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Irzan H, Pozzi M, Chikhladze N, Cebanu S, Tadevosyan A, Calcii C, Tsiskaridze A, Melbourne A, Strazzer S, Modat M, Molteni E. Emerging Treatments for Disorders of Consciousness in Paediatric Age. Brain Sci 2022; 12:198. [PMID: 35203961 PMCID: PMC8870410 DOI: 10.3390/brainsci12020198] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
The number of paediatric patients living with a prolonged Disorder of Consciousness (DoC) is growing in high-income countries, thanks to substantial improvement in intensive care. Life expectancy is extending due to the clinical and nursing management achievements of chronic phase needs, including infections. However, long-known pharmacological therapies such as amantadine and zolpidem, as well as novel instrumental approaches using direct current stimulation and, more recently, stem cell transplantation, are applied in the absence of large paediatric clinical trials and rigorous age-balanced and dose-escalated validations. With evidence building up mainly through case reports and observational studies, there is a need for well-designed paediatric clinical trials and specific research on 0-4-year-old children. At such an early age, assessing residual and recovered abilities is most challenging due to the early developmental stage, incompletely learnt motor and cognitive skills, and unreliable communication; treatment options are also less explored in early age. In middle-income countries, the lack of rehabilitation services and professionals focusing on paediatric age hampers the overall good assistance provision. Young and fast-evolving health insurance systems prevent universal access to chronic care in some countries. In low-income countries, rescue networks are often inadequate, and there is a lack of specialised and intensive care, difficulty in providing specific pharmaceuticals, and lower compliance to intensive care hygiene standards. Despite this, paediatric cases with DoC are reported, albeit in fewer numbers than in countries with better-resourced healthcare systems. For patients with a poor prospect of recovery, withdrawal of care is inhomogeneous across countries and still heavily conditioned by treatment costs as well as ethical and cultural factors, rather than reliant on protocols for assessment and standardised treatments. In summary, there is a strong call for multicentric, international, and global health initiatives on DoC to devote resources to the paediatric age, as there is now scope for funders to invest in themes specific to DoC affecting the early years of the life course.
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Affiliation(s)
- Hassna Irzan
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Marco Pozzi
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
| | - Nino Chikhladze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Serghei Cebanu
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Artashes Tadevosyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan 0025, Armenia;
| | - Cornelia Calcii
- Faculty of Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, MD-2004 Chišināu, Moldova; (S.C.); (C.C.)
| | - Alexander Tsiskaridze
- Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia; (N.C.); (A.T.)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
- Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 7JE, UK
| | - Sandra Strazzer
- Scientific Institute IRCCS E. Medea, Acquired Brain Injury Unit, 22040 Bosisio Parini, Italy; (M.P.); (S.S.)
- Rehabilitation Service, “Usratuna” Health and Rehabilitation Centre, Juba, South Sudan
| | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King’s College London, London WC2R 2LS, UK; (H.I.); (A.M.); (M.M.)
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Gandhi P, Tobin S, Vongphakdi M, Copley A, Watter K. A scoping review of interventions for adults with dysarthria following traumatic brain injury. Brain Inj 2020; 34:466-479. [DOI: 10.1080/02699052.2020.1725844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Pooja Gandhi
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Shilagh Tobin
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Monrada Vongphakdi
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Anna Copley
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Kerrin Watter
- Acquired Brain Injury Transitional Rehabilitation Service, Division of Rehabilitation, Metro South Health, Brisbane, Australia
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Ahn H, Lewis R, Santos A, Cheng CL, Noonan VK, Dvorak MF, Singh A, Linassi AG, Christie S, Goytan M, Atkins D. Forecasting Financial Resources for Future Traumatic Spinal Cord Injury Care Using Simulation Modeling. J Neurotrauma 2017; 34:2917-2923. [PMID: 28594315 PMCID: PMC5653147 DOI: 10.1089/neu.2016.4936] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Survivors of traumatic spinal cord injury (tSCI) have intense healthcare needs during acute and rehabilitation care and often through the rest of life. To prepare for a growing and aging population, simulation modeling was used to forecast the change in healthcare financial resources and long-term patient outcomes between 2012 and 2032. The model was developed with data from acute and rehabilitation care facilities across Canada participating in the Access to Care and Timing project. Future population and tSCI incidence for 2012 and 2032 were predicted with data from Statistics Canada and the Canadian Institute for Health Information. The projected tSCI incidence for 2012 was validated with actual data from the Rick Hansen SCI Registry of the participating facilities. Using a medium growth scenario, in 2032, the projected median age of persons with tSCI is 57 and persons 61 and older will account for 46% of injuries. Admissions to acute and rehabilitation facilities in 2032 were projected to increase by 31% and 25%, respectively. Because of the demographic shift to an older population, an increase in total population life expectancy with tSCI of 13% was observed despite a 22% increase in total life years lost to tSCI between 2012 and 2032. Care cost increased 54%, and rest of life cost increased 37% in 2032, translating to an additional CAD $16.4 million. With the demographics and management of tSCI changing with an aging population, accurate projections for the increased demand on resources will be critical for decision makers when planning the delivery of healthcare after tSCI.
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Affiliation(s)
- Henry Ahn
- 1 University of Toronto Spine Program , Toronto, Ontario, Canada
| | - Rachel Lewis
- 2 Centre for Operations Excellence, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
| | - Argelio Santos
- 3 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | | | | | - Marcel F Dvorak
- 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
| | - Anoushka Singh
- 5 SCI Clinical Research Unit, Toronto Western Hospital , Toronto, Ontario, Canada
| | - A Gary Linassi
- 6 Department of Physical Medicine and Rehabilitation, University of Saskatchewan , Saskatoon, Saskatchewan, Canada
| | - Sean Christie
- 7 Research Division of Neurosurgery, Dalhousie University , Halifax, Nova Scotia, Canada
| | - Michael Goytan
- 8 Sections of Orthopedics and Neurosurgery, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Derek Atkins
- 9 Operations and Logistics Division, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
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Pluripotency of Stem Cells from Human Exfoliated Deciduous Teeth for Tissue Engineering. Stem Cells Int 2016; 2016:5957806. [PMID: 27313627 PMCID: PMC4904107 DOI: 10.1155/2016/5957806] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/04/2016] [Indexed: 12/11/2022] Open
Abstract
Stem cells from human exfoliated deciduous teeth (SHED) are highly proliferative pluripotent cells that can be retrieved from primary teeth. Although SHED are isolated from the dental pulp, their differentiation potential is not limited to odontoblasts only. In fact, SHED can differentiate into several cell types including neurons, osteoblasts, adipocytes, and endothelial cells. The high plasticity makes SHED an interesting stem cell model for research in several biomedical areas. This review will discuss key findings about the characterization and differentiation of SHED into odontoblasts, neurons, and hormone secreting cells (e.g., hepatocytes and islet-like cell aggregates). The outcomes of the studies presented here support the multipotency of SHED and their potential to be used for tissue engineering-based therapies.
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Arriola VD, Rozelle JW. Traumatic Brain Injury in United States Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Hispanic Veterans-A Review Using the PRISMA Method. Behav Sci (Basel) 2016; 6:E3. [PMID: 26771647 PMCID: PMC4810037 DOI: 10.3390/bs6010003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 01/01/2016] [Accepted: 01/06/2016] [Indexed: 11/16/2022] Open
Abstract
Traumatic brain injury (TBI) is commonly defined by Menon et al. as an "alteration of the brain function, or other evidence of brain pathology, caused by an external force." TBI can be caused by penetrating trauma to the head in which the magnitude of the injury is dependent on the magnitude of the forces that are applied to the head. The consequences of TBI can range from minimal to severe disability and even death. The major objectives of this systematic review are to survey the current literature on Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Hispanic veterans with TBI. To complete this analysis, the Preferred Reporting Items for Systematic Reviews and MetaAnalysis (PRISMA) identified 875 articles in common and retrieved a total of 34 articles that met the inclusion criteria, consisted of OEF/OIF Hispanic veterans, reported quantitative data, and were conducted with adult U.S. veterans living in the United States. Since TBI diagnosis was unclear in most articles, only five articles that used the VATBIST instrument were analyzed. The results suggested that there is a lack of research on OEF/OIF Hispanic veterans and Hispanic subgroups. Future studies need to be conducted to consider minority groups while analyzing data involving TBI.
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Affiliation(s)
- Vanessa D Arriola
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112, USA.
| | - Jeffrey W Rozelle
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112, USA.
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Siman-Tov M, Radomislensky I, Knoller N, Bahouth H, Kessel B, Klein Y, Michaelson M, Avraham Rivkind BM, Shaked G, Simon D, Soffer D, Stein M, Jeroukhimov I, Peleg K. Incidence and injury characteristics of traumatic brain injury: Comparison between children, adults and seniors in Israel. Brain Inj 2016; 30:83-9. [PMID: 26734841 DOI: 10.3109/02699052.2015.1104551] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To assess the incidence and injury characteristics of hospitalized trauma patients diagnosed with TBI. METHODS A retrospective study of all injured hospitalized patients recorded in the National Trauma Registry at 19 trauma centres in Israel between 2002-2011. Incidence and injury characteristics were examined among children, adults and seniors. RESULTS The annual incidence rate of hospitalized TBI for the Israeli population in 2011 was 31.8/100,000. Age-specific incidence was highest among seniors with a dramatic decrease in TBI-related mortality rate among them. Adults, in comparison to children and seniors, had higher rates of severe TBI, severe and critical injuries, more admission to the intensive care unit, underwent surgery, were hospitalization for more than 2 weeks and were discharged to rehabilitation. After adjusting for age, gender, ethnicity, mechanism of injury and injury severity score, TBI-related in-hospital mortality was higher among seniors and adults compared to children. CONCLUSION Seniors are at high risk for TBI-related in-hospital mortality, although adults had more severe and critical injuries and utilized more hospital resources. However, seniors showed the most significant reduction in mortality rate during the study period. Appropriate intervention programmes should be designed and implemented, targeted to reduce TBI among high risk groups.
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Affiliation(s)
- Maya Siman-Tov
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Irina Radomislensky
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Nachshon Knoller
- b Department of Neurosurgery , Sheba Medical Center , Tel-Hashomer , Israel , and
| | - Hany Bahouth
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Boris Kessel
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Yoram Klein
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Moshe Michaelson
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Bala Miklosh Avraham Rivkind
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Gad Shaked
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Daniel Simon
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Dror Soffer
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Michael Stein
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Igor Jeroukhimov
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and
| | - Kobi Peleg
- a Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Public Health Policy , Tel-Hashomer , Israel and.,c Department of Disaster Management , School of Public Health, Tel Aviv University , Israel
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Missios S, Bekelis K. The association of insurance status and race with the procedural volume of traumatic brain injury patients. Injury 2016; 47:154-9. [PMID: 26187434 DOI: 10.1016/j.injury.2015.06.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/09/2015] [Accepted: 06/24/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The influence of non-medical factors on the volume of procedures undergone by TBI patients remains an issue of debate. We investigated the association of lack of insurance and African-American race with the procedural volume of TBI patients. METHODS We performed a retrospective cohort study involving TBI patients, who were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011. Multivariable logistic regression with mixed effects to control for clustering at the hospital level was used to investigate the association of insurance status and race with high volume of procedures for TBI patients. RESULTS Of the 392,292 TBI patients, who were registered in NTDB and met the inclusion criteria, 9850 (3.8%) underwent high procedural volume, defined as 2 or more procedures during hospitalization (2 standard deviations over the mean). Multivariable logistic regression analysis demonstrated an association of uninsured patients with decreased possibility of high procedural volume (OR, 0.68; 95% CI, 0.63-0.73). This persisted after using a mixed effects model to control for clustering at the hospital level (OR, 0.66; 95% CI, 0.61-0.71). In stratified samples, uninsured patients demonstrated similar associations even for GCS below 8 (OR, 0.69; 95% CI, 0.64-0.75), or ISS above 15 (OR, 0.74; 95% CI, 0.69-0.79). Multivariable logistic regression analysis did not demonstrate an association of African Americans with procedural volume (OR, 0.93; 95% CI, 0.86-1.02). CONCLUSIONS During the hospitalization of TBI patients, lack of insurance was associated with lower procedural volume. When controlling for insurance status, we did not observe any race associated disparities in procedural volume.
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Affiliation(s)
- Symeon Missios
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, United States
| | - Kimon Bekelis
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
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Missios S, Bekelis K. Nonmedical factors and the transfer of spine trauma patients initially evaluated at Level III and IV trauma centers. Spine J 2015; 15:2028-35. [PMID: 25998327 DOI: 10.1016/j.spinee.2015.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/08/2015] [Accepted: 05/13/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The influence of nonmedical factors on the disposition of spine trauma patients, initially seen in less specialized institutions, remains an issue of debate. PURPOSE To investigate the association of lack of insurance and African-American race with the probability of being transferred to a Level I or II trauma center, after being evaluated in the emergency department (ED) of Level III or IV trauma centers for spine trauma. STUDY DESIGN/SETTING This was a retrospective cohort study. PATIENT SAMPLE A total of 14,133 patients who were registered in National Trauma Data Bank (NTDB) from 2009 to 2011 and initially evaluated in the ED of Level III or IV trauma centers for spine trauma were included. OUTCOME MEASURES The outcome measures were rates of transfer to a higher level of care trauma center. METHODS We performed a retrospective cohort study involving spine trauma patients, who were registered in the NTDB between 2009 and 2011. Regression techniques, controlling for clustering at the hospital level, were used to investigate the association of insurance status and race with the possibility of transfer. RESULTS Overall, 4,142 patients (29.31%) were transferred to a higher level of care institution, and 9,738 (70.69%) were admitted to a Level III or IV trauma center. Multivariable logistic regression analysis demonstrated an association of uninsured patients with increased possibility of transfer (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.22-1.61). This persisted after using a mixed effects model to control for clustering at the hospital level (OR, 1.65; 95% CI, 1.37-1.96). African-American race was not associated with the decision to transfer, when using a mixed effects model (OR, 1.15; 95% CI, 0.89-1.48). However, African-Americans with Glasgow Coma Scale greater than 8 (OR, 1.40; 95% CI, 1.13-1.74) or Injury Severity Score less than 15 (OR, 1.54; 95% CI, 1.21-1.96) were associated with a higher likelihood of transfer. CONCLUSIONS In summary, lack of insurance was associated with increased possibility of transfer to higher level of care institutions, after evaluation in a Level III or IV trauma center ED for spine trauma. The same was true for African-Americans with milder injuries.
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Affiliation(s)
- Symeon Missios
- Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA
| | - Kimon Bekelis
- Department of Neurosurgery, Louisiana State University Health Sciences Center, 1541 Kings Hwy, Shreveport, LA 71103, USA.
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Rate of Disorders of Consciousness in a Prospective Population-Based Study of Adults With Traumatic Brain Injury. J Head Trauma Rehabil 2014; 29:E31-43. [DOI: 10.1097/htr.0000000000000017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Morisse E, Favarel-Garrigues JF, Couadau E, Mikulski M, Xavier L, Ryckwaert Y, Garcia F, Lecoq Saint-Gilles H, Amar J, Legouale JS, Gervolino S, Guerrier G. Incidence of hospital-admitted severe traumatic brain injury and in-hospital fatality rates in a Pacific Island country: a 5-year retrospective study. Brain Inj 2014; 28:1436-40. [PMID: 24950253 DOI: 10.3109/02699052.2014.919526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Epidemiology of severe traumatic brain injury (TBI) is poorly defined in the Pacific region, including in New Caledonia. The aim of this study was to assess the incidence, causes and outcome of hospital-admitted severe TBI in the whole population of New Caledonia. METHODS A retrospective study on patients with severe TBI admitted to the only trauma centre during the 5-year period (2008-2012) was performed. The electronic patient register was searched for diagnoses of intracranial injuries to identify patients. Severe TBI was defined as a Glasgow Coma Scale Score ≤ 8 during the first 24 hours after injury. RESULTS The annual incidence ranged from 10/100 000 in 2010 to 15/100 000 in 2011. Road traffic accidents (n = 109; 71%), falls (n = 26; 17%) and assaults (n = 19; 12%) were causes of severe TBI. Young Melanesian adults (median age = 26 [19-36]) were the most affected. In ICU, the overall case-fatality rate was 25%. The mortality rate was the highest among victims of assaults (47%). CONCLUSIONS The high incidence of hospital-admitted patients with severe TBI in this study combined with high in-ICU mortality rates supports the need for targeted public health action to prevent assaults and traffic road accidents in this vulnerable population.
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Harrop JS, Ghobrial GM, Chitale R, Krespan K, Odorizzi L, Fried T, Maltenfort M, Cohen M, Vaccaro A. Evaluating initial spine trauma response: injury time to trauma center in PA, USA. J Clin Neurosci 2014; 21:1725-9. [PMID: 24932590 DOI: 10.1016/j.jocn.2014.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 11/24/2022]
Abstract
Historical perceptions regarding the severity of traumatic spinal cord injury has led to considerable disparity in triage to tertiary care centers. This article retrospectively reviews a large regional trauma database to analyze whether the diagnosis of spinal trauma affected patient transfer timing and patterns. The Pennsylvania Trauma database was retrospectively reviewed. All acute trauma patient entries for level I and II centers were categorized for diagnosis, mechanism, and location of injury, analyzing transportation modality and its influence on time of arrival. A total of 1162 trauma patients were identified (1014 blunt injuries, 135 penetrating injuries and 12 other) with a mean transport time of 3.9 hours and a majority of patients arriving within 7 hours (>75%). Spine trauma patients had the longest mean arrival time (5.2 hours) compared to blunt trauma (4.2 hours), cranial neurologic injuries (4.35 hours), and penetrating injuries (2.13 hours, p<0.0001). There was a statistically significant correlation between earlier arrivals and both cranial trauma (p=0.0085) and penetrating trauma (p<0.0001). The fastest modality was a fire rescue (0.93 hours) or police (0.63 hours) vehicle with Philadelphia County (1.1 hour) having the quickest arrival times. Most trauma patients arrived to a specialty center within 7 hours of injury. However subsets analysis revealed that spine trauma patients had the greatest transit times. Present research trials for spinal cord injuries suggest earlier intervention may lead to improved recovery. Therefore, it is important to focus on improvement of the transportation triage system for traumatic spinal patients.
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Affiliation(s)
- James S Harrop
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA.
| | - George M Ghobrial
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Rohan Chitale
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Kelly Krespan
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Laura Odorizzi
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Tristan Fried
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Mitchell Maltenfort
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Murray Cohen
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA
| | - Alexander Vaccaro
- Departments of Neurological and Orthopedic Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, Philadelphia, PA 19107, USA
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Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma 2014; 31:531-40. [PMID: 23962031 PMCID: PMC3949434 DOI: 10.1089/neu.2013.3094] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.
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Affiliation(s)
- Terje Sundstrøm
- 1 Department of Biomedicine, University of Bergen , Bergen, Norway
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14
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Furlan JC, Tung K, Fehlings MG. Process Benchmarking Appraisal of Surgical Decompression of Spinal Cord following Traumatic Cervical Spinal Cord Injury: Opportunities To Reduce Delays in Surgical Management. J Neurotrauma 2013; 30:487-91. [DOI: 10.1089/neu.2012.2539] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julio C. Furlan
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Canada
- Department of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Canada
- Lyndhurst Centre, Toronto Rehabilitation Institute, University of Toronto, Toronto, Canada
| | - Kayee Tung
- Krembil Neuroscience Centre, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Michael G. Fehlings
- Department of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Canada
- Krembil Neuroscience Centre, Spinal Program, Toronto Western Hospital, University Health Network, Toronto, Canada
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Canada
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McLaughlin N, Laws ER, Oyesiku NM, Katznelson L, Kelly DF. Pituitary Centers of Excellence. Neurosurgery 2012; 71:916-24; discussion 924-6. [DOI: 10.1227/neu.0b013e31826d5d06] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Pituitary tumors and associated neuroendocrine disorders pose significant challenges in diagnostic and therapeutic management. Optimal care of the “pituitary patient” is best provided in a multidisciplinary collaborative environment that includes not only experienced pituitary practitioners in neurosurgery and endocrinology, but also in otorhinolaryngological surgery, radiation oncology, medical oncology, neuro-ophthalmology, diagnostic and interventional neuroradiology, and neuropathology. We provide the background and rationale for recognizing pituitary centers of excellence and suggest a voluntary verification process, similar to that used by the American College of Surgeons for Trauma Center verification. We propose that pituitary centers of excellence should fulfill 3 key missions: (1) provide comprehensive care and support to patients with pituitary disorders; (2) provide residency training, fellowship training, and/or continuing medical education in the management of pituitary and neuroendocrine disease; and (3) contribute to research in pituitary disorders. As this is a preliminary proposal, we recognize several issues that warrant further consideration including center and surgeon practice volume as well as oversight of the verification process.
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Affiliation(s)
- Nancy McLaughlin
- Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Edward R. Laws
- Pituitary and Neuroendocrine Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nelson M. Oyesiku
- Pituitary Center and Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Laurence Katznelson
- Pituitary Center and Departments of Neurosurgery and Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Daniel F. Kelly
- Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
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Oliver M, Inaba K, Tang A, Branco BC, Barmparas G, Schnüriger B, Lustenberger T, Demetriades D. The changing epidemiology of spinal trauma: a 13-year review from a Level I trauma centre. Injury 2012; 43:1296-300. [PMID: 22648015 DOI: 10.1016/j.injury.2012.04.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 12/20/2011] [Accepted: 04/27/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Spinal injuries secondary to trauma are a major cause of patient morbidity and a source of significant health care expenditure. Increases in traffic safety standards and improved health care resources may have changed the characteristics and incidence of spinal injury. The purpose of this study was to review a single metropolitan Level I trauma centre's experience to assess the changing characteristics and incidence of traumatic spinal injuries and spinal cord injuries (SCI) over a 13-year period. PATIENTS AND METHODS A retrospective review of patients admitted to a Level I trauma centre between 1996 and 2008 was performed. Patients with spinal fractures and SCI were identified. Demographics, mechanism of injury, level of spinal injury and Injury Severity Score (ISS) were extracted. The outcomes assessed were the incidence rate of SCI and in-hospital mortality. RESULTS Over the 13-year period, 5.8% of all trauma patients suffered spinal fractures, with 21.7% of patients with spinal injuries having SCI. Motor vehicle accidents (MVAs) were responsible for the majority of spinal injuries (32.6%). The mortality rate due to spinal injury decreased significantly over the study period despite a constant mean ISS. The incidence rate of SCI also decreased over the years, which was paralleled by a significant reduction in MVA associated SCI (from 23.5% in 1996 to 14.3% in 2001 to 6.7% in 2008). With increasing age there was an increase in spinal injuries; frequency of blunt SCI; and injuries at multiple spinal levels. CONCLUSION This study demonstrated a reduction in mortality attributable to spinal injury. There has been a marked reduction in SCI due to MVAs, which may be related to improvements in motor vehicle safety and traffic regulations. The elderly population was more likely to suffer SCI, especially by blunt injury, and at multiple levels. Underlying reasons may be anatomical, physiological or mechanism related.
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Affiliation(s)
- M Oliver
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA 90033-4525, USA.
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17
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Perheentupa U, Kinnunen I, Grénman R, Aitasalo K, Mäkitie AA. Management and outcome of pediatric skull base fractures. Int J Pediatr Otorhinolaryngol 2010; 74:1245-50. [PMID: 20800299 DOI: 10.1016/j.ijporl.2010.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 07/26/2010] [Accepted: 07/28/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The management of skull base fractures in the pediatric age group continues to be a major challenge even for experienced multidisciplinary teams. This retrospective study was undertaken at a tertiary care academic hospital to evaluate the management and outcome of pediatric skull base fractures. METHODS Retrospective analysis covering a period of 13.5 years (from 1996 to 2009) and 63 patients (mean age 10.7 years; range 1-18 years) was performed. RESULTS A road traffic accident was the most frequent etiological factor (38%). The most common skull base fracture type was temporal bone fracture (64%). Longitudinal temporal fractures were observed in 45% and transversal in 23% of these patients; in 10 cases (25%) the fracture was comminuted or mixed type. A fracture involving the spheno-ethmoidal complex was the second most common type of basilar skull fracture (41%) followed by fracture through the orbital bone (35%). Forty-three percent of the patients had a concomitant intracranial injury. Early neurological deficits were diagnosed in 21 patients (33%) and 10 patients (16%) had permanent neurological deficits. One patient died after 1 week of intensive care treatment. Fifty-four patients (86%) were discharged home and 8 patients (13%) were discharged for further rehabilitation. Glasgow Coma Scale score of 8 or lower correlated with moderate to poor outcome. CONCLUSIONS We conclude that skull base fracture is a rare injury in childhood. Mortality is uncommon, but this trauma is commonly associated with intracranial injury. Early neurological deficits are caused by traumatic brain injury and were observed in one-third of the patients. However, only less than one-sixth suffered from permanent neurological or neuropsychiatric disorders.
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Affiliation(s)
- Ulla Perheentupa
- Department of Otolaryngology - Head and Neck Surgery, Turku University Hospital and University of Turku, Finland.
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18
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Furlan JC, Kattail D, Fehlings MG. The impact of co-morbidities on age-related differences in mortality after acute traumatic spinal cord injury. J Neurotrauma 2010; 26:1361-7. [PMID: 19275470 DOI: 10.1089/neu.2008.0764] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the shift in demographics of spinal cord injury (SCI) due to an aging population, relatively little has been reported regarding the effect of age on outcomes after SCI. This study examines the potential confounding effect of co-morbidities on the age-related differences in the hospital mortality following acute traumatic SCI. All consecutive patients with SCI who were admitted to our spine center from 1996 to 2007 were included. Co-morbidities were classified using the Charlson Co-morbidity Index (CCI), Cumulative Illness Rating Scale, and the number of ICD-9 codes. Major potential confounders included age, gender, co-morbidity, and level and severity of SCI. There were 217 males and 80 females with ages from 15 to 96 years. Most patients had an incomplete cervical SCI following falls or motor vehicle accidents. The mean in-hospital mortality rate was 5.7%. Using univariate analyses, older age, relevant pre-existing medical conditions, and motor complete SCI were major risk factors for in-hospital death after acute SCI. Among the three co-morbidity assessments, the CCI was the most reliable co-morbidity index for prediction of hospital mortality in SCI patients after controlling for age in the Cox proportional hazard modeling. In addition, the CCI appears to be a major confounder, which accounts for the majority of age-related differences in mortality following SCI. Our findings have implications for future clinical trials of therapies for adult patients with acute SCI and for management strategies of elderly individuals with SCI.
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Affiliation(s)
- Julio C Furlan
- Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada.
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19
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Kumar R, Mahapatra AK. The changing "epidemiology" of pediatric head injury and its impact on the daily clinical practice. Childs Nerv Syst 2009; 25:813-23. [PMID: 19212766 DOI: 10.1007/s00381-009-0820-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Indexed: 12/01/2022]
Abstract
AIM This article focuses on the developments that occurred during the last two decades in the management of pediatric head injury. It describes the changes in incidence, various advancements in diagnosis, management, prognosis, prevention and strategies required for better outcome, and control of head injury. MATERIALS AND METHODS Thorough evaluation of various papers, research, and our experience revealed that in developed countries, there has been a decreasing trend in head trauma incidence and trauma-related deaths as compared to developing countries. RESULTS This is mainly attributed to the widespread implementation of preventive measures. The development in imaging facilities, better characterization and grading of severe trauma (see, for example, diffuse axonal injury), an advanced understanding of the pathophysiology of secondary brain injury, endocrinological disturbances, predictive factors of outcome, development in neurophysiological monitoring, management advances in critical care units, implementation of safely measures, etc. have brought a significant change in overall outcome and profile of pediatric head injury CONCLUSION The further developments in field of brain plasticity, stem cell, rehabilitation, evolution of new drugs, preventive community measures, and global policies to deal with head trauma are expected to play a major role in days to come. The development of future pediatric trauma centers based on current evolutions (in order to achieve a good outcome), global and emphatic preventions of trauma will be required to establish equilibrium between developed and developing countries.
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Affiliation(s)
- Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, Uttar Pradesh, India.
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20
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Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus 2009; 25:E13. [PMID: 18980473 DOI: 10.3171/foc.2008.25.11.e13] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cardiovascular complications in the acute stage following traumatic spinal cord injury (SCI) require prompt medical attention to avoid neurological compromise, morbidity, and death. In this review, the authors summarize the neural regulation of the cardiovascular system as well as the pathophysiology, diagnosis, and management of major cardiovascular complications that can occur following acute (up to 30 days) traumatic SCI. Hypotension (both supine and orthostatic), autonomic dysreflexia, and cardiac arrhythmias (including persistent bradycardia) are attributed to the loss of supraspinal control of the sympathetic nervous system that commonly occurs in patients with severe spinal cord lesions at T-6 or higher. Current evidence-based guidelines recommend: 1) monitoring of cardiac and hemodynamic parameters in the acute phase of SCI; 2) maintenance of a minimum mean arterial blood pressure of 85 mm Hg during the hyperacute phase (1 week after SCI); 3) timely detection and appropriate treatment of neurogenic shock and cardiac arrhythmias; and 4) immediate and adequate treatment of episodes of acute autonomic dysreflexia. In addition to these forms of cardiovascular dysfunction, individuals with acute SCIs are at high risk for deep venous thrombosis (DVT) and pulmonary embolism due to loss of mobility and, potentially, altered fibrinolytic activity, abnormal platelet function, and impaired circadian variations of hemostatic and fibrinolytic parameters. Current evidence supports a recommendation for thromboprophylaxis using mechanical methods and anticoagulants during the acute stage up to 3 months following SCI, depending on the severity and level of injury. Low-molecular-weight heparin is the first choice for anticoagulant prophylaxis in patients with acute SCI. Although there is insufficient evidence to recommend (or refute) the use of screening tests for DVT in asymptomatic adults with acute SCI, this strategy may detect asymptomatic DVT in at least 9.4% of individuals who undergo thromboprophylaxis using lowmolecular- weight heparin. Indications and treatment of DVT and acute pulmonary embolism are well established and are summarized in this review. Recognition of cardiovascular complications after acute SCI is essential to minimize adverse outcomes and to optimize recovery.
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Affiliation(s)
- Julio C Furlan
- Division of Genetics and Development, Toronto Western Research Institute, University Health Network, Ontario, Canada
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21
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Furlan JC, Kattail D, Fehlings M. The impact of co-morbidities on age-related differences in mortality after acute traumatic spinal cord injury. J Neurotrauma 2009. [DOI: 10.1089/neu.2008-0764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Abstract
Traumatic brain injury is a leading cause of morbidity and death in both industrialized and developing countries. To date, there is no targeted pharmacological treatment that effectively limits the progression of secondary injury. The delayed progression of deterioration of grey and white matter gives hope that a meaningful intervention can be applied in a realistic timeframe following initial trauma. In this review we discuss new insights into the subcellular mechanisms of secondary injury that have highlighted numerous potential targets for intervention.
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Affiliation(s)
- Eugene Park
- Cara Phelan Centre for Trauma Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
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23
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Andelic N, Sigurdardottir S, Brunborg C, Roe C. Incidence of hospital-treated traumatic brain injury in the Oslo population. Neuroepidemiology 2008; 30:120-8. [PMID: 18334828 DOI: 10.1159/000120025] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 12/31/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this prospective, population-based study is to present the incidence of hospital-treated traumatic brain injury (TBI) in Oslo, Norway, and to describe the severity of brain injuries and outcome of the patients' acute medical care. METHODS Data were obtained from hospital admission registers and medical records from May 2005 to May 2006. The initial severity of TBI was measured by the Glasgow Coma Scale. The region is urban with a population of 534,129. RESULTS The 445 patients identified represent an annual incidence of 83.3/100,000. The median age was 29 years. The male:female ratio was 1.8:1.0. The highest incidence of TBI hospitalizations was found in the elderly males and the youngest children. The most common causes of TBI were falls (51%) and transport accidents (29.7%). Intracranial lesions were found more often in the elderly. The case fatality rate was 2.0/100 hospitalized patients and was highest in the elderly. CONCLUSIONS The incidence of hospital-treated TBI in this study is considerably lower than that found in previous studies from Norway and Scandinavia. Despite the apparent decline in TBI hospitalization rates, our findings should also draw attention to the need for more effective preventive programmes related to falls. Studies that assess long-term consequences of TBI in elderly patients are also needed.
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Affiliation(s)
- Nada Andelic
- Department of Physical Medicine and Rehabilitation, Ulleval University Hospital, Oslo, Norway.
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24
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Schmidt OI, Leinhase I, Hasenboehler E, Morgan SJ, Stahel PF. [The relevance of the inflammatory response in the injured brain]. DER ORTHOPADE 2007; 36:248, 250-8. [PMID: 17333066 DOI: 10.1007/s00132-007-1061-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Research efforts in recent years have defined traumatic brain injury (TBI) as a predominantly immunological and inflammatory disorder. This perception is based on the fact that the overwhelming neuroinflammatory response in the injured brain contributes to the development of posttraumatic edema and to neuropathological sequelae which are, in large part, responsible for the adverse outcome. While the "key" mediators of neuroinflammation, such as the cytokine cascade and the complement system, have been clearly defined by studies in experimental TBI models, their exact pathways of interaction and pathophysiological implications remain to be further elucidated. This lack of knowledge is partially due to the concept of a "dual role" of the neuroinflammatory response after TBI. This notion implies that specific inflammatory molecules may mediate diverse functions depending on their local concentration and kinetics of expression in the injured brain. The inflammation-induced effects range from beneficial aspects of neuroprotection to detrimental neurotoxicity. The lack of success in pushing anti-inflammatory therapeutic concepts from"bench to bedside" for patients with severe TBI strengthens the further need for advances in basic research on the molecular aspects of the neuroinflammatory network in the injured brain. The present review summarizes the current knowledge from experimental studies in this field of research and discusses potential future targets of investigation.
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Affiliation(s)
- O I Schmidt
- Zentrum für Traumatologie, Fachbereich Unfall- und Wiederherstellungschirurgie, Klinikum Sankt Georg, Leipzig
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25
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Keris V, Lavendelis E, Macane I. Association Between Implementation of Clinical Practice Guidelines and Outcome for Traumatic Brain Injury. World J Surg 2007; 31:1352-5. [PMID: 17464541 DOI: 10.1007/s00268-007-9002-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is the leading cause of death in the population under 40 years of age in Western countries, and the same was true for Latvia in 1999. This indicated a strong need to improve the management of TBI. The Latvian Society of Neurosurgeons in collaboration with related societies created a dedicated working group, and the Guidelines for Medical Management of TBI in Latvia (Guidelines) were developed in 2001. This study aimed to assess the association between implementation of the Guidelines and the outcome of TBI patients. METHODS The Guidelines were printed and distributed to relevant clinical units and teaching institutions. To assess the impact of the Guidelines on the outcome of TBI, Latvian medical statistics were researched. All patients admitted to emergency departments and registered as either discharged or dead with a diagnosis of head trauma from 1998 to 2004 were included in a retrospective survey. The primary endpoint accepted for analysis was the hospital case fatality rate (HCFR). RESULTS The survey included 73,062 consecutive cases. The annual incidence rate of TBI admissions was stable during the period 1998 to 2004 (range 41.5-46.0/10,000), and the incidence of moderate and severe TBI (range 7.2-8.7/10,000) showed no significant trends. There was a reduction of HCFR from 3.7% during 1998-2000 to 2.6% during 2002-2004 (relative risk 0.72; 95% confidence interval 0.67-0.76; p = 0.03). CONCLUSION Implementation of the Guidelines was associated with a statistically significant decrease of HCFR in TBI patients.
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Affiliation(s)
- Valdis Keris
- Department of Neurosurgery, Clinical Hospital Gailezers, Riga Stradins' University, Riga, Latvia.
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26
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Belegu V, Oudega M, Gary DS, McDonald JW. Restoring function after spinal cord injury: promoting spontaneous regeneration with stem cells and activity-based therapies. Neurosurg Clin N Am 2007; 18:143-68, xi. [PMID: 17244561 DOI: 10.1016/j.nec.2006.10.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although neural regeneration is an active research field today, no current treatments can aid regeneration after spinal cord injury. This article reviews the feasibility of spinal cord repair and provides an overview of the range of strategies scientists are taking toward regeneration. The major focus of this article is the future role of stem cell transplantation and similar rehabilitative restorative approaches designed to optimize spontaneous regeneration by mobilizing endogenous stem cells and facilitating other cellular mechanisms of regeneration, such as axonal growth and myelination.
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Affiliation(s)
- Visar Belegu
- The International Center for Spinal Cord Injury, Kennedy Krieger Institute, Department of Neurology, Johns Hopkins University School of Medicine, 707 North Broadway, Room 518, Baltimore, MD 21205, USA
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Furlan JC, Fehlings MG. A Web-based systematic review on traumatic spinal cord injury comparing the "citation classics" with the consumers' perspectives. J Neurotrauma 2006; 23:156-69. [PMID: 16503800 DOI: 10.1089/neu.2006.23.156] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Although the citation index of an article is not a direct measure of its quality or importance, it is a measure of recognition that may suggest its impact on the scientific community. This study was undertaken to examine the characteristics of the top 100 most frequently cited articles (so-called "citation classics") on traumatic spinal cord injury (SCI) that were published between 1986 and 2003, and to compare this selected professional literature with the consumers' perspective on the key issues in SCI research. The 100 top-cited articles on traumatic SCI were identified using the Internet database of the Science Citation Index Expanded and the Web of Science with the terms "spinal cord injury" and "spinal cord injuries." Meeting abstracts, letters, and editorials were excluded. No language restriction was applied. From a consumers' perspective, the areas of greatest interest for people with SCI as reported in two previous large-scale surveys include motor function, bowel and bladder control, sexual function, and pain. The final list of citation classics on traumatic SCI included 82 original articles and 18 article reviews, which were cited 146 times on average. Topics on basic science (63%) were more frequent than clinical studies (37%). The years of publication were distributed in a bell-shape curve with a peak between 1992 and 1994. North American and European centers (99%) led the list of the citation classics. Most of the top 100 most frequently cited articles on traumatic SCI (63%) explicitly focused on at least one of the topics of greatest interest to individuals with SCI. Motor function was the leading topic in the matching list between professional literature and consumers' perspective. This bibliometric analysis, for the first time, identifies the key features of the citation classics on traumatic SCI between 1986 and 2003, a period that represents one of an unprecedented increase in knowledge in this field. The 100 top-cited peer-reviewed articles have been predominantly focused on basic science SCI research indicating a need for greater bench-to-bedside translational studies in SCI research. Although the body of this top-cited professional literature mostly matches with the consumers' perspective, most of this research has been focused on motor function assessment and recovery following SCI.
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Affiliation(s)
- Julio C Furlan
- Department of Surgery, Division of Neurosurgery, University of Toronto, Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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28
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Abstract
STUDY DESIGN An evidence-based review and summary of literature from multiple disciplines involved in spine trauma. OBJECTIVES To outline epidemiologic, clinical, and research issues influencing spine trauma in a longitudinal perspective. In addition, to provide guidance to clinicians and researchers to ensure that philosophies pertaining to the betterment of spine trauma care are understood and supported. SUMMARY OF BACKGROUND DATA Epidemiologic data have provided insight into future demands the elderly patient with spine injury will place on the health care system. Regional trauma programs have emerged with further specialization resulting in regionalized spine trauma care. Evidence-based guidelines have streamlined imaging, and biomaterial advancements have facilitated the stabilization of the spinal column and decompression of the spinal cord. Promising experimental therapies promoting axonal regeneration and neuroprotective agents are beginning clinical trials, generating cautious optimism that effective therapies for spinal cord injuries will emerge. The unsustainable economics of increasing technology and patient expectations will make economic evaluation critical. METHODS Evidence-based review of current literature and expert opinion. CONCLUSIONS Multicenter spine trauma registries with patient-reported outcomes will allow many questions around spine trauma to be answered using the highest levels of evidence. This process in synergy with technical and biologic developments should ensure progress toward optimal care of the spine trauma patient. Future challenges will be to treat the breadth and magnitude of the discoveries within the fiscal restraints of the health care system and ensure its affordability for society.
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Affiliation(s)
- Charles G Fisher
- Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada.
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Mittelstaedt H, Luecke T, Thomé C, Fiedler F. Severe traumatic brain injury complicated by status asthmaticus: favorable neurological outcome despite excessive hypercapnia. ACTA ACUST UNITED AC 2006; 60:888-90. [PMID: 16612314 DOI: 10.1097/01.ta.0000208154.93652.a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hendric Mittelstaedt
- Departments of Anesthesiology and Critical Care, University Hospital of Mannheim, University of Heidelberg, Germany.
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Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To describe the incidence, clinical features, and treatment of traumatic spinal cord injury (SCI) treated at a Canadian tertiary care center. SUMMARY OF BACKGROUND DATA Understanding the current epidemiology of acute traumatic SCI is essential for public resource allocation and primary prevention. Recent reports suggest that the mean age of patients with SCI may be increasing. METHODS We retrospectively reviewed hospital records on all patients with traumatic SCI between January 1997 and June 2001 (n = 151). Variables assessed included age, gender, length of hospitalization, type and mechanism of injury, associated spinal fractures, neurologic deficit, and treatment. RESULTS Annual age-adjusted incidence rates were 42.4 per million for adults aged 15-64 years, and 51.4 per million for those 65 years and older. Motor vehicle accidents accounted for 35% of SCI. Falls were responsible for 63% of SCI among patients older than 65 years and for 31% of injuries overall. Cervical SCI was most common, particularly in the elderly, and was associated with fracture in only 56% of cases. Thoracic and lumbar SCI were associated with spinal fractures in 100% and 85% of cases, respectively. In-hospital mortality was 8%. Mortality was significantly higher among the elderly. Treatment of thoracic and lumbar fractures associated with SCI was predominantly surgical, whereas cervical fractures were equally likely to be treated with external immobilization alone or with surgery. CONCLUSION A large proportion of injuries was seen among older adults, predominantly as a result of falls. Prevention programs should expand their focus to include home safety and avoidance of falls in the elderly.
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Affiliation(s)
- Gwynedd E Pickett
- London Health Sciences Centre, University of Western Ontario, London, Canada
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Kazanis I. CNS injury research; reviewing the last decade: methodological errors and a proposal for a new strategy. ACTA ACUST UNITED AC 2005; 50:377-86. [PMID: 16274749 DOI: 10.1016/j.brainresrev.2005.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 05/22/2005] [Accepted: 09/27/2005] [Indexed: 01/31/2023]
Abstract
During the last decades the field of Traumatic Brain Injury (TBI) has been characterized by a paucity of new treatments. This is in contrast to the amount of pre-clinical experimental work and the number of clinical trials done. This paper aims to contribute to the ongoing debate on the reasons that have led to this phenomenon. A reasonable suggestion could be the presence of methodological limitations when comparing and integrating experimental results. The first methodological drawback, which is shortly discussed, is the insistence (during the last decades) on the concept of "similarity to the human pathology" as the main criterion to evaluate results, and the constant effort to create a "super model" that would fully replicate human TBI cases. The second methodological limitation examined is the lack of a common way to present and analyze data. It is proposed that the basic neuro-histo-pathology of each injury model should serve as the ground on which hypotheses should be built, as it could constitute the common basis for comparisons between different experimental settings. In this context, 95 papers reporting experimental results from various models of animal CNS injury were reviewed in order to examine the extent to which results were presented and analyzed using a common basis. No such common basis was observed; moreover, the review revealed a remarkable lack of histopathological examination of the animals, especially when biochemical and/or behavioral endpoints were assessed. It is argued that this practice deprives data of an objective common basis. Conclusively, a new theoretical way of organizing experimental work in the field of TBI is briefly presented.
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Affiliation(s)
- Ilias Kazanis
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK.
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Abstract
This review examines the derivation of the NICE guidelines and discusses some of the problems of putting research into practice.
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Affiliation(s)
- J Dunning
- Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 3BW, UK.
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Kazanis I, Bozas E, Philippidis H, Stylianopoulou F. Neuroprotective effects of insulin-like growth factor-I (IGF-I) following a penetrating brain injury in rats. Brain Res 2003; 991:34-45. [PMID: 14575874 DOI: 10.1016/s0006-8993(03)03525-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The elucidation of the molecular mechanisms involved in the response of brain tissue to trauma and the recognition of substances with neuroprotective properties is a prerequisite for the development of rational therapeutic approaches. In this study, we used a model of, unilateral, penetrating stab-like brain injury and examined the possible beneficial effects of post-injury administration of insulin-like growth factor-I (IGF-I) both at the cellular level, 4 and 12 h post-injury, and on the physical condition of the animals up to 1 week following the trauma. The consequences of injury were assessed by immunohistochemically observing the expression of heat-shock protein 70 (Hsp70), which is thought to be a marker of cell stress and injury, and by staining the tissue with the TUNEL reaction, in order to detect apoptotic cell death. Injury resulted in an increase in the number of Hsp70 and TUNEL positive cells in the peritraumatic area. The physical condition of the rats was followed by measuring body weight changes, food and water intake and by estimating their "motor activity". IGF-I administration resulted in a significant decrease in the number of Hsp70 and TUNEL positive cells in the peritraumatic area. Additionally, it improved the total "motor activity" of injured rats, increased food intake and attenuated the post-injury body weight loss. IGF-I thus emerges as a factor acting both at the cellular level as a neuroprotectant and at the systemic level as an anabolic agent.
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Affiliation(s)
- Ilias Kazanis
- Laboratory of Biology-Biochemistry, Faculty of Nursing, University of Athens, 123 Papadiamantopoulou Str, 115 27, Athens, Greece
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