scholarly journals Disability Rating Scale in the First Few Weeks After a Severe Traumatic Brain Injury as a Predictor of 6-Month Functional Outcome

Neurosurgery ◽  
2020 ◽  
Author(s):  
Jose-Miguel Yamal ◽  
Imoigele P Aisiku ◽  
H Julia Hannay ◽  
Frances A Brito ◽  
Claudia S Robertson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Clinical Decision Making ◽  
Injury Severity ◽  
Rating Scale ◽  
Characteristic Curve ◽  
Disability Rating Scale ◽  
Severe Tbi ◽  
Disability Rating

Abstract BACKGROUND An early acute marker of long-term neurological outcome would be useful to help guide clinical decision making and therapeutic effectiveness after severe traumatic brain injury (TBI). We investigated the utility of the Disability Rating Scale (DRS) as early as 1 wk after TBI as a predictor of favorable 6-mo Glasgow Outcome Scale extended (GOS-E). OBJECTIVE To determine the predictability of a favorable 6-mo GOS-E using the DRS measured during weeks 1 to 4 of injury. METHODS The study is a sub analysis of patients enrolled in the Epo Severe TBI Trial (n = 200) to train and validate L1-regularized logistic regression models. DRS was collected at weeks 1 to 4 and GOS-E at 6 mo. RESULTS The average area under the receiver operating characteristic curve was 0.82 for the model with baseline demographic and injury severity variables and week 1 DRS and increased to 0.88 when including weekly DRS until week 4. CONCLUSION This study suggests that week 1 to 4 DRS may be predictors of favorable 6-mo outcome in severe TBI patients and thus useful both for clinical prognostication as well as surrogate endpoints for adaptive clinical trials.

scholarly journals Outcome of severe traumatic brain injury: comparison of three monitoring approaches

2003 ◽  
Vol 15 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Ruwaida Isa ◽  
Wan Aasim Wan Adnan ◽  
Ghazaime Ghazali ◽  
Zamzuri Idris ◽  
Abdul Rahman Izaini Ghani ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Rating Scale ◽  
Monitoring Method ◽  
Disability Rating Scale ◽  
Significant Difference ◽  
The Status ◽  
Disability Rating ◽  
Multimodality Approach

The determination of cerebral perfusion pressure (CPP) is regarded as vital in monitoring patients with severe traumatic brain injury. Besides indicating the status of cerebral blood flow (CBF), it also reveals the status of intracranial pressure (ICP). The abnormal or suboptimal level of CPP is commonly correlated with high values of ICP and therefore with poor patient outcomes. Eighty-two patients were divided into three groups of patients receiving treatment based on CPP and CBF, ICP alone, and conservative methods during two different observation periods. The characteristics of these three groups were compared based on age, sex, time between injury and hospital arrival, Glasgow Coma Scale score, pupillary reaction to light, surgical intervention, and computerized tomography scanning findings according to the Marshall classification system. Only time between injury and arrival (p = 0.001) was statistically significant. There was a statistically significant difference in the proportions of good outcomes between the multimodality group compared with the group of patients that underwent a single intracranial-based monitoring method and the group that received no monitoring (p = 0.003) based on a disability rating scale after a follow up of 12 months. Death was the focus of outcome in this study in which the multimodality approach to monitoring had superior results.

Self-awareness four years after severe traumatic brain injury: discordance between the patient’s and relative’s complaints. Results from the PariS-TBI study

2017 ◽  
Vol 32 (5) ◽  
pp. 692-704 ◽  
Author(s):  
Camille Chesnel ◽  
Claire Jourdan ◽  
Eleonore Bayen ◽  
Idir Ghout ◽  
Emmanuelle Darnoux ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Significant Relationship ◽  
Injury Severity ◽  
Chronic Phase ◽  
Functional Independence ◽  
Severe Tbi

Objective: To evaluate the patient’s awareness of his or her difficulties in the chronic phase of severe traumatic brain injury (TBI) and to determine the factors related to poor awareness. Design/Setting/Subjects: This study was part of a larger prospective inception cohort study of patients with severe TBI in the Parisian region (PariS-TBI study). Intervention/Main measures: Evaluation was carried out at four years and included the Brain Injury Complaint Questionnaire (BICoQ) completed by the patient and his or her relative as well as the evaluation of impairments, disability and quality of life. Results: A total of 90 patient-relative pairs were included. Lack of awareness was measured using the unawareness index that corresponded to the number of discordant results between the patient and relative in the direction of under evaluation of difficulties by the patient. The only significant relationship found with lack of awareness was the subjective burden perceived by the relative (Zarit Burden Inventory) ( r = 0.5; P < 0.00001). There was no significant relationship between lack of awareness and injury severity, pre-injury socio-demographic data, cognitive impairments, mood disorders, functional independence (Barthel index), global disability (Glasgow Outcome Scale), return to work at four years or quality of life (Quality Of Life after Brain Injury scale (QOLIBRI)). Conclusion: Lack of awareness four years post severe TBI was not related to the severity of the initial trauma, sociodemographic data, the severity of impairments, limitations of activity and participation, or the patient’s quality of life. However, poor awareness did significantly influence the weight of the burden perceived by the relative.

scholarly journals Genetic Variation in the TP53 Gene and Patient Outcomes Following Severe Traumatic Brain Injury

2020 ◽  
Vol 22 (3) ◽  
pp. 334-340 ◽  
Author(s):  
Kaleigh Mellett ◽  
Dianxu Ren ◽  
Sheila Alexander ◽  
Nicole Osier ◽  
Sue R. Beers ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Rating Scale ◽  
P53 Protein ◽  
Tp53 Gene ◽  
The United States ◽  
Preliminary Evidence ◽  
Disability Rating Scale ◽  
Severe Tbi ◽  
A Prospective Study

Traumatic brain injury (TBI) is a leading cause of death and disability, with more than 5 million people in the United States living with long-term complications related to TBI. This study examined the relationship between TP53, the gene that codes for the protein p53, and outcome variability following severe TBI. The p53 protein impacts neuronal apoptosis following TBI, thus investigation into TP53 genetic variability as a prognosticator for TBI outcomes (mortality, Glasgow Outcome Scale [GOS], Neurobehavioral Rating Scale [NRS], and Disability Rating Scale [DRS]) is warranted. Participants ( N = 429) with severe TBI (Glasgow Coma Scale score ≤8) were enrolled into a prospective study with outcomes assessed over 24 months following injury. The single-nucleotide polymorphism Arg72Pro (rs1042522), a functional missense polymorphism for which the CC homozygous genotype is most efficient at inducing apoptosis, was investigated. Individuals with the CC genotype (arginine homozygotes) were more likely to have poorer outcomes at 24 months following TBI compared to individuals with CG/GG genotypes (GOS: p = .048, DRS: p = .022). These findings add to preliminary evidence that p53 plays a role in recovery following TBI and, if further replicated, could support investigations into p53-based therapies for treating TBI.

Recovery of Impairments After Severe Traumatic Brain Injury: Findings From a Prospective, Multicentre Study

2006 ◽  
Vol 7 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Robyn L. Tate ◽  
Ross D. Harris ◽  
Ian D. Cameron ◽  
Bridget M. Myles ◽  
Julie B. Winstanley ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Rating Scale ◽  
Hand Function ◽  
Rehabilitation Program ◽  
Acute Injury ◽  
Prospective Multicentre Study ◽  
Severe Tbi ◽  
Clinically Significant

AbstractThis study aimed to describe the recovery of impairments after severe traumatic brain injury (TBI) over a 3-year period. An inception cohort over 2 years was recruited from 11 brain injury rehabilitation units participating in a state-wide program. The 131 individuals with TBI were assessed at admission to the rehabilitation program, 18 months and 3 years post-trauma. This report described results from the Disability Rating Scale (DRS) and Mayo-Portland Adaptability Index (MPAI). Regression analyses, examining the influence of five acute injury variables on DRS and MPAI, revealed that posttraumatic amnesia (PTA) was a significant individual predictor. Data were thus analysed according to duration of PTA: 1 to 2 weeks (n= 19), 2 to 4 weeks (n= 44) and more than 4 weeks (n= 68). At program admission there was poorer overall level of functioning on the DRS in the longest PTA group, but no difference between the shorter PTA groups. Significant improvements occurred on the DRS for all PTA groups over the first 18 months posttrauma, with improvements continuing between 18 months and 3 years. At the 3-year follow-up, frequency data from the MPAI indicated that clinically significant impairments in mobility, hand function, communication and behaviour were uncommon in the shorter PTA groups, although 36% to 47% continued to experience cognitive impairments. Impairments were common in the longest PTA group in some areas, particularly cognition where two thirds or more continued to experience clinically significant impairments in attention, memory and novel problem-solving. These results confirm the predictive significance of PTA duration regarding longer-term level of recovery. They also highlight the limitation in classifying the ‘severe’ TBI category as an homogenous group: significant subgroup differences occurred on medical and functional variables at program admission, 18 months and 3 years posttrauma. These data further substantiate the persistence of neuropsychological impairments in the face of good physical recovery at all levels of severity within the severe TBI group.

scholarly journals LO67: Association between hypotension and mortality in critically ill patients with severe traumatic brain injury: experience at a single Canadian trauma center

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S32
Author(s):  
R. Green ◽  
M. Erdogan ◽  
N. Kureshi ◽  
D. Clarke
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Injury Severity ◽  
Motor Vehicle ◽  
Treatment Guidelines ◽  
Multiple Logistic Regression Analysis ◽  
Trauma Team ◽  
Common Mechanism ◽  
Severe Tbi

Introduction: Hypotension is known to be associated with increased mortality in severe traumatic brain injury (TBI) patients. Systolic blood pressure (SBP) of &lt;90 mmHg is the threshold for hypotension in consensus TBI treatment guidelines; however, evidence suggests hypotension should be defined at higher levels for these patients. Our objective was to determine the influence of hypotension on mortality in TBI patients requiring ICU admission using different thresholds of SBP on arrival at the emergency department (ED). Methods: Retrospective cohort study of patients with severe TBI (Abbreviated Injury Scale Head score ≥3) admitted to ICU at the QEII Health Sciences Centre (Halifax, Canada) between 2002 and 2013. Patients were grouped by SBP on ED arrival ( &lt;90 mmHg, &lt;100 mmHg, &lt;110 mmHg). We performed multiple logistic regression analysis with mortality as the dependent variable. Models were adjusted for confounders including age, gender, Injury Severity Score (ISS), injury mechanism, and trauma team activation (TTA). Results: A total of 1233 patients sustained a severe TBI and were admitted to the ICU during the study period. The mean age was 43.4 ± 23.9 years and most patients were male (919/1233; 74.5%). The most common mechanism of injury was motor vehicle collision (491/1233; 41.2%) followed by falls (427/1233; 35.8%). Mean length of stay in the ICU was 6.1 ± 6.4 days, and the overall mortality rate was 22.7%. SBP on arrival was available for 1182 patients. The &lt;90 mmHg group had 4.6% (54/1182) of these patients; mean ISS was 20.6 ± 7.8 and mortality was 40.7% (22/54). The &lt;100 mmHg had 9.3% (110/1182) of patients; mean ISS was 19.3 ± 7.9 and mortality was 34.5% (38/110). The &lt;110 mmHg group had 16.8% (198/1182) of patients; mean ISS was 17.9 ± 8.0 and mortality was 28.8% (57/198). After adjusting for confounders, the association between hypotension and mortality was 2.22 (95% CI 1.19-4.16) using a &lt;90 mmHg cutoff, 1.79 (95% CI 1.12-2.86) using a &lt;100 mmHg cutoff, and 1.50 (95% CI 1.02-2.21) using a &lt;110 mmHg cutoff. Conclusion: While we found that TBI patients with a SBP &lt;90 mmHg were over 2 times more likely to die, patients with an SBP &lt;110 mmHg on ED arrival were still 1.5 times more likely to die from their injuries compared to patients without hypotension. These results suggest that establishing a higher threshold for clinically meaningful hypotension in TBI patients is warranted.

Are Initial Radiographic and Clinical Scales Associated With Subsequent Intracranial Pressure and Brain Oxygen Levels After Severe Traumatic Brain Injury?

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1095-1105 ◽  
Author(s):  
Michael Katsnelson ◽  
Larami Mackenzie ◽  
Suzanne Frangos ◽  
Mauro Oddo ◽  
Joshua M. Levine ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Severe Traumatic Brain Injury ◽  
Injury Severity ◽  
Interquartile Range ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Clinical Scales ◽  
Severe Tbi

Abstract BACKGROUND: Prediction of clinical course and outcome after severe traumatic brain injury (TBI) is important. OBJECTIVE: To examine whether clinical scales (Glasgow Coma Scale [GCS], Injury Severity Score [ISS], and Acute Physiology and Chronic Health Evaluation II [APACHE II]) or radiographic scales based on admission computed tomography (Marshall and Rotterdam) were associated with intensive care unit (ICU) physiology (intracranial pressure [ICP], brain tissue oxygen tension [PbtO2]), and clinical outcome after severe TBI. METHODS: One hundred one patients (median age, 41.0 years; interquartile range [26-55]) with severe TBI who had ICP and PbtO2 monitoring were identified. The relationship between admission GCS, ISS, APACHE II, Marshall and Rotterdam scores and ICP, PbtO2, and outcome was examined by using mixed-effects models and logistic regression. RESULTS: Median (25%–75% interquartile range) admission GCS and APACHE II without GCS scores were 3.0 (3–7) and 11.0 (8–13), respectively. Marshall and Rotterdam scores were 3.0 (3–5) and 4.0 (4–5). Mean ICP and PbtO2 during the patients' ICU course were 15.5 ± 10.7 mm Hg and 29.9 ± 10.8 mm Hg, respectively. Three-month mortality was 37.6%. Admission GCS was not associated with mortality. APACHE II (P = .003), APACHE-non-GCS (P = .004), Marshall (P &lt; .001), and Rotterdam scores (P &lt; .001) were associated with mortality. No relationship between GCS, ISS, Marshall, or Rotterdam scores and subsequent ICP or PbtO2 was observed. The APACHE II score was inversely associated with median PbtO2 (P = .03) and minimum PbtO2 (P = .008) and had a stronger correlation with amount of time of reduced PbtO2. CONCLUSION: Following severe TBI, factors associated with outcome may not always predict a patient's ICU course and, in particular, intracranial physiology.

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