Is there a Sex Difference in the Course Following Traumatic Brain Injury?

2004 ◽  
Vol 5 (4) ◽  
pp. 299-310 ◽  
Author(s):  
Catherine J. Kirkness ◽  
Robert L. Burr ◽  
Pamela H. Mitchell ◽  
David W. Newell
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Animal Studies ◽  
Injury Severity ◽  
The United States ◽  
Initial Injury ◽  
Rate Of Recovery ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Physiologic Data

Traumatic brain injury (TBI) is a significant cause of death and disability in the United States. Sex has not been thoroughly examined as a factor that may influence outcome following TBI. Clinical studies involving humans that have focused on sex and TBI outcome have yielded inconclusive results, yet sex-related physiologic differences have been demonstrated in animal studies. The purpose of this study is to examine the interaction of sex and age in relation to outcome at 3 and 6 months postinjury in a population of individuals with TBI. The sample includes 157 subjects (124 males, 33 females), 16 to 89 years of age, admitted to a level 1 trauma center following TBI. Physiologic data and information about injury severity and clinical course were gathered during hospitalization. Outcome was assessed at 3 and 6 months postinjury using the Extended Glasgow Outcome Scale (GOSE) and Functional Status Examination (FSE). In this sample, there was a significant relationship between sex and age with respect to functional outcome at 6 months following TBI, controlling for initial injury severity. Females age 30 years or older had significantly poorer outcome as measured by the GOSE (P = 0.031) and the FSE (P = 0.037) than either males or younger females. There was also a very different rate of recovery, with women age 30 years and older, on average, showing no improvement between 3 and 6 months postinjury. Further study is needed to elucidate the reasons why sex may affect outcome following TBI.

Implementation of a Traumatic Brain Injury Guideline at A Dod Level 1 Trauma Center

2022 ◽  
Vol 272 ◽  
pp. 117-124
Author(s):  
Dominick Vitale ◽  
Phillip Kemp Bohan ◽  
Remealle How ◽  
Travis Arnold-Lloyd ◽  
James K Aden ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Level 1 ◽  
Level 1 Trauma Center

scholarly journals Detection of S-100β Protein in Plasma and Urine After a Mild Traumatic Brain Injury

2019 ◽  
Vol 46 (5) ◽  
pp. 599-602 ◽  
Author(s):  
Natalie Le Sage ◽  
Pier-Alexandre Tardif ◽  
Jérôme Frenette ◽  
Marcel Émond ◽  
Jean-Marc Chauny ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Trauma Center ◽  
Invasive Procedure ◽  
Urine Samples ◽  
Non Invasive ◽  
Plasma And Urine Samples ◽  
Level 1 ◽  
Level 1 Trauma Center

ABSTRACT:This study assessed whether S-100β protein could be measured in urine when detectable in plasma after a mild traumatic brain injury (mTBI). Clinical data, plasma and urine samples were collected for the 46 adult patients prospectively enrolled in the emergency department (ED) of a Level 1 trauma center. S-100β protein concentrations were analysed using ELISA. S-100β protein was detectable in 91% and 71% of plasma and urine samples, but values were not correlated (r = 0.002). Urine sampling would have been a non-invasive procedure, but it does not appear to be useful in the ED during the acute phase after an mTBI.

External retrospective validation of Brain Injury Guidelines criteria and modified guidelines for improved care value in the management of patients with low-risk neurotrauma

2020 ◽  
Vol 133 (6) ◽  
pp. 1880-1885 ◽  
Author(s):  
Miner Ross ◽  
Priscilla S. Pang ◽  
Ahmed M. Raslan ◽  
Nathan R. Selden ◽  
Justin S. Cetas
Keyword(s):  
Brain Injury ◽  
Trauma Center ◽  
Injury Severity ◽  
Radiographic Progression ◽  
Medical Intervention ◽  
Neurosurgical Procedures ◽  
Radiographic Findings ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
Neurosurgical Intervention

OBJECTIVEConventional management of patients with neurotrauma frequently consists of routine, repeat head CT at preordained intervals with ICU-level monitoring, regardless of injury severity. The Brain Injury Guidelines (BIG) are a classification tool for stratifying patients into injury severity and risk-of-progression categories based on presenting clinical and radiographic findings. In the present study, the authors aimed to validate BIG criteria at a single level 1 trauma center.METHODSPatients were classified according to BIG criteria and evaluated for subsequent radiographic progression or development of neurological decline. A 2-year retrospective cohort review of consecutive patients with neurotrauma (n = 590) was undertaken. The authors then developed a modified BIG algorithm for use at their institution and followed its implementation prospectively over 555 consecutive patients.RESULTSIn the retrospective analysis, no patient in the BIG 1 category (n = 88, 14.9%) demonstrated progression or neurological decline, and 7.5% of BIG 2 patients (n = 107, 18.1%) demonstrated mild radiographic progression without any decline or need for additional neurosurgical or medical intervention, whereas 15.4% of BIG 3 patients (n = 395, 66.9%) underwent additional neurosurgical procedures. In the prospective analysis, no BIG 1 (n = 105, 18.9%) or BIG 2 (n = 48, 8.6%) patients demonstrated a clinical decline or required any further neurosurgical intervention. By contrast, 12.9% of BIG 3 patients (n = 402, 72%) required immediate neurosurgical intervention, and a further 2.0% required delayed intervention based on clinical and/or radiographic evidence of injury progression.CONCLUSIONSApplication of the BIG criteria in a single large level 1 trauma center reliably sorted patients into appropriate risk categories that accurately guided ongoing management.

Early Prognostication after Traumatic Brain Injury: Specific Validation of the IMPACT Prognostic Calculator in a Level 1 Trauma Center

2019 ◽  
Vol 80 (06) ◽  
pp. 423-429
Author(s):  
Anna Jung ◽  
Felix Arlt ◽  
Maciej Rosolowski ◽  
Jürgen Meixensberger
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Roc Analysis ◽  
Time Frame ◽  
Extended Model ◽  
Severe Tbi ◽  
Level 1 ◽  
The Impact ◽  
Level 1 Trauma Center

AbstractThe present study evaluated the usefulness of the IMPACT prognostic calculator (IPC) for patients receiving acute neurointensive care at a level 1 trauma center in Germany. A total of 139 patients with traumatic brain injury (TBI) were assessed. One day after trauma, the extended model of the IPC was found to provide the most valid prediction of 6-month mortality/unfavorable outcome. Different time frames within the first day could be determined by analyzing mild, moderate, and severe TBI cohorts. The CORE + CT model at time frame Z2 (<6 h from the point of first documentation) for mild TBI exhibited the highest values in the receiver operating characteristic (ROC) analysis (area under the curve [AUC], 0.9; sensitivity, 1; specificity, 0.7). For patients with moderate head injury at time frame Z2/3 (<6–12 h from point of first documentation), the extended model fit best. For patients with severe TBI, the extended model at time frame Z6 (48–72 h from point of first documentation) best predicted 6-month mortality and unfavorable outcome (ROC analysis: AUC, 0.542/0.445; sensitivity, 0.167/0.364; specificity, 0.575/0.444). Center-specific validation demonstrated the validity of the IPC in the early phase after TBI. These findings support the usefulness of the IPC for predicting the prognosis of patients with TBI. However, further prospective validation using a larger TBI cohort is needed.

scholarly journals Models of Traumatic Brain Injury in Aged Animals: A Clinical Perspective

2019 ◽  
Vol 33 (12) ◽  
pp. 975-988
Author(s):  
Aiwane Iboaya ◽  
Janna L. Harris ◽  
Alexandra Nielsen Arickx ◽  
Randolph J. Nudo
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Animal Models ◽  
Animal Studies ◽  
The United States ◽  
Older Individuals ◽  
Clinical Perspective ◽  
Aged Animal ◽  
Physiological Mechanisms ◽  
Relevant Variables

Traumatic brain injury (TBI) is a major cause of morbidity and mortality in the United States, with advanced age being one of the major predictors of poor prognosis. To replicate the mechanisms and multifaceted complexities of human TBI and develop prospective therapeutic treatments, various TBI animal models have been developed. These models have been essential in furthering our understanding of the pathophysiology and biochemical effects on brain mechanisms following TBI. Despite these advances, translating preclinical results to clinical application, particularly in elderly individuals, continues to be challenging. This review aims to provide a clinical perspective, identifying relevant variables currently not replicated in TBI animal models, to potentially improve translation to clinical practice, especially as it applies to elderly populations. As background for this clinical perspective, we reviewed articles indexed on PubMed from 1970 to 2019 that used aged animal models for studying TBI. These studies examined end points relevant for clinical translation, such as neurocognitive effects, sensorimotor behavior, physiological mechanisms, and efficacy of neuroprotective therapies. However, compared with the higher incidence of TBI in older individuals, animal studies on the basic science of aging and TBI remain remarkably scarce. Moreover, a fundamental disconnect remains between experiments in animal models of TBI and successful translation of findings for treating the older TBI population. In this article, we aim to provide a clinical perspective on the unique attributes of TBI in older individuals and a critical appraisal of the research to date on TBI in aged animal models as well as recommendations for future studies.

Ethnicity/race and service-connected disability disparities in civilian traumatic brain injury mechanism of injury and VHA health services costs in military veterans: Evidence from a Level 1 Trauma Center and VA Medical Center

Trauma ◽  
2020 ◽  
pp. 146040862091443
Author(s):  
CE Dismuke-Greer ◽  
SM Fakhry ◽  
MD Horner ◽  
TK Pogoda ◽  
MJ Pugh ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
African American ◽  
Brain Injury ◽  
Military Service ◽  
Trauma Center ◽  
Mechanism Of Injury ◽  
Level 1 ◽  
Level 1 Trauma Center ◽  
African American Race ◽  
Hispanic White

Introduction The objective of this study was to examine the association of military veteran socio-demographics and service-connected disability with civilian mechanism of traumatic brain injury and long-term Veterans Health Administration (VHA) costs. Methods We conducted a 17-year retrospective longitudinal cohort study of veterans with a civilian-related traumatic brain injury from a Level 1 Trauma Center between 1999 and 2013, with VHA follow-up through 2016. We merged trauma center VHA data, and used logit to model mechanism of injury, and generalized linear model to model VHA costs. Results African American race or Hispanic ethnicity veterans had a higher unadjusted rate of civilian assault/gun as mechanism of injury (15.38%) relative to non-Hispanic White (7.19%). African American race or Hispanic veterans who were discharged from the trauma center with traumatic brain injury and followed in VHA had more than twice the odds of assault/gun (OR 2.47; 95% CI 1.16:5.26), after adjusting for sex, age, and military service-connected disability. Veterans with service-connected disability ≥50% had more than twice the odds of assault/gun (OR 2.48; 95% CI 0.97:6.31). Assault/gun was associated with significantly higher annual VHA costs post-discharge ($16,807; 95% CI 672:32,941) among non-Hispanic White veterans. Military service-connected disability ≥50% was associated with higher VHA costs among both non-Hispanic White ($44,987; 95% CI $17,159:$72,816) and African American race or Hispanic ($37,901; 95% CI $4,543:$71,258) veterans. Conclusions We found that African American race or Hispanic veterans had higher adjusted likelihood of assault/gun mechanism of traumatic brain injury, and non-Hispanic White veterans had higher adjusted annual VHA resource costs associated with assault/gun, post trauma center discharge. Veterans with higher than 50% service-connected disability had higher likelihood of assault/gun and higher adjusted annual VHA resource costs. Assault/gun prevention efforts may be indicated within the VHA, especially in minority and service-connected disability veterans. More data from Level 1 Trauma Centers are needed to assess the generalizability of these findings.

scholarly journals Results of delayed follow-up imaging in traumatic brain injury

2016 ◽  
Vol 124 (3) ◽  
pp. 703-709 ◽  
Author(s):  
Adam Ross Befeler ◽  
William Gordon ◽  
Nickalus Khan ◽  
Julius Fernandez ◽  
Michael Scott Muhlbauer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Demographic Data ◽  
Data Types ◽  
Surgical Interventions ◽  
Imaging Results ◽  
Level 1 ◽  
Level 1 Trauma Center

OBJECT There is a paucity of scientific evidence available about the benefits of outpatient follow-up imaging for traumatic brain injury patients. In this study, 1 year of consecutive patients at a Level 1 trauma center were analyzed to determine if there is any benefit to routinely obtaining CT of the head at the outpatient follow-up visit. METHODS This single-institution retrospective review was performed on all patients with a traumatic brain injury seen at a Level 1 trauma center in 2013. Demographic data, types of injuries, surgical interventions, radiographic imaging in inpatient and outpatient settings, and outcomes were assessed through a review of the institution’s trauma registry, patient charts, and imaging. RESULTS Five hundred twenty-five patients were seen for traumatic brain injury in 2013 at Regional One Health in Memphis, Tennessee. One hundred eighty-five patients (35%) presented for outpatient follow-up, all with CT scans of the head. Seven of these patients (4%) showed worsening of their intracranial injuries on outpatient imaging studies; however, surgical intervention was recommended for only 3 of these patients (2%). All patients requiring an intervention had neurological deterioration prior to their follow-up appointment. CONCLUSIONS These experiences suggest that outpatient follow-up imaging for traumatic brain injury should be done selectively, as it was not helpful for patients who did not exhibit worsening of neurological signs or symptoms. Furthermore, routine outpatient imaging results in unnecessary resource utilization and radiation exposure.

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