scholarly journals Comorbidity in adults with traumatic brain injury and all-cause mortality: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029072 ◽  
Author(s):  
Chen Xiong ◽  
Sara Hanafy ◽  
Vincy Chan ◽  
Zheng Jing Hu ◽  
Mitchell Sutton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Self Report ◽  
Qualitative Description ◽  
Comorbid Condition ◽  
Comorbid Conditions ◽  
Eligibility Criteria ◽  
Wide Range ◽  
All Cause Mortality

ObjectivesComorbidity in traumatic brain injury (TBI) has been recognised to alter the clinical course of patients and influence short-term and long-term outcomes. We synthesised the evidence on the effects of different comorbid conditions on early and late mortality post-TBI in order to (1) examine the relationship between comorbid condition(s) and all-cause mortality in TBI and (2) determine the influence of sociodemographic and clinical characteristics of patients with a TBI at baseline on all-cause mortality.DesignSystematic review.Data sourcesMedline, Central, Embase, PsycINFO and bibliographies of identified articles were searched from May 1997 to January 2019.Eligibility criteria for selecting studiesIncluded studies met the following criteria: (1) focused on comorbidity as it related to our outcome of interest in adults (ie, ≥18 years of age) diagnosed with a TBI; (2) comorbidity was detected by any means excluding self-report; (3) reported the proportion of participants without comorbidity and (4) followed participants for any period of time.Data extraction and synthesisTwo independent reviewers extracted the data and assessed risk of bias using the Quality in Prognosis Studies tool. Data were synthesised through tabulation and qualitative description.ResultsA total of 27 cohort studies were included. Among the wide range of individual comorbid conditions studied, only low blood pressure was a consistent predictors of post-TBI mortality. Other consistent predictors were traditional sociodemographic risk factors. Higher comorbidity scale, scores and the number of comorbid conditions were not consistently associated with post-TBI mortality.ConclusionsGiven the high number of comorbid conditions that were examined by the single studies, research is required to further substantiate the evidence and address conflicting findings. Finally, an enhanced set of comorbidity measures that are suited for the TBI population will allow for better risk stratification to guide TBI management and treatment.PROSPERO registration numberCRD42017070033

scholarly journals Traumatic Brain Injury: Effect of Litigation Status on Executive Functioning—A Pilot Study

2020 ◽  
Author(s):  
Simi Prakash K. ◽  
Rajakumari P. Reddy ◽  
Anna R. Mathulla ◽  
Jamuna Rajeswaran ◽  
Dhaval P. Shukla
Keyword(s):  
Traumatic Brain Injury ◽  
Working Memory ◽  
Depressive Symptoms ◽  
Brain Injury ◽  
Concept Formation ◽  
Verbal Working Memory ◽  
Self Report ◽  
Semantic Fluency ◽  
Set Shifting ◽  
Wide Range

AbstractTraumatic brain injury (TBI) is associated with a wide range of physiological, behavioral, emotional, and cognitive sequelae. Litigation status is one of the many factors that has an impact on recovery. The aim of this study was to compare executive functions, postconcussion, and depressive symptoms in TBI patients with and without litigation. A sample of 30 patients with TBI, 15 patients with litigation (medicolegal case [MLC]), and 15 without litigation (non-MLC) was assessed. The tools used were sociodemographic and clinical proforma, executive function tests, Rivermead Post-Concussion Symptom Questionnaire, and Beck Depression Inventory. Assessment revealed that more than 50% of patients showed deficits in category fluency, set shifting, and concept formation. The MLC group showed significant impairment on verbal working memory in comparison to the non-MLC group. The performance of both groups was comparable on tests of semantic fluency, visuospatial working memory, concept formation, set shifting, planning, and response inhibition. The MLC group showed more verbal working memory deficits in the absence of significant postconcussion and depressive symptoms on self-report measures.

Does magnesium sulfate have a role in the management of severe traumatic brain injury in civilian and military populations? A systematic review and meta-analysis

2018 ◽  
Vol 164 (6) ◽  
pp. 442-449 ◽  
Author(s):  
Marc W H Lyons ◽  
W J Blackshaw
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Treatment Group ◽  
Magnesium Sulfate ◽  
Meta Analysis ◽  
Therapeutic Window ◽  
All Cause Mortality ◽  
Severe Tbi ◽  
Secondary Outcomes

IntroductionTraumatic brain injury (TBI) is a significant cause of combat morbidity. Currently, the medical management of TBI is limited to supportive critical care. Magnesium sulfate has been studied as a potentially beneficial therapeutic agent.MethodsA systematic review and meta-analysis was undertaken, examining the role of magnesium in the management of severe TBI in adults. The primary outcome of the study was all-cause mortality, with secondary outcomes of Glasgow Outcome Score (GOS) and GCS. EMBASE, MEDLINE, CINAHL, WHO Trial Registry and the Cochrane Library database were systematically searched, with data included until 1 February 2017. Inclusion criteria were: human study; aged >13 years; randomised controlled trial; severe TBI. Exclusion criteria were: data collected prior to 1 January 2002; magnesium commenced >24 hours postinjury; magnesium therapy for <24 hours. Statistical analysis was conducted using Stata (V.13.1).ResultsThe pooled results of six studies found all-cause mortality not to be significantly different in the treatment group (RR 0.84, 95% CI 0.54 to 1.33; P=0.46) with an I2 value of >70%. With regard to the secondary outcomes, no significant difference in GOS scores between treatment and control was demonstrated. GCS showed a significant improvement in the treatment group.ConclusionsThe meta-analysis found a lack of evidence for magnesium pharmacotherapy in severe TBI, although the data were noted to be conflicting and significantly heterogeneous. Further study is recommended to ascertain whether a therapeutic window exists for magnesium in severe TBI.

scholarly journals Diagnosis and Treatment of Depression Following Traumatic Brain Injury

2013 ◽  
Vol 14 (1) ◽  
pp. 63-76 ◽  
Author(s):  
Theodore Tsaousides ◽  
Teresa A. Ashman ◽  
Wayne A. Gordon
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Eligibility Criteria ◽  
Pilot Studies ◽  
Behavioural Interventions ◽  
The Past ◽  
Treatment Of Depression ◽  
Wide Range ◽  
Pharmacological Studies ◽  
Biomedical Interventions

Depression is one of the most common psychiatric diagnoses among individuals with traumatic brain injury (TBI). Prevalence of post-TBI depression (PTBID) ranges from 12 to 60% and is generally higher than rates reported in the general population. The wide range in reported rates is attributed to methodological variability across studies, including measurement and sampling differences. Several systematic reviews have been published in the past 5 years, reporting on outcomes for depression across different classes of interventions, including pharmacological, biomedical and behavioural. The consensus across reviews is that more research is necessary to develop evidence-based practice guidelines. The present narrative review synthesises the findings of previous studies, focusing on the nature of the interventions, the eligibility criteria for inclusion and the assessment of outcome. Pharmacological studies are generally more rigorous methodologically, but provide mixed findings. Other biomedical interventions are only at the initial stages of research development, including case and pilot studies. The results of behavioural studies are positive regarding improvements in mood. However, the number of efficacy studies of behavioural interventions for depression is extremely limited. Recommendations for designing interventions are provided.

The timeframe for safe resumption of high-level mobility following traumatic brain injury is currently unknown: a systematic review

2021 ◽  
pp. 1-11
Author(s):  
Sara Gallow ◽  
Laura Hilet ◽  
Edwina Sutherland ◽  
Jennifer McGinley ◽  
John Olver ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
High Level
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