Prediction of headache severity (density and functional impact) after traumatic brain injury: A longitudinal multicenter study

Cephalalgia ◽  
2013 ◽  
Vol 33 (12) ◽  
pp. 998-1008 ◽  
Author(s):  
William C Walker ◽  
Jennifer H Marwitz ◽  
Amber R Wilk ◽  
Jessica M Ketchum ◽  
Jeanne M Hoffman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Repeated Measures ◽  
Time Course ◽  
Time Points ◽  
Female Sex ◽  
Severe Tbi ◽  
Generalized Linear Mixed Effects ◽  
Prospective Longitudinal

Background: Headache (HA) following traumatic brain injury (TBI) is common, but predictors and time course are not well established, particularly after moderate to severe TBI. Methods: A prospective, longitudinal cohort study of HA severity post-TBI was conducted on 450 participants at seven participating rehabilitation centers. Generalized linear mixed-effects models (GLMMs) were used to model repeated measures (months 3, 6, and 12 post-TBI) of two outcomes: HA density (a composite of frequency, duration, and intensity) and HA disruptions to activities of daily living (ADL). Results: Although HA density and ADL disruptions were nominally highest during the first three months post-TBI, neither showed significant changes over time. At all time points, history of pre-injury migraine was by far the strongest predictor of both HA density and ADL disruptions (odds ratio (OR) = 8.0 and OR = 7.2, averaged across time points, respectively). Furthermore, pre-injury non-migraine HA (at three and six months post-TBI), penetrating-type TBI (at six months post-TBI), and female sex (at six and 12 months post-TBI) were each associated with an increase in the odds of a more severe HA density. Severity of TBI (post-traumatic amnesia (PTA) duration) was not associated with either outcome. Conclusion: Individuals with HA at three months after moderate-severe TBI do not improve over the ensuing nine months with respect to HA density or ADL disruptions. Those with pre-injury HA, particularly of migraine type, are at greatest risk for HA post-TBI. Other independent risk factors are penetrating-type TBI and, to a lesser degree and post-acutely only, female sex. Individuals with these risk factors should be monitored and considered for aggressive early intervention.

Blunt cerebrovascular injuries in severe traumatic brain injury: incidence, risk factors, and evolution

2017 ◽  
Vol 127 (1) ◽  
pp. 16-22 ◽  
Author(s):  
Pierre Esnault ◽  
Mickaël Cardinale ◽  
Henry Boret ◽  
Erwan D'Aranda ◽  
Ambroise Montcriol ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Anticoagulation Therapy ◽  
Spine Injury ◽  
Hemorrhagic Complication ◽  
Injury Incidence ◽  
Severe Tbi ◽  
Systemic Anticoagulation

OBJECTIVEBlunt cerebrovascular injuries (BCVIs) affect approximately 1% of patients with blunt trauma. An antithrombotic or anticoagulation therapy is recommended to prevent the occurrence or recurrence of neurovascular events. This treatment has to be carefully considered after severe traumatic brain injury (TBI), due to the risk of intracranial hemorrhage expansion. Thus, the physician in charge of the patient is confronted with a hemorrhagic and ischemic risk. The main objective of this study was to determine the incidence of BCVI after severe TBI.METHODSThe authors conducted a prospective, observational, single-center study including all patients with severe TBI admitted in the trauma center. Diagnosis of BCVI was performed using a 64-channel multidetector CT. Characteristics of the patients, CT scan results, and outcomes were collected. A multivariate logistic regression model was developed to determine the risk factors of BCVI. Patients in whom BCVI was diagnosed were treated with systemic anticoagulation.RESULTSIn total, 228 patients with severe TBI who were treated over a period of 7 years were included. The incidence of BCVI was 9.2%. The main risk factors were as follows: motorcycle crash (OR 8.2, 95% CI 1.9–34.8), fracture involving the carotid canal (OR 11.7, 95% CI 1.7–80.9), cervical spine injury (OR 13.5, 95% CI 3.1–59.4), thoracic trauma (OR 7.3, 95% CI 1.1–51.2), and hepatic lesion (OR 13.3, 95% CI 2.1–84.5). Among survivors, 82% of patients with BCVI received systemic anticoagulation therapy, beginning at a median of Day 1.5. The overall stroke rate was 19%. One patient had an intracranial hemorrhagic complication.CONCLUSIONSBlunt cerebrovascular injuries are frequent after severe TBI (incidence 9.2%). The main risk factors are high-velocity lesions and injuries near cervical arteries.

scholarly journals Pituitary deficiency and precocious puberty after childhood severe traumatic brain injury: a long-term follow-up prospective study

2019 ◽  
Vol 180 (5) ◽  
pp. 281-290 ◽  
Author(s):  
Yamina Dassa ◽  
Hélène Crosnier ◽  
Mathilde Chevignard ◽  
Magali Viaud ◽  
Claire Personnier ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Precocious Puberty ◽  
Central Precocious Puberty ◽  
Height Velocity ◽  
Prospective Longitudinal Study ◽  
Pituitary Dysfunction ◽  
Severe Tbi ◽  
Prospective Longitudinal

Objectives Childhood traumatic brain injury (TBI) is a public health issue. Our objectives were to determine the prevalence of permanent pituitary hormone deficiency and to detect the emergence of other pituitary dysfunctions or central precocious puberty several years after severe TBI. Design Follow-up at least 5 years post severe TBI of a prospective longitudinal study. Patients Overall, 66/87 children, who had endocrine evaluation 1 year post severe TBI, were included (24 with pituitary dysfunction 1 year post TBI). Main outcome measures In all children, the pituitary hormones basal levels were assessed at least 5 years post TBI. Growth hormone (GH) stimulation tests were performed 3–4 years post TBI in children with GH deficiency (GHD) 1 year post TBI and in all children with low height velocity (<−1 DS) or low IGF-1 (<−2 DS). Central precocious puberty (CPP) was confirmed by GnRH stimulation test. Results Overall, 61/66 children were followed up 7 (5–10) years post TBI (median; (range)); 17/61 children had GHD 1 year post TBI, and GHD was confirmed in 5/17 patients. For one boy, with normal pituitary function 1 year post TBI, GHD was diagnosed 6.5 years post TBI. 4/61 patients developed CPP, 5.7 (2.4–6.1) years post-TBI. Having a pituitary dysfunction 1 year post TBI was significantly associated with pituitary dysfunction or CPP more than 5 years post TBI. Conclusion Severe TBI in childhood can lead to permanent pituitary dysfunction; GHD and CPP may appear after many years. We recommend systematic hormonal assessment in children 1 year after severe TBI and a prolonged monitoring of growth and pubertal maturation. Recommendations should be elaborated for the families and treating physicians.

scholarly journals Lactate Albumin Ratio is Associated with Mortality in Patients with Moderate to Severe Traumatic Brain Injury

2020 ◽  
Author(s):  
Ruoran Wang ◽  
Min He ◽  
Xiaofeng Ou ◽  
Xiaoqi Xie ◽  
Yan Kang
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Logistic Regression ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Prognostic Model ◽  
Multivariate Logistic Regression ◽  
Albumin Ratio ◽  
Severe Tbi ◽  
Auc Value

Abstract Background: Traumatic brain injury (TBI) is a serious public health issue all over the world. This study was designed to evaluate the prognostic value of lactate to albumin ratio (LAR) on moderate to severe traumatic brain injury.Methods: Clinical data of 273 moderate to severe TBI patients hospitalized in West China Hospital between May 2015 and January 2018 were collected. Multivariate logistic regression analyses were used to explore risk factors and construct prognostic model of in-hospital mortality in this cohort. Nomogram was drawn to visualize the prognostic model. Receiver operating characteristic (ROC) curve and calibration curve were respectively drawn to evaluate discriminative ability and stability of this model.Results: Non-survivors had higher LAR than survivors (1.0870 vs 0.5286, p<0.001). Results of multivariate logistic regression analysis showed that GCS (OR=0.818, p=0.008), blood glucose (OR=1.232, p<0.001), LAR (OR=1.883, p=0.012), and red blood cell distribution (RDW)-SD (OR=1.179, p=0.004) were independent risk factors of in-hospital mortality in included patients. These four factors were utilized to construct prognostic model. The area under the ROC curve (AUC) value of single lactate and LAR were 0.733 (95%Cl; 0.673-0.794) and 0.780 (95%Cl; 0.725-0.835), respectively. The AUC value of the prognostic model was 0.868 (95%Cl; 0.826-0.909), which was higher than that of LAR (Z=2.5143, p<0.05).Conclusions: LAR is a readily available prognostic marker of moderate to severe TBI patients. Prognostic model incorporating LAR is beneficial for clinicians to evaluate possible progression and make treatment decisions in these patients.

Reinjury After Moderate to Severe TBI: Rates and Risk Factors in the NIDILRR Traumatic Brain Injury Model Systems

2020 ◽  
Vol 36 (1) ◽  
pp. E50-E60
Author(s):  
Sarah M. Bannon ◽  
Raj G. Kumar ◽  
Jennifer Bogner ◽  
Therese M. O'Neil-Pirozzi ◽  
Lisa Spielman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Model Systems ◽  
Traumatic Brain Injury Model ◽  
Injury Model ◽  
Severe Tbi

scholarly journals Longitudinal volumetric MRI study of pituitary gland following severe traumatic brain injury

2012 ◽  
Vol 19 (3) ◽  
pp. 193-202 ◽  
Author(s):  
Sorin C. Craciunas ◽  
Carmen M. Cirstea ◽  
Hung-Wen Yeh ◽  
Lewis Hutfles ◽  
Joann Lierman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pituitary Gland ◽  
Magnetic Resonance Images ◽  
Time Points ◽  
Patient Demographics ◽  
Pituitary Dysfunction ◽  
Mri Morphometry ◽  
Severe Tbi ◽  
Mri Study

Abstract Purpose: Previous studies have suggested that the hypopituitarism following traumatic brain injury (TBI) is more prevalent than traditionally thought. The objective of this study was to characterize longitudinal MRI morphometric changes of pituitary gland in patients with severe TBI. Materials and methods: Fourteen patients who had suffered a severe TBI (Glasgow Coma Score=3 - 8) underwent MRI at three time points: Time 1 (mean=31. 5 days), Time 2 (98. 0) and Time 3 (185. 5). The pituitary gland volume was quantified by manually tracing on T1-weighted magnetic resonance images. Data from TBI patients were compared to 14 age- and sexmatched uninjured controls. The relationships between pituitary volumetric measures and patient demographics, length of respiratory support and coma, and presence of intracranial hemorrhage or skull fractures were also analyzed. Results: Following TBI, the pituitary volumes were significantly greater at all three time points: Time 1: median=665mm3, range=460-830mm3, p=0. 007; Time 2: 694mm3, 467-866mm3, 0. 007; and Time 3: 655mm3, 444- 795mm3, 0. 015, compared with controls (504mm3, 433-591mm3). At Time 1, pituitary volume was increased in 10 out of 14 patients. Of these, early pituitary enlargements persisted up to six months in nine patients. Pituitary enlargements were negatively correlated with GCS, but not with other variables. Conclusion: Following a severe TBI, early pituitary enlargement found in most of our patients persisted in the chronic phases. Our data suggest a potential role of MRI morphometry in early prediction of pituitary dysfunction following head trauma, but further studies including hormonal measurements are necessary for validation.

scholarly journals The radiological interpretation of possible microbleeds after moderate or severe traumatic brain injury: a longitudinal study

2021 ◽  
Author(s):  
Anke W. van der Eerden ◽  
Thomas L. A. van den Heuvel ◽  
Marnix C. Maas ◽  
Priya Vart ◽  
Pieter E. Vos ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Longitudinal Study ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Time Points ◽  
Computer Aided ◽  
Clinical Consequences ◽  
Severe Tbi ◽  
Over Time

Abstract Introduction In order to augment the certainty of the radiological interpretation of “possible microbleeds” after traumatic brain injury (TBI), we assessed their longitudinal evolution on 3-T SWI in patients with moderate/severe TBI. Methods Standardized 3-T SWI and T1-weighted imaging were obtained 3 and 26 weeks after TBI in 31 patients. Their microbleeds were computer-aided detected and classified by a neuroradiologist as no, possible, or definite at baseline and follow-up, separately (single-scan evaluation). Thereafter, the classifications were re-evaluated after comparison between the time-points (post-comparison evaluation). We selected the possible microbleeds at baseline at single-scan evaluation and recorded their post-comparison classification at follow-up. Results Of the 1038 microbleeds at baseline, 173 were possible microbleeds. Of these, 53.8% corresponded to no microbleed at follow-up. At follow-up, 30.6% were possible and 15.6% were definite. Of the 120 differences between baseline and follow-up, 10% showed evidence of a pathophysiological change over time. Proximity to extra-axial injury and proximity to definite microbleeds were independently predictive of becoming a definite microbleed at follow-up. The reclassification level differed between anatomical locations. Conclusions Our findings support disregarding possible microbleeds in the absence of clinical consequences. In selected cases, however, a follow-up SWI-scan could be considered to exclude evolution into a definite microbleed.

A prospective study of the recovery of attention from acute to 2 years following pediatric traumatic brain injury

2005 ◽  
Vol 11 (1) ◽  
pp. 84-98 ◽  
Author(s):  
CATHY CATROPPA ◽  
VICKI ANDERSON
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Prospective Study ◽  
Speed Of Processing ◽  
Pediatric Traumatic Brain Injury ◽  
Time Points ◽  
Severe Tbi ◽  
Ongoing Development ◽  
A Prospective Study ◽  
Over Time

Limited research has investigated specific attentional sequelae following pediatric traumatic brain injury (TBI), such as sustained, selective, and shifting attention, as well as speed of processing. Little is known about the pattern of recovery of these skills or their interaction with ongoing development. The present study examined attentional abilities at acute, 6-, 12-, and 24-month time points postinjury in a group of 71 children who had sustained a mild, moderate, or severe TBI. Results indicated that children who sustained a severe TBI generally performed poorest, but showed most recovery over time. The pattern of recovery was dependent on the attentional component being measured. Specifically, deficits were most evident on more complex and timed tasks. While a number of areas showed recovery over time, for some attentional components, difficulties persisted to 24 months postinjury. (JINS, 2005,11, 84–98.)

A Prospective Analysis of Derangement of Coagulation Profile in Adult and Pediatric Age Group in Moderate-to-Severe Traumatic Brain Injury

2018 ◽  
Vol 15 (02/03) ◽  
pp. 087-093
Author(s):  
Swarup Sohan Gandhi ◽  
Manish Mann ◽  
Shashikant Jain ◽  
Ugan Singh Meena ◽  
Virendra Deo Sinha
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Age Groups ◽  
Age Group ◽  
Pediatric Age ◽  
Coagulation Profile ◽  
Pediatric Age Group ◽  
Severe Tbi

Abstract Background and Aim of Study Coagulopathy is a common occurrence following traumatic brain injury (TBI). Various studies have reported the incidence and risk factors of coagulopathy and their correlation with poor outcome in adult as well as pediatric age group. In our study, we aim to analyze trauma-induced coagulopathy in adult and pediatric patients. Methods Adult (> 18 years) and pediatric (< 18 years) patients of TBI admitted in the intensive care unit of a trauma center of a tertiary care center had been studied from August 2015 to March 2018. Patients were further subdivided into moderate and severe TBI based on Glasgow Coma Scale (GCS) of 9 to 12 and < 9, respectively. Coagulation profile (prothrombin time [PT], activated partial thromboplastin time [APTT], thrombin time, fibrinogen, and D-dimer) and arterial blood gas (ABG) analysis were done on day of admission and on days 3 and 7. Coagulation profiles were analyzed in both the age groups, and risk factors were studied and correlated with the mortality and morbidity based on the Glasgow outcome score. Results Two hundred patients including 143 adults and 57 pediatric patients were included. Mean age among the adult and pediatric population was 31.51 ± 16.83 and 11.5 ± 5.90 years, respectively. In adults, 96 (83.62%) out of 116 in severe TBI group and 20 (74.07%) out of 27 in moderate TBI group developed coagulopathy, and in pediatric age group, 14 (70%) out of 20 in moderate TBI and 30 (81.08%) out of 37 in severe TBI developed coagulopathy. Midline shift was significantly associated with coagulopathy in both the age groups (p value < 0.039). Mortality was not significantly different in patients with coagulopathy between the age groups, but improved status as per the Glasgow outcome score was more in pediatric age group. Conclusion The development of coagulopathy is a frequent complication in patients with moderate to severe TBI in both age groups. Even though it is not closely associated with death in this study, it may be regarded as a marker of injury severity.

Time course for autoregulation recovery following severe traumatic brain injury

2009 ◽  
Vol 111 (4) ◽  
pp. 695-700 ◽  
Author(s):  
Gill E. Sviri ◽  
Rune Aaslid ◽  
Colleen M. Douville ◽  
Anne Moore ◽  
David W. Newell
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Scale Score ◽  
Severe Traumatic Brain Injury ◽  
Glasgow Coma Scale Score ◽  
Time Course ◽  
Diffuse Brain Injury ◽  
Severe Tbi ◽  
Diffuse Brain

Object The aim of the present study was to evaluate the time course for cerebral autoregulation (AR) recovery following severe traumatic brain injury (TBI) Methods Thirty-six patients (27 males and 9 females, mean ± SEM age 33 ± 15.1 years) with severe TBI underwent serial dynamic AR studies with leg cuff deflation as a stimulus, until recovery of the AR responses was measured. Results The AR was impaired (AR index < 2.8) in 30 (83%) of 36 patients on Days 3–5 after injury, and in 19 individuals (53%) impairments were found on Days 9–11 after the injury. Nine (25%) of 36 patients exhibited a poor AR response (AR index < 1) on postinjury Days 12–14, which eventually recovered on Days 15–23. Fifty-eight percent of the patients with a Glasgow Coma Scale score of 3–5, 50% of those with diffuse brain injury, 54% of those with elevated intracranial pressure, and 40% of those with poor outcome had no AR recovery in the first 11 days after injury. Conclusions Autoregulation recovery after severe TBI can be delayed, and failure to recover during the 2nd week after injury occurs mainly in patients with a lower Glasgow Coma Scale score, diffuse brain injury, elevated ICP, or unfavorable outcome. The finding suggests that perfusion pressure management should be considered in some of the patients for a period of at least 2 weeks.

scholarly journals Prevalence of Pituitary Dysfunction After Severe Traumatic Brain Injury in Children and Adolescents: A Large Prospective Study

2014 ◽  
Vol 99 (6) ◽  
pp. 2052-2060 ◽  
Author(s):  
Claire Personnier ◽  
Hélène Crosnier ◽  
Philippe Meyer ◽  
Mathilde Chevignard ◽  
Isabelle Flechtner ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Children And Adolescents ◽  
Predictive Factors ◽  
Public Health Issue ◽  
Prospective Longitudinal Study ◽  
Pituitary Dysfunction ◽  
Igf I ◽  
Severe Tbi ◽  
Prospective Longitudinal

Context: Traumatic brain injury (TBI) in childhood is a major public health issue. Objective: We sought to determine the prevalence of pituitary dysfunction in children and adolescents after severe TBI and to identify any potential predictive factors. Design: This was a prospective longitudinal study. Setting: The study was conducted at a university hospital. Patients: Patients, hospitalized for severe accidental or inflicted TBI, were included. The endocrine assessment was performed between 6 and 18 months after the injury. Main Outcome Measures: Basal and dynamic tests of pituitary function were performed in all patients and GH dynamic testing was repeated in patients with low stimulated GH peak (&lt;7 ng/mL). The diagnosis of proven severe GH deficiency (GHD) was based on the association of two GH peaks less than 5 ng/mL on both occasions of testing and IGF-I levels below −2 SD score. Initial cranial tomography or magnetic resonance imaging was analyzed retrospectively. Results: We studied 87 children and adolescents [60 males, median age 6.7 y (range 0.8–15.2)] 9.5 ± 3.4 months after the TBI (73 accidental, 14 inflicted). The second GH peak, assessed 4.9 ± 0.1 months after the first evaluation, remained low in 27 children and adolescents. Fifteen patients had a GH peak less than 5 ng/mL (mean IGF-I SD score −1.3 ± 1.5) and five (5.7%) strict criteria for severe GHD. Two children had mild central hypothyroidism and one had ACTH deficiency. We did not find any predictive factors associated with existence of GHD (demographic characteristics, growth velocity, trauma severity, and radiological parameters). Conclusion: At 1 year after the severe TBI, pituitary dysfunction was found in 8% of our study sample. We recommend systematic hormonal assessment in children and adolescents 12 months after a severe TBI and prolonged clinical endocrine follow-up.

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