognitive scales makes direct comparison between studies difficult. Future research into lesser explored domains and a more detailed assessment of neurocognitive deficits in young children are required to better understand the true burden of paediatric TBI.

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Incidence and impact of withdrawal of life-sustaining therapies in clinical trials of severe traumatic brain injury: A systematic review

Clinical Trials ◽

10.1177/1740774518771233 ◽

2018 ◽

Vol 15 (4) ◽

pp. 398-412 ◽

Cited By ~ 4

Author(s):

Guillaume Leblanc ◽

Amélie Boutin ◽

Michèle Shemilt ◽

François Lauzier ◽

Lynne Moore ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Clinical Trials ◽

Brain Injury ◽

Randomized Controlled Trials ◽

Severe Traumatic Brain Injury ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact ◽

Overall Mortality

Background Most deaths following severe traumatic brain injury follow decisions to withdraw life-sustaining therapies. However, the incidence of the withdrawal of life-sustaining therapies and its potential impact on research data interpretation have been poorly characterized. The aim of this systematic review was to assess the reporting and the impact of withdrawal of life-sustaining therapies in randomized clinical trials of patients with severe traumatic brain injury. Methods We searched Medline, Embase, Cochrane Central, BIOSIS, and CINAHL databases and references of included trials. All randomized controlled trials published between January 2002 and August 2015 in the six highest impact journals in general medicine, critical care medicine, and neurocritical care (total of 18 journals) were considered for eligibility. Randomized controlled trials were included if they enrolled adult patients with severe traumatic brain injury (Glasgow Coma Scale ≤ 8) and reported data on mortality. Our primary objective was to assess the proportion of trials reporting the withdrawal of life-sustaining therapies in a publication. Our secondary objectives were to describe the overall mortality rate, the proportion of deaths following the withdrawal of life-sustaining therapies, and to assess the impact of the withdrawal of life-sustaining therapies on trial results. Results From 5987 citations retrieved, we included 41 randomized trials (n = 16,364, ranging from 11 to 10,008 patients). Overall mortality was 23% (range = 3%–57%). Withdrawal of life-sustaining therapies was reported in 20% of trials (8/41, 932 patients in trials) and the crude number of deaths due to the withdrawal of life-sustaining therapies was reported in 17% of trials (7/41, 884 patients in trials). In these trials, 63% of deaths were associated with the withdrawal of life-sustaining therapies (105/168). An analysis carried out by imputing a 4% differential rate in instances of withdrawal of life-sustaining therapies between study groups yielded different results and conclusions in one third of the trials. Conclusion Data on the withdrawal of life-sustaining therapies are incompletely reported in randomized controlled trials of patients with severe traumatic brain injury. Given the high proportion of deaths due to the withdrawal of life-sustaining therapies in severe traumatic brain injury patients, and the potential of this medical decision to influence the results of clinical trials, instances of withdrawal of life-sustaining therapies should be systematically reported in clinical trials in this group of patients.

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Reading Abilities Post Traumatic Brain Injury in Adolescents and Adults: A Systematic Review and Meta-Analysis

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-20-00213 ◽

2021 ◽

Vol 30 (2) ◽

pp. 789-816

Author(s):

Yalian Pei ◽

Katy H. O'Brien

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Reading Speed ◽

Meta Analysis ◽

Assessment Tools ◽

Attention And Memory ◽

Reading Abilities ◽

Adolescents And Adults ◽

The Impact

Purpose People with traumatic brain injury (TBI) often struggle with complex reading, limiting participation in work and educational settings. This systematic review and meta-analysis examined studies of reading conducted with adolescents and adults with TBI to describe reading problems post TBI and investigate underlying factors for the effects of TBI on reading abilities. Method The search was conducted in EBSCO (including MEDLINE, PsycINFO, etc.), BIOSIS, ProQuest, and Web of Science. Empirical studies that used samples with a mean age greater than 10 years, reported injury characteristics, and investigated complex reading abilities (defined as greater than single-word reading) were eligible for this review. Study quality was evaluated using QualSyst. Study and sample characteristics, measures, and outcomes of interest were extracted and synthesized in the review. Studies that compared reading abilities between people with and without TBI were included in the meta-analysis. Results Twenty-four studies met inclusion criteria, six of which addressed reading in pediatric samples. Findings from heterogeneous samples supported the existence of reading deficits post TBI, including mild TBI. In studies of children, comprehension was examined most frequently, whereas reading speed was the focus of most adult studies. Oculomotor functions and processing speed were related to reading speed; cognitive functions, such as attention and memory, were associated with reading comprehension. Intervention studies were limited, but most reported positive effects. The meta-analysis confirmed the impact of TBI on reading with a large effect size ( g = 1.23). Demographic, injury, and study variables did not moderate overall reading outcomes, but male sex was a significant moderator of impairment in reading speed. Discussion Global reading ability, including both comprehension and speed, is negatively impacted by TBI. Future research should continue to explore reading after TBI, including its underlying mechanisms, effects on complex reading activities such as inferencing, development of screening and assessment tools that address a range of functional reading needs, and efficacy of reading-related interventions.

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