scholarly journals Unraveling the Biopsychosocial Factors of Fatigue and Sleep Problems After Traumatic Brain Injury: Protocol for a Multicenter Longitudinal Cohort Study (Preprint)

2018 ◽  
Author(s):  
Jessica Bruijel ◽  
Sven Z Stapert ◽  
Annemiek Vermeeren ◽  
Jennie L Ponsford ◽  
Caroline M van Heugten
Keyword(s):  
Social Support ◽  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Brain Damage ◽  
Emotional State ◽  
Sleep Problems ◽  
Family Participation ◽  
Severe Tbi ◽  
Support Family

BACKGROUND Fatigue and sleep problems are common after a traumatic brain injury (TBI) and are experienced as highly distressing symptoms, playing a significant role in the recovery trajectory, and they can drastically impact the quality of life and societal participation of the patient and their family and friends. However, the etiology and development of these symptoms are still uncertain. OBJECTIVE The aim of this study is to examine the development of fatigue and sleep problems following moderate to severe TBI and to explore the changes in underlying biological (pain, brain damage), psychological (emotional state), and social (support family, participation) factors across time. METHODS This study is a longitudinal multicenter observational cohort study with 4 measurement points (3, 6, 12, and 18 months postinjury) including subjective questionnaires and cognitive tasks, preceded by 7 nights of actigraphy combined with a sleep diary. Recruitment of 137 moderate to severe TBI patients presenting at emergency and neurology departments or rehabilitation centers across the Netherlands is anticipated. The evolution of fatigue and sleep problems following TBI and their association with possible underlying biological (pain, brain damage), psychological (emotional state), and social (support family, participation) factors will be examined. RESULTS Recruitment of participants for this longitudinal cohort study started in October 2017, and the enrollment of participants is ongoing. The first results are expected at the end of 2020. CONCLUSIONS To the authors’ knowledge, this is the first study that examines the development of both post-TBI fatigue and sleep longitudinally within a biopsychosocial model in moderate to severe TBI using both subjective and objective measures. Identification of modifiable factors such as mood and psychosocial stressors may give direction to the development of interventions for fatigue and sleep problems post-TBI. CLINICALTRIAL Netherlands Trial Register NTR7162; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=7162 (Archived by WebCite at http://www.webcitation.org/6z3mvNLuy) INTERNATIONAL REGISTERED REPOR RR1-10.2196/11295

scholarly journals Early diagnosis of mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI): protocol for a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047305
Author(s):  
Susan Alcock ◽  
Divjeet Batoo ◽  
Sudharsana Rao Ande ◽  
Rob Grierson ◽  
Marco Essig ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Early Diagnosis ◽  
Hospital Mortality ◽  
Brain Death ◽  
Severe Traumatic Brain Injury ◽  
Health Research ◽  
Ct Perfusion ◽  
Severe Tbi

IntroductionSevere traumatic brain injury (TBI) is a catastrophic neurological condition with significant economic burden. Early in-hospital mortality (<48 hours) with severe TBI is estimated at 50%. Several clinical examinations exist to determine brain death; however, most are difficult to elicit in the acute setting in patients with severe TBI. Having a definitive assessment tool would help predict early in-hospital mortality in this population. CT perfusion (CTP) has shown promise diagnosing early in-hospital mortality in patients with severe TBI and other populations. The purpose of this study is to validate admission CTP features of brain death relative to the clinical examination outcome for characterizing early in-hospital mortality in patients with severe TBI.Methods and analysisThe Early Diagnosis of Mortality using Admission CT Perfusion in Severe Traumatic Brain Injury Patients study, is a prospective cohort study in patients with severe TBI funded by a grant from the Canadian Institute of Health Research. Adults aged 18 or older, with evidence of a severe TBI (Glasgow Coma Scale score ≤8 before initial resuscitation) and, on mechanical ventilation at the time of imaging are eligible. Patients will undergo CTP at the time of first imaging on their hospital admission. Admission CTP compares with the reference standard of an accepted bedside clinical assessment for brainstem function. Deferred consent will be used. The primary outcome is a binary outcome of mortality (dead) or survival (not dead) in the first 48 hours of admission. The planned sample size for achieving a sensitivity of 75% and a specificity of 95% with a CI of ±5% is 200 patients.Ethics and disseminationThis study has been approved by the University of Manitoba Health Research Ethics Board. The findings from our study will be disseminated through peer-reviewed journals and presentations at local rounds, national and international conferences. The public will be informed through forums at the end of the study.Trial registration numberNCT04318665

scholarly journals Early Dynamics of Cerebrospinal CD14+ Monocytes and CD15+ Granulocytes in Patients after Severe Traumatic Brain Injury: A Cohort Study

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Lukas Kurt Postl ◽  
Viktoria Bogner ◽  
Martijn van Griensven ◽  
Marc Beirer ◽  
Karl Georg Kanz ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Serum Albumin ◽  
Significant Influence ◽  
Severe Traumatic Brain Injury ◽  
Elective Surgery ◽  
Flow Analysis ◽  
Severe Tbi

In traumatic brain injury (TBI) the analysis of neuroinflammatory mechanisms gained increasing interest. In this context certain immunocompetent cells might play an important role. Interestingly, in the actual literature there exist only a few studies focusing on the role of monocytes and granulocytes in TBI patients. In this regard it has recently reported that the choroid plexus represents an early, selective barrier for leukocytes after brain injury. Therefore the aim of this study was to evaluate the very early dynamics of CD14+ monocytes and CD15+ granulocyte in CSF of patients following severe TBI with regard to the integrity of the BBB. Cytometric flow analysis was performed to analyze the CD14+ monocyte and CD15+ granulocyte population in CSF of TBI patients. The ratio of CSF and serum albumin as a measure for the BBB’s integrity was assessed in parallel. CSF samples of patients receiving lumbar puncture for elective surgery were obtained as controls. Overall 15 patients following severe TBI were enrolled. 10 patients were examined as controls. In patients, the monocyte population as well as the granulocyte population was significantly increased within 72 hours after TBI. The BBB’s integrity did not have a significant influence on the cell count in the CSF.

scholarly journals Use of Vasopressors Increases the Risk of Mortality in Severe Traumatic Brain Injury: A Nationwide Retrospective Cohort Study in Japan

2021 ◽  
Author(s):  
Sanae Hosomi ◽  
Tomotaka Sobue ◽  
Tetsuhisa Kitamura ◽  
Atsushi Hirayama ◽  
Hiroshi Ogura ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Cohort Study ◽  
Brain Injury ◽  
Propensity Score ◽  
Hospital Discharge ◽  
Severe Traumatic Brain Injury ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Severe Tbi

Abstract Background: Pharmacological elevation of blood pressure is frequently incorporated in severe traumatic brain injury (TBI) management algorithms. However, there is limited evidence on prevalent clinical practices regarding resuscitation for severe TBI using vasopressors. We conducted a nationwide retrospective cohort study to determine the association between the use of vasopressors and mortality following discharge from hospital in patients with severe TBI, and to determine whether the use of vasopressors affects emergency department mortality or the occurrence of cognitive dysfunction.Methods: Data were collected between January 2004 and December 2018 by the Japanese Trauma Data Bank, which includes data from 272 emergency hospitals in Japan. Adults aged ≥ 16 years with severe TBI, without other major injuries, were examined. A severe TBI was defined based on the Abbreviated Injury Scale code and a Glasgow Coma Scale score of 3–8 on admission. Multivariable and propensity score matching analyses were performed. Statistical significance was assessed using a 95% CI.Results: In total, 10,284 patients were eligible for analysis, with 650 patients (6.32%) included in the vasopressor group and 9,634 patients (93.68%) included in the non-vasopressor group. The proportion of deaths on hospital discharge was higher in the vasopressor group than in the non-vasopressor group (81.69% [531/650] vs. 40.21% [3,874/9,634]). This finding was confirmed by multivariable logistic regression analysis (adjusted odds ratio [OR], 5.71; 95% confidence interval [CI]: 4.56–7.16). Regarding propensity score-matched patients, the proportion of deaths on hospital discharge remained higher in the vasopressor group than in the non-vasopressor group (81.66% [530/649] vs. 50.69% [329/649]) (OR, 4.33; 95% CI: 3.37–5.57). The vasopressor group had a higher emergency department mortality rate than the non-vasopressor group (8.01% [52/649] vs. 2.77% [18/649]) (OR, 3.05; 95% CI: 1.77–5.28). There was no reduction in complications of cognitive disorders in the vasopressor group (5.39% [35/649] vs. 5.55% [36/649]) (OR, 0.97; 95% CI: 0.60–1.57).Conclusions: In this population, the use of vasopressors for severe TBI was associated with higher mortality on hospital discharge. Our results suggest that vasopressors should be avoided in most cases of severe TBI.

scholarly journals Pattern and Outcome of Pediatric Traumatic Brain Injury: A Prospective Cohort Study at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

2019 ◽  
Author(s):  
Tuji Bedry ◽  
Henok Tadele
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Intracranial Bleeding ◽  
Southern Ethiopia ◽  
Severe Tbi ◽  
Hawassa University

Abstract Background Traumatic brain injury (TBI), a major public health problem, is the most common cause of death/disability in children. Glasgow coma scale is used to assess, decide treatment and follow up of TBI. TBI causes and outcome data are scarce from sub-Saharan Africa, non-existent from Ethiopia. We aimed to document pattern and predictors of childhood TBI outcome in a teaching hospital, Southern Ethiopia. METHODS Prospective cohort study was conducted from September 2017 to September 2018 among pediatrics TBI presented to Hawassa University Hospital. Data were collected by structured questionnaires and analyzed using SPSS version 20. Logistic regression was carried out and significant associations were declared at p-value of < 0.05. RESULT During 1year period there were 4258 emergency room(ER) visits, TBI contributed to 317(7.4%) cases. The mean age of study subjects was 7.66±3.88 years. Boys, predominantly above 5years of age, comprise 218(68.8%) of study subjects with male to female ratio of 2.2:1. Pedestrian RTA 119 (37.5%) and falls 104 (32.8%) were the commonest causes of TBI. Mild, moderate, and severe TBI were documented in 231(72.9%), 61(19.2%), and 25(7.9%) of cases respectively. Most of TBI cases presented within 24hrs of injury 258(81.4%). Recovery with no neurologic deficit, 267(84.2%); focal neurologic deficit, 30(9.5%); depressed mentation, 10(3.2%) and death 10(3.2%) were documented. Presence of increased intracranial pressure(ICP) at admission [AOR: 1.415 (95% CI: 0.458-9.557)], severe TBI [AOR: 2.103 (95% CI: 0.965-4.524)], presence of hyperglycemia [AOR: 2.318 (95% CI: 0.873-7.874)] and head computed tomographic(CT) scans of contusion, diffuse axonal injury (DAI) or intracranial bleeding [AOR: 2.45 (95% CI: 0.811-7.952)] were found to be predictors of TBI outcome. CONCLUSION TBI contributed to 7.4% of pediatric ER visits. Boys above 5years of age were highly affected. Pedestrian RTA and falls, early presentation (<24hrs of injury) and mild form of TBI were the common documented patterns. Presence of increased ICP, hyperglycemia, severe TBI and CT findings of contusion, DAI/intracranial bleeding were predictors of poor outcome. Public awareness on road safety, childhood safety in preventing falls/animal injuries, closer follow-up of TBI cases for ICP and glycemic controls are recommended.

Clinical Significance of Vascular Occlusive Events following Moderate-to-Severe Traumatic Brain Injury: An Observational Cohort Study

2022 ◽  
Author(s):  
Alexander Fletcher-Sandersjöö ◽  
Charles Tatter ◽  
Jonathan Tjerkaski ◽  
Jiri Bartek Jr ◽  
Mikael Svensson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Clinical Significance ◽  
Skull Fracture ◽  
Observational Cohort Study ◽  
Vein Thrombosis ◽  
Therapeutic Opportunity ◽  
Severe Tbi ◽  
Observational Cohort

AbstractPreventing hemorrhage progression is a potential therapeutic opportunity in traumatic brain injury (TBI) management, but its use has been limited by fear of provoking vascular occlusive events (VOEs). However, it is currently unclear whether VOE actually affects outcome in these patients. The aim of this study was to determine incidence, risk factors, and clinical significance of VOE in patients with moderate-to-severe TBI. A retrospective observational cohort study of adults (≥15 years) with moderate-to-severe TBI was performed. The presence of a VOE during hospitalization was noted from hospital charts and radiological reports. Functional outcome, using the Glasgow Outcome Scale (GOS), was assessed at 12 months posttrauma. Univariate and multivariate logistic regressions were used for endpoint assessment. In total, 848 patients were included, with a median admission Glasgow Coma Scale of 7. A VOE was detected in 54 (6.4%) patients, of which cerebral venous thrombosis was the most common (3.2%), followed by pulmonary embolism (1.7%) and deep vein thrombosis (1.3%). Length of ICU stay (p < 0.001), body weight (p = 0.002), and skull fracture (p = 0.004) were independent predictors of VOE. VOE development did not significantly impact 12-month GOS, even after adjusting for potential confounders using propensity score matching. In conclusion, VOE in moderate-to-severe TBI patients was relatively uncommon, and did not affect 12-month GOS. This suggests that the potential benefit of treating bleeding progression might outweigh the risks of VOE.

scholarly journals Pediatric Sleep Difficulties after Moderate–Severe Traumatic Brain Injury

2013 ◽  
Vol 19 (7) ◽  
pp. 829-834 ◽  
Author(s):  
Ruth E. Sumpter ◽  
Liam Dorris ◽  
Thomas Kelly ◽  
Thomas M. McMillan
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Behavioral Problems ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Self Report ◽  
Sleep Habits ◽  
Severe Tbi ◽  
Pediatric Tbi ◽  
Sleep Difficulties

AbstractThe objective of this study is to systematically investigate sleep following moderate–severe pediatric traumatic brain injury (TBI). School-aged children with moderate–severe TBI identified via hospital records were invited to participate, along with a school-age sibling. Subjective reports and objective actigraphy correlates of sleep were recorded: Children's Sleep Habits Questionnaire (CSHQ), Sleep Self-Report questionnaire (SSR), and 5-night actigraphy. TBI participants (n= 15) and their siblings (n= 15) participated. Significantly more sleep problems were parent-reported (CSHQ:p= 0.003;d= 1.57), self-reported (SSR:p= 0.003;d= 1.40), and actigraph-recorded in the TBI group (sleep efficiency:p= 0.003;d= 1.23; sleep latency:p= 0.018;d= 0.94). There was no evidence of circadian rhythm disorders, and daytime napping was not prevalent. Moderate–severe pediatric TBI was associated with sleep inefficiency in the form of sleep onset and maintenance problems. This preliminary study indicates that clinicians should be aware of sleep difficulties following pediatric TBI, and their potential associations with cognitive and behavioral problems in a group already at educational and psychosocial risk. (JINS, 2013,19, 1–6)

Increasing Leisure Activity Following Severe Traumatic Brain Injury: Does It Make a Difference?

2006 ◽  
Vol 7 (2) ◽  
pp. 107-118 ◽  
Author(s):  
Jacinta M. Douglas ◽  
Maree Dyson ◽  
Peter Foreman
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Repeated Measures ◽  
Community Integration ◽  
Leisure Activities ◽  
Repeated Measures Design ◽  
Severe Tbi

AbstractThe majority of people with severe traumatic brain injury (TBI) experience long-term disability and are unable to return to their usual activities. Services that offer community social and leisure participation programs are likely to reduce the social burden associated with severe TBI. The aim of this study was to gain an understanding of the personal effects of becoming engaged in community leisure activities. It was hypothesised that adults with severe TBI who participated regularly in leisure activities over a 6-month period would show measurable positive change in the domains of community integration, social support, mental health and quality of life (QOL). Participants numbered 25 adults (mean age 36.95 years) who had been referred to community leisure programs participated in the study. All participants had sustained severe injuries (post-traumatic amnesia > 1 month). A repeated measures design over 6 months was used. Assessment involved a semistructured interview, global subjective QOL rating and administration of standardised measures: SF-12v2, Neurobehavioral Functioning Inventory, Instrumental-Expressive Social Support-Scale, and Community Integration Questionnaire. Adults who participated regularly over 6 months reported positive and statistically significant changes in social integration and mental health. These findings support the use of assisted community participation programs for adults with severe TBI.

scholarly journals Functional Outcomes 6 Months After Severe Traumatic Brain Injury Following Admission Into Intensive Care Unit: A Cohort Study in Two Tertiary Hospitals

2018 ◽  
Vol 28 (7) ◽  
pp. 830-851
Author(s):  
Salizar M. Ludin ◽  
Nor’ain A. Rashid ◽  
Mohamed S. Awang ◽  
Mohd B. M. Nor
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Odds Ratio ◽  
Functional Outcomes ◽  
Psychosocial Problems ◽  
Future Research ◽  
Post Injury ◽  
Severe Tbi

Severe traumatic brain injury (TBI) survivors show physical and functional improvements but continue to have cognitive and psychosocial problems throughout recovery. However, the functional outcome of severe TBI in Malaysia is unknown. The objective of this study is to measure the functional outcomes of severe TBI within 6 months post-injury. A cohort study was done on 33 severe TBI survivors. The Glasgow Outcome Scale–Extended (GOSE) was used in this study. The mean age of the participants was 31.79 years (range: 16-73 years). The logistic regression model was statistically significant, χ²(5, N = 33) = 29.09, p < .001. The length of stay (LOS) in incentive care unit ( p = .049, odds ratio = 6.062) and duration on ventilator ( p = .048, odds ratio = 0.083) were good predictors of the functional outcomes. Future research should focus on larger sample size of severe TBI in Malaysia.

scholarly journals Role of CCL2 (MCP-1) in Traumatic Brain Injury (TBI): Evidence from Severe TBI Patients and CCL2−/− Mice

2009 ◽  
Vol 30 (4) ◽  
pp. 769-782 ◽  
Author(s):  
Bridgette D Semple ◽  
Nicole Bye ◽  
Mario Rancan ◽  
Jenna M Ziebell ◽  
M Cristina Morganti-Kossmann
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Damage ◽  
Closed Head Injury ◽  
Lesion Volume ◽  
Cellular Mechanisms ◽  
Cytokine Network ◽  
Secondary Brain Damage ◽  
Severe Tbi

Cerebral inflammation involves molecular cascades contributing to progressive damage after traumatic brain injury (TBI). The chemokine CC ligand-2 (CCL2) (formerly monocyte chemoattractant protein-1, MCP-1) is implicated in macrophage recruitment into damaged parenchyma after TBI. This study analyzed the presence of CCL2 in human TBI, and further investigated the role of CCL2 in physiological and cellular mechanisms of secondary brain damage after TBI. Sustained elevation of CCL2 was detected in the cerebrospinal fluid (CSF) of severe TBI patients for 10 days after trauma, and in cortical homogenates of C57Bl/6 mice, peaking at 4 to 12 h after closed head injury (CHI). Neurological outcome, lesion volume, macrophage/microglia infiltration, astrogliosis, and the cerebral cytokine network were thus examined in CCL2-deficient (−/−) mice subjected to CHI. We found that CCL2−/− mice showed altered production of multiple cytokines acutely (2 to 24 h); however, this did not affect lesion size or cell death within the first week after CHI. In contrast, by 2 and 4 weeks, a delayed reduction in lesion volume, macrophage accumulation, and astrogliosis were observed in the injured cortex and ipsilateral thalamus of CCL2−/− mice, corresponding to improved functional recovery as compared with wild-type mice after CHI. Our findings confirm the significant role of CCL2 in mediating post-traumatic secondary brain damage.

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