Outcomes after Complicated and Uncomplicated Mild Traumatic Brain Injury at Three-and Six-Months Post-Injury: Results from the CENTER-TBI Study

The objective of this study was to provide a comprehensive examination of the relation of complicated and uncomplicated mild traumatic brain injury (mTBI) with multidimensional outcomes at three- and six-months after TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) research project. Patients after mTBI (Glasgow Coma scale (GCS) score of 13–15) enrolled in the study were differentiated into two groups based on computed tomography (CT) findings: complicated mTBI (presence of any traumatic intracranial injury on first CT) and uncomplicated mTBI (absence of any traumatic intracranial injury on first CT). Multidimensional outcomes were assessed using seven instruments measuring generic and disease-specific health-related quality of life (HRQoL) (SF-36 and QOLIBRI), functional outcome (GOSE), and psycho-social domains including symptoms of post-traumatic stress disorder (PTSD) (PCL-5), depression (PHQ-9), and anxiety (GAD-7). Data were analyzed using a multivariate repeated measures approach (MANOVA-RM), which inspected mTBI groups at three- and six-months post injury. Patients after complicated mTBI had significantly lower GOSE scores, reported lower physical and mental component summary scores based on the SF-36 version 2, and showed significantly lower HRQoL measured by QOLIBRI compared to those after uncomplicated mTBI. There was no difference between mTBI groups when looking at psychological outcomes, however, a slight improvement in PTSD symptoms and depression was observed for the entire sample from three to six months. Patients after complicated mTBI reported lower generic and disease specific HRQoL and worse functional outcome compared to individuals after uncomplicated mTBI at three and six months. Both groups showed a tendency to improve from three to six months after TBI. The complicated mTBI group included more patients with an impaired long-term outcome than the uncomplicated group. Nevertheless, patients, clinicians, researchers, and decisions-makers in health care should take account of the short and long-term impact on outcome for patients after both uncomplicated and complicated mTBI.

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Exosomal MicroRNA Differential Expression in Plasma of Young Adults with Chronic Mild Traumatic Brain Injury and Healthy Control

Biomedicines ◽

10.3390/biomedicines10010036 ◽

2021 ◽

Vol 10 (1) ◽

pp. 36

Author(s):

Rany Vorn ◽

Maiko Suarez ◽

Jacob C. White ◽

Carina A. Martin ◽

Hyung-Suk Kim ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Young Adults ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Pathophysiological Mechanism ◽

Post Injury ◽

Persistent Symptoms ◽

Healthy Control ◽

Underlying Mechanisms

Chronic mild traumatic brain injury (mTBI) has long-term consequences, such as neurological disability, but its pathophysiological mechanism is unknown. Exosomal microRNAs (exomiRNAs) may be important mediators of molecular and cellular changes involved in persistent symptoms after mTBI. We profiled exosomal microRNAs (exomiRNAs) in plasma from young adults with or without a chronic mTBI to decipher the underlying mechanisms of its long-lasting symptoms after mTBI. We identified 25 significantly dysregulated exomiRNAs in the chronic mTBI group (n = 29, with 4.48 mean years since the last injury) compared to controls (n = 11). These miRNAs are associated with pathways of neurological disease, organismal injury and abnormalities, and psychological disease. Dysregulation of these plasma exomiRNAs in chronic mTBI may indicate that neuronal inflammation can last long after the injury and result in enduring and persistent post-injury symptoms. These findings are useful for diagnosing and treating chronic mTBIs.

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Self-Reported Complaints as Prognostic Markers for Outcome After Mild Traumatic Brain Injury in Elderly: A Machine Learning Approach

Frontiers in Neurology ◽

10.3389/fneur.2021.751539 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mayra Bittencourt ◽

Sebastián A. Balart-Sánchez ◽

Natasha M. Maurits ◽

Joukje van der Naalt

Keyword(s):

Machine Learning ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Elderly Patients ◽

Neck Pain ◽

Functional Outcome ◽

Mild Traumatic Brain Injury ◽

Prognostic Markers ◽

The Elderly ◽

Post Injury

Self-reported complaints are common after mild traumatic brain injury (mTBI). Particularly in the elderly with mTBI, the pre-injury status might play a relevant role in the recovery process. In most mTBI studies, however, pre-injury complaints are neither analyzed nor are the elderly included. Here, we aimed to identify which individual pre- and post-injury complaints are potential prognostic markers for incomplete recovery (IR) in elderly patients who sustained an mTBI. Since patients report many complaints across several domains that are strongly related, we used an interpretable machine learning (ML) approach to robustly deal with correlated predictors and boost classification performance. Pre- and post-injury levels of 20 individual complaints, as self-reported in the acute phase, were analyzed. We used data from two independent studies separately: UPFRONT study was used for training and validation and ReCONNECT study for independent testing. Functional outcome was assessed with the Glasgow Outcome Scale Extended (GOSE). We dichotomized functional outcome into complete recovery (CR; GOSE = 8) and IR (GOSE ≤ 7). In total 148 elderly with mTBI (median age: 67 years, interquartile range [IQR]: 9 years; UPFRONT: N = 115; ReCONNECT: N = 33) were included in this study. IR was observed in 74 (50%) patients. The classification model (IR vs. CR) achieved a good performance (the area under the receiver operating characteristic curve [ROC-AUC] = 0.80; 95% CI: 0.74–0.86) based on a subset of only 8 out of 40 pre- and post-injury complaints. We identified increased neck pain (p = 0.001) from pre- to post-injury as the strongest predictor of IR, followed by increased irritability (p = 0.011) and increased forgetfulness (p = 0.035) from pre- to post-injury. Our findings indicate that a subset of pre- and post-injury physical, emotional, and cognitive complaints has predictive value for determining long-term functional outcomes in elderly patients with mTBI. Particularly, post-injury neck pain, irritability, and forgetfulness scores were associated with IR and should be assessed early. The application of an ML approach holds promise for application in self-reported questionnaires to predict outcomes after mTBI.

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Patients with mild traumatic brain injury: Immediate and long-term outcome compared to intra-cranial injuries on CT scan

Brain Injury ◽

10.1080/02699050600832569 ◽

2006 ◽

Vol 20 (11) ◽

pp. 1131-1137 ◽

Cited By ~ 31

Author(s):

Charlotte Sadowski-Cron ◽

Jörg Schneider ◽

Pascal Senn ◽

Bogdan P. Radanov ◽

Pietro Ballinari ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Ct Scan ◽

Mild Traumatic Brain Injury ◽

Term Outcome ◽

Long Term Outcome

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Early Predictors for Long-Term Functional Outcome After Mild Traumatic Brain Injury in Frail Elderly Patients

Journal of Head Trauma Rehabilitation ◽

10.1097/htr.0000000000000368 ◽

2018 ◽

pp. 1 ◽

Cited By ~ 8

Author(s):

Amaal Eman Abdulle ◽

Myrthe E. de Koning ◽

Harm J. van der Horn ◽

Myrthe E. Scheenen ◽

Gerwin Roks ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Elderly Patients ◽

Functional Outcome ◽

Mild Traumatic Brain Injury ◽

Frail Elderly ◽

Early Predictors

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Faculty Opinions recommendation of Long-term outcome in patients with mild traumatic brain injury: a prospective observational study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.12458956.13670054 ◽

2011 ◽

Author(s):

Carlos Bagley ◽

Ankit Mehta

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Observational Study ◽

Mild Traumatic Brain Injury ◽

Prospective Observational Study ◽

Term Outcome ◽

Long Term Outcome

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Repetitive Mild Traumatic Brain Injury in the Developing Brain: Effects on Long-Term Functional Outcome and Neuropathology

Journal of Neurotrauma ◽

10.1089/neu.2015.3958 ◽

2016 ◽

Vol 33 (7) ◽

pp. 641-651 ◽

Cited By ~ 34

Author(s):

Emin Fidan ◽

Jesse Lewis ◽

Anthony E. Kline ◽

Robert H. Garman ◽

Henry Alexander ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Mild Traumatic Brain Injury ◽

Developing Brain

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The Nature of Permanent Post-concussion Symptoms after Mild Traumatic Brain Injury

Brain Impairment ◽

10.1017/brimp.2013.17 ◽

2013 ◽

Vol 14 (2) ◽

pp. 235-242 ◽

Cited By ~ 8

Author(s):

Nigel S. King ◽

Simon Kirwilliam

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Post Injury ◽

Factors Affecting ◽

Wide Range ◽

Mean Time ◽

Poor Concentration ◽

Do So

Objective: Very few studies have examined permanent post-concussion symptoms (PCSs) after mild traumatic brain injury (MTBI). None have reported the nature of such symptoms. Our recent study was the first to report on a wide range of factors affecting PCSs in a representative sample of such patients. This paper presents the frequencies of the different PCSs experienced by this group and compares them with PCSs at earlier stages post injury.Method: One hundred consecutively referred patients to a Community Head Injury Service in Buckinghamshire, UK, for the treatment of long-term PCSs after MTBI were invited to participate in the original study. Those consenting to do so (n = 24, mean time post injury = 6.9 years) completed a Rivermead Post Concussion Symptoms Questionnaire. The frequency of the types of symptoms reported is presented. These are then contrasted with comparable PCS presentations at 7–10 days and 6 months post injury from two other studies.Results: Fatigue was reported by all long-term patients. Poor concentration, sleep disturbance, taking longer to think and irritability were the other most frequently endorsed permanent symptoms. The least reported were blurred/double vision, photophobia, nausea, headache and dizziness. A similar pattern was present in those at earlier stages post injury.Conclusions: The most common permanent PCSs may be those best conceptualised as the more cognitively and emotionally based symptoms, and the least common the more somatically based ones. There may be some consistency in the nature of PCSs reported over time.

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Plasma Phospholipid Metabolites Associate With Functional Outcomes Following Mild Traumatic Brain Injury in Older Adults

Biological Research For Nursing ◽

10.1177/1099800420942889 ◽

2020 ◽

Vol 23 (1) ◽

pp. 127-135

Author(s):

Sarah R. Martha ◽

Kuan-Fu Chen ◽

Yvonne Lin ◽

Hilaire J. Thompson

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Functional Outcome ◽

Mild Traumatic Brain Injury ◽

Plasma Phospholipid ◽

Phospholipid Metabolism ◽

Plasma Metabolites ◽

Post Injury ◽

Outcome Differences

Objective: To compare differences using a metabolomics approach in older adults (≥55) with mild traumatic brain injury (mTBI) to control adults and to identify a signature profile related to functional outcome 3–6 months post-injury. Methods: We performed metabolomics analysis using LC-MS of untargeted aqueous metabolites on plasma samples taken from a parent prospective cohort study. Older adults with mTBI (n = 14) were purposively sampled to include participants with worsening (decrease in GOS-E of at least 1 level) and improved (increase in GOS-E of at least 1 level) outcomes from 3 to 6 months. The data were analyzed using PLS-DA with VIP scores, Random Forest, and spline fit between the different groups as a function of time for exposure on outcome. Results: Separation of comparisons were seen at 24 hours (negative ionization) and 6 months (positive ionization), revealing two metabolites of interest, phosphatidylcholine and phosphatidylethanolamine. Phosphatidylcholine levels were higher in those with mTBI compared to controls ( p < 0.05), while lower concentration of phosphatidylethanolamine was seen in those with mTBI compared to controls ( p < 0.05). Phosphatidylinositol-3,4,5-trisphosphate was significant in those with mTBI compared to controls (n = 10) based on improved (n = 6) versus worsened (n = 8) outcomes from 3 to 6 months. Conclusion: We identified plasma metabolites related to phospholipid metabolism in older adults following mTBI and associated with long-term functional outcome. These findings may underly pathological mechanisms of outcome differences in older adults who experience mTBI.

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