Effect of early tranexamic acid treatment on fatigue in patients with mild traumatic brain injury: data from the CRASH-3 clinical trial

Background: Each year world-wide about 65 million people sustain a mild traumatic brain injury (mTBI). Fatigue is a common and distressing symptom after mTBI. We examine the effect of tranexamic acid (TXA) on fatigue in patients with mTBI using data from the CRASH-3 trial. Methods: The CRASH-3 trial randomised 9,202 patients with traumatic brain injury and no significant extracranial bleeding to receive TXA or placebo within 3 hours of injury. The primary outcome was death from head injury within 28 days of injury. The methods and results are presented elsewhere. Fatigue was recorded as “None”, “Moderate” or “Extreme.” This study examines the effect of TXA on extreme fatigue in the 2,632 patients with mTBI (Glasgow Coma Scale [GCS] score≥13). Our analyses were not prespecified. Results: Our study primary outcome, extreme fatigue, was reported for 10 (0.8%) of 1,328 patients receiving TXA and 19 (1.5%) of 1,288 patients receiving placebo (risk ratio [RR]=0.51, 95% confidence interval [CI] 0.24-1.09). Death within 28 days of injury was reported for 34 (2.6%) of 1,328 patients receiving TXA versus 47 (3.6%) of 1,288 patients receiving placebo (RR=0.70, 95% CI 0.45-1.08). Among patients allocated to TXA, 44 (3.3%) patients either died or reported extreme fatigue versus 66 (5.1%) patients among those allocated to placebo (RR=0.65, 95% CI 0.44-0.94). Conclusions: Early tranexamic acid treatment may reduce fatigue in mTBI patients, but these results need to be confirmed in a larger trial. Registration: ISRCTN (ISRCTN15088122, 19/07/2011), ClinicalTrials.gov (NCT01402882, 26/07/2011), EudraCT (2011-003669-14, 25/07/2011), Pan African Clinical Trial Registry (PACTR20121000441277, 30/10/2012).

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Association of Stress-Induced Hyperglycemia and Diabetic Hyperglycemia with Mortality in Patients with Traumatic Brain Injury: Analysis of a Propensity Score-Matched Population

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17124266 ◽

2020 ◽

Vol 17 (12) ◽

pp. 4266

Author(s):

Yu-Chin Tsai ◽

Shao-Chun Wu ◽

Ting-Min Hsieh ◽

Hang-Tsung Liu ◽

Chun-Ying Huang ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Propensity Score ◽

Primary Outcome ◽

Mortality Rates ◽

Research Database ◽

Health Records ◽

Medical Centers ◽

Using Data ◽

Gcs Score

Background: Hyperglycemia at the time of hospital admission is associated with higher morbidity and mortality rates in patients with traumatic brain injury (TBI). Using data from the Chang Gung Research Database (CGRD), this study aimed to compare mortality outcomes between patients with stress-induced hyperglycemia (SIH), diabetic hyperglycemia (DH), and nondiabetic normoglycemia (NDN). The study occurred at Keelung, Linkou, Chiayi, and Kaohsiung Chang Gung Memorial Hospitals (CGMHs). Methods: A total of 1166, 6318, 3622, and 5599 health records from Keelung, Linkou, Chiayi, and Kaohsiung CGMHs, respectively, were retrieved from the CGRD for hospitalized patients with TBI between January 2001 and December 2015. After propensity score matching for sex, age, and Glasgow Coma Scale (GCS) score, the matched cohorts were compared to evaluate differences in the primary outcome between patients with SIH, DH, and NDN. In-hospital mortality was the primary outcome. Results: The analysis of matched patient populations revealed that at the Kaohsiung CGMH, patients with SIH had 1.63-fold (95% CI: 1.09–2.44; p = 0.017) and 1.91-fold (95% CI: 1.12–3.23; p = 0.017) higher odds of mortality than patients with NDN and DH, respectively. Similar patterns were found at the Linkou CGMH; patients with SIH had higher odds of mortality than patients with NDN and DH. In contrast, at the Keelung CGMH, patients with SIH had significantly higher odds of mortality than those with NDN (OR: 3.25; 95% CI: 1.06–9.97; p = 0.039). At the Chiayi CGMH, there were no significant differences in mortality rates among all groups. Conclusions: This study’s results suggest that SIH and DH differ in their effect on the outcomes of patients with TBI. The results were similar between medical centers but not nonmedical centers; in the medical centers, patients with SIH had significantly higher odds of mortality than patients with either NDN or DH.

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What are the strongest indicators of intracerebral hemorrhage in mild traumatic brain injury?

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000717 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000717

Author(s):

Panu Teeratakulpisarn ◽

Phati Angkasith ◽

Thanakorn Wannakul ◽

Parichat Tanmit ◽

Supatcha Prasertcharoensuk ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

High Risk ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Skull Fracture ◽

Brain Ct ◽

Baseline Characteristics ◽

Gcs Score ◽

The Brain

BackgroundAlthough there are eight factors known to indicate a high risk of intracranial hemorrhage (ICH) in mild traumatic brain injury (TBI), identification of the strongest of these factors may optimize the utility of brain CT in clinical practice. This study aimed to evaluate the predictors of ICH based on baseline characteristics/mode of injury, indications for brain CT, and a combination of both to determine the strongest indicator.MethodsThis was a descriptive, retrospective, analytical study. The inclusion criteria were diagnosis of mild TBI, high risk of ICH, and having undergone a CT scan of the brain. The outcome of the study was any type of ICH. Stepwise logistic regression analysis was used to find the strongest predictors according to three models: (1) injury pattern and baseline characteristics, (2) indications for CT scan of the brain, and (3) a combination of models 1 and 2.ResultsThere were 100 patients determined to be at risk of ICH based on indications for CT of the brain in patients with acute head injury. Of these, 24 (24.00%) had ICH. Model 1 found that injury due to motor vehicle crash was a significant predictor of ICH, with an adjusted OR (95% CI) of 11.53 (3.05 to 43.58). Models 2 and 3 showed Glasgow Coma Scale (GCS) score of 13 to 14 after 2 hours of observation and open skull or base of skull fracture to be independent predictors, with adjusted OR (95% CI) of 11.77 (1.32 to 104.96) and 5.88 (1.08 to 31.99) according to model 2.DiscussionOpen skull or base of skull fracture and GCS score of 13 to 14 after 2 hours of observation were the two strongest predictors of ICH in mild TBI.Level of evidenceIII.

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Actualization of effective stratified therapy in patients with mild traumatic brain injury (clinical trial)

Consilium Medicum ◽

10.26442/2075-1753_2018.2.69-77 ◽

2018 ◽

Vol 20 (2) ◽

pp. 69-77

Author(s):

I.N. Samartsev ◽

◽

S.A. Zhivolupov ◽

E.V. Jakovlev ◽

◽

...

Keyword(s):

Clinical Trial ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury

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Hospital admission and readmission among homeless patients with neurologic disease: Retraction and replacement

Neurology ◽

10.1212/wnl.0000000000007645 ◽

2019 ◽

Vol 92 (24) ◽

pp. e2822-e2831 ◽

Cited By ~ 7

Author(s):

Nicole Rosendale ◽

Elan L. Guterman ◽

John P. Betjemann ◽

S. Andrew Josephson ◽

Vanja C. Douglas

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Primary Outcome ◽

Cross Sectional Study ◽

Primary Diagnosis ◽

Hospital Level ◽

Cross Sectional ◽

Using Data ◽

Patients With Epilepsy ◽

Inpatient Database

ObjectiveTo characterize the most common neurologic diagnoses leading to hospitalization for homeless compared to housed individuals and to assess whether homelessness is an independent risk factor for 30-day readmission after an admission for a neurologic illness.MethodsWe performed a retrospective serial cross-sectional study using data from the Healthcare Cost and Utilization Project California State Inpatient Database from 2006 to 2011. Adult patients with a primary neurologic discharge diagnosis were included. The primary outcome was 30-day readmission. We used multilevel logistic regression to examine the association between homelessness and readmission after adjustment for patient factors.ResultsWe identified 1,082,347 patients with a neurologic primary diagnosis. The rate of homelessness was 0.37%. The most common indications for hospitalization among homeless patients were seizure and traumatic brain injury, both of which were more common in the homeless compared to housed population (19.3% vs 8.1% and 31.9% vs 9.2%, respectively, p < 0.001). A multilevel mixed-effects model controlling for patient age, sex, race, insurance type, comorbid conditions, and clustering on the hospital level found that homelessness was associated with increased 30-day readmission (odds ratio 1.5, 95% confidence interval 1.4–1.6, p < 0.001). This association persisted after this analysis was repeated within specific diagnoses (patients with epilepsy, trauma, encephalopathy, and neuromuscular disease).ConclusionThe most common neurologic reasons for admission among homeless patients are seizure and traumatic brain injury; these patients are at high risk for readmission. Future interventions should target the drivers of readmissions in this vulnerable population.

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In Patient with Suspected Mild Traumatic Brain Injury Are Non-neurosurgical CT Abnormalities and GCS Score Associated with Cognitive Impairment?

Academic Emergency Medicine ◽

10.1197/j.aem.2007.03.868 ◽

2007 ◽

Vol 14 (5 Supplement 1) ◽

pp. S61-S62

Author(s):

L. Papa ◽

J. Demery ◽

E. Rees ◽

S. McCormick ◽

S. Heaton ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Cognitive Impairment ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Gcs Score

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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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