scholarly journals Prevalence of Sensory Dysfunction in Smell and/or Taste in Veterans with Traumatic Brain Injury and Link to Demographics and Comorbidities

2021 ◽  
Author(s):  
Lyan M Cabello Ballester ◽  
Isabel C Borrás-Fernández ◽  
Gerardo Jovet-Toledo ◽  
Irma L Molina-Vicenty
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
General Population ◽  
Combat Veterans ◽  
Statistical Significance ◽  
Demographic Characteristics ◽  
Chi Square ◽  
Sensory Dysfunction ◽  
Taste Dysfunction ◽  
The U.S

ABSTRACT Introduction Traumatic brain injury (TBI) entails chronic neurological symptoms and deficits, such as smell and taste impairment. In the general population, a prevalence of 13.5% for smell impairment, 17% for taste impairment, and 2.2% for both have been reported. Studies establishing prevalence of sensorial dysfunction in the U.S. general population showed that prevalence increased with age and was higher in ethnic minorities and men. To understand the mechanisms that lead to these deficits, the prevalence of sensory dysfunction was studied in the Veteran TBI population of the VA Caribbean Healthcare System (VACHS). The aims were to find the prevalence of sensorial dysfunction in smell and/or taste in TBI patients at the VACHS Polytrauma Clinic and its association with demographic characteristics and medical comorbidities. The hypothesis was that the prevalence of sensory dysfunction in smell and/or taste of VACHS Veterans (mostly Hispanics minority) with TBI will be higher than the one historically reported in the literature for the U.S. general population. Materials and Methods A retrospective record review was held at the VACHS Polytrauma Clinic from January 2018 to January 2020 (before coronavirus disease 2019 pandemic) to evaluate the prevalence of sensory dysfunction. Data on demographics and comorbidities in the electronic medical records, and the TBI Second-Level Evaluation note, that was previously completed by a physician from the Polytrauma Clinic at the VACHS to diagnose and characterized the TBI event, were reviewed. Data were summarized using descriptive statistics. To establish the relation among demographic characteristics and comorbidities with the prevalence of smell and/or taste sensory dysfunction, chi-square and Fisher’s exact tests were used. Results A total of 81 records were reviewed. This corresponded to all the patients diagnosed with TBI in the VACHS Polytrauma Clinic from January 2018 to January 2020. The prevalence of sensory dysfunction in the studied population was 38.3%. Men tend to present a higher prevalence of smell and/or taste dysfunction (40.0%) in comparison with women (16.7%); however, the difference did not achieve statistical significance (P = .399). Hispanics had a relatively higher prevalence of sensory dysfunction than non-Hispanics, but this difference did not reach statistical significance (P = .210). Forty-nine subjects were combat Veterans (60.5%). There was a significant correlation regarding the combat status of the subjects (P = .014), where 24 of the 49 combat Veterans presented smell and/or taste dysfunction (49.0%). A marginal significance was observed for obesity; obese participants were less likely to have a significant smell and/or taste dysfunction (P = .053). Conclusion The investigators found that the prevalence of sensory dysfunction in smell and/or taste in VACHS Veterans with TBI was 38.3% (n = 31). A significant association was found between smell and/or taste dysfunction and being a combat veteran (P = .018). A marginally significant association to obesity was also observed (P = .053). To the scientific community, the results will serve as a base for sensorial dysfunction and TBI research given that this prevalence, and the correlation to demographics and comorbidities, has not been fully established in the Veteran population.

scholarly journals Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome

2021 ◽  
Author(s):  
Gopal Krishna ◽  
Varun Aggarwal ◽  
Ishwar Singh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Clinical Outcome ◽  
Road Traffic ◽  
Statistical Significance ◽  
Platelet Counts ◽  
Coagulation Abnormalities ◽  
The Mean ◽  
D Dimer

Abstract Introduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis. Design Prospective study. Methods The study included 50 patients of isolated TBI with cohorts of moderate (MHI) and severe head injury (SHI). Coagulopathy was graded according to the values of parameters in single laboratory. The incidence of coagulopathy according to the severity of TBI and correlation with disseminated intravascular coagulation (DIC) score, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen was observed. The comparison was also made between expired and discharged patients within each group. It also compared coagulation derailments with clinical presentation (Glasgow Coma Scale [GCS]) and outcome (Glasgow Outcome Scale [GOS]). Results Road traffic accident was the primary (72%) mode of injury. Fifty-two percent had MHI and rest had SHI. Eighty-four percent of cases were managed conservatively. The mean GCS was 12.23 and 5.75 in MHI and SHI, respectively. Sixty-two percent of MHI and 96% of the patients with SHI had coagulation abnormalities. On statistical analysis, DIC score (p < 0.001) strongly correlated with the severity of head injury and GOS. PT and APTT were also significantly associated with the severity of TBI. In patients with moderate TBI, D-dimer and platelet counts showed association with clinical outcome. Fibrinogen levels did not show any statistical significance. The mean platelet counts remained normal in both the groups of TBI. The mean GOS was 1.54 and 4.62 in SHI and MHI, respectively. Conclusion Coagulopathy is common in isolated TBI. The basic laboratory parameters are reliable predictors of coagulation abnormalities in TBI. Coagulopathy is directly associated with the severity of TBI, GCS, and poor outcome.

scholarly journals Long-Term Survival Following Traumatic Brain Injury: A Population-Based Parametric Survival Analysis

2016 ◽  
Vol 47 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Gordon W. Fuller ◽  
Jeanine Ransom ◽  
Jay Mandrekar ◽  
Allen W. Brown
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
General Population ◽  
Life Expectancy ◽  
Health Planning ◽  
Population Based ◽  
Post Injury ◽  
Term Survival ◽  
Parametric Survival

Background: Long-term mortality may be increased following traumatic brain injury (TBI); however, the degree to which survival could be reduced is unknown. We aimed at modelling life expectancy following post-acute TBI to provide predictions of longevity and quantify differences in survivorship with the general population. Methods: A population-based retrospective cohort study using data from the Rochester Epidemiology Project (REP) was performed. A random sample of patients from Olmsted County, Minnesota with a confirmed TBI between 1987 and 2000 was identified and vital status determined in 2013. Parametric survival modelling was then used to develop a model to predict life expectancy following TBI conditional on age at injury. Survivorship following TBI was also compared with the general population and age- and gender-matched non-head injured REP controls. Results: Seven hundred and sixty nine patients were included in complete case analyses. The median follow-up time was 16.1 years (interquartile range 9.0-20.4) with 120 deaths occurring in the cohort during the study period. Survival after acute TBI was well represented by a Gompertz distribution. Victims of TBI surviving for at least 6 months post-injury demonstrated a much higher ongoing mortality rate compared to the US general population and non-TBI controls (hazard ratio 1.47, 95% CI 1.15-1.87). US general population cohort life table data was used to update the Gompertz model's shape and scale parameters to account for cohort effects and allow prediction of life expectancy in contemporary TBI. Conclusions: Survivors of TBI have decreased life expectancy compared to the general population. This may be secondary to the head injury itself or result from patient characteristics associated with both the propensity for TBI and increased early mortality. Post-TBI life expectancy estimates may be useful to guide prognosis, in public health planning, for actuarial applications and in the extrapolation of outcomes for TBI economic models.

scholarly journals Correspondence of the Boston Assessment of Traumatic Brain Injury-Lifetime and In-Theater Department of Defense Medical Records

2021 ◽  
Author(s):  
Sahra Kim ◽  
Alyssa Currao ◽  
Jennifer R. Fonda ◽  
Brigitta Beck ◽  
Alexandra Kenna ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Department Of Defense ◽  
Medical Records ◽  
Brain Injuries ◽  
Injury Severity ◽  
Assessment Tools ◽  
System Level ◽  
Chi Square ◽  
Convenience Sample

Abstract Background: Since 2006, efforts have been made to increase the identification of traumatic brain injuries (TBIs) in post-9/11 military personnel. The BAT-L is the first validated instrument to diagnose TBIs throughout the lifespan in post-9/11 Veterans. The objective is to investigate the correspondence of the Boston Assessment of TBI-Lifetime (BAT-L) diagnostic prevalence and injury severity of traumatic brain injury with in-theater medical records from Department of Defense (DoD). Methods: A convenience sample of 153 Veterans deployed in 2011 enrolled in the TRACTS longitudinal cohort study was examined. Retrospective review of DoD online medical records to determine diagnostic prevalence and injury severity for all head injury cases during deployment were compared with diagnostic prevalence and injury severity from the BAT-L clinical interview using Chi-square analyses.Results: There was moderate correspondence for TBI diagnosis between the BAT-L and DoD records (κ = 0.42). Sensitivity was 72.7% and specificity was 82.8%. Comparison of injury severity also had moderate correspondence (κ = 0.41). Missing TBI diagnostic data from DoD records was frequent; 43% percent of TBIs reported on the BAT-L did not have any documentation of mTBI assessment or diagnosis in DoD records while 83% did not have in-theater documentation.Conclusions: Diagnosis of TBI via the BAT-L retrospective interview was both sensitive and specific when compared to DoD medical records. However, diagnostic correspondence was only moderate. This lack of diagnostic agreement was related to multiple factors including lack of documentation of injury, differences in assessment tools and goals, and other combat-related motivational factors associated with failure to report injuries while deployed. Several policies were implemented to address underreporting and under-documentation of TBI, yet challenges remain. Findings suggest changes at both individual-level (e.g. service members) and system-level (e.g. DoD/military branches) are needed to adequately diagnose and document all TBI during deployment.

scholarly journals Six-year analysis of traumatic injuries of the craniomaxillofacial area: relation between maxillofacial and traumatic brain injuries

2021 ◽  
Vol 105 (1) ◽  
pp. 56-60
Author(s):  
E. Shuminsky ◽  
◽  
A. Kopchak ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Correlation Analysis ◽  
Brain Injuries ◽  
Statistical Significance ◽  
Maxillofacial Trauma ◽  
Traumatic Injuries ◽  
The Face ◽  
The Difference ◽  
Panfacial Fractures

Summary. Craniofacial trauma is one of the most difficult types of injuries. There is disagreement among various authors about the relationship between maxillofacial trauma (MFT) and traumatic brain injury (TBI). Purpose. Retrospectively evaluate the epidemiology of traumatic injuries of the craniomaxillofacial area and determine whether there is a relationship between different isolated or combined fractures of the facial bones and brain damage. Materials and methods. The case histories of three groups of patients with isolated fractures of the mandible (I group), isolated fractures of the midface zone (II group) and combined fractures of all areas of the face (III group), who were hospitalized in the period from 2012 to 2017, were analyzed. The main epidemiological indicators were determined. The analysis of indicators of severity of MFT and TBI is carried out. Correlation analysis of indicators, analysis using the Kruskal- Wallis test and Steel-Dwass test for pairwise comparisons was performed. Results. Were treated519 patients. 457 men (88 %) and 62 women (12 %). The main causes of injuries were assaults (40 %). Correlation analysis did not reveal the dependence of MFT and TBI. The difference in severity of isolated fractures of the mandible and midface bones was statistically significant, and there is a statistical significance between the severity of TBI in case of isolated fractures of midface bones and panfacial fractures (p < 0.05). Conclusions. The severity of maxillofacial trauma in the case of panfacial fractures is on average 3 times higher than in the case of isolated fractures of the lower jaw or midface bones. The severity of TBI is largely consistent with concussion in all groups, but in the group with panfacial fractures, the median rate is lower comparing to other groups. Key words: Glasgow coma scale, fracture, Le Fort, traumatic brain injury

scholarly journals Effect Sizes for Symptomatic and Cognitive Improvements in Traumatic Brain Injury Following Hyperbaric Oxygen Therapy

2021 ◽  
Author(s):  
Adam Thomas Biggs ◽  
Hugh M. Dainer ◽  
Lanny F Littlejohn
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Brain Injuries ◽  
Statistical Significance ◽  
Traumatic Brain Injuries ◽  
Therapeutic Benefit ◽  
Effect Sizes

Hyperbaric oxygen therapy has been proposed as a method to treat traumatic brain injuries. The combination of pressure and increased oxygen concentration produces a higher content of dissolved oxygen in the bloodstream, which could generate a therapeutic benefit for brain injuries. This dissolved oxygen penetrates deeper into damaged brain tissue than otherwise possible and promotes healing. The result includes improved cognitive functioning and an alleviation of symptoms. However, randomized controlled trials have failed to produce consistent conclusions across multiple studies. There are numerous explanations that might account for the mixed evidence, although one possibility is that prior evidence focuses primarily on statistical significance. The current analyses explored existing evidence by calculating an effect size from each active treatment group and each control group among previous studies. An effect size measure offers several advantages when comparing across studies as it can be used to directly contrast evidence from different scales, and it provides a proximal measure of clinical significance. When exploring the therapeutic benefit through effect sizes, there was a robust and consistent benefit to individuals who underwent hyperbaric oxygen therapy. Placebo effects from the control condition could account for approximately one-third of the observed benefits, but there appeared to be a clinically significant benefit to using hyperbaric oxygen therapy as a treatment intervention for traumatic brain injuries. This evidence highlights the need for design improvements when exploring interventions for traumatic brain injury as well as the importance of focusing on clinical significance in addition to statistical significance.

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.

Traumatic Brain Injury in the General Population

2019 ◽  
Vol 207 (1) ◽  
pp. 38-42 ◽  
Author(s):  
Andrew C. Hale ◽  
Kipling M. Bohnert ◽  
Rebecca Grekin ◽  
Rebecca K. Sripada
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
General Population
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