Impact of mild traumatic brain injury understanding on intended help-seeking behaviour

Children do not always receive adequate medical attention following a mild traumatic brain injury (mTBI), despite the necessity of this treatment. Adult mTBI knowledge may be one factor that affects if a child receives medical attention, but little is known about association between mTBI knowledge and help-seeking behaviour. Participants were 212 females and 58 males, including 84 parents, with a mean age of 35.57 years (standard deviation = 10.96). A questionnaire evaluated participants’ understanding of mTBI and vignettes to evaluate behavioural intentions regarding help-seeking behaviour after an mTBI. Only 40.0% of participants were able to recall an adequate number of mTBI symptoms (5+). Surprisingly, mTBI history was not associated with better mTBI knowledge, t(df, 268) = 1.29, p = .20. Similarly, knowing a close friend or family member with mTBI was not associated with higher mTBI knowledge, t(df = 268) = .81, p = .4. Further, neither mTBI symptom knowledge nor vignette child age (young = 5 years, older = 15 years) significantly predicted participants’ cited intentions to perform help-seeking behaviour. Consistent with the existing research, the current study demonstrates a continued lack of mTBI knowledge in the general population. However, this may not be a factor that influences an adult’s decision to take a child to hospital following mTBI. Future research should investigate the association between help-seeking intentions and actual behaviour in relation to paediatric mTBI.

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LO86: Lack of association between four biomarkers and the presence of persistent post-concussion symptoms after a mild traumatic brain injury

CJEM ◽

10.1017/cem.2020.140 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S38-S39

Author(s):

N. Le Sage ◽

J. Frenette ◽

J. Chauny ◽

S. Berthelot ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Clinical Data ◽

Neuron Specific Enolase ◽

Primary Outcome Measure ◽

S100b Protein ◽

Future Research ◽

Enzyme Linked Immunosorbent Assay ◽

Persistent Symptoms

Introduction: Mild Traumatic Brain Injury (mTBI) is a common problem: each year in Canada, its incidence is estimated at 500-600 cases per 100 000. Between 10 and 56% of mTBI patients develop persistent post-concussion symptoms (PPCS) that can last for more than 90 days. It is therefore important for clinicians to identify patients who are at risk of developing PPCS. We hypothesized that blood biomarkers drawn upon patient arrival to the Emergency Department (ED) could help predict PPCS. The main objective of this project was to measure the association between four biomarkers and the incidence of PPCS 90 days post mTBI. Methods: Patients were recruited in seven Canadian ED. Non-hospitalized patients, aged ≥14 years old with a documented mTBI that occurred ≤24 hrs of ED consultation, with a GCS ≥13 at arrival were included. Sociodemographic and clinical data as well as blood samples were collected in the ED. A standardized telephone questionnaire was administered at 90 days post ED visit. The following biomarkers were analyzed using enzyme-linked immunosorbent assay (ELISA): S100B protein, Neuron Specific Enolase (NSE), cleaved-Tau (c-Tau) and Glial fibrillary acidic protein (GFAP). The primary outcome measure was the presence of persistent symptoms at 90 days after mTBI, as assessed using the Rivermead Post-Concussion symptoms Questionnaire (RPQ). A ROC curve was constructed for each biomarker. Results: 1276 patients were included in the study. The median age for this cohort was 39 (IQR 23-57) years old, 61% were male and 15% suffered PPCS. The median values (IQR) for patients with PPCS compared to those without were: 43 pg/mL (26-67) versus 42 pg/mL (24-70) for S100B protein, 50 pg/mL (50-223) versus 50 pg/mL (50-199) for NSE, 2929 pg/mL (1733-4744) versus 3180 pg/mL (1835-4761) for c-Tau and 1644 pg/mL (650-3215) versus 1894 pg/mL (700-3498) for GFAP. For each of these biomarkers, Areas Under the Curve (AUC) were 0.495, 0.495, 0.51 and 0.54, respectively. Conclusion: Among mTBI patients, S100B protein, NSE, c-Tau or GFAP during the first 24 hours after trauma do not seem to be able to predict PPCS. Future research testing of other biomarkers is needed in order to determine their usefulness in predicting PPCS when combined with relevant clinical data.

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B-72 The Relationship between Anxiety and Postconcussive Symptomology in patients with Mild Traumatic Brain Injury

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.155 ◽

2019 ◽

Vol 34 (6) ◽

pp. 1020-1020

Author(s):

K Cornett

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Injury Severity ◽

Small Sample ◽

Future Research ◽

Control Group ◽

Patient Report ◽

The Relationship ◽

Report Measure

Abstract Objective Research literature has demonstrated the role that pre-morbid anxiety has in prolonging recovery from mild traumatic brain injury (mTBI). The aim of this investigation is to clarify the degree of the relationship between anxiety and postconcussive symptomology in patients with mTBI. Method This study compared scores from a patient-report measure of anxiety, the General Anxiety Disorder-7 (GAD-7), to scores from a patient-report measure of postconcussion symptom severity, the Neurobehavioral Symptom Inventory (NSI). Participants were recruited from September 2018 to December 2019 who had been referred for clinical evaluation to Rehabilitation Institute of Washington’s Brain Injury Services (a privately-run, interdisciplinary, outpatient clinic). 39 adult participants (30 males and nine females) completed both the GAD-7 and NSI. No control group was used. Injury severity level was ascertained via review of the medical records. Patients underwent an abbreviated evaluation with a clinical neuropsychologist. As a part of this initial evaluation, patients completed an intake packet, which included the NSI and GAD-7. Results The relationship between the ordinal variables (i.e., anxiety and postconscussive symptomology) was assessed using spearman’s rho. Anxiety had a strong, statistically significant relationship with postconcussive symptomology (rho = 0.670, p = 0.000). Conclusions Anxiety and postconcussive symptomology severity are associated in this population of patients with mTBI. Limitations of this current investigation include a small sample size and no control group. This study indicates the need for controlled studies in future research to address the above-encountered limitations. Nevertheless, this study lends support to the prevalence of anxiety in those with elevated postconcussive symptomology and the need to monitor this in assessment and treatment.

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A cost-effectiveness and value of information analysis to inform future research of tranexamic acid for older adults experiencing mild traumatic brain injury

10.21203/rs.3.rs-1065513/v1 ◽

2021 ◽

Author(s):

Jack Williams ◽

Katharine Ker ◽

Ian Roberts ◽

Haleema Shakur-Still ◽

Alec Miners

Keyword(s):

Traumatic Brain Injury ◽

Cost Effectiveness ◽

Brain Injury ◽

Tranexamic Acid ◽

Mild Traumatic Brain Injury ◽

Cost Effective ◽

Future Research ◽

Base Case ◽

Mild Tbi ◽

Value Of Perfect Information

Abstract Background Tranexamic acid reduces head injury deaths in patients with CT scan evidence of intracranial bleeding after mild traumatic brain injury (TBI). However, the cost-effectiveness of tranexamic acid for people with mild TBI in the pre-hospital setting, prior to CT scanning, is uncertain. A large randomised controlled trial (CRASH-4) is planned to address this issue, but the economic justification for it has not been established. The aim of the analysis was to estimate the likelihood of tranexamic acid being cost-effective given current evidence, the treatment effects required for cost-effectiveness, and the expected value of performing further research. Methods An early economic decision model compared usual care for mild TBI with and without tranexamic acid, for adults aged 70 and above. The evaluation was performed from a UK healthcare perspective over a lifetime time horizon, with costs reported in 2020 pounds (GBP) and outcomes reported as quality adjusted life years (QALYs). All analyses used a £20,000 per QALY cost-effectiveness threshold. Results In the base case analysis, tranexamic acid was associated with an incremental cost-effectiveness ratio of £4,994 per QALY gained, and was 85% likely to be cost-effective in the base case probabilistic sensitivity analysis. The value of perfect information was £13.2 million, and the value of perfect information for parameters that could be collected in a trial was £12.4 million. The all-cause mortality risk ratio for tranexamic acid and the functional outcomes following TBI had the most impact on cost-effectiveness. Conclusions Tranexamic acid can be cost-effective at a very modest treatment effect, and there is a high value of performing future research in the UK. The value in a global context is likely to be far higher.

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Cognitive Rehabilitation Following Mild Traumatic Brain Injury using Hypnotic Suggestion

10.31219/osf.io/cxqth ◽

2019 ◽

Author(s):

Jonas Kristoffer Lindeløv

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Cognitive Rehabilitation ◽

Digit Span ◽

Depression Scale ◽

Cost Effective ◽

Future Research ◽

Neurological Patient ◽

Hypnotic Suggestion

Introduction: Cost-effective rehabilitation of persistent cognitive problems following Mild Traumatic Brain Injury (MTBI) remains elusive. Method: Here, we extend previous findings on hypnotic suggestion for neurological patient groups by administering it to 22 participants suffering from persistent reduced vocational performance following MTBI. Results: Following eight weekly 1-hour treatments, we observed large effects on the Mental Fatigue Scale and Digit Span. There were medium-sized effects on the Hospital Anxiety and Depression Scale, but no effect on the Trail Making Test. Effect sizes were larger for participants with no ongoing litigation. Conclusion: In terms of effectiveness, the results compare well to conventional treatments for MTBI. We discuss limitations and propose avenues for future research.

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Quantitative analysis tool for clinical functional MRI in mild traumatic brain injury

Undersea and Hyperbaric Medicine ◽

10.22462/13.15.2019.3 ◽

2019 ◽

pp. 245-249

Author(s):

Peter E. Cartwright ◽

◽

Thomas G. Perkins ◽

Priya Santhanam ◽

Lindell K. Weaver ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Quantitative Analysis ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Sequence Data ◽

Future Research ◽

Analysis Tool ◽

Clinical Interpretation ◽

Quantification Analysis ◽

Study Participants

Functional magnetic resonance imaging (fMRI) has been available commercially for clinical diagnostic use for many years. However, both clinical interpretation of fMRI by a neuroradiologist and quantitative analysis of fMRI data can require significant personnel resources that exceed reimbursement. In this report, a fully automated computerbased quantification methodology (Enumerated Auditory Response, EAR) has been developed to provide an auditory fMRI assessment of patients who have suffered a mild traumatic brain injury. Fifty-five study participants with interpretable auditory fMRI sequence data were assessed by EAR analysis, as well as both clinical radiologist fMRI interpretation and voxelwise general linear model (GLM) analysis. Comparison between the clinical interpretation and the two computer analysis methods resulted in 67% concordance (identical), 32% near-concordance (one level difference), and 1% discordant. Comparison between the clinical computer-based quantification (EAR) and GLM analysis yielded significant correlations in right and left ear responses (p<0.05) for the full subject group. Automated fMRI quantification analysis equivalent to EAR might be appropriate for both future research projects with constrained resources, as well as possible routine clinical use.

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Prospective Memory in Service Members with Mild Traumatic Brain Injury

Military Medicine ◽

10.1093/milmed/usz062 ◽

2019 ◽

Vol 184 (11-12) ◽

pp. 723-730

Author(s):

Jill R Settle ◽

Deborah M Clawson ◽

Marc M Sebrechts ◽

Louis M French ◽

Adreanna T Massey Watts ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Prospective Memory ◽

Implementation Intentions ◽

Medical Center ◽

Event Related Potential ◽

Service Members ◽

Future Research ◽

Injury Type

Abstract Introduction Prospective memory (PM) is the ability to remember the intention to perform an action in the future. Following mild traumatic brain injury (mTBI), the brain structures supporting such PM may be compromised. PM is essential for remembering activities specific to TBI survivors that promote recovery, such as following doctors’ orders, taking necessary medications, completing physical rehabilitation exercises, and maintaining supportive social relationships. Since the year 2000, more than 315,897 US Service Members are reported to have sustained an mTBI1, yet little has been done to address possible PM concerns. Therefore, identifying impaired PM and interventions that may ameliorate such deficits is important. The primary aim of this study was to determine whether task encoding using implementation intentions leads to better PM performance than encoding using rote rehearsal in Service Members with mTBI (n = 35) or with bodily injuries but no TBI (n = 8) at baseline and 6 months later. Materials and Method Participants were randomized to one of the two encoding conditions. They were asked to remember to complete a series of four tasks over the course of a 2-hour event-related potential session and to contact a staff member during a specified 2-hour window later that day. PM performance was assessed based on completion of each task at the appropriate time. IRB approval was obtained from The Catholic University of America, Walter Reed National Military Medical Center, and Ft. Belvoir Community Hospital. Results Service Members with mTBI using implementation intentions outperformed those using rote rehearsal. The effect of injury type and the interaction between encoding condition and injury type did not yield differences that were statistically significant. Conclusions The results suggest that implementation intentions may be a useful PM remediation strategy for those who have sustained mTBI. Future research should validate these findings in a larger sample

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B-73 The Relationship Between Subjective and Objective Disinhibition in Mild Traumatic Brain Injury

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.156 ◽

2019 ◽

Vol 34 (6) ◽

pp. 1021-1021

Author(s):

K Holiday ◽

A Clark ◽

S Sorg ◽

V Merritt ◽

M Nakhla ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Response Inhibition ◽

Objective Response ◽

Group Analysis ◽

Future Research ◽

Cognitive Difficulties ◽

T Score ◽

Subjective Complaints

Abstract Objective Veterans with mild traumatic brain injury (mTBI) frequently report cognitive difficulties, though these are not always supported by objective neuropsychological testing. The current study compared mTBI Veterans with subjective disinhibition to Veteran Controls (VC) on an objective response inhibition task while controlling for depression. Methods 53 mTBI Veterans and 31 VC with optimal effort completed a go/no-go response inhibition (RI) task and measures of subjective disinhibition (Frontal Systems Executive Behavior scale) and depression (Beck Depression Inventory-II). ANCOVAs compared RI performances of VC without cognitive complaints to (1) the total sample of mTBI Veterans and (2) to mTBI Veterans with (t-score>60; mTBI+disinhibition; n = 23) and without (t-score < 60; mTBI-disinhibition; n = 30) subjective complaints of disinhibition. Results Relative to the VC group, the mTBI Veterans endorsed significantly greater depressive symptoms (p < .001). No significant differences in RI performance were observed when the total mTBI sample was compared to VC. However, in the three group analysis, there was a significant effect of group (p = .002) controlling for depression (p = .396). Post-hoc analyses revealed the mTBI+disinhibition group performed significantly worse than the mTBI-disinhibition (p < .001) and VC (p < .001) groups; no significance differences in RI performance were observed between the mTBI-disinhibition and VC groups (p = .914). Conclusions While the larger mTBI group did not differ from VC on RI performance, mTBI Veterans with subjective disinhibition complaints evidenced poorer objective RI. Findings therefore suggest that Veterans with elevated subjective complaints may be at risk for experiencing objective cognitive difficulties. Future research is needed to elucidate the neural underpinnings of these group differences as well as clinical outcomes.

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A-97 Headache before and after Mild Traumatic Brain Injury: Acute-to-Subacute Outcomes in Patients with no Headache, Pre-Existing Headache, and Post-Traumatic Headache

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab062.115 ◽

2021 ◽

Vol 36 (6) ◽

pp. 1145-1145

Author(s):

Justin E Karr ◽

Michael W Williams ◽

Grant L Iverson ◽

Sheng-Jean Huang ◽

Chi-Cheng Yang

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Neuropsychological Tests ◽

Neuropsychological Test ◽

Future Research ◽

Cognitive Symptoms ◽

Post Injury ◽

Before And After ◽

Post Traumatic

Abstract Objective Patients who experience a mild traumatic brain injury (MTBI) may have a headache condition preceding injury, develop a post-traumatic headache after injury, or experience headache neither before nor after injury. This study examined whether MTBI patients with no headache, pre-existing headache, and post-traumatic headache differed in acute-to-subacute outcomes. Method Patients with MTBI were recruited from an outpatient neurosurgery clinic in Taipei, Taiwan after emergency department referral (N = 291; 40.2% men; M = 37.9 ± 13.9 years-old; Mdn = 7 days-since-injury, range = 0–21), completing neuropsychological tests of attention, memory, and verbal fluency and questionnaires evaluating depression, anxiety, and post-concussion symptoms. Participants with no headache (reported neither pre- or post-injury), pre-existing headache (reported pre-injury headache, of whom some reported worsened post-injury headache), and post-traumatic headache (denied pre-injury headache, reported post-injury headache) were compared using non-parametric ANCOVA, controlling for gender and days-since-injury. Results Neuropsychological test performances did not differ between headache groups. Participants with pre-injury headache and post-traumatic headache had greater change in self-reported physical (F = 25.52, p < 0.011, η2 = 0.15) and cognitive symptoms (F = 3.74, p = 0.025, η2 = 0.03) than participants with no headache. Participants with pre-injury headache reported worse post-injury anxiety symptoms than participants with post-traumatic headache (F = 12.02, p < 0.011, η2 = 0.08). Conclusion(s) Participants with pre-injury and post-traumatic headache did not differ in outcome within 21 days of injury but had worse self-reported physical and cognitive symptoms than participants with no headache. Most participants with pre-injury headache experienced worsened headache following MTBI (53.7%). Future research is needed to assess whether more specific headache subtypes are differentially associated with MTBI outcome.

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Reactive balance responses after mild traumatic brain injury (mTBI): a scoping review

10.1101/2020.12.17.20248433 ◽

2020 ◽

Author(s):

Amanda Morris ◽

Tallie Casucci ◽

Mary M. McFarland ◽

Ben Cassidy ◽

Ryan Pelo ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Scoping Review ◽

Quantitative Measure ◽

Cognitive Testing ◽

Cochrane Library ◽

Future Research ◽

Postural Response ◽

Postural Responses

AbstractBackgroundBalance testing after concussion or mild traumatic brain injury (mTBI) can be useful in determining acute and chronic neuromuscular deficits that are unapparent from symptom scores or cognitive testing alone. However, current assessments of balance do not comprehensively evaluate all three classes of balance: maintaining a posture, voluntary movement, and reactive postural response. Despite the utility of reactive postural responses in predicting fall risk in other balance impaired populations, the effect of mTBI on reactive postural responses remains unclear.PurposeTo (1) examine the extent and range of available research on reactive postural responses in people post-mTBI and (2) determine if reactive postural responses (balance recovery) are affected by mTBI.Study DesignScoping review.MethodsStudies were identified using Medline, Embase, CINAHL, Cochrane Library, Dissertations and Theses Global, PsycINFO, SportDiscus, and Web of Science. Inclusion criteria were: injury classified as mTBI with no confounding central or peripheral nervous system dysfunction beyond those stemming from the mTBI, quantitative measure of reactive postural response, and a discrete, externally driven perturbation was used to test reactive postural response.ResultsA total of 4,247 publications were identified and a total of two studies (4 publications) were included in the review.ConclusionThe limited number of studies available on this topic highlight the lack of knowledge on reactive postural responses after mTBI. This review provides a new direction for balance assessments after mTBI and recommends incorporating all three classes of postural control in future research.

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Post-traumatic headache due to mild traumatic brain injury: Current knowledge and future directions

Cephalalgia ◽

10.1177/0333102420970188 ◽

2020 ◽

pp. 033310242097018

Author(s):

Todd J Schwedt

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Diagnostic Criteria ◽

Mild Traumatic Brain Injury ◽

Current Knowledge ◽

Research Priorities ◽

Narrative Review ◽

Future Research ◽

Persistent Symptoms ◽

Post Traumatic

Background/objective Post-traumatic headache is one of the most common and persistent symptoms following mild traumatic brain injury. The objective of this narrative review is to provide an update on the diagnostic criteria, clinical presentation, epidemiology, pathophysiology, and treatment of post-traumatic headache, and to identify future research priorities. Methods This is a narrative review of the literature regarding post-traumatic headache attributed to mild traumatic brain injury. Results Onset of post-traumatic headache within 7 days of injury is the only evidence for a causal relationship between the injury and the headache included in the diagnostic criteria. Post-traumatic headache often resolves within the first few days of onset, whereas it persists for at least 3 months in 30–50%. The majority of insights into post-traumatic headache pathophysiology come from pre-clinical animal studies and human imaging studies, which implicate structural, functional, metabolic, and neuroinflammatory mechanisms for post-traumatic headache. There is a paucity of quality evidence for how to best treat post-traumatic headache. Conclusions Although meaningful progress has been made in the post-traumatic headache field, priorities for future research are numerous, including the optimization of diagnostic criteria, a greater understanding of post-traumatic headache pathophysiology, identifying mechanisms and predictors for post-traumatic headache persistence, and identifying safe, well-tolerated, effective therapies.

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