scholarly journals Cerebral venous thrombosis in traumatic brain injury: a cause of secondary insults and added mortality

2020 ◽  
pp. 1-9
Author(s):  
Dag Ferner Netteland ◽  
Magnus Mejlænder-Evjensvold ◽  
Nils O. Skaga ◽  
Else Charlotte Sandset ◽  
Mads Aarhus ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Venous Thrombosis ◽  
Subgroup Analysis ◽  
Severity Score ◽  
Cerebral Venous Thrombosis ◽  
Control Group ◽  
Mr Venography ◽  
Adjusted Analysis ◽  
Icd 10

OBJECTIVECerebral venous thrombosis (CVT) is increasingly recognized in traumatic brain injury (TBI), but its complications and effect on outcome remain undetermined. In this study, the authors characterize the complications and outcome effect of CVT in TBI patients.METHODSIn a retrospective, case-control study of patients included in the Oslo University Hospital trauma registry and radiology registry from 2008 to 2014, the authors identified TBI patients with CVT (cases) and without CVT (controls). The groups were matched regarding Abbreviated Injury Scale 1990, update 1998 (AIS’98) head region severity score 3–6. Cases were identified by AIS’98 or ICD-10 code for CVT and CT or MR venography findings confirmed to be positive for CVT, whereas controls had no AIS’98 or ICD-10 code for CVT and CT venography or MR venography findings confirmed to be negative for CVT. All images were reviewed by a neuroradiologist. Rates of complications due to CVT were recorded, and mortality was assessed both unadjusted and in a multivariable logistic regression analysis adjusting for initial Glasgow Coma Scale score, Rotterdam CT score, and Injury Severity Score. Complications and mortality were also assessed in prespecified subgroup analysis according to CVT location and degree of occlusion from CVT. Lastly, mortality was assessed in an exploratory subgroup analysis according to the presence of complications from CVT.RESULTSThe CVT group (73 patients) and control group (120 patients) were well matched regarding baseline characteristics. In the CVT group, 18% developed venous infarction, 11% developed intracerebral hemorrhage, and 19% developed edema, all representing complications secondary to CVT. Unadjusted 30-day mortality was 16% in the CVT group and 4% in the no-CVT group (p = 0.004); however, the difference was no longer significant in the adjusted analysis (OR 2.24, 95% CI 0.63–8.03; p = 0.215). Subgroup analysis by CVT location showed an association between CVT location and rate of complications and an unadjusted 30-day mortality of 50% for midline or bilateral CVT and 8% for unilateral CVT compared with 4% for no CVT (p < 0.001). The adjusted analysis showed a significantly higher mortality in the midline/bilateral CVT group than in the no-CVT group (OR 8.41, 95% CI 1.56–45.25; p = 0.032).CONCLUSIONSThere is a significant rate of complications from CVT in TBI patients, leading to secondary brain insults. The rate of complications is dependent on the anatomical location of the CVT, and midline and bilateral CVT is associated with an increased 30-day mortality in TBI patients.

scholarly journals Tranexamic Acid is Associated with Reduced Mortality, Hemorrhagic Expansion, and Vascular Occlusive Events in Traumatic Brain Injury – Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Julius July ◽  
Raymond Pranata
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Tranexamic Acid ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Low Risk ◽  
Control Group ◽  
Vein Thrombosis ◽  
Neurosurgical Intervention

Abstract Introduction This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of tranexamic acid (TXA) on traumatic brain injury (TBI). Methods We performed a systematic literature search on topics that compared intravenous TXA to placebo in patients with TBI up until January 2019 from several electronic databases. Results There were 30.522‬ patients from 7 studies. Meta-analysis showed that TXA was associated with reduced mortality (RR 0.92 [0.88, 0.97], p=0.002; I 2 : 0%) and hemorrhagic expansion (RR 0.79 [0.64, 0.97], p=0.03; I 2 : 0%). Both TXA and control group has a similar need for neurosurgical intervention (p=0.87) and unfavourable Glasgow Outcome Scale (GOS) (p=0.59). The rate for vascular occlusive events (p=0.09), and its deep vein thrombosis subgroup (p=0.23), pulmonary embolism subgroup (p=1), stroke subgroup (p=0.38), and myocardial infarction subgroup (p=0.15) were similar in both groups. Subgroup analysis on RCTs with low risk of bias showed that TXA was associated with reduced mortality and hemorrhagic expansion. TXA was associated with reduced vascular occlusive events (RR 0.85 [0.73, 0.99], p=0.04; I 2 : 4%). GRADE was performed for the RCT with low risk of bias subgroup, it showed a high certainty of evidence for lower mortality, less hemorrhage expansion, and similar need for neurosurgical intervention in TXA group compared to placebo group. Conclusion TXA was associated with reduced mortality and hemorrhagic expansion but similar need for neurosurgical intervention and unfavorable GOS. Vascular occlusive events were slightly lower in TXA group on subgroup analysis of RCTs with low risk of bias.

scholarly journals Catechins decrease neurological severity score through apoptosis and neurotropic factor pathway in rat traumatic brain injury

2017 ◽  
Vol 36 (2) ◽  
pp. 110
Author(s):  
Retty Ratnawati ◽  
Annisa Nurul Arofah ◽  
Anastasia Novitasari ◽  
Sartika Dewi Utami ◽  
Made Ayu Hariningsih ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severity Score ◽  
Caspase 3 ◽  
Negative Control Group ◽  
Positive Control ◽  
Negative Control ◽  
Control Group ◽  
Caspase 8 ◽  
Neurotropic Factor

<p>BACKGROUND<br />Catechins inhibits apoptosis through anti oxidant and anti inflamation pathway. Catechins also increases brain-derived neurotrophic factor (BDNF). There was a few research that explained the role of catechins in traumatic brain injury (TBI). The objective of the study was to evaluate the effect of catechins administration on neurologic severity score (NSS) through apoptosis and neurotropic pathway in traumatic brain injury rat model.</p><p>METHODS<br />A post test only controlled group design was performed using traumatic brain injury rat (Rattus novergicus) model through weight drop models. It was devided into negative control group, positive control group, TBI+catechins 513 mg/kgBW, TBI+catechins 926 mg/kgBW, TBI+catechins 1113 mg/kgBW. NSS was measured in the first hours, day three, and day seven. The expressions of NFkB, TNFa, Bcl-2, Bax, caspase 3, caspase 8, BDNF, and the numbers of apoptosis cells were evaluated by imunohistochemystry method. One way Anova and Kruskal Wwallis were used to analyse the data.</p><p>Results <br />TNFa, caspase 8, number of apoptosis cells were significantly decreased on the seventh day administration compared to the third day administration (p&lt;0.05). Catechins increased the expression of Bcl-2/Bax and BDNF significantly (p&lt;0.05). Yet, there were no significant differences between expression of caspase 3, NSS, Bcl-2/Bax ratio, and BDNF toward third days administration of catechins compared with seven days administration (p&gt;0.050).</p><p>Conclusions<br />Administration of catechins decreased NSS through inhibiting inflammation and apoptosis, as well as induced the neurotrophic factors in rat brain injury. Catechins may serve as a potential intervention for TBI.</p>

Evaluating the utility of ICD-10 diagnostic criteria for postconcussion syndrome following mild traumatic brain injury

2006 ◽  
Vol 12 (1) ◽  
pp. 111-118 ◽  
Author(s):  
SHAUNA KASHLUBA ◽  
JOSEPH E. CASEY ◽  
CHRIS PANIAK
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diagnostic Criteria ◽  
Mild Traumatic Brain Injury ◽  
International Classification Of Diseases ◽  
Control Group ◽  
Postconcussion Syndrome ◽  
Post Injury ◽  
Icd 10 ◽  
Time Periods

The present study investigated the utility of the International Classification of Diseases and Related Health Problems, 10th edition (ICD-10) diagnostic criteria for postconcussion syndrome (PCS) symptoms by comparing symptom endorsement rates in a group of patients with mild traumatic brain injury (MTBI) to those of a noninjured control group at one month and three months post-injury. The 110 MTBI patients and 118 control participants were group-matched on age, gender, and education level. Seven of the nine self-reported ICD-10 PCS symptoms differentiated the groups at one month post-injury and two symptoms differentiated the groups at three months post-injury: symptom endorsement rates were higher in the MTBI group at both time periods. Fatiguing quickly and dizziness/vertigo best differentiated the groups at both time periods, while depression and anxiety/tension failed to differentiate the groups at either time period. Collectively, the ICD-10 PCS symptoms accurately classified the MTBI patients at one month post-injury, with the optimal positive test threshold of endorsement of five symptoms coinciding with a sensitivity and specificity of 73% and 61%, respectively. The ICD-10 PCS symptoms were unable to accurately classify the MTBI patients at three months post-injury. (JINS, 2006,12, 111–118.)

scholarly journals Remotely delivered environmental enrichment intervention for traumatic brain injury: Study protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e039767
Author(s):  
Zorry Belchev ◽  
Mary Ellene Boulos ◽  
Julia Rybkina ◽  
Kadeen Johns ◽  
Eliyas Jeffay ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Active Control ◽  
Environmental Enrichment ◽  
Spatial Navigation ◽  
Controlled Trial ◽  
Control Group ◽  
Hippocampal Atrophy ◽  
Active Control Group ◽  
Navigation Group

IntroductionIndividuals with moderate-severe traumatic brain injury (m-sTBI) experience progressive brain and behavioural declines in the chronic stages of injury. Longitudinal studies found that a majority of patients with m-sTBI exhibit significant hippocampal atrophy from 5 to 12 months post-injury, associated with decreased cognitive environmental enrichment (EE). Encouragingly, engaging in EE has been shown to lead to neural improvements, suggesting it is a promising avenue for offsetting hippocampal neurodegeneration in m-sTBI. Allocentric spatial navigation (ie, flexible, bird’s eye view approach), is a good candidate for EE in m-sTBI because it is associated with hippocampal activation and reduced ageing-related volume loss. Efficacy of EE requires intensive daily training, prohibitive within most current health delivery systems. The present protocol is a novel, remotely delivered and self-administered intervention designed to harness principles from EE and allocentric spatial navigation to offset hippocampal atrophy and potentially improve hippocampal functions such as navigation and memory for patients with m-sTBI.Methods and analysisEighty-four participants with chronic m-sTBI are being recruited from an urban rehabilitation hospital and randomised into a 16-week intervention (5 hours/week; total: 80 hours) of either targeted spatial navigation or an active control group. The spatial navigation group engages in structured exploration of different cities using Google Street View that includes daily navigation challenges. The active control group watches and answers subjective questions about educational videos. Following a brief orientation, participants remotely self-administer the intervention on their home computer. In addition to feasibility and compliance measures, clinical and experimental cognitive measures as well as MRI scan data are collected pre-intervention and post-intervention to determine behavioural and neural efficacy.Ethics and disseminationEthics approval has been obtained from ethics boards at the University Health Network and University of Toronto. Findings will be presented at academic conferences and submitted to peer-reviewed journals.Trial registration numberVersion 3, ClinicalTrials.gov Registry (NCT04331392).

scholarly journals Multisite medical record review of emergency department visits for traumatic brain injury

2021 ◽  
Vol 27 (S1) ◽  
pp. i42-i48
Author(s):  
Barbara A Gabella ◽  
Jeanne E Hathaway ◽  
Beth Hume ◽  
Jewell Johnson ◽  
Julia F Costich ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Skull Fracture ◽  
Signs And Symptoms ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Intracranial Injury ◽  
Imaging Results ◽  
Icd 10

BackgroundIn 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes.MethodsFour study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI).ResultsPPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%.DiscussionICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

Combined Memory Training: An Approach for Episodic Memory Deficits in Traumatic Brain Injury

2021 ◽  
Vol 30 (2S) ◽  
pp. 920-932
Author(s):  
Elisabeth Cochran D'Angelo ◽  
Beth A. Ober ◽  
Gregory K. Shenaut
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Treatment Group ◽  
Episodic Memory ◽  
Semantic Memory ◽  
Memory Deficits ◽  
Control Group ◽  
Wait List ◽  
Wait List Control Group ◽  
Wait List Control

Purpose The study aimed to test a combination of semantic memory and traditional episodic memory therapies on episodic memory deficits in adults with traumatic brain injury. Method Twenty-five participants who had been diagnosed with traumatic brain injury and had episodic memory deficits were randomly assigned either to a combined memory treatment group ( n = 16) or to a wait-list control group ( n = 9). Before and after treatment, they completed standardized neuropsychological testing for episodic memory and related cognitive domains, including the California Verbal Learning Test–Second Edition, the Controlled Oral Word Association Test, the University of Southern California Repeatable Episodic Memory Test, the Wechsler Abbreviated Scale of Intelligence–Second Edition Matrices, the Test of Everyday Attention, the Memory Assessment Clinics Self-Rating Scale, the Expressive Vocabulary Test–Second Edition, and the Story Recall subtest from the Rivermead Behavioural Memory Test. In addition to a traditional episodic memory therapy, the treatment group received a novel semantic memory–focused therapy, which involved participants finding meaningful connections between diverse concepts represented by sets of two or three words. Results The treatment group demonstrated statistically significant improvement in memory for list learning tasks, and there was a significant difference from pretest to posttest between the treatment group and the wait-list control group. Clinical significance was demonstrated for the treatment group using minimally important difference calculations. Conclusion Combined memory therapy resulted in significant improvements in episodic memory, semantic memory, and attention, in comparison to no treatment. Supplemental Material https://doi.org/10.23641/asha.14049968

Validation of ICD-10 codes shows intracranial venous thrombosis incidence to be higher than previously reported

2018 ◽  
Vol 49 (1) ◽  
pp. 58-61 ◽  
Author(s):  
Joel D Handley ◽  
Hedley CA Emsley
Keyword(s):  
Positive Predictive Value ◽  
Cerebral Infarction ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
International Classification Of Diseases ◽  
Coding System ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
In Pregnancy

Background: Intracranial venous thrombosis (ICVT) accounts for around 0.5% of all stroke cases. There have been no previously published studies of the International Classification of Diseases, Tenth Edition (ICD-10) validation for the identification of ICVT admissions in adults. Objective: The aims of this study were to validate and quantify the performance of the ICD-10 coding system for identifying cases of ICVT in adults and to derive an estimate of incidence. Method: Administrative data were collected for all patients admitted to a regional neurosciences centre over a 5-year period. We searched for the following ICD-10 codes at any position: G08.X (intracranial and intraspinal phlebitis and thrombophlebitis), I67.6 (non-pyogenic thrombosis of intracranial venous system), I63.6 (cerebral infarction due to cerebral venous thrombosis, non-pyogenic), O22.5 (cerebral venous thrombosis in pregnancy) and O87.3 (cerebral venous thrombosis in the puerperium). Results: Sixty-five admissions were identified by at least one of the relevant ICD-10 codes. The overall positive predictive value (PPV) for confirmed ICVT from all of the admissions combined was 92.3% (60 out of 65) with the results for each code as follows: G08.X 91.5% (54 of 59), O22.5 100% (4 of 4), I67.6 100% (1 of 1), I63.6 100% (1 of 1) and O87.3 100% (1 of 1). There were 40 unique cases of ICVT over a 5-year period giving an annual incidence of ICVT of 5 per million. Conclusions: All codes gave a high PPV. Implications for practice: As demonstrated in previous studies, the incidence of ICVT may be higher than previously thought.

Profiles of Executive Function Across Children with Distinct Brain Disorders: Traumatic Brain Injury, Stroke, and Brain Tumor

2017 ◽  
Vol 23 (7) ◽  
pp. 529-538 ◽  
Author(s):  
Gabriel C. Araujo ◽  
Tanya N. Antonini ◽  
Vicki Anderson ◽  
Kathryn A. Vannatta ◽  
Christina G. Salley ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Tumor ◽  
Executive Function ◽  
Brain Injury ◽  
Executive Functions ◽  
Control Group ◽  
Medical Illness ◽  
Brain Disorders ◽  
Brain Disorder ◽  
Orthopedic Injury

AbstractObjectives:This study examined whether children with distinct brain disorders show different profiles of strengths and weaknesses in executive functions, and differ from children without brain disorder.Methods:Participants were children with traumatic brain injury (N=82; 8–13 years of age), arterial ischemic stroke (N=36; 6–16 years of age), and brain tumor (N=74; 9–18 years of age), each with a corresponding matched comparison group consisting of children with orthopedic injury (N=61), asthma (N=15), and classmates without medical illness (N=68), respectively. Shifting, inhibition, and working memory were assessed, respectively, using three Test of Everyday Attention: Children’s Version (TEA-Ch) subtests: Creature Counting, Walk-Don’t-Walk, and Code Transmission. Comparison groups did not differ in TEA-Ch performance and were merged into a single control group. Profile analysis was used to examine group differences in TEA-Ch subtest scaled scores after controlling for maternal education and age.Results:As a whole, children with brain disorder performed more poorly than controls on measures of executive function. Relative to controls, the three brain injury groups showed significantly different profiles of executive functions. Importantly, post hoc tests revealed that performance on TEA-Ch subtests differed among the brain disorder groups.Conclusions:Results suggest that different childhood brain disorders result in distinct patterns of executive function deficits that differ from children without brain disorder. Implications for clinical practice and future research are discussed. (JINS, 2017,23, 529–538)

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