Evaluation of Outcomes in Patients Receiving Amantadine to Improve Alertness After Traumatic Brain Injury

2020 ◽  
pp. 001857872092080
Author(s):  
Rim M. Hadgu ◽  
Amne Borghol ◽  
Christopher Gillard ◽  
Candice Wilson ◽  
Suzan Elqess Mossa ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Retrospective Cohort ◽  
Optimal Dose ◽  
Inpatient Setting ◽  
Single Center ◽  
Off Label ◽  
The Mean ◽  
Gcs Score

Background: Amantadine has been used off-label to improve alertness after traumatic brain injury (TBI). The goal of this study is to assess the mean change at 72 hours and in course of therapy (COT) Glasgow Coma Scale (GCS) score after amantadine initiation and to correlate the change in GCS score with participation in physical therapy (PT) and occupational therapy (OT) among patients with TBI receiving amantadine during the first hospitalization. Methods: This single-center, retrospective, cohort study included patients ≥18 years old hospitalized for a TBI from August 2012 to February 2018 and received ≥1 dose of amantadine to increase alertness. The primary endpoint is the mean change in 72-hour GCS score after amantadine initiation. The secondary endpoint is the mean change in COT GCS score after amantadine initiation and the correlation between the change in GCS score and percent PT and OT participation at 72 hours and during the COT. Results: Seventy-nine patients were included. The mean age of patients was 41 years, and 79.8% of the patients were men. The mean change in 72-hour GCS score was +0.75 (95% confidence interval [CI] = 0.09-1.42, P = .027), and the mean change in COT GCS score was +2.29 (95% CI = 1.68-2.90, P < .001). There was no significant correlation between the increase in GCS score and percent PT/OT session participation at 72 hours and during the COT, r = −0.15 ( P = .24) and r = −0.02 ( P = .74), respectively. The percent PT/OT session participation at 72-hour post-amantadine initiation was 61.3% compared with 65.9% during the COT. Conclusion: There were small but statistically significant increases in the mean change at 72 hours and in COT GCS score; however, they were not correlated with percent PT/OT participation. Other studies are needed to determine the appropriate time and GCS score to initiate amantadine along with the optimal dose in the inpatient setting.

scholarly journals Use of Vasopressors Increases the Risk of Mortality in Severe Traumatic Brain Injury: A Nationwide Retrospective Cohort Study in Japan

2021 ◽  
Author(s):  
Sanae Hosomi ◽  
Tomotaka Sobue ◽  
Tetsuhisa Kitamura ◽  
Atsushi Hirayama ◽  
Hiroshi Ogura ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Cohort Study ◽  
Brain Injury ◽  
Propensity Score ◽  
Hospital Discharge ◽  
Severe Traumatic Brain Injury ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Practices

Abstract BackgroundPharmacological elevation of blood pressure is frequently incorporated in severe traumatic brain injury management algorithms. However, there is limited evidence on prevalent clinical practices regarding resuscitation for severe traumatic brain injury using vasopressors. We conducted a nationwide retrospective cohort study to determine the association between the use of vasopressors and mortality following hospital discharge in patients with severe traumatic brain injury, and to determine whether the use of vasopressors affects emergency department mortality or the occurrence of cognitive dysfunction.MethodsData were collected between January 2004 and December 2018 from the Japanese Trauma Data Bank, which includes data from 272 emergency hospitals in Japan. Adults aged ≥16 years with severe traumatic brain injury, without other major injuries, were examined. A severe traumatic brain injury was defined based on the Abbreviated Injury Scale code and a Glasgow Coma Scale score of 3–8 on admission. Multivariable analysis and propensity score matching were performed. Statistical significance was assessed using 95% confidence intervals (CIs).ResultsIn total, 10 284 patients were eligible for analysis, with 650 patients (6.32%) included in the vasopressor group and 9634 patients (93.68%) included in the non-vasopressor group. The proportion of deaths on hospital discharge was higher in the vasopressor group than in the non-vasopressor group (81.69% [531/650] vs. 40.21% [3,874/9,634]). This finding was confirmed by multivariable logistic regression analysis (adjusted odds ratio [OR], 5.71; 95% CI: 4.56–7.16). Regarding propensity score-matched patients, the proportion of deaths on hospital discharge remained higher in the vasopressor group than in the non-vasopressor group (81.66% [530/649] vs. 50.69% [329/649]) (OR, 4.33; 95% CI: 3.37–5.57). The vasopressor group had a higher emergency department mortality rate than the non-vasopressor group (8.01% [52/649] vs. 2.77% [18/649]) (OR, 3.05; 95% CI: 1.77–5.28). There was no reduction in complications of cognitive disorders in the vasopressor group (5.39% [35/649] vs. 5.55% [36/649]) (OR, 0.97; 95% CI: 0.60–1.57).ConclusionsIn this population, the use of vasopressors for severe traumatic brain injury was associated with higher mortality on hospital discharge. Our results suggest that vasopressors should be avoided in most cases of severe traumatic brain injury.

A retrospective cohort study of comorbidity trajectories associated with traumatic brain injury in veterans of the Iraq and Afghanistan wars

Brain Injury ◽  
2016 ◽  
Vol 30 (12) ◽  
pp. 1481-1490 ◽  
Author(s):  
Mary Jo Pugh ◽  
Erin P. Finley ◽  
Chen-Pin Wang ◽  
Laurel A. Copeland ◽  
Carlos A. Jaramillo ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort

Mortality Over Four Decades After Traumatic Brain Injury Rehabilitation: A Retrospective Cohort Study

2009 ◽  
Vol 90 (9) ◽  
pp. 1506-1513 ◽  
Author(s):  
Cynthia L. Harrison-Felix ◽  
Gale G. Whiteneck ◽  
Amitabh Jha ◽  
Michael J. DeVivo ◽  
Flora M. Hammond ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Injury Rehabilitation

Propranolol in the Management of Infantile Hemangiomas: Clinical Response and Predictors

2012 ◽  
Vol 16 (3) ◽  
pp. 169-173 ◽  
Author(s):  
Alexandra Balma-Mena ◽  
Ajith Chakkittakandiyil ◽  
Miriam Weinstein ◽  
Perla Lansang ◽  
Nhung Ho ◽  
...  
Keyword(s):  
Cohort Study ◽  
Side Effects ◽  
Clinical Response ◽  
Retrospective Cohort ◽  
Analogue Scale ◽  
Optimal Dose ◽  
Duration Of Therapy ◽  
Predictors Of Response ◽  
Percent Improvement ◽  
The Mean

Background: Recent data suggest that propranolol is an effective treatment for infantile hemangiomas (IHs). Data on the optimal dose, duration of therapy, and predictors of response are currently lacking. Objective: To assess the clinical response to and predictors of propranolol use in the treatment of IH. Methods: Retrospective cohort study of 44 patients. Two independent assessors evaluated improvement by comparing serial digital photographs using a 100 mm visual analogue scale (VAS), where 5 mm change represented 10% change in the size or appearance of the IH. Results: Propranolol was started at a mean age of 7.8 (SD 8.21) months and was used for 7.3 (SD 4.8) months before weaning. The mean percent improvement compared to baseline (as measured by the VAS) was 78% (SD 23%). Minor adverse events were noted in 32% of patients. The most significant predictor of regrowth after weaning was a IH > 5 cm in size ( p = .017). Conclusions: Propranolol is effective in IH, but the side effects and the possibility of regrowth should be considered.

scholarly journals Ten-year trends in traumatic brain injury: a retrospective cohort study of California emergency department and hospital revisits and readmissions

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022297 ◽  
Author(s):  
Renee Y Hsia ◽  
Amy J Markowitz ◽  
Feng Lin ◽  
Joanna Guo ◽  
Debbie Y Madhok ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Retrospective Cohort Study ◽  
Hospital Readmission ◽  
Retrospective Cohort ◽  
Secondary Outcome ◽  
Common Mechanism ◽  
First Year ◽  
Severity Of Injury

ObjectiveTo describe visits and visit rates of adults presenting to emergency departments (EDs) with a diagnosis of traumatic brain injury (TBI). TBI is a major cause of death and disability in the USA; yet, current literature is limited because few studies examine longer-term ED revisits and hospital readmission patterns of TBI patients across a broad spectrum of injury severity, which can help inform potential unmet healthcare needs.DesignWe performed a retrospective cohort study.SettingWe analysed non-public patient-level data from California’s Office of Statewide Health Planning and Development for years 2005 to 2014.ParticipantsWe identified 1.2 million adult patients aged ≥18 years presenting to California EDs and hospitals with an index diagnosis of TBI.Primary and secondary outcome measuresOur main outcomes included revisits, readmissions and mortality over time. We also examined demographics, mechanism and severity of injury and disposition at discharge.ResultsWe found a 57.7% increase in the number of TBI ED visits, representing a 40.5% increase in TBI visit rates over the 10-year period (346–487 per 100 000 residents). During this time, there was also a 33.8% decrease in the proportion of patients admitted to the hospital. Older, publicly insured and black populations had the highest visit rates, and falls were the most common mechanism of injury (45.5% of visits). Of all patients with an index TBI visit, 40.5% of them had a revisit during the first year, with 46.7% of them seeking care at a different hospital from their initial hospital or ED visit. Additionally, of revisits within the first year, 13.4% of them resulted in hospital readmission.ConclusionsThe large proportion of patients with TBI who are discharged directly from the ED, along with the high rates of revisits and readmissions, suggest a role for an established system for follow-up, treatment and care of TBI.

Sign in / Sign up

Export Citation Format

Share Document