scholarly journals Early rehabilitation intervention is associated with significant positive functional outcomes in traumatic brain injury: a retrospective analysis

2021 ◽  
Author(s):  
Siddharth Rai ◽  
Mallikarjun Gunjiganvi ◽  
Awale Rupali Bhalachandra ◽  
Harleen Uppal
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcome ◽  
Retrospective Analysis ◽  
Trauma Center ◽  
Public Health Problem ◽  
Early Rehabilitation ◽  
Functional Improvement ◽  
Ethic Committee Approval ◽  
The Impact

Background: Traumatic brain injury (TBI) is a global public health problem affecting adversely health care system. While acute trauma care has been documented to improve outcomes, the impact of early rehabilitation on outcome is not well documented especially in the developing world like ours. Predicting functional outcome from admission variables helps in intervention development, and appropriate fund allocation for TBI treatment. Therefore, we accepted a challenge to do a retrospective study on TBI patients admitted in our newly established and resource limited trauma center. The aim of the study was to assess the effect of early rehabilitation on TBI patients on functional improvement and to prognosticate the improvement from early admission variables.Methods: Study was conducted at Apex Trauma Center, SGPGIMS, Lucknow analysis of prospectively maintained data. Retrospective analysis of records of patients, admitted within 48 hrs of moderate to severe injury, was done after Institute Ethic Committee approval. Statistical analysis used was regression analysis and multivariate analysis was done between possible risk factors and FIM gain.Results: There was significant FIM score improvement from admission to discharge (p<0.001). Factors associated with a higher FIM gain were admission FIM motor and cognitive scores, GCS score on admission and length of hospital stay.Conclusions: Our study strongly suggests that a dedicated rehabilitation programme, designed according to the functional needs of TBI patient, helps in improved functional outcome and recovery.

The Effect of Early Rehabilitation Intervention on Functional Outcome in Patients with Traumatic Brain Injury: A Systematic Review Protocol

2020 ◽  
Author(s):  
Hamidreza khankeh ◽  
Mohammad Eghbali ◽  
Sayed Ali Hosseini ◽  
Vafa Rahimi-Movaghar
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Early Rehabilitation ◽  
Functional Improvement ◽  
Factors Affecting ◽  
Review Protocol ◽  
Review Study

Abstract Introduction: Traumatic Brain Injury (TBI) is a serious health problem which is considered as a silent epidemic. Early rehabilitation interventions are among significant factors affecting the functional improvement, reduction of disability and impairment in patients. Initial observations indicate evidence for the effectiveness of such interventions; however, there is no related systematic review study conducted so far. The main objective of the present study is to investigate the prevalence of the interventions and to determine the effectiveness of such interventions on functional outcomes for patients with TBI. Methodology: In order to find related studies, several data bases such as Embase, Medline, Scopus, PubMed and Web of Science and also Gray Literature are observed. Inclusion and exclusion criteria are designed and modified by a team of experts. Observation of the content of the titles and abstracts will be done by two reviewers and then the data will be extracted and evaluated. All the studies published in English between 1990 and 2019 were included. Primary outcomes include the frequency of early rehabilitation interventions and the effects of such interventions on functional outcomes. If possible, meta-analysis will be conducted as well. Discussion: The results of this systematic review study will contribute to identification and clarification of different types of rehabilitation interventions and the effects of such interventions on TBI patients’ functional outcomes.

Abstract 4: The Effect of Prehospital Hypoxia and Hypotension on Outcome in Major Traumatic Brain Injury: A Deadly Combination

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Daniel W Spaite ◽  
Uwe Stolz ◽  
Bentley J Bobrow ◽  
Vatsal Chikani ◽  
Duane Sherrill ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Trauma Center ◽  
Treatment Guidelines ◽  
Controlled Study ◽  
Negative Effect ◽  
Severe Tbi ◽  
The Impact ◽  
The Relationship

BACKGROUND: Hypoxia (HOx) or hypotension (HT) occurring during the EMS management of major traumatic brain injury-TBI reduces survival. However, little is known about the impact of both HOx and HT, occurring together, on outcome. Only a handful of reports have studied the combination of prehospital HOx/HT in TBI and the largest of these only had 14 cases with both. Objectives: To evaluate the associations between mortality and prehospital HOx and HT, both separately and in combination. METHODS: All moderate/severe TBI cases (CDC Barell Matrix Type-1) in the Excellence in Prehospital Injury Care (EPIC) TBI Study (a statewide, before/after controlled study of the impact of implementing the EMS TBI Treatment Guidelines-NIH/NINDS: 1R01NS071049) from 1/1/08-6/30/12 were evaluated [exclusions: age<10; death before ED arrival; EMS O2 saturation-“sat”<11%; EMS SBP less than 40 or greater than 200; missing sat (5.4% of cases) or SBP (3.1% of cases)]. The relationship between mortality and HOx (sat <90) and/or HT (SBP<90) was assessed with crude and adjusted odds ratios (cOR, aOR) using multivariable logistic regression, controlling for important confounders (see Figure) and accounting for clustering by Trauma Center. RESULTS: 9194 cases were included [Median age: 46 (IQR: 26-65); Male: 68.1%]. 8109 (88.2%) had no HOx/HT, 535 (5.8%) had HOx only, 419 (4.6%) had HT only, and 131 (1.4%) had both HOx/HT. The Figure shows the cORs and aORs for death. CONCLUSION: In this large analysis of major TBI, prehospital HOx and HT were associated with significantly increased mortality. However, the combination of HT and HOx together had a profoundly-negative effect on survival even after controlling for significant confounders. In fact, the aOR for death in patients with both HOx/HT was more than 3 times greater than for those with HOx or HT alone. Since the TBI Guidelines emphasize the prevention and treatment of HOx and HT, their implementation has the potential to significantly impact outcome.

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.

Retrospective analysis of neuropsychological change in veterans following traumatic brain injury

2014 ◽  
Author(s):  
John W. Capps ◽  
Michael A. Francis ◽  
Jacob S. Wisnoski ◽  
Angela W. Sekely ◽  
Marlee Caldwell ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Retrospective Analysis

One-year costs of intensive care in pediatric patients with traumatic brain injury

2021 ◽  
Vol 27 (1) ◽  
pp. 79-86
Author(s):  
Era D. Mikkonen ◽  
Markus B. Skrifvars ◽  
Matti Reinikainen ◽  
Stepani Bendel ◽  
Ruut Laitio ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Brain Injury ◽  
Social Security ◽  
Functional Outcome ◽  
Injury Severity ◽  
Pediatric Population ◽  
Favorable Outcome ◽  
Index Hospitalization ◽  
Pediatric Tbi

OBJECTIVETraumatic brain injury (TBI) is a major cause of death and disability in the pediatric population. The authors assessed 1-year costs of intensive care in pediatric TBI patients.METHODSIn this retrospective multicenter cohort study of four academic ICUs in Finland, the authors used the Finnish Intensive Care Consortium database to identify children aged 0–17 years treated for TBI in ICUs between 2003 and 2013. The authors reviewed all patient health records and head CT scans for admission, treatment, and follow-up data. Patient outcomes included functional outcome (favorable outcome defined as a Glasgow Outcome Scale score of 4–5) and death within 6 months. Costs included those for the index hospitalization, rehabilitation, and social security up to 1 year after injury. To assess costs, the authors calculated the effective cost per favorable outcome (ECPFO).RESULTSIn total, 293 patients were included, of whom 61% had moderate to severe TBI (Glasgow Coma Scale [GCS] score 3–12) and 40% were ≥ 13 years of age. Of all patients, 82% had a favorable outcome and 9% died within 6 months of injury. The mean cost per patient was €48,719 ($54,557) (95% CI €41,326–€56,112). The index hospitalization accounted for 66%, rehabilitation costs for 27%, and social security costs for 7% of total healthcare costs. The ECPFO was €59,727 ($66,884) (95% CI €52,335–€67,120). A higher ECPFO was observed among patients with clinical and treatment-related variables indicative of parenchymal swelling and high intracranial pressure. Lower ECPFO was observed among patients with higher admission GCS scores and those who had epidural hematomas.CONCLUSIONSGreater injury severity increases ECPFO and is associated with higher postdischarge costs in pediatric TBI patients. In this pediatric cohort, over two-thirds of all resources were spent on patients with favorable functional outcome, indicating appropriate resource allocation.

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