scholarly journals Neurotrauma clinicians’ perspectives on the contextual challenges associated with long-term follow-up following traumatic brain injury in low-income and middle-income countries: a qualitative study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041442
Author(s):  
Brandon George Smith ◽  
Charlotte Jane Whiffin ◽  
Ignatius N Esene ◽  
Claire Karekezi ◽  
Tom Bashford ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Qualitative Study ◽  
Health Concern ◽  
Middle Income ◽  
Middle Income Countries ◽  
Semistructured Interviews ◽  
Long Term Follow Up

IntroductionTraumatic brain injury (TBI) is a global public health concern; however, low/middle-income countries (LMICs) face the greatest burden. The WHO recognises the significant differences between patient outcomes following injuries in high-income countries versus those in LMICs. Outcome data are not reliably recorded in LMICs and despite improved injury surveillance data, data on disability and long-term functional outcomes remain poorly recorded. Therefore, the full picture of outcome post-TBI in LMICs is largely unknown.Methods and analysisThis is a cross-sectional pragmatic qualitative study using individual semistructured interviews with clinicians who have experience of neurotrauma in LMICs. The aim of this study is to understand the contextual challenges associated with long-term follow-up of patients following TBI in LMICs. For the purpose of the study, we define ‘long-term’ as any data collected following discharge from hospital. We aim to conduct individual semistructured interviews with 24–48 neurosurgeons, beginning February 2020. Interviews will be recorded and transcribed verbatim. A reflexive thematic analysis will be conducted supported by NVivo software.Ethics and disseminationThe University of Cambridge Psychology Research Ethics Committee approved this study in February 2020. Ethical issues within this study include consent, confidentiality and anonymity, and data protection. Participants will provide informed consent and their contributions will be kept confidential. Participants will be free to withdraw at any time without penalty; however, their interview data can only be withdrawn up to 1 week after data collection. Findings generated from the study will be shared with relevant stakeholders such as the World Federation of Neurosurgical Societies and disseminated in conference presentations and journal publications.

Evaluation and Management of Frontal Sinus Fractures

Neurotrauma ◽  
2019 ◽  
pp. 143-154
Author(s):  
Geoffrey Peitz ◽  
Mark A. Miller ◽  
Gregory W. J. Hawryluk ◽  
Ramesh Grandhi
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Frontal Sinus ◽  
Operative Management ◽  
Intracranial Extension ◽  
Long Term Follow Up ◽  
Initial Injury ◽  
Management Algorithms

Frontal sinus fractures are usually associated with traumatic brain injury and nasoorbitoethmoidal fractures. Much of the available evidence is retrospective, and management algorithms vary. In general, nondisplaced fractures without nasofrontal outflow tract (NFOT) obstruction may be managed with clinical and radiographic follow-up whereas fracture displacement, NFOT obstruction, and persistent CSF leaks are indications for operative management. The bicoronal incision and bifrontal craniotomy allow for proper access to the frontal sinus. If there is NFOT obstruction, the sinus should be cranialized or possibly obliterated if only the anterior table is fractured. The NFOT and sinus are packed with bone chips, fat, or muscle and then sealed with a pericardial graft, fascial graft, or synthetic dural substitute. Inadequate cranialization or obliteration can result in mucocele or mucopyocele, intracranial extension of which can lead to brain abscess or meningitis. Complications can occur years after the initial injury so long-term follow-up is necessary.

scholarly journals Long-term follow-up of patients with mild traumatic brain injury: A mixed-method study

2013 ◽  
Vol 45 (8) ◽  
pp. 758-764 ◽  
Author(s):  
S Åhman ◽  
B Saveman ◽  
J Styrke ◽  
U Björnstig ◽  
B Stålnacke
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Mixed Method ◽  
Mixed Method Study ◽  
Long Term Follow Up

scholarly journals Low prevalence of hypopituitarism after traumatic brain injury: a multicenter study

2011 ◽  
Vol 165 (2) ◽  
pp. 225-231 ◽  
Author(s):  
N E Kokshoorn ◽  
J W A Smit ◽  
W A Nieuwlaat ◽  
J Tiemensma ◽  
P H Bisschop ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Trauma ◽  
Tolerance Test ◽  
Pituitary Insufficiency ◽  
Acth Stimulation ◽  
Cross Sectional ◽  
Long Term Follow Up

ObjectiveHypopituitarism after traumatic brain injury (TBI) is considered to be a prevalent condition. However, prevalence rates differ considerably among reported studies, due to differences in definitions, endocrine assessments of hypopituitarism, and confounding factors, such as timing of evaluation and the severity of the trauma.AimTo evaluate the prevalence of hypopituitarism in a large cohort of TBI patients after long-term follow-up using a standardized endocrine evaluation.Study designCross-sectional study.Patients and methodsWe included 112 patients with TBI, hospitalized for at least 3 days and duration of follow-up >1 year after TBI from five (neurosurgical) referral centers. Evaluation of pituitary function included fasting morning hormone measurements and insulin tolerance test (n=90) or, when contraindicated, ACTH stimulation and/or CRH stimulation tests and a GH releasing hormone–arginine test (n=22). Clinical evaluation included quality of life questionnaires.ResultsWe studied 112 patients (75 males), with median age 48 years and mean body mass index (BMI) 26.7±4.8 kg/m2. Mean duration of hospitalization was 11 (3–105), and 33% of the patients had a severe trauma (Glasgow Coma Scale <9) after TBI. The mean duration of follow-up was 4 (1–12) years.Hypopituitarism was diagnosed in 5.4% (6/112) of patients: severe GH deficiency (n=3), hypogonadism (n=1), adrenal insufficiency (n=2). Patients diagnosed with pituitary insufficiency had significantly higher BMI (P=0.002).ConclusionIn this study, the prevalence of hypopituitarism during long-term follow-up after TBI was low. Prospective studies are urgently needed to find reliable predictive tools for the identification of patients with a significant pre-test likelihood for hypopituitarism after TBI.

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