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Eggertsen PP, Cordsen P, Lauritsen J, Johnsen SP, Nielsen JF. Incidence and Prevalence of Concussion in Denmark from 1999-2018: A Nationwide Cohort Study. J Neurotrauma 2024. [PMID: 39096128 DOI: 10.1089/neu.2024.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Concussion is a common diagnosis in emergency rooms, yet contemporary incidence and prevalence estimates are sparse and rely on self-reported data. A nationwide cohort study was conducted to provide up-to-date information, covering the entire Danish population from 1999 to 2018. Hospital contacts with a concussion diagnosis, including emergency room visits, hospital admissions, and outpatient contacts, were retrieved from the Danish National Patient Registry (DNPR), and incidence rates were age-standardized and stratified. The 20-year prevalence was defined as the percentage of Danes alive in 2018 who had experienced a concussion since 1999. The diagnostic codes used were the ICD-10 code S06.0 and a local Danish code for 'observation for concussion' (DZ033D). Additional data on activities related to concussion injuries were obtained from the Accident Analysis Group at Odense University Hospital through DNPR. Findings from the study indicated that during the period 1999-2018, the total age-standardized concussion incidence rate increased by 10% to 308 per 100,000 person-years (95% confidence interval (CI): 304-313). Notable time trends included 1) a reduced sex difference from 40% to 6% (95% CI: 3%-9%), 2) a doubled incidence rate in children aged 0-1 and in seniors aged over 80, 3) an increased utilization of head imaging across all age groups, except children, 4) a decline in the proportion of traffic-related concussions, and 5) a prevalence of concussion of 4.9% (95% CI: 4.89% - 4.93%) in 2018. The increasing incidence of concussions among the elderly is concerning in light of an aging population, and warrants further investigation, as evidence-based preventive interventions for falls exist. Additionally, the increased utilization of head imaging across all age groups except children calls for attention toward avoidance of unnecessary radiation exposure. Despite a drop in traffic-related cases, concussions remain highly prevalent. In conclusion, these findings indicate that concussions are an important public health concern, necessitating ongoing surveillance, research, and targeted resource allocation to address concussion management and prevention effectively.
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Affiliation(s)
- Peter Preben Eggertsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Voldbyvej 15A, Hammel, Denmark, 8541
- Aarhus University, Department of Clinical Medicine, Aarhus, Midtjylland, Denmark;
| | - Pia Cordsen
- Danish Center for Health Services Research, Aalborg, Denmark
- Aalborg Universitet, Aalborg, Region Nordjylland, Denmark;
| | - Jens Lauritsen
- Accident Analysis Group, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Syddanmark, Denmark;
| | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Aalborg, Denmark
- Aalborg Universitet, Aalborg, Region Nordjylland, Denmark;
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
- Aarhus University, Department of Clinical Medicine, Aarhus, Midtjylland, Denmark;
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Derouin Y, Delhomme T, Launey Y, Bouras M, Sautenet B, Sébille V, Cinotti R. A Systematic Review of Reported Outcomes in Randomized Controlled Trials Targeting Early Interventions in Moderate-to-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 39013835 DOI: 10.1089/neu.2023.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Randomized controlled trials (RCTs) are the cornerstone to evaluate the efficacy of an intervention. To assess the methodology of clinical research, we performed a systematic review that evaluated the different outcomes used in RCTs targeting the early phase of moderate-to-severe adult TBI from 1983 to October 31, 2023. We extracted each outcome and organized them according to the COMET and OMERACT framework (core area, broad domains, target domains, and finally outcomes). A total of 190 RCTs were included, including 52,010 participants. A total of 557 outcomes were reported and classified between the following core areas: pathophysiological manifestations [169 RCTs (88.9%)], life impact [117 RCTs (61.6%)], death [94 RCTs (49.5%)], resource use [72 RCTs (37.9%)], and adverse events [41 RCTs (21.6%)]. We identified 29 broad domains and 89 target domains. Among target domains, physical functioning [111 (58.4%)], mortality [94 (49.5%)], intracranial pressure target domain [68 (35.8%)], and hemodynamics [53 (27.9%)] were the most frequent. Outcomes were mostly clinician-reported [177 (93.2%)], while patient-reported outcomes were rarely reported [11 (5.8%)]. In our review, there was significant heterogeneity in the choice of end-points in TBI clinical research. There is an urgent need for consensus and homogeneity to improve the quality of clinical research in this area.
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Affiliation(s)
- Yvan Derouin
- CHU Nantes, Pôle Anesthésie Réanimations, Nantes Université, Nantes, France
- INSERM, MethodS in Patients-centered outcomes and HEalth Research, Nantes Université, Univ Tours, CHU Nantes, CHU Tours, Nantes, France
| | - Thomas Delhomme
- CHU Nantes, Pôle Anesthésie Réanimations, Nantes Université, Nantes, France
| | - Yoann Launey
- CHU Rennes, Département d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital Pontchaillou, Rennes Université, Rennes, France
| | - Marwan Bouras
- CHU Nantes, Pôle Anesthésie Réanimations, Nantes Université, Nantes, France
- INSERM, Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France
| | - Bénédicte Sautenet
- INSERM, MethodS in Patients-centered outcomes and HEalth Research, Nantes Université, Univ Tours, CHU Nantes, CHU Tours, Nantes, France
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, Université de Tours, Université de Nantes, Tours, France
| | - Véronique Sébille
- INSERM, MethodS in Patients-centered outcomes and HEalth Research, Nantes Université, Univ Tours, CHU Nantes, CHU Tours, Nantes, France
- Plateforme de Méthodologie et Biostatistique, CHU Nantes, Nantes, France
| | - Raphaël Cinotti
- CHU Nantes, Pôle Anesthésie Réanimations, Nantes Université, Nantes, France
- INSERM, MethodS in Patients-centered outcomes and HEalth Research, Nantes Université, Univ Tours, CHU Nantes, CHU Tours, Nantes, France
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Deli A, Green AL. Deep Brain Stimulation for Consciousness Disorders; Technical and Ethical Considerations. NEUROETHICS-NETH 2024; 17:35. [PMID: 39091894 PMCID: PMC11289033 DOI: 10.1007/s12152-024-09570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 07/10/2024] [Indexed: 08/04/2024]
Abstract
Disorders of Consciousness (DoC) result in profound functional impairment, adversely affecting the lives of a predominantly younger patient population. Currently, effective treatment options for those who have reached chronicity (prolonged symptom duration over 4 weeks) are extremely limited, with the majority of such cases facing life-long dependence on carers and a poor quality of life. Here we briefly review the current evidence on caseload, diagnostic and management options in the United Kingdom (UK), United States of America (USA) and the European Union (EU). We identify key differences as well as similarities in these approaches across respective healthcare systems, highlighting unmet needs in this population. We subsequently present past efforts and the most recent advances in the field of surgical modulation of consciousness through implantable neurostimulation systems. We examine the ethical dilemmas that such a treatment approach may pose, proposing mediating solutions and methodological adjustments to address these concerns. Overall, we argue that there is a strong case for the utilisation of deep brain stimulation (DBS) in the DoC patient cohort. This is based on both promising results of recent clinical trials as well as technological developments. We propose a revitalization of surgical neuromodulation for DoC with a multicenter, multidisciplinary approach and strict monitoring guidelines, in order to not only advance treatment options but also ensure the safeguarding of patients' welfare and dignity.
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Affiliation(s)
- Alceste Deli
- Nuffield Department of Surgical Sciences and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alexander L. Green
- Nuffield Department of Surgical Sciences and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Stojsavljević A, Jagodić J, Perović T, Manojlović D, Pavlović S. Changes of Target Essential Trace Elements in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Biomedicines 2024; 12:1589. [PMID: 39062163 PMCID: PMC11274787 DOI: 10.3390/biomedicines12071589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Multiple sclerosis (MS) is a chronic, complex, and demyelinating disease closely associated with altered levels of trace elements. Although the first studies into the role of trace elements in MS were published in the 1970s, for five decades it has remained unknown whether trace elements can be part of this heterogeneous neurological disease. (2) Materials and methods: To drive toward at a potential solution, we conducted a systematic review and meta-analysis to elucidate whether there were differences in circulating levels of neurologically important essential trace elements (Zn, Fe, Co, Cu, Mn, and Se) between MS cases and controls. (3) Results: This study revealed significantly lower serum/plasma Zn and Fe levels and higher Cu levels in MS-affected individuals compared to controls. At the same time, no significant differences were found between the MS cases and controls regarding their serum/plasma levels of Co, Mn, or Se. Thus, the loss of Fe and Zn should be considered in supplementation/nutrition strategies for MS patients. On the other hand, since high serum Cu levels indicate a burden on the bloodstreams of MS patients, Cu should be excluded from mineral supplement strategies. Furthermore, all three trace elements (Fe, Zn, and Cu) should be considered from an etiological point of view, and, most importantly, their levels in the bloodstreams of MS patients should be monitored. (4) Conclusions: This study highlights the way for personalized and targeted strategies in the management of MS.
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Affiliation(s)
- Aleksandar Stojsavljević
- Innovation Center, Faculty of Chemistry, University of Belgrade, Studentski Trg 12-16, 11000 Belgrade, Serbia
| | - Jovana Jagodić
- Faculty of Chemistry, University of Belgrade, 11000 Belgrade, Serbia; (J.J.); (D.M.)
| | - Tatjana Perović
- Psychiatric Hospital, University Medical Center Zvezdara, 11000 Belgrade, Serbia;
- Serbian RE&CBT Centre, 11000 Belgrade, Serbia
| | - Dragan Manojlović
- Faculty of Chemistry, University of Belgrade, 11000 Belgrade, Serbia; (J.J.); (D.M.)
| | - Slađan Pavlović
- Institute for Biological Research “Siniša Stanković”-National Institute of the Republic of Serbia, University of Belgrade, 11108 Belgrade, Serbia;
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Bölükbaş K, Edwards L, Baguley DM, Fackrell K. Clinical experiences, current approaches, opinions and awareness of healthcare professionals regarding the audio-vestibular consequences of individuals with traumatic brain injury: a cross-sectional online survey study. BMJ Open 2024; 14:e078017. [PMID: 38977364 PMCID: PMC11256030 DOI: 10.1136/bmjopen-2023-078017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 05/27/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVE To explore the experiences, current approaches, opinions and awareness of healthcare professionals (HCPs) caring for adults with traumatic brain injury (TBI) regarding the audio-vestibular consequences. DESIGN/SETTING Cross-sectional online survey study. PARTICIPANTS HCPs with experience of caring for adults with TBI, who were not ENT (ear nose throat) specialists or audiologists. METHODS The study was conducted from May 2022 to December 2022. The online survey consisted of 16 closed and open-text questions in English and Turkish about clinical experience, current approaches and awareness of audio-vestibular consequences following TBI. Frequencies of responses to closed questions and associations between variables were analysed using SPSS V.28. Open-text responses were summarised in Microsoft Excel. RESULTS Seventy HCPs participated from 17 professions and 14 countries, with the majority from the UK (42.9%). HCPs stated that 'some' to 'all' of their patients had auditory problems such as 'inability to understand speech-in-noise' (66%), 'tinnitus' (64%), 'hyperacusis' (57%) and balance problems such as 'dizziness' (79%) and 'vertigo' (67%). Usually, HCPs asked about the balance status of patients at appointments and when they observed dizziness and/or balance disorder they used screening tests, most commonly finger-to-nose (53%). For auditory impairments, HCPs preferred referring patients with TBI to audiology/ENT services. However, 6% of HCPs felt that audio-vestibular conditions could be ignored on referral because patients with TBI struggled with many impairments. Additionally, 44% would suggest hearing aids to patients with TBI with hearing loss 'if they would like to use' rather than 'definitely'. CONCLUSIONS Many audio-vestibular impairments are observed by HCPs caring for patients with TBI. The assessment and intervention opinions and awareness of HCPs for these impairments vary. However, non-expert HCPs may not be aware of negative consequences of untreated audio-vestibular impairments following TBI. Therefore, developing a simple framework for screening and indications of audio-vestibular impairments for referral may be helpful for non-audiological specialists regularly seeing these patients.
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Affiliation(s)
- Kübra Bölükbaş
- Hearing Sciences, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute of Health and Social Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Laura Edwards
- Division of Rehabilitation Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - David M Baguley
- Hearing Sciences, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute of Health and Social Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Kathryn Fackrell
- Hearing Sciences, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute of Health and Social Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
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Nisted I, Hellemose LA, Eggertsen PP, Odgaard L, Bek T, Nielsen JF. Convergence insufficiency in patients with post-concussion syndrome is accompanied by a higher symptom load: a cross-sectional study. Brain Inj 2024; 38:645-651. [PMID: 38530005 DOI: 10.1080/02699052.2024.2334355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To estimate the prevalence of convergence insufficiency (CI) in adult patients with post-concussion syndrome and determine the impact of CI on symptom load. METHODS Cross-sectional study of 103 patients with neurological symptoms 2-6 months after a concussion. Symptoms were assessed with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and CI was diagnosed using near point of convergence, vergence facility, and the Convergence Insufficiency Symptom Survey. The RPQ score for patients with and without CI was compared, and sensitivity, specificity, and area under the receiver operating characteristic curve for the two visually related RPQ questions as indicators of CI were calculated. RESULTS The proportion of patients diagnosed with symptomatic CI was 20.4% (95% confidence interval: 13.1-29.5%). The RPQ score was significantly higher for patients with symptomatic CI both before (p = .01) and after removal of the two visually related questions in the RPQ-questionnaire (p = .03). The two visually related RPQ questions were unable to detect CI. CONCLUSION In patients with post-concussion syndrome, the load of nonvisual symptoms is higher in the presence of CI. A prospective interventional study on CI is required to study the relationship between CI and other post-concussion symptoms.
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Affiliation(s)
- Ivan Nisted
- Danish College of Optometry and Vision Science, Dania Academy, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Line Amalie Hellemose
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Peter Preben Eggertsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Lene Odgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
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Eryilmaz A, Sahin T. Comparison of scoring systems for patients with head injury presenting to the emergency department. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02589-6. [PMID: 38940949 DOI: 10.1007/s00068-024-02589-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE The present study aimed to compare the National Emergency X-Radiography Utilization Study II (NEXUS-II), New Orleans Criteria (NOC), Canadian Computed Tomography (CT) Head Rule (CCTHR) scoring systems, and Advanced Trauma Life Support (ATLS®) 10th edition algorithm in patients with head injury presenting to the emergency department and to investigate the effectiveness of these scoring systems in determining injury severity and the need for cranial CT scanning. METHODS This prospective and observational study was conducted in a tertiary care emergency medicine clinic. The study included 794 adult patients who had a Glasgow Coma Scale (GCS) score ≥ 13, and were considered as having minor head injury. Patients included in the study were categorized as having low or high risk according to the CCTHR, NOC, NEXUS-II scores, and ATLS algorithm. RESULTS The mean age of the patients was 40.7 ± 18.7 years, and 592 (74.6%) were male. The proportion of patients considered as having high risk was 27.7%, 84.8%, and 34.5% according to CCTHR, NOC, and NEXUS-II, respectively. According to the ATLS, 14.7% and 14.1% of the patients were considered at medium risk and high risk, respectively. CT scanning was performed in 757 (95.3%) patients, and pathologic findings were detected in 18 patients (2.3%). NOC in contrary showed a sensitivity of 100% but a specificity of 15.6%. CONCLUSION In our region, there was no significant difference among the CCTHR, NEXUS-II systems, and ATLS algorithm regarding the accuracy of pathological findings in patients with head injury; any of these systems can be used in clinical practice and determining CT scan necessity. Although the sensitivity of the NOC system is very high, it has been observed that its low specificity may lead to a large number of unnecessary CT scans, which may increase the patient-based cost and waiting time in the emergency department.
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Affiliation(s)
- Alihan Eryilmaz
- Emergency Medicine Clinic, Inegol State Hospital, Bursa, Türkiye, Turkey
| | - Taner Sahin
- Department of Emergency Medicine, University of Health Science Kayseri Medicine Faculty, Kayseri, Türkiye, Turkey.
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Kelley W, Zreik K, Gergen A, Williams J, Jacobson LE, Nahmias J, Tatar A, Murry J, Grigorian A, Ong A, Stein DM, Scalea TM, Lauerman MH. Early Pharmacologic Therapy in Patients With Blunt Cerebrovascular Injury and TBI: Is it Safe and Effective? An EAST Multicenter Study. Am Surg 2024; 90:1330-1337. [PMID: 38253324 DOI: 10.1177/00031348241230094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Blunt cerebrovascular injury (BCVI) with concurrent traumatic brain injury (TBI) presents increased risk of both ischemic stroke and bleeding. This study investigated the safety and survival benefit of BCVI treatment (antithrombotic and/or anticoagulant therapy) in this population. We hypothesized that treatment would be associated with fewer and later strokes in patients with BCVI and TBI without increasing bleeding complications. METHODS Patients with head AIS >0 were selected from a database of BCVI patients previously obtained for an observational trial. A Kaplan-Meier analysis compared stroke survival in patients who received BCVI treatment to those who did not. Logistic regression was used to evaluate for confounding variables. RESULTS Of 488 patients, 347 (71.1%) received BCVI treatment and 141 (28.9%) did not. BCVI treatment was given at a median of 31 h post-admission. BCVI treatment was associated with lower stroke rate (4.9% vs 24.1%, P < .001 and longer stroke-free survival (P < .001), but also less severe systemic injury. Logistic regression identified motor GCS and BCVI treatment as the only predictors of stroke. No patients experienced worsening TBI because of treatment. DISCUSSION Patients with BCVI and TBI who did not receive BCVI treatment had an increased rate of stroke early in their hospital stay, though this effect may be confounded by worse motor deficits and systemic injuries. BCVI treatment within 2-3 days of admission may be safe for patients with mean head AIS of 2.6. Future prospective trials are needed to confirm these findings and determine optimal timing of BCVI treatment in TBI patients with BCVI.
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Affiliation(s)
- William Kelley
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Khaled Zreik
- Department of Surgery, Sanford Health, Sioux Falls, SD, USA
| | - Anna Gergen
- Department of Surgery, University of Colorado Denver, Aurora, CO, USA
| | - Jamie Williams
- Department of Surgery, Ascension St. Vincent Hospital, Indianapolis, IN, USA
| | - Lewis E Jacobson
- Department of Surgery, Ascension St. Vincent Hospital, Indianapolis, IN, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California - Irvine, Irvine, CA, USA
| | - Anthony Tatar
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jason Murry
- Department of Surgery, UT Health Tyler, Tyler, TX, USA
| | - Areg Grigorian
- Department of Surgery, University of California - Irvine, Irvine, CA, USA
| | - Adrian Ong
- Department of Surgery, Towerhealth, West Reading, PA, USA
| | - Deborah M Stein
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas M Scalea
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Margaret H Lauerman
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Edwards L, Tesorero V, Zonouzi F, Santullo P, Owen P, Gordon AL. The use of frailty questionnaires in inpatients in two neurorehabilitation units in the East Midlands - A cross-sectional cohort study with follow-up to 1-year after discharge from inpatient rehabilitation. J R Coll Physicians Edinb 2024; 54:120-126. [PMID: 38578071 DOI: 10.1177/14782715241242509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Frailty correlates with poor clinical outcomes and is not routinely assessed in neurorehabilitation inpatient settings. METHODS We recruited adults from two neurorehabilitation units. We administered six validated tools for assessing frailty and collected data around length of stay, discharge, readmission and change in rehabilitation outcome measures. RESULTS Seventy-eight participants aged between 31 and 84 years were recruited with a range of neurological diagnoses. Frailty prevalence ranged between 23% and 46%, depending on the scale used, with little agreement between tools. Frailty status did not correlate with age, gender, length of stay, discharge destination and rehabilitation outcome measures. One-year readmission was higher in participants rated as frail by the Frail-Non-Disabled Questionnaire, the FRESH-screening questionnaire and the Clinical Frailty Scale. CONCLUSION Frailty ascertainment was variable depending on the tool used. Three frailty indices predicted readmission rate at 1 year but no other outcome measures. Therefore, frailty tools may have limited utility in this clinical population.
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Affiliation(s)
- Laura Edwards
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Academic Unit of Injury, Rehabilitation and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK
| | - Vina Tesorero
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fattaneh Zonouzi
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Piera Santullo
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Phoebe Owen
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adam L Gordon
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Academic Unit of Injury, Rehabilitation and Inflammation Sciences (IRIS), University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
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10
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Pisică D, Volovici V, Yue JK, van Essen TA, den Boogert HF, Vande Vyvere T, Haitsma I, Nieboer D, Markowitz AJ, Yuh EL, Steyerberg EW, Peul WC, Dirven CMF, Menon DK, Manley GT, Maas AIR, Lingsma HF. Clinical and Imaging Characteristics, Care Pathways, and Outcomes of Traumatic Epidural Hematomas: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study. Neurosurgery 2024:00006123-990000000-01172. [PMID: 38771081 DOI: 10.1227/neu.0000000000002982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/05/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Guideline recommendations for surgical management of traumatic epidural hematomas (EDHs) do not directly address EDHs that co-occur with other intracranial hematomas; the relative rates of isolated vs nonisolated EDHs and guideline adherence are unknown. We describe characteristics of a contemporary cohort of patients with EDHs and identify factors influencing acute surgery. METHODS This research was conducted within the longitudinal, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury cohort study which prospectively enrolled patients with traumatic brain injury from 65 hospitals in 18 European countries from 2014 to 2017. All patients with EDH on the first scan were included. We describe clinical, imaging, management, and outcome characteristics and assess associations between site and baseline characteristics and acute EDH surgery, using regression modeling. RESULTS In 461 patients with EDH, median age was 41 years (IQR 24-56), 76% were male, and median EDH volume was 5 cm3 (IQR 2-20). Concomitant acute subdural hematomas (ASDHs) and/or intraparenchymal hemorrhages were present in 328/461 patients (71%). Acute surgery was performed in 99/461 patients (21%), including 70/86 with EDH volume ≥30 cm3 (81%). Larger EDH volumes (odds ratio [OR] 1.19 [95% CI 1.14-1.24] per cm3 below 30 cm3), smaller ASDH volumes (OR 0.93 [95% CI 0.88-0.97] per cm3), and midline shift (OR 6.63 [95% CI 1.99-22.15]) were associated with acute surgery; between-site variation was observed (median OR 2.08 [95% CI 1.01-3.48]). Six-month Glasgow Outcome Scale-Extended scores ≥5 occurred in 289/389 patients (74%); 41/389 (11%) died. CONCLUSION Isolated EDHs are relatively infrequent, and two-thirds of patients harbor concomitant ASDHs and/or intraparenchymal hemorrhages. EDHs ≥30 cm3 are generally evacuated early, adhering to Brain Trauma Foundation guidelines. For heterogeneous intracranial pathology, surgical decision-making is related to clinical status and overall lesion burden. Further research should examine the optimal surgical management of EDH with concomitant lesions in traumatic brain injury, to inform updated guidelines.
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Affiliation(s)
- Dana Pisică
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Victor Volovici
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - John K Yue
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Thomas A van Essen
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Division of Neurosurgery, Department of Surgery, QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hugo F den Boogert
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thijs Vande Vyvere
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Iain Haitsma
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Daan Nieboer
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Amy J Markowitz
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Esther L Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Ewout W Steyerberg
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center and Haaglanden Medical Center, Leiden and The Hague, the Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - David K Menon
- Division of Anaesthesia, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
- Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Hester F Lingsma
- Department of Public Health, Center for Medical Decision Making, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
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11
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Arippa F, Pau M, Marcello R, Atzeni L, Simone Vullo S, Monticone M. An integrated approach to the assessment of balance and functional mobility in individuals with history of severe traumatic brain injury. Heliyon 2024; 10:e30665. [PMID: 38765073 PMCID: PMC11098832 DOI: 10.1016/j.heliyon.2024.e30665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/11/2024] [Accepted: 05/01/2024] [Indexed: 05/21/2024] Open
Abstract
Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales. The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI.
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Affiliation(s)
- Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Rosa Marcello
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS G. Brotzu Hospital, Cagliari, Italy
| | - Laura Atzeni
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS G. Brotzu Hospital, Cagliari, Italy
| | - Salvatore Simone Vullo
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS G. Brotzu Hospital, Cagliari, Italy
| | - Marco Monticone
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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12
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Steinheber J, Kanz KG, Biberthaler P, Flatz W, Bogner-Flatz V. [Head injuries and their wound treatment]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:391-402. [PMID: 38619616 DOI: 10.1007/s00113-024-01430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
Head injuries are frequent occurrences in emergency departments worldwide and are notable for the fact that attention must be paid to the sequelae of intracranial and extracranial trauma. It is crucial to assess potential intracranial injuries and to strive for both medically sound and esthetically pleasing extracranial outcomes. The aim of this continuing education article is to provide a refresher on knowledge of head injuries and the associated nuances for wound care.
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Affiliation(s)
- Jakob Steinheber
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungschirurgie, Sportmedizin, Kreisklinik Ebersberg, Ebersberg, Deutschland
| | - Karl-Georg Kanz
- Zentrale Notaufnahme, Klinikum rechts der Isar der Technischen Universität München und Ärztlicher Bezirksbeauftragter Rettungsdienst Oberbayern West, München, Deutschland
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Wilhelm Flatz
- Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-Universität München, München, Deutschland
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13
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Chen DY, Wu PF, Zhu XY, Zhao WB, Shao SF, Xie JR, Yuan DF, Zhang L, Li K, Wang SN, Zhao H. Risk factors and predictive model of cerebral edema after road traffic accidents-related traumatic brain injury. Chin J Traumatol 2024; 27:153-162. [PMID: 38458896 PMCID: PMC11138350 DOI: 10.1016/j.cjtee.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/06/2023] [Accepted: 01/29/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE Cerebral edema (CE) is the main secondary injury following traumatic brain injury (TBI) caused by road traffic accidents (RTAs). It is challenging to be predicted timely. In this study, we aimed to develop a prediction model for CE by identifying its risk factors and comparing the timing of edema occurrence in TBI patients with varying levels of injuries. METHODS This case-control study included 218 patients with TBI caused by RTAs. The cohort was divided into CE and non-CE groups, according to CT results within 7 days. Demographic data, imaging data, and clinical data were collected and analyzed. Quantitative variables that follow normal distribution were presented as mean ± standard deviation, those that do not follow normal distribution were presented as median (Q1, Q3). Categorical variables were expressed as percentages. The Chi-square test and logistic regression analysis were used to identify risk factors for CE. Logistic curve fitting was performed to predict the time to secondary CE in TBI patients with different levels of injuries. The efficacy of the model was evaluated using the receiver operator characteristic curve. RESULTS According to the study, almost half (47.3%) of the patients were found to have CE. The risk factors associated with CE were bilateral frontal lobe contusion, unilateral frontal lobe contusion, cerebral contusion, subarachnoid hemorrhage, and abbreviated injury scale (AIS). The odds ratio values for these factors were 7.27 (95% confidence interval (CI): 2.08 - 25.42, p = 0.002), 2.85 (95% CI: 1.11 - 7.31, p = 0.030), 2.62 (95% CI: 1.12 - 6.13, p = 0.027), 2.44 (95% CI: 1.25 - 4.76, p = 0.009), and 1.5 (95% CI: 1.10 - 2.04, p = 0.009), respectively. We also observed that patients with mild/moderate TBI (AIS ≤ 3) had a 50% probability of developing CE 19.7 h after injury (χ2 = 13.82, adjusted R2 = 0.51), while patients with severe TBI (AIS > 3) developed CE after 12.5 h (χ2 = 18.48, adjusted R2 = 0.54). Finally, we conducted a receiver operator characteristic curve analysis of CE time, which showed an area under the curve of 0.744 and 0.672 for severe and mild/moderate TBI, respectively. CONCLUSION Our study found that the onset of CE in individuals with TBI resulting from RTAs was correlated with the severity of the injury. Specifically, those with more severe injuries experienced an earlier onset of CE. These findings suggest that there is a critical time window for clinical intervention in cases of CE secondary to TBI.
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Affiliation(s)
- Di-You Chen
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China; Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Peng-Fei Wu
- Chongqing Key Laboratory of Traffic Injury and Vehicle Ergonomics, Chongqing, 400042, China
| | - Xi-Yan Zhu
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Wen-Bing Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Shi-Feng Shao
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jing-Ru Xie
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Dan-Feng Yuan
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Liang Zhang
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Kui Li
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Shu-Nan Wang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China.
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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14
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Eggertsen PP, Palmfeldt J, Schytz HW, Hay D, Olsen RKJ, Nielsen JF. Serum calcitonin gene-related peptide in patients with persistent post-concussion symptoms, including headache: a cohort study. J Neurol 2024; 271:2458-2472. [PMID: 38231270 PMCID: PMC11055722 DOI: 10.1007/s00415-024-12181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) plays an important role in migraine pathophysiology, and post-traumatic headache (PTH) frequently presents with migraine-like features. Despite several clinical similarities, few studies have explored CGRP in PTH and concussion. This study investigates serum CGRP levels in patients with persistent post-concussion symptoms (PPCS), including PTH. METHODS This cohort study was based on serum samples from individuals aged 18-30 years with PPCS who participated in a previously published randomized controlled trial of a non-pharmacological intervention. The primary outcome was serum CGRP concentrations, determined at baseline before randomization and at follow-up 7 months later, using an enzyme-linked immunosorbent assay (ELISA). CGRP levels at baseline were compared with healthy anonymous blood donors in the same age group. RESULTS Baseline serum samples were collected from 86 participants with PPCS. The participants were most often female (78%) and migraine-like headache was the most frequent headache phenotype (74%). Serum CGRP levels were higher in participants with PPCS than in 120 healthy individuals (median: 158.5 pg/mL vs. 76.3 pg/mL, p = 0.050). A stratified analysis revealed that females with PPCS had a fivefold higher median than healthy females (166.3 pg/mL vs. 32.1 pg/mL, p = 0.0006), while no differences were observed in males (p = 0.83). At follow-up, CGRP levels decreased with a median change of - 1.3 pg/mL (95% confidence interval: - 17.6-0, p = 0.024). DISCUSSION Elevated serum levels of CGRP in patients with PPCS and a decrease over time suggest an involvement of CGRP in PTH/PPCS. If confirmed in other studies, it could pave the way for CGRP-targeted therapies, which could have clinical significance.
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Affiliation(s)
- Peter Preben Eggertsen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15A, 8450, Hammel, Denmark.
- Department of Clinical Medicine, Research Unit for Molecular Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Johan Palmfeldt
- Department of Clinical Medicine, Research Unit for Molecular Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Henrik Winther Schytz
- Faculty of Health and Medical Sciences, Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Debbie Hay
- Department of Pharmacology and Toxicology, University of Otago, 362 Leith Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Rikke Katrine Jentoft Olsen
- Department of Clinical Medicine, Research Unit for Molecular Medicine, Aarhus University Hospital and Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Jørgen Feldbæk Nielsen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Voldbyvej 15A, 8450, Hammel, Denmark
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15
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Kokko L, Snäll J, Puolakkainen T, Piippo-Karjalainen A, Suominen A, Thorén H. Concomitant head or neck injury increases risk of traumatic brain injury in facial fracture patients. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00101-3. [PMID: 39095305 DOI: 10.1016/j.bjoms.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/11/2024] [Accepted: 04/24/2024] [Indexed: 08/04/2024]
Abstract
Concomitant traumatic brain injury (TBI) is common in facial fracture patients and prompt intervention is crucially important to minimise the risk of potential long-term sequalae. In order to achieve rapid diagnosis, clinicians need to be aware of the risk factors associated with concomitant TBI and facial fractures. Previous literature suggests that a facial fracture can be considered a significant indicator of TBI. Nevertheless, a large data gap remains on specific injury patterns of facial fractures and associated TBI. Therefore, the objective of this study was to estimate and compare the frequency of and risk factors for TBI in patients with and without different types of additional injuries. The retrospective cohort study included 1836 facial fracture patients aged at least 18 years. The outcome variable was TBI with radiological findings in computed tomography or magnetic resonance imaging. The primary predictor variables were associated injury outside the head and neck, associated cranial fracture and associated neck injury. Based on this study, associated cranial fracture increased the risk of TBI 4.7-fold. Patients with associated neck injury had a 2.1-fold risk of TBI. In addition, significant predictors for TBI were increasing age (p = 0.0004), high energy of injury (p < 0.0001) and anticoagulant medication (p = 0.0003). Facial fracture patients with associated injuries in the head and neck region are at significant risk of TBI. In clinical work, multiprofessional evaluation of facial fracture patients should be routine and repeated survey should be targeted especially at high-risk patients to identify TBIs.
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Affiliation(s)
- L Kokko
- Department of Oral and Maxillofacial Surgery, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland.
| | - J Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 1, PL 41, 00014 Helsingin Yliopisto, Helsinki, Finland; Helsinki University Hospital, Haartmaninkatu 4, PL 320, 00029, HUS, Helsinki, Finland
| | - T Puolakkainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 1, PL 41, 00014 Helsingin Yliopisto, Helsinki, Finland; Helsinki University Hospital, Haartmaninkatu 4, PL 320, 00029, HUS, Helsinki, Finland
| | - A Piippo-Karjalainen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, PL 320, 00029, HUS, Helsinki, Finland
| | - A Suominen
- Department of Community Dentistry, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
| | - H Thorén
- Department of Oral and Maxillofacial Surgery, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
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16
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Lang J, Sun B, Feng S, Sun G. Impaired autophagic flux in the human brain after traumatic brain injury. Neuroreport 2024; 35:387-398. [PMID: 38526944 PMCID: PMC10965136 DOI: 10.1097/wnr.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/14/2024] [Indexed: 03/27/2024]
Abstract
Emerging evidence indicates that dysfunctional autophagic flux significantly contributes to the pathology of experimental traumatic brain injury (TBI). The current study aims to clarify its role post-TBI using brain tissues from TBI patients. Histological examinations, including hematoxylin and eosin, Nissl staining, and brain water content analysis, were employed to monitor brain damage progression. Electron microscopy was used to visualize autophagic vesicles. Western blotting and immunohistochemistry were performed to analyze the levels of important autophagic flux-related proteins such as Beclin1, autophagy-related protein 5, lipidated microtubule-associated protein light-chain 3 (LC3-II), autophagic substrate sequestosome 1 (SQSTM1/p62), and cathepsin D (CTSD), a lysosomal enzyme. Immunofluorescence assays evaluated LC3 colocalization with NeuN, P62, or CTSD, and correlation analysis linked autophagy-related protein levels with brain water content and Nissl bodies. Early-stage TBI results showed increased autophagic vesicles and LC3-positive neurons, suggesting autophagosome accumulation due to enhanced initiation and reduced clearance. As TBI progressed, LC3-II and P62 levels increased, while CTSD levels decreased. This indicates autophagosome overload from impaired degradation rather than increased initiation. The study reveals a potential association between worsening brain damage and impaired autophagic flux post-TBI, positioning improved autophagic flux as a viable therapeutic target for TBI.
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Affiliation(s)
- Jiadong Lang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, the People’s Republic of China
| | - Boyu Sun
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, the People’s Republic of China
| | - Shiyao Feng
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, the People’s Republic of China
| | - Guozhu Sun
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, the People’s Republic of China
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17
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Mustafa AFM, Ab Mukmin L, Mazlan MZ, Ghani ARI, Wan Hassan WMN, Hassan MH. Analysis on Short-Term Outcomes for Cerebral Protection Treatment in Post Severe Traumatic Brain Injury Patients: A Single Neurosurgical Centre Study. Malays J Med Sci 2024; 31:142-152. [PMID: 38694580 PMCID: PMC11057832 DOI: 10.21315/mjms2024.31.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/29/2023] [Indexed: 05/04/2024] Open
Abstract
Background Severe traumatic brain injury (TBI) is a leading cause of disability worldwide and cerebral protection (CP) management might determine the outcome of the patient. CP in severe TBI is to protect the brain from further insults, optimise cerebral metabolism and prevent secondary brain injury. This study aimed to analyse the short-term Glasgow Outcome Scale (GOS) at the intensive care unit (ICU) discharge and a month after ICU discharge of patients post CP and factors associated with the favourable outcome. Methods This is a prospective cohort study from January 2021 to January 2022. The short-term outcomes of patients were evaluated upon ICU discharge and 1 month after ICU discharge using GOS. Favourable outcome was defined as GOS 4 and 5. Generalised Estimation Equation (GEE) was adopted to conduct bivariate GEE and subsequently multivariate GEE to evaluate the factors associated with favourable outcome at ICU discharge and 1 month after discharge. Results A total of 92 patients with severe TBI with GOS of 8 and below admitted to ICU received CP management. Proportion of death is 17% at ICU discharge and 0% after 1 month of ICU discharge. Proportion of favourable outcome is 26.1% at ICU discharge and 61.1% after 1 month of ICU discharge. Among factors evaluated, age (odds ratio [OR] = 0.96; 95% CI: 0.94, 0.99; P = 0.004), duration of CP (OR = 0.41; 95% CI: 0.20, 0.84; P = 0.014) and hyperosmolar therapy (OR = 0.41; CI 95%: 0.21, 0.83; P = 0.013) had significant association. Conclusion CP in younger age, longer duration of CP and patient not receiving hyperosmolar therapy are associated with favourable outcomes. We recommend further clinical trial to assess long term outcome of CP.
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Affiliation(s)
- Ahmad Fikri Muhammad Mustafa
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Laila Ab Mukmin
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohd Zulfakar Mazlan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Abdul Rahman Izaini Ghani
- Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Wan Mohd Nazaruddin Wan Hassan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohamad Hasyizan Hassan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Hospital USM, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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18
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Pantelatos RI, Stenberg J, Follestad T, Sandrød O, Einarsen CE, Vik A, Skandsen T. Improvement in Functional Outcome from 6 to 12 Months After Moderate and Severe Traumatic Brain Injury Is Frequent, But May Not Be Detected With the Glasgow Outcome Scale Extended. Neurotrauma Rep 2024; 5:139-149. [PMID: 38435078 PMCID: PMC10908320 DOI: 10.1089/neur.2023.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
The aims of this study were (1) to report outcome and change in outcome in patients with moderate and severe traumatic brain injury (mo/sTBI) between 6 and 12 months post-injury as measured by the Glasgow Outcome Scale Extended (GOSE), (2) to explore if demographic/injury-related variables can predict improvement in GOSE score, and (3) to investigate rate of improvement in Disability Rating Scale (DRS) score, in patients with a stable GOSE. All surviving patients ≥16 years of age who were admitted with mo/sTBI (Glasgow Coma Scale [GCS] score ≤13) to the regional trauma center in Central Norway between 2004 and 2019 were prospectively included (n = 439 out of 503 eligible). GOSE and DRS were used to assess outcome. Twelve-months post-injury, 13% with moTBI had severe disability (GOSE 2-4) versus 27% in sTBI, 26% had moderate disability (GOSE 5-6) versus 41% in sTBI and 62% had good recovery (GOSE 7-8) versus 31% in sTBI. From 6 to 12 months post-injury, 27% with moTBI and 32% with sTBI had an improvement, whereas 6% with moTBI and 6% with sTBI had a deterioration in GOSE score. Younger age and higher GCS score were associated with improved GOSE score. Improvement was least frequent for patients with a GOSE score of 3 at 6 months. In patients with a stable GOSE score of 3, an improvement in DRS score was observed in 22 (46%) patients. In conclusion, two thirds and one third of patients with mo/sTBI, respectively, had a good recovery. Importantly, change, mostly improvement, in GOSE score between 6 and 12 months was frequent and argues against the use of 6 months outcome as a time end-point in research. The GOSE does, however, not seem to be sensitive to actual change in function in the lower categories and a combination of outcome measures may be needed to describe the consequences after TBI.
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Affiliation(s)
- Rabea Iris Pantelatos
- Department of Neuromedicine, Movement Science, and Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jonas Stenberg
- Department of Neuromedicine, Movement Science, and Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology and Nuclear Medicine, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Turid Follestad
- Clinical Research Unit Central Norway, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oddrun Sandrød
- Clinic of Anaesthesia and Intensive Care, Department of Intensive Care Medicine, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cathrine Elisabeth Einarsen
- Department of Neuromedicine, Movement Science, and Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine, Movement Science, and Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Neuroclinic, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine, Movement Science, and Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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19
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Ritter K, Somnuke P, Hu L, Griemert EV, Schäfer MKE. Current state of neuroprotective therapy using antibiotics in human traumatic brain injury and animal models. BMC Neurosci 2024; 25:10. [PMID: 38424488 PMCID: PMC10905838 DOI: 10.1186/s12868-024-00851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
TBI is a leading cause of death and disability in young people and older adults worldwide. There is no gold standard treatment for TBI besides surgical interventions and symptomatic relief. Post-injury infections, such as lower respiratory tract and surgical site infections or meningitis are frequent complications following TBI. Whether the use of preventive and/or symptomatic antibiotic therapy improves patient mortality and outcome is an ongoing matter of debate. In contrast, results from animal models of TBI suggest translational perspectives and support the hypothesis that antibiotics, independent of their anti-microbial activity, alleviate secondary injury and improve neurological outcomes. These beneficial effects were largely attributed to the inhibition of neuroinflammation and neuronal cell death. In this review, we briefly outline current treatment options, including antibiotic therapy, for patients with TBI. We then summarize the therapeutic effects of the most commonly tested antibiotics in TBI animal models, highlight studies identifying molecular targets of antibiotics, and discuss similarities and differences in their mechanistic modes of action.
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Affiliation(s)
- Katharina Ritter
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstraße 1 (Bld. 505), Mainz, 55131, Germany
| | - Pawit Somnuke
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstraße 1 (Bld. 505), Mainz, 55131, Germany
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Lingjiao Hu
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstraße 1 (Bld. 505), Mainz, 55131, Germany
- Department of Gastroenterology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Eva-Verena Griemert
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstraße 1 (Bld. 505), Mainz, 55131, Germany
| | - Michael K E Schäfer
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstraße 1 (Bld. 505), Mainz, 55131, Germany.
- Focus Program Translational Neurosciences (FTN, Johannes Gutenberg-University Mainz, Mainz, Germany.
- Research Center for Immunotherapy, University Medical Center, Johannes Gutenberg- University Mainz, Mainz, Germany.
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20
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Schönberg NKT, Poppel J, Howell D, Wagner J, Höfinger M, Fabri N, Bonke EM, Rojczyk P, Hösl M, Kiwull L, Schröder SA, Blaschek A, Vill K, Koerte IK, Huppert D, Heinen F, Bonfert MV. Instrumented Balance Error Scoring System in Children and Adolescents-A Cross Sectional Study. Diagnostics (Basel) 2024; 14:513. [PMID: 38472985 DOI: 10.3390/diagnostics14050513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
Background: The Balance Error Scoring System (BESS) is a commonly used method for clinically evaluating balance after traumatic brain injury. The utilization of force plates, characterized by their cost-effectiveness and portability, facilitates the integration of instrumentation into the BESS protocol. Despite the enhanced precision associated with instrumented measures, there remains a need to determine the clinical significance and feasibility of such measures within pediatric cohorts. Objective: To report a comprehensive set of posturographic measures obtained during instrumented BESS and to examine the concurrent validity, reliability, and feasibility of instrumented BESS in the pediatric point of care setting. Methods: Thirty-seven participants (18 female; aged 13.32 ± 3.31 years) performed BESS while standing on a force plate to simultaneously compute stabilometric measures (instrumented BESS). Ellipse area (EA), path length (PL), and sway velocity (VM) were obtained for each of the six BESS positions and compared with the respective BESS scores. Additionally, the effects of sex and age were explored. A second BESS repetition was performed to evaluate the test-retest reliability. Feedback questionnaires were handed out after testing to evaluate the feasibility of the proposed protocol. Results: The BESS total score was 20.81 ± 6.28. While there was no statistically significant age or sex dependency in the BESS results, instrumented posturography demonstrated an age dependency in EA, VM, and PL. The one-leg stance on a soft surface resulted in the highest BESS score (8.38 ± 1.76), EA (218.78 cm2 ± 168.65), PL (4386.91 mm ± 1859.00), and VM (21.93 mm/s ± 9.29). The Spearman's coefficient displayed moderate to high correlations between the EA (rs = 0.429-0.770, p = 0.001-0.009), PL (rs = 0.451-0.809, p = 0.001-0.006), and VM (rs = 0.451-0.809, p = 0.001-0.006) when compared with the BESS scores for all testing positions, except for the one-leg stance on a soft surface. The BESS total score significantly correlated during the first and second repetition (rs = 0.734, p ≤ 0.001), as did errors during the different testing positions (rs = 0.489-0.799, p ≤ 0.001-0.002), except during the two-legged stance on a soft surface. VM and PL correlated significantly in all testing positions (rs = 0.465-0.675, p ≤ 0.001-0.004; (rs = 0.465-0.675, p ≤ 0.001-0.004), as did EA for all positions except for the two-legged stance on a soft surface (rs = 0.392-0.581, p ≤ 0.001-0.016). A total of 92% of participants stated that the instructions for the testing procedure were very well-explained, while 78% of participants enjoyed the balance testing, and 61% of participants could not decide whether the testing was easy or hard to perform. Conclusions: Instrumented posturography may complement clinical assessment in investigating postural control in children and adolescents. While the BESS score only allows for the consideration of a total score approximating postural control, instrumented posturography offers several parameters representing the responsiveness and magnitude of body sway as well as a more differentiated analysis of movement trajectory. Concise instrumented posturography protocols should be developed to augment neuropediatric assessments in cases where a deficiency in postural control is suspected, potentially stemming from disruptions in the processing of visual, proprioceptive, and/or vestibular information.
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Affiliation(s)
- Nils K T Schönberg
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Julius Poppel
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - David Howell
- Department of Orthopedics, University of Colorado School of Medicine, Colorado Children's Hospital, Sports Medicine Center, Aurora, CO 80045, USA
| | - Johanna Wagner
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Michael Höfinger
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Nicole Fabri
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Elena M Bonke
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Philine Rojczyk
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Lorenz Kiwull
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Clinic for Child Neurology and Social Pediatrics, Kinderzentrum Maulbronn gGmbH, 75433 Maulbronn, Germany
| | - Sebastian A Schröder
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Clinic for Child Neurology and Social Pediatrics, Kinderzentrum Maulbronn gGmbH, 75433 Maulbronn, Germany
| | - Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80337 Munich, Germany
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21
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Wang S, Liu A, Xu C, Hou J, Hong J. GLP-1(7-36) protected against oxidative damage and neuronal apoptosis in the hippocampal CA region after traumatic brain injury by regulating ERK5/CREB. Mol Biol Rep 2024; 51:313. [PMID: 38374452 PMCID: PMC10876747 DOI: 10.1007/s11033-024-09244-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Glucagon-like peptide-1 (GLP-1) (7-36) amide, an endogenous active form of GLP-1, has been shown to modulate oxidative stress and neuronal cell survival in various neurological diseases. OBJECTIVE This study investigated the potential effects of GLP-1(7-36) on oxidative stress and apoptosis in neuronal cells following traumatic brain injury (TBI) and explored the underlying mechanisms. METHODS Traumatic brain injury (TBI) models were established in male SD rats for in vivo experiments. The extent of cerebral oedema was assessed using wet-to-dry weight ratios following GLP-1(7-36) intervention. Neurological dysfunction and cognitive impairment were evaluated through behavioural experiments. Histopathological changes in the brain were observed using haematoxylin and eosin staining. Oxidative stress levels in hippocampal tissues were measured. TUNEL staining and Western blotting were employed to examine cell apoptosis. In vitro experiments evaluated the extent of oxidative stress and neural apoptosis following ERK5 phosphorylation activation. Immunofluorescence colocalization of p-ERK5 and NeuN was analysed using immunofluorescence cytochemistry. RESULTS Rats with TBI exhibited neurological deterioration, increased oxidative stress, and enhanced apoptosis, which were ameliorated by GLP-1(7-36) treatment. Notably, GLP-1(7-36) induced ERK5 phosphorylation in TBI rats. However, upon ERK5 inhibition, oxidative stress and neuronal apoptosis levels were elevated, even in the presence of GLP-1(7-36). CONCLUSION In summary, this study suggested that GLP-1(7-36) suppressed oxidative damage and neuronal apoptosis after TBI by activating ERK5/CREB.
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Affiliation(s)
- Shuwei Wang
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, 063000, Hebei, China
| | - Aijun Liu
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, 063000, Hebei, China
| | - Chaopeng Xu
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, 063000, Hebei, China
| | - Jingxuan Hou
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, 063000, Hebei, China
| | - Jun Hong
- Department of Neurosurgery, Tangshan Gongren Hospital, Tangshan, 063000, Hebei, China.
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22
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Juffermans NP, Gözden T, Brohi K, Davenport R, Acker JP, Reade MC, Maegele M, Neal MD, Spinella PC. Transforming research to improve therapies for trauma in the twenty-first century. Crit Care 2024; 28:45. [PMID: 38350971 PMCID: PMC10865682 DOI: 10.1186/s13054-024-04805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
Improvements have been made in optimizing initial care of trauma patients, both in prehospital systems as well as in the emergency department, and these have also favorably affected longer term outcomes. However, as specific treatments for bleeding are largely lacking, many patients continue to die from hemorrhage. Also, major knowledge gaps remain on the impact of tissue injury on the host immune and coagulation response, which hampers the development of interventions to treat or prevent organ failure, thrombosis, infections or other complications of trauma. Thereby, trauma remains a challenge for intensivists. This review describes the most pressing research questions in trauma, as well as new approaches to trauma research, with the aim to bring improved therapies to the bedside within the twenty-first century.
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Affiliation(s)
- Nicole P Juffermans
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
- Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Tarik Gözden
- Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Ross Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Jason P Acker
- Canadian Blood Services, Innovation and Portfolio Management, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Michael C Reade
- Medical School, University of Queensland, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Marc Maegele
- Department of Trauma and Orthopedic Surgery Cologne-Merheim Medical Center Institute of Research, Operative Medicine University Witten-Herdecke, Cologne, Germany
| | - Matthew D Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Philip C Spinella
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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23
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Campana S, Cecchetti L, Venturi M, Buemi F, Foti C, Cerasa A, Vicario CM, Carboncini MC, Tomaiuolo F. Evolution of Severe Closed Head Injury: Assessing Ventricular Volume and Behavioral Measures at 30 and 90 Days Post-Injury. J Clin Med 2024; 13:874. [PMID: 38337568 PMCID: PMC10856794 DOI: 10.3390/jcm13030874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Assessing functional outcomes in Severe Closed Head Injury (SCHI) is complex due to brain parenchymal changes. This study examines the Ventricles to Intracranial Volume Ratio (VBR) as a metric for these changes and its correlation with behavioral scales. Methods: Thirty-one SCHI patients were included. VBR was derived from CT scans at 3, 30, and 90 days post-injury and compared with Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), and Early Rehabilitation Barthel Index (ERBI) assessments at 30 and 90 days. Results: Ten patients were excluded post-decompressive craniectomy or ventriculoperitoneal shunt. Findings indicated a VBR decrease at 3 days, suggesting acute phase compression, followed by an increase from 30 to 90 days, indicative of post-acute brain atrophy. VBR correlated positively with the Marshall score in the initial 72 h, positioning it as an early indicator of subsequent brain atrophy. Nevertheless, in contrast to the Marshall score, VBR had stronger associations with DRS and ERBI at 90 days. Conclusions: VBR, alongside behavioral assessments, presents a robust framework for evaluating SCHI progression. It supports early functional outcome correlations informing therapeutic approaches. VBR's reliability underscores its utility in neurorehabilitation for ongoing SCHI assessment and aiding clinical decisions.
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Affiliation(s)
- Serena Campana
- Neurorehabilitation Unit, Auxilium Vitae Volterra, Via Borgo San Lazzero 5, 56048 Volterra, Italy;
| | - Luca Cecchetti
- Social and Affective Neuroscience (SANe) Group, MoMiLab, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy
| | - Martina Venturi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Francesco Buemi
- Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera Papardo, 98158 Messina, Italy;
| | - Cristina Foti
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy;
- S. Anna Institute, 88900 Crotone, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
| | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, 98125 Messina, Italy;
| | - Maria Chiara Carboncini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy;
| | - Francesco Tomaiuolo
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
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24
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Qian Y, Li X, Li G, Liu H, Li Q, Liu X, Zhang Y, He Z, Zhao Y, Fan H. Astrocyte-Derived Exosomal miR-148a-3p Suppresses Neuroinflammation and Restores Neurological Function in Traumatic Brain Injury by Regulating the Microglial Phenotype. eNeuro 2024; 11:ENEURO.0336-23.2024. [PMID: 38272675 PMCID: PMC10860656 DOI: 10.1523/eneuro.0336-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024] Open
Abstract
Interactions between astrocytes and microglia play an important role in the regeneration and repair of traumatic brain injury (TBI), and exosomes are involved in cell-cell interactions. A TBI model was constructed in rats. Brain extract (Ext) was isolated 1 d after TBI. Astrocyte-derived exosomes were obtained by coculturing Ext with primary astrocytes, and the morphology of exosomes was observed by electron microscopy. The isolated exosomes were cocultured with microglia to observe phenotypic changes in M1 and M2 markers. Aberrant RNA expression was detected in necrotic brain tissue and edematous brain tissue. The role of miR-148a-3p in regulating microglial phenotype was explored by knocking down or overexpressing miR-148a-3p. Finally, the effect of miR-148a-3p on TBI was studied in a rat TBI model. Astrocyte-derived exosomes stimulated by Ext promoted the transition of microglia from the M1 phenotype to the M2 phenotype. MiR-148a-3p was highly expressed in TBI. Transfecting miR-148a-3p promoted the transition of microglia from the M1 phenotype to the M2 phenotype and inhibited the lipopolysaccharide-induced inflammatory response in pre-microglia. In a rat TBI model, miR-148a-3p significantly improved the modified neurological severity score and attenuated brain injury, which promoted the transition of microglia from the M1 phenotype to the M2 phenotype. MiR-148a-3p alleviated TBI by inhibiting the nuclear factor κB pathway. Astrocyte-derived exosomal miR-148a-3p regulates the microglial phenotype, inhibits neuroinflammation, and restores neurological function in TBI. These results provide new potential targets for the treatment of TBI.
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Affiliation(s)
- Yan Qian
- Rehabilitation Medicine, Qujing No.1 Hospital, Qujing, Yunnan 655000, China
| | - Xin Li
- Rehabilitation Medicine, Qujing No.1 Hospital, Qujing, Yunnan 655000, China
| | - Guiliang Li
- Rehabilitation Medicine, Qujing No.1 Hospital, Qujing, Yunnan 655000, China
| | - Huali Liu
- Rehabilitation Medicine, Qujing No.1 Hospital, Qujing, Yunnan 655000, China
| | - Qiaofen Li
- Rehabilitation Medicine, Qujing No.1 Hospital, Qujing, Yunnan 655000, China
| | - Xia Liu
- Rehabilitation Medicine, Qujing No.1 Hospital, Qujing, Yunnan 655000, China
| | - Yang Zhang
- Rehabilitation Medicine, Qujing No.1 Hospital, Qujing, Yunnan 655000, China
| | - Zongying He
- Rehabilitation Medicine, Qujing No.1 Hospital, Qujing, Yunnan 655000, China
| | - Ying Zhao
- Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650000, China
| | - Hong Fan
- Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650000, China
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25
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Razavi SM, Arab ZN, Niknejad A, Hosseini Y, Fouladi A, Khales SD, Shahali M, Momtaz S, Butler AE, Sukhorukov VN, Jamialahmadi T, Abdolghaffari AH, Sahebkar A. Therapeutic effects of anti-diabetic drugs on traumatic brain injury. Diabetes Metab Syndr 2024; 18:102949. [PMID: 38308863 DOI: 10.1016/j.dsx.2024.102949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
AIMS In this narrative review, we have analyzed and synthesized current studies relating to the effects of anti-diabetic drugs on traumatic brain injury (TBI) complications. METHODS Eligible studies were collected from Scopus, Google Scholar, PubMed, and Cochrane Library for clinical, in-vivo, and in-vitro studies published on the impact of anti-diabetic drugs on TBI. RESULTS Traumatic brain injury (TBI) is a serious brain disease that is caused by any type of trauma. The pathophysiology of TBI is not yet fully understood, though physical injury and inflammatory events have been implicated in TBI progression. Several signaling pathways are known to play pivotal roles in TBI injuries, including Nuclear factor erythroid 2-related factor 2 (Nrf2), High mobility group box 1 protein/Nuclear factor kappa B (HMGB1/NF-κB), Adiponectin, Mammalian Target of Rapamycin (mTOR), Toll-Like Receptor (TLR), Wnt/β-catenin, Janus Kinase/Signal Transducers and Activators of Transcription (JAK/STAT), Nod-like receptor protein3 (NLRP3) inflammasome, Phosphoglycerate kinase 1/Kelch-like ECH-associated protein 1 (PGK1/KEAP1)/Nrf2, and Mitogen-activated protein kinase (MAPK) . Recent studies suggest that oral anti-diabetic drugs such as biguanides, thiazolidinediones (TZDs), sulfonylureas (SUs), sodium-glucose cotransporter-2 inhibitors (SGLT2is), dipeptidyl peptidase-4 inhibitors (DPPIs), meglitinides, and alpha-glucosidase inhibitors (AGIs) could have beneficial effects in the management of TBI complications. These drugs may downregulate the inflammatory pathways and induce antioxidant signaling pathways, thus alleviating complications of TBI. CONCLUSION Based on this comprehensive literature review, antidiabetic medications might be considered in the TBI treatment protocol. However, evidence from clinical trials in patients with TBI is still warranted.
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Affiliation(s)
- Seyed Mehrad Razavi
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Zahra Najafi Arab
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Amirhossein Niknejad
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Yasamin Hosseini
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Abtin Fouladi
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saba Darban Khales
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mostafa Shahali
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeideh Momtaz
- GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran; Department of Toxicology and Pharmacology, School of Pharmacy, and Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | - Alexandra E Butler
- Research Department, Royal College of Surgeons in Ireland Bahrain, Adliya, Bahrain
| | - Vasily N Sukhorukov
- Institute of General Pathology and Pathophysiology, Moscow, Russia; Institute of Experimental Cardiology Named after Academician V.N. Smirnov, Federal State Budgetary Institution National Medical Research Center of Cardiology Named after Academician E.I. Chazov, Moscow, Russia
| | - Tannaz Jamialahmadi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hossein Abdolghaffari
- Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; GI Pharmacology Interest Group (GPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Carmichael J, Ponsford J, Gould KR, Spitz G. Characterizing depression after traumatic brain injury using a symptom-oriented approach. J Affect Disord 2024; 345:455-466. [PMID: 37879410 DOI: 10.1016/j.jad.2023.10.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Progress in addressing depression after traumatic brain injury (TBI) has been limited. Traditional approaches to measuring depression classify individuals with diverse symptoms as having the same problem. We adopted a novel, symptom-oriented approach to characterize post-TBI depression, emphasizing specific symptoms rather than the number of symptoms. METHODS We assessed depressive symptoms cross-sectionally in 393 participants with moderate-severe TBI (range 0.4-35.4 years post-injury; M = 12.6) using the Inventory of Depression and Anxiety Symptoms - Expanded Version (IDAS-II). We analyzed symptoms of DSM-5 major depressive disorder (MDD), separating compound symptoms into sub-symptoms. We quantified depression heterogeneity across 16 specific symptoms and explored associations between each symptom and personal, injury-related, treatment, and functional/psychosocial outcome factors. RESULTS 28 % of participants self-reported a current depression diagnosis, and 35 % met DSM-5 symptom criteria for MDD. Depressed participants (according to either self-reported diagnosis or MDD symptom criteria) were more likely to endorse each specific depressive symptom, including those that overlap with TBI. Post-TBI depression was highly heterogeneous, with 84-91 % of depressed participants (depending on classification method) showing a unique symptom profile not shared with any other individual. The most common symptom profile was shared by only three individuals. This heterogeneity was meaningful, as specific depressive symptoms had distinct associations with personal, injury-related, treatment, and outcome factors. LIMITATIONS Cross-sectional design. We only analyzed DSM-5 MDD symptoms, and some symptoms were assessed using only one item. CONCLUSIONS A symptom-oriented approach to post-TBI depression captures the individual's unique profile of depressive symptoms, which relate differently to outcomes and other factors. We recommend future studies investigating post-TBI depression analyze specific symptoms alongside overall depression scores.
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Affiliation(s)
- Jai Carmichael
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Kate Rachel Gould
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Gershon Spitz
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia; Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Bransby L, Rosenich E, Maruff P, Lim YY. How Modifiable Are Modifiable Dementia Risk Factors? A Framework for Considering the Modifiability of Dementia Risk Factors. J Prev Alzheimers Dis 2024; 11:22-37. [PMID: 38230714 PMCID: PMC10995020 DOI: 10.14283/jpad.2023.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/06/2023] [Indexed: 01/18/2024]
Abstract
Many risk factors for dementia, identified from observational studies, are potentially modifiable. This raises the possibility that targeting key modifiable dementia risk factors may reduce the prevalence of dementia, which has led to the development of dementia risk reduction and prevention strategies, such as intervention trials or dementia prevention guidelines. However, what has rarely been considered in the studies that inform these strategies is the extent to which modifiable dementia risk factors can (1) be identified by individuals, and (2) be readily modified by individuals. Characteristics of modifiable dementia risk factors such as readiness of identification and targeting, as well as when they should be targeted, can influence the design, or success of strategies for reducing dementia risk. This review aims to develop a framework for classifying the degree of modifiability of dementia risk factors for research studies. The extent to which these modifiable dementia risk factors could be modified by an individual seeking to reduce their dementia risk is determined, as well as the resources that might be needed for both risk factor identification and modification, and whether modification may be optimal in early-life (aged <45 years), midlife (aged 45-65 years) or late-life (aged >65 years). Finally, barriers that could influence the ability of an individual to engage in risk factor modification and, ultimately, dementia risk reduction are discussed.
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Affiliation(s)
- L Bransby
- Lisa Bransby, Turner Institute for Brain and Mental Health, 18 Innovation Walk, Clayton, VIC 3800, Australia;
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Aqel S, Al-Thani N, Haider MZ, Abdelhady S, Al Thani AA, Kobeissy F, Shaito AA. Biomaterials in Traumatic Brain Injury: Perspectives and Challenges. BIOLOGY 2023; 13:21. [PMID: 38248452 PMCID: PMC10813103 DOI: 10.3390/biology13010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 01/23/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of mortality and long-term impairment globally. TBI has a dynamic pathology, encompassing a variety of metabolic and molecular events that occur in two phases: primary and secondary. A forceful external blow to the brain initiates the primary phase, followed by a secondary phase that involves the release of calcium ions (Ca2+) and the initiation of a cascade of inflammatory processes, including mitochondrial dysfunction, a rise in oxidative stress, activation of glial cells, and damage to the blood-brain barrier (BBB), resulting in paracellular leakage. Currently, there are no FDA-approved drugs for TBI, but existing approaches rely on delivering micro- and macromolecular treatments, which are constrained by the BBB, poor retention, off-target toxicity, and the complex pathology of TBI. Therefore, there is a demand for innovative and alternative therapeutics with effective delivery tactics for the diagnosis and treatment of TBI. Tissue engineering, which includes the use of biomaterials, is one such alternative approach. Biomaterials, such as hydrogels, including self-assembling peptides and electrospun nanofibers, can be used alone or in combination with neuronal stem cells to induce neurite outgrowth, the differentiation of human neural stem cells, and nerve gap bridging in TBI. This review examines the inclusion of biomaterials as potential treatments for TBI, including their types, synthesis, and mechanisms of action. This review also discusses the challenges faced by the use of biomaterials in TBI, including the development of biodegradable, biocompatible, and mechanically flexible biomaterials and, if combined with stem cells, the survival rate of the transplanted stem cells. A better understanding of the mechanisms and drawbacks of these novel therapeutic approaches will help to guide the design of future TBI therapies.
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Affiliation(s)
- Sarah Aqel
- Medical Research Center, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Najlaa Al-Thani
- Research and Development Department, Barzan Holdings, Doha P.O. Box 7178, Qatar
| | - Mohammad Z. Haider
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Samar Abdelhady
- Faculty of Medicine, Alexandria University, Alexandria 21544, Egypt;
| | - Asmaa A. Al Thani
- Biomedical Research Center and Department of Biomedical Sciences, College of Health Science, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Firas Kobeissy
- Department of Neurobiology, Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Morehouse School of Medicine, 720 Westview Dr. SW, Atlanta, GA 30310, USA
| | - Abdullah A. Shaito
- Biomedical Research Center, Department of Biomedical Sciences at College of Health Sciences, College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
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Magnusson BM, Koskinen LOD. Classification and Characterization of Traumatic Brain Injuries in the Northern Region of Sweden. J Clin Med 2023; 13:8. [PMID: 38202015 PMCID: PMC10780294 DOI: 10.3390/jcm13010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a common cause of death and disability, the incidence of which in northern Sweden is not fully investigated. This study classifies and characterize epidemiological and demographic features of TBIs in a defined population in Umeå county, Sweden. Specifically, to evaluate frequencies of (1) intracranial lesions detected with computed tomography (CT), (2) need for emergency intervention, and (3) hospital admission, in minimal, mild, moderate, and severe TBI, respectively. METHODS The data were gathered from 4057 TBI patients visiting our emergency room (ER) during a two-year period (2015-2016), of whom 56% were men and approximately 95% had minimal TBIs (Glasgow Coma Scale (GCS), score 15). RESULTS Of all injuries, 97.8% were mild (GCS 14-15), 1.7% were moderate (GCS 9-13), and 0.5% were severe (GCS < 9). CT scans were performed on 46% of the patients, with 28% being hospitalized. A high annual TBI incidence of 1350 cases per 100,000 citizens was found. The mortality rate was 0.5% with the majority as expected in the elderly group (>80 years). CONCLUSIONS Minimal TBIs were not as mild as previously reported, with a relatively high frequency of abnormal CT findings and a high mortality rate. No emergency intervention was required in patients in the GCS 13-15 group with normal CT scans. These findings have implications for clinical practice in the ER with the suggestion to include biomarkers to reduce unnecessary CT scans.
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Affiliation(s)
- Beatrice M. Magnusson
- Department of Surgery and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Lars-Owe D. Koskinen
- Department of Clinical Science, Neurosciences, Umeå University, 901 87 Umeå, Sweden;
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Stojsavljević A, Lakićević N, Pavlović S. Mercury and Autism Spectrum Disorder: Exploring the Link through Comprehensive Review and Meta-Analysis. Biomedicines 2023; 11:3344. [PMID: 38137565 PMCID: PMC10741416 DOI: 10.3390/biomedicines11123344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Mercury (Hg) is a non-essential trace metal with unique neurochemical properties and harmful effects on the central nervous system. In this study, we present a comprehensive review and meta-analysis of peer-reviewed research encompassing five crucial clinical matrices: hair, whole blood, plasma, red blood cells (RBCs), and urine. We assess the disparities in Hg levels between gender- and age-matched neurotypical children (controls) and children diagnosed with autism spectrum disorder (ASD) (cases). After applying rigorous selection criteria, we incorporated a total of 60 case-control studies into our meta-analysis. These studies comprised 25 investigations of Hg levels in hair (controls/cases: 1134/1361), 15 in whole blood (controls/cases: 1019/1345), 6 in plasma (controls/cases: 224/263), 5 in RBCs (controls/cases: 215/293), and 9 in urine (controls/cases: 399/623). This meta-analysis did not include the data of ASD children who received chelation therapy. Our meta-analysis revealed no statistically significant differences in Hg levels in hair and urine between ASD cases and controls. In whole blood, plasma, and RBCs, Hg levels were significantly higher in ASD cases compared to their neurotypical counterparts. This indicates that ASD children could exhibit reduced detoxification capacity for Hg and impaired mechanisms for Hg excretion from their bodies. This underscores the detrimental role of Hg in ASD and underscores the critical importance of monitoring Hg levels in ASD children, particularly in early childhood. These findings emphasize the pressing need for global initiatives aimed at minimizing Hg exposure, thus highlighting the critical intersection of human-environment interaction and neurodevelopment health.
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Affiliation(s)
- Aleksandar Stojsavljević
- Innovative Centre, Faculty of Chemistry, University of Belgrade, Studentski Trg 12–16, 11000 Belgrade, Serbia
| | - Novak Lakićević
- Clinical Centre of Montenegro, Clinic for Neurosurgery, Ljubljanska bb, 81000 Podgorica, Montenegro;
| | - Slađan Pavlović
- Institute for Biological Research “Siniša Stanković”—National Institute of the Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11060 Belgrade, Serbia;
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Ibáñez Pérez de la Blanca MA. Antithrombotic and risk of hemorrhagic complications in over-60-year-olds after mild-minimal traumatic brain injury. Brain Inj 2023; 37:1355-1361. [PMID: 38152883 DOI: 10.1080/02699052.2023.2284907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 08/22/2023] [Indexed: 12/29/2023]
Abstract
PRIMARY OBJECTIVE to identify if antithombotics are risk factors for intracereral lesion in older adults with minimal-mild traumatic brain injury (m-mTBI). RESEARCH DESING prospective cohort study. METHODS AND PROCEDURES We included 2,303 patients over 60 years arriving at our Emergency Department within 24 hours of an mTBI with a Glasgow Coma Scale (GSC) of 14-15. Data were gathered on clinical history, cranial CT scans, blood analyses. OUTCOMES AND RESULTS 91.1% had an admission GSC score of 15, and 23.6% developed intracranial complications. In bivariate analyses, statins were associated with a 1.28-fold lower risk of IC. Hemorrhagic progression was 29.76-fold higher in patients receiving anticoagulants, with no difference among anticoagulant types. Male sex, GSC of 14, alcohol consumption, and the presence of tumor were risk factors for IC. In multivariate analysis, GSC of 14, alcohol consumption, and malignancy emerged as risk factors for these complications, neurological disease and diabetes as protective factors. After exclusion of neurological disease and diabetes from the multivariate model, a GSC of 14 showed the highest predictive capacity. CONCLUSIONS Antithrombotics intake are not risks factor for intracranial injury in minimal-mild brain injury trauma. Further research is needed taking account of their fragility and comorbidities.
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de Wit K, Mercuri M, Clayton N, Mercier É, Morris J, Jeanmonod R, Eagles D, Varner C, Barbic D, Buchanan IM, Ali M, Kagoma YK, Shoamanesh A, Engels P, Sharma S, Worster A, McLeod S, Émond M, Stiell I, Papaioannou A, Parpia S. Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen. CMAJ 2023; 195:E1614-E1621. [PMID: 38049159 PMCID: PMC10699318 DOI: 10.1503/cmaj.230634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Ground-level falls are common among older adults and are the most frequent cause of traumatic intracranial bleeding. The aim of this study was to derive a clinical decision rule that safely excludes clinically important intracranial bleeding in older adults who present to the emergency department after a fall, without the need for a computed tomography (CT) scan of the head. METHODS This prospective cohort study in 11 emergency departments in Canada and the United States enrolled patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed. We collected data on 17 potential predictor variables. The primary outcome was the diagnosis of clinically important intracranial bleeding within 42 days of the index emergency department visit. An independent adjudication committee, blinded to baseline data, determined the primary outcome. We derived a clinical decision rule using logistic regression. RESULTS The cohort included 4308 participants, with a median age of 83 years; 2770 (64%) were female, 1119 (26%) took anticoagulant medication and 1567 (36%) took antiplatelet medication. Of the participants, 139 (3.2%) received a diagnosis of clinically important intracranial bleeding. We developed a decision rule indicating that no head CT is required if there is no history of head injury on falling; no amnesia of the fall; no new abnormality on neurologic examination; and the Clinical Frailty Scale score is less than 5. Rule sensitivity was 98.6% (95% confidence interval [CI] 94.9%-99.6%), specificity was 20.3% (95% CI 19.1%-21.5%) and negative predictive value was 99.8% (95% CI 99.2%-99.9%). INTERPRETATION We derived a Falls Decision Rule, which requires external validation, followed by clinical impact assessment. Trial registration: ClinicalTrials. gov, no. NCT03745755.
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Affiliation(s)
- Kerstin de Wit
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont.
| | - Mathew Mercuri
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Natasha Clayton
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Éric Mercier
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Judy Morris
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Rebecca Jeanmonod
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Debra Eagles
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Catherine Varner
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - David Barbic
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Ian M Buchanan
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Mariyam Ali
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Yoan K Kagoma
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Ashkan Shoamanesh
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Paul Engels
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Sunjay Sharma
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Andrew Worster
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Shelley McLeod
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Marcel Émond
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Ian Stiell
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Alexandra Papaioannou
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
| | - Sameer Parpia
- Department of Emergency Medicine (de Wit), Queen's University, Kingston, Ont.; Division of Emergency Medicine, Department of Medicine (de Wit, Mercuri, Buchanan, Worster), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (de Wit, Parpia), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mercuri), University of Toronto, Ont.; Emergency Department (Clayton), Hamilton Health Sciences; Department of Medicine (Clayton, Ali, Shoamanesh, Papaioannou, Parpia), McMaster University, Hamilton, Ont.; Centre de recherche du Centre hospitalier universitaire de Québec (Mercier) - Université Laval, Laval, Que.; VITAM - Centre de recherche en santé durable (Mercier, Émond), Québec, Que.; Department of Family Medicine and Emergency Medicine (Morris, Émond), Université de Montréal, Montréal, Que.; St. Luke's University Health Network (Jeanmonod), Bethlehem, Penn.; Department of Emergency Medicine (Eagles, Stiell), Ottawa Hospital Research Institute; School of Epidemiology and Public Health (Eagles, Stiell), University of Ottawa, Ottawa, Ont.; Schwartz/Reisman Emergency Medicine Institute (Eagles), Sinai Health, Toronto, Ont.; Clinical Epidemiology Program (Varner, McLeod), Ottawa Hospital Research Institute, Ottawa, Ont.; Division of Emergency Medicine (Varner, McLeod), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Department of Emergency Medicine (Barbic), University of British Columbia; Centre for Health Evaluation Outcome Sciences (Barbic), St. Paul's Hospital, Vancouver, BC; Department of Medical Imaging (Kagoma) and of Surgery (Engels, Sharma), McMaster University, Hamilton, Ont
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Wimmer Del Solar J, Rojas-Líbano D, Bastías Barra P, Cisternas Vera C, Chávez Martel P, Rozas Vidal JP, Rodríguez IP, Fontecilla Villalobos E. Epidemiology of Work-Related Traumatic Brain Injury and COVID-19 Pandemic Lockdown Consequences: Experience in a Reference Center in Chile. J Occup Environ Med 2023; 65:1045-1050. [PMID: 37705398 DOI: 10.1097/jom.0000000000002967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Work-related traumatic brain injury is a frequent cause of chronic morbidity, mortality, and high treatment costs. Its causes are highly environmentally determined and were affected by COVID-19 pandemic lockdowns. OBJECTIVE We aimed to describe traumatic brain injury (TBI) epidemiology in working population and evaluate its modifications during the COVID-19 pandemic. METHODS We performed a 2-year retrospective epidemiological analysis of TBI patients hospitalized in a tertiary work-related hospital before and during the COVID-19 pandemic. RESULTS In the prepandemic period, TBI patients were predominantly men, with a bimodal age distribution. Crash accidents were the leading work-related traumatic brain injury cause. During COVID-19 pandemic lockdowns, there was a positive correlation between street traffic and TBI rate, presenting increased motor crash accidents as a cause of TBI. CONCLUSIONS These results are relevant for planning and focalization of resources for TBI prevention.
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Affiliation(s)
- Jonathan Wimmer Del Solar
- From the Departamento de Neurología, Hospital del Trabajador, Asociación Chilena de Seguridad, Santiago, Chile (J.W.D.S., P.B.B., P.C.M., J.P.R.V., P.I.R., E.F.V.); Departamento de Neurología, Clínica Meds, Santiago, Chile (J.W.D.S.); Programa de Especialidades Médicas en Neurología, Escuela de Postgrado, Universidad de Santiago de Chile, Santiago, Chile (J.W.D.S.); Centro de Estudios en Neurociencia Humana y Neuropsicología, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile (D.R.-L.); Programa de Especialidades Médicas en Fisiatría, Escuela de Postgrado, Universidad Mayor, Santiago, Chile (C.C.V.); and Hospital Clínico de la Fuerza Aérea de Chile (FACh), General Dr. Raúl Yazigi J., Santiago, Chile (P.B.B.)
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Ichwan K, Gazali S, Suherman S, Desiana D, Nurjannah N. Plasma interleukin 6 as an outcome predictor of traumatic brain injury patients. NARRA J 2023; 3:e234. [PMID: 38455629 PMCID: PMC10919736 DOI: 10.52225/narra.v3i3.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/26/2023] [Indexed: 03/09/2024]
Abstract
Traumatic brain injury is one of the leading causes of death and disability in young adults. Previous studies have suggested that neuroinflammatory process involves the overexpression of interleukin 6 (IL-6); however, data on the predictive ability of IL-6 is limited and conflicting in traumatic head injury patients. The aim of this study was to assess the ability of plasma IL-6 as a predictor of outcome in head injury patients. A cross-sectional study was conducted between June and December 2020 among traumatic head injury patients admitted to Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Demographic, clinical data, and IL-6 level were collected and measured on admission. The outcome was assessed by the Glasgow outcome scale extended (GOSE) in the first- and third-month of post-injury. A total of 50 traumatic brain injury patients were recruited of which 54% were male, 64% had mild head injury, 82% had leukocytosis, and 60% had non-bleeding head CT scan. The mean of IL-6 level was 79.32 pg/mL while the GOSE scores ranged from 1 (death) to 8 (upper good recovery). Early IL-6 level (<24 hours post-injury) was significantly correlated with worse outcome in traumatic head injury, though the correlation strength was moderate (p<0.001; r=-0.42). As a predictor, IL-6 yielded the area under curve (AUC) value of 93.5% (p<0.001) and a cut-off point of 46.33 pg/mL. The sensitivity and specificity of this predictor were 87.5% and 95.24%, respectively. In conclusion, early IL-6 level can be used as a predictor for traumatic head injury. Nevertheless, further multi-center study with a bigger sample size is needed to confirm this finding.
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Affiliation(s)
- Khairunnisa Ichwan
- Department of Neurology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Syahrul Gazali
- Department of Neurology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Suherman Suherman
- Department of Neurology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Desiana Desiana
- Department of Clinical Pathology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Department of Clinical Pathology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia
| | - Nurjannah Nurjannah
- Department of Public Health, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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Kumari S, Jaiswal M, Ojha BK. Is basal cisternostomy in traumatic brain injury a need of hour or white elephant - A randomized trial to answer. Surg Neurol Int 2023; 14:412. [PMID: 38213437 PMCID: PMC10783667 DOI: 10.25259/sni_825_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/01/2023] [Indexed: 01/13/2024] Open
Abstract
Background Basal cisternostomy (BC) recently emerged as an adjuvant/alternative procedure to decompressive craniectomy (DC) in traumatic brain injuries (TBIs) with its potential to effectively reduce both intracranial pressure (ICP) and brain edema. However, its role in TBI is not yet established in the true sense and with clarity. The objective of the present study was to evaluate the effect of adjuvant BC on ICP, mortality, and clinicoradiological outcome. Methods A single-center randomized control trial was conducted. Fifty patients were assigned to each DC-group and DC+BC-group. Randomization was done using the sealed envelope method. Both groups were followed in the postoperative period to compare the impact of surgery on ICP, radiological changes, and clinical outcome (mortality, days on ventilator/in intensive care unit (ICU), and Glasgow outcome scale-extended (GOS-E) at 12 weeks). Results Both groups were comparable in terms of preoperative clinicoradiological characteristics. On postoperative days 1, 2, and 3, mean ICP was significantly low in the DC+BC-group (P < 0.0001). The decline in ICP in the DC+BC-group was significant in both moderate and severe TBI patients. In comparison, DC+BC-group has a shorter duration of mechanical ventilation/ICU stay and significantly better GOS-E score at 12 weeks (P < 0.0001*). The mortality rate was less in the DC+BC-group (48%) as compared to the DC-group (64%). Among radiological features, mean midline shift and mean outward brain herniation were significantly less in the DC+BC group. Bone-flap replacement was possible in ten patients of DC+BC-group at the time of primary surgery. Conclusion Results of our study indicated that BC is beneficial in reducing both ICP and brain edema, which translates into favorable clinicoradiological outcomes.
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Affiliation(s)
| | - Manish Jaiswal
- Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India
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Herrero Babiloni A, Bouferguene Y, Exposto FG, Beauregard R, Lavigne GJ, Moana-Filho EJ, Arbour C. The prevalence of persistent post-traumatic headache in adult civilian traumatic brain injury: a systematic review and meta-analysis on the past 14 years. Pain 2023; 164:2627-2641. [PMID: 37390366 DOI: 10.1097/j.pain.0000000000002949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/23/2023] [Indexed: 07/02/2023]
Abstract
ABSTRACT The most recent prevalence estimate of post-traumatic headache (PTH) after traumatic brain injury (TBI) in veterans and civilians dates back to 2008. The prevalence was found to be 57.8%, with surprising higher rates (75.3%) in mild TBI when compared with those with moderate/severe TBI (32.1%). However, the revision of mild TBI diagnostic criteria and an historic peak of TBI in the elderly individuals attributed to the ageing population may lead to different results. Thus, we conducted a systematic review and meta-analysis to assess the updated prevalence of PTH during the past 14 years only in civilians. A literature search was conducted following PRISMA guidelines guided by a librarian. Screening, full-text assessment, data extraction, and risk of bias assessment were performed blindly by 2 raters. Meta-analysis of proportions using the Freeman and Tukey double arcsine method of transformation was conducted. Heterogeneity, sensitivity analysis, and meta-regressions were performed with the predictors: year of publication, mean age, sex, TBI severity, and study design. Sixteen studies were selected for the qualitative analysis and 10 for the meta-analysis. The overall prevalence estimate of PTH was 47.1%, (confidence interval = 34.6, 59.8, prediction intervals = 10.8, 85.4), being similar at different time points (3, 6, 12, and 36+ months). Heterogeneity was high, and none of the meta-regressions were significant. The overall prevalence of PTH after TBI over the past 14 years remains high even if assessed only in civilians. However, the prevalence rates attributed to mild and moderate/severe TBI were similar, differing significantly from previous reports. Efforts are needed to improve TBI outcomes.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montréal, QC, Canada
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
| | - Yasmine Bouferguene
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
| | - Fernando G Exposto
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Roxanne Beauregard
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
| | - Gilles J Lavigne
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
- Faculty of Dental Medicine, Université de Montréal, QC, Canada
| | - Estephan J Moana-Filho
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Caroline Arbour
- Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada
- Faculty of Nursing, Université de Montréal, QC, Canada
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Martínez-Rivas JJ, Rodríguez-Lucas F, Planells G, Corrales D, Cocho D. Risk of cerebral hemorrhage in mild traumatic brain injury and antithrombotic treatment. Rev Clin Esp 2023; 223:604-609. [PMID: 37898355 DOI: 10.1016/j.rceng.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/21/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment. METHOD We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with ≥1 risk factor at admission and at 24 h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed. RESULTS We evaluated 907 patients with a mean age of 73 ± 19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24 h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs 11.9% without treatment, p = 0.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24 h, 3 were asymptomatic and one case that worsened the initial headache. No asymptomatic patient without lesion on initial clinical cranial CT presented at 24 h. CONCLUSIONS Our study suggests that patients with asymptomatic mTBI, without a lesion on the initial cranial CT, would not require the observation period or CT control regardless of antithrombotic treatment or INR level.
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Affiliation(s)
- J J Martínez-Rivas
- Servicio de urgencias, Hospital General de Granollers, Barcelona, Spain.
| | - F Rodríguez-Lucas
- Servicio de urgencias, Hospital General de Granollers, Barcelona, Spain
| | - G Planells
- Servicio de urgencias, Hospital General de Granollers, Barcelona, Spain
| | - D Corrales
- Servicio de urgencias, Hospital General de Granollers, Barcelona, Spain
| | - D Cocho
- Servicio de Neurología, Hospital General de Granollers, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain
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Klang A, Molero Y, Lichtenstein P, Larsson H, D’Onofrio BM, Marklund N, Oldenburg C, Rostami E. Access to Rehabilitation After Hospitalization for Traumatic Brain Injury: A National Longitudinal Cohort Study in Sweden. Neurorehabil Neural Repair 2023; 37:763-774. [PMID: 37953612 PMCID: PMC10685696 DOI: 10.1177/15459683231209315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Rehabilitation is suggested to improve outcomes following traumatic brain injury (TBI), however, the extent of access to rehabilitation among TBI patients remains unclear. OBJECTIVE To examine the level of access to rehabilitation after TBI, and its association with health and sociodemographic factors. METHOD We conducted a longitudinal cohort study using Swedish nationwide healthcare and sociodemographic registers. We identified 15 880 TBI patients ≥18 years hospitalized ≥3 days from 2008 to 2012 who were stratified into 3 severity groups; grade I (n = 1366; most severe), grade II (n = 5228), and grade III (n = 9268; least severe). We examined registered contacts with specialized rehabilitation or geriatric care (for patients ≥65 years) during the hospital stay, and/or within 1 year post-discharge. We performed a generalized linear model analysis to estimate the risk ratio (RR) for receiving specialized rehabilitation or geriatric care after a TBI based on sociodemographic and health factors. RESULTS Among TBI patients, 46/35% (grade I), 14/40% (grade II), and 5/18% (grade III) received specialized rehabilitation or geriatric care, respectively. Being currently employed or studying was positively associated (RR 1.7, 2.3), while living outside of a city area was negatively associated (RR 0.36, 0.79) with receiving specialized rehabilitation or geriatric care. Older age and a prior substance use disorder were negatively associated with receiving specialized rehabilitation (RR 0.51 and 0.81). CONCLUSION Our results suggest insufficient and unequal access to rehabilitation for TBI patients, highlighting the importance of organizing and standardizing post-TBI rehabilitation to meet the needs of patients, regardless of their age, socioeconomic status, or living area.
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Affiliation(s)
- Andrea Klang
- Department of Medical Sciences, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Yasmina Molero
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian Matthew D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Niklas Marklund
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Christian Oldenburg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elham Rostami
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden
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Geng X, Wu H, Liu C, Qi L, Ballah AK, Che W, Wu S, Fu T, Li N, Wei X, Cheng R, Pang Z, Ji H, Wang Y, Wang X. Construction and validation of a predictive model of pneumonia for ICU patients with traumatic brain injury (TBI). Neurosurg Rev 2023; 46:308. [PMID: 37985473 DOI: 10.1007/s10143-023-02208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/28/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
The incidence of pneumonia in ICU patients with TBI is very high, seriously affecting the prognosis. This study aims to construct a predictive model for pneumonia in ICU patients with TBI and provide help for the prevention of TBI-related pneumonia.Clinical data of ICU patients with TBI were collected from the Medical Information Mart for Intensive Care (MIMIC)-IV database and hospital data. Variables were screened by lasso and multivariate logistic regression to construct a predictive nomogram model, verified in internal validation cohort and external validation cohort by receiver operator characteristic (ROC) curve, calibration curve and decision curve analysis (DCA).A total of 1850 ICU patients with TBI were enrolled in the study from the MIMIC-IV database, including 1298 in the training cohort and 552 in internal validation cohort. The external validation cohort included 240 ICU patients with TBI from hospital data. Nine variables were selected from the training cohort by lasso regression and multivariate logistic regression, and a pneumonia prediction nomogram was constructed. This nomogram has a high discrimination in training, internal validation and external validation cohorts (AUC = 0.857, 0.877, 0.836). The calibration curve and DCA showed that this nomogram had a high calibration and better clinical decision-making efficiency.The nomogram showed excellent discrimination and clinical utility to predict pneumonia, and could identify pneumonia high-risk patients early, thus providing personalised treatment strategies for ICU patients with TBI.
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Affiliation(s)
- Xin Geng
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Hao Wu
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Chenan Liu
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Linrui Qi
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Augustine K Ballah
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Wenqiang Che
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Shuaishuai Wu
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Tengyue Fu
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Ning Li
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xiaocong Wei
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Rui Cheng
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Zhigang Pang
- Department of Pneumology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Hongming Ji
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Yonghong Wang
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
| | - Xiangyu Wang
- Department of Neurosurgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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40
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Brossard C, Grèze J, de Busschère JA, Attyé A, Richard M, Tornior FD, Acquitter C, Payen JF, Barbier EL, Bouzat P, Lemasson B. Prediction of therapeutic intensity level from automatic multiclass segmentation of traumatic brain injury lesions on CT-scans. Sci Rep 2023; 13:20155. [PMID: 37978266 PMCID: PMC10656472 DOI: 10.1038/s41598-023-46945-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
The prediction of the therapeutic intensity level (TIL) for severe traumatic brain injury (TBI) patients at the early phase of intensive care unit (ICU) remains challenging. Computed tomography images are still manually quantified and then underexploited. In this study, we develop an artificial intelligence-based tool to segment brain lesions on admission CT-scan and predict TIL within the first week in the ICU. A cohort of 29 head injured patients (87 CT-scans; Dataset1) was used to localize (using a structural atlas), segment (manually or automatically with or without transfer learning) 4 or 7 types of lesions and use these metrics to train classifiers, evaluated with AUC on a nested cross-validation, to predict requirements for TIL sum of 11 points or more during the 8 first days in ICU. The validation of the performances of both segmentation and classification tasks was done with Dice and accuracy scores on a sub-dataset of Dataset1 (internal validation) and an external dataset of 12 TBI patients (12 CT-scans; Dataset2). Automatic 4-class segmentation (without transfer learning) was not able to correctly predict the apparition of a day of extreme TIL (AUC = 60 ± 23%). In contrast, manual quantification of volumes of 7 lesions and their spatial location provided a significantly better prediction power (AUC = 89 ± 17%). Transfer learning significantly improved the automatic 4-class segmentation (DICE scores 0.63 vs 0.34) and trained more efficiently a 7-class convolutional neural network (DICE = 0.64). Both validations showed that segmentations based on transfer learning were able to predict extreme TIL with better or equivalent accuracy (83%) as those made with manual segmentations. Our automatic characterization (volume, type and spatial location) of initial brain lesions observed on CT-scan, publicly available on a dedicated computing platform, could predict requirements for high TIL during the first 8 days after severe TBI. Transfer learning strategies may improve the accuracy of CNN-based segmentation models.Trial registrations Radiomic-TBI cohort; NCT04058379, first posted: 15 august 2019; Radioxy-TC cohort; Health Data Hub index F20220207212747, first posted: 7 February 2022.
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Affiliation(s)
- Clément Brossard
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Jules Grèze
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Jules-Arnaud de Busschère
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Arnaud Attyé
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Marion Richard
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Florian Dhaussy Tornior
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Clément Acquitter
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Jean-François Payen
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Emmanuel L Barbier
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Pierre Bouzat
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France
| | - Benjamin Lemasson
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), U1216, Eq. "Neuroimagerie Fonctionnelle et Perfusion Cérébrale", 38700, Grenoble, France.
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Rashno M, Sarkaki A, Farbood Y, Rashno M, Khorsandi L, Naseri MKG, Dianat M. Possible mechanisms involved in the neuroprotective effects of chrysin against mild traumatic brain injury-induced spatial cognitive decline: An in vivo study in a rat model. Brain Res Bull 2023; 204:110779. [PMID: 37827266 DOI: 10.1016/j.brainresbull.2023.110779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
Traumatic brain injury (TBI) is recognized as an important risk factor for cognitive deficits. The present study was designed to determine the potential neuroprotective effects of chrysin, a natural flavonoid compound, against TBI-induced spatial cognitive decline and the possible mechanisms involved. Oral administration of chrysin (25, 50, or 100 mg/kg/day) was initiated in rats immediately following the induction of the diffuse TBI model using the weight-dropping Marmarou model. Spatial cognitive ability, hippocampal synaptic plasticity, blood-brain barrier (BBB) permeability, brain water content, and histological changes were assessed at scheduled time points. The animals subjected to TBI exhibited spatial cognitive decline in the Morris water maze (MWM) test, which was accompanied by inhibition of hippocampal long-term potentiation (LTP) induction at the perforant path-dentate gyrus (PP-DG) synapses. Additionally, TBI caused BBB disruption, brain edema, and neuronal loss. Interestingly, treatment with chrysin (especially in the dose of 100 mg/kg) alleviated all the above-mentioned neuropathological changes related to TBI. The results provide evidence that chrysin improves TBI-induced spatial cognitive decline, which may be partly related to the amelioration of hippocampal synaptic dysfunction, alleviation of BBB disruption, reduction of brain edema, and prevention of neuronal loss.
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Affiliation(s)
- Masome Rashno
- Department of Physiology, School of Medicine, Persian Gulf Physiology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Sarkaki
- Department of Physiology, School of Medicine, Persian Gulf Physiology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Yaghoob Farbood
- Department of Physiology, School of Medicine, Persian Gulf Physiology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Rashno
- Department of Immunology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Cellular and Molecular Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Layasadat Khorsandi
- Cellular and Molecular Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Kazem Gharib Naseri
- Department of Physiology, School of Medicine, Persian Gulf Physiology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahin Dianat
- Department of Physiology, School of Medicine, Persian Gulf Physiology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Park HA, Lim B, Ro YS. Trends in traumatic brain injury-related emergency department visits in Korea: a report from the National Emergency Department Information System (NEDIS) 2018-2022. Clin Exp Emerg Med 2023; 10:S63-S68. [PMID: 37967865 PMCID: PMC10662516 DOI: 10.15441/ceem.23.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Hang A Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Borami Lim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Young Sun Ro
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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Cociu S, Hamann CJ, Cebanu S, Cazacu-Stratu A, Coman MA, Peek-Asa C. Traumatic head injuries in Moldova: a cross-sectional analysis of medical registry data. Folia Med (Plovdiv) 2023; 65:775-782. [PMID: 38351760 PMCID: PMC10865622 DOI: 10.3897/folmed.65.e91262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/12/2022] [Indexed: 02/16/2024] Open
Abstract
AIM The aims of this study were to evaluate the demographics and crash profiles of road traffic-related traumatic brain injury (TBI) patients treated at two emergency departments in the Republic of Moldova, and to identify areas for prevention.
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Affiliation(s)
- Svetlana Cociu
- Department of Preventive Medicine, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Cara J. Hamann
- Department of Epidemiology, The University of Iowa, College of Public Health, US, Iowa
| | - Serghei Cebanu
- Department of Preventive Medicine, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Republic of Moldova, Chisinau
| | - Angela Cazacu-Stratu
- Department of Preventive Medicine, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Republic of Moldova, Chisinau
| | - Mădălina Adina Coman
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai
| | - Corinne Peek-Asa
- Department of Epidemiology, University of California, San Diego, School of Public Health
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Tsakiris C, Siempis T, Lianos GD, Vlachodimitropoulou L, Voulgaris S, Alexiou GA. Blood biomarkers: a new solution to the silent pandemic of traumatic brain injury. Biomark Med 2023; 17:783-785. [PMID: 38223950 DOI: 10.2217/bmm-2023-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Affiliation(s)
- Charalampos Tsakiris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45110, Greece
| | - Timoleon Siempis
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45110, Greece
| | - Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45110, Greece
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45110, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, 45110, Greece
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Kaplan ZR, van der Vlegel M, van Dijck JT, Pisică D, van Leeuwen N, Lingsma HF, Steyerberg EW, Haagsma JA, Majdan M, Polinder S. Intramural Healthcare Consumption and Costs After Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. J Neurotrauma 2023; 40:2126-2145. [PMID: 37212277 PMCID: PMC10541942 DOI: 10.1089/neu.2022.0429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Traumatic brain injury (TBI) is a global public health problem and a leading cause of mortality, morbidity, and disability. The increasing incidence combined with the heterogeneity and complexity of TBI will inevitably place a substantial burden on health systems. These findings emphasize the importance of obtaining accurate and timely insights into healthcare consumption and costs on a multi-national scale. This study aimed to describe intramural healthcare consumption and costs across the full spectrum of TBI in Europe. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core study is a prospective observational study conducted in 18 countries across Europe and in Israel. The baseline Glasgow Coma Scale (GCS) was used to differentiate patients by brain injury severity in mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤8) TBI. We analyzed seven main cost categories: pre-hospital care, hospital admission, surgical interventions, imaging, laboratory, blood products, and rehabilitation. Costs were estimated based on Dutch reference prices and converted to country-specific unit prices using gross domestic product (GDP)-purchasing power parity (PPP) adjustment. Mixed linear regression was used to identify between-country differences in length of stay (LOS), as a parameter of healthcare consumption. Mixed generalized linear models with gamma distribution and log link function quantified associations of patient characteristics with higher total costs. We included 4349 patients, of whom 2854 (66%) had mild, 371 (9%) had moderate, and 962 (22%) had severe TBI. Hospitalization accounted for the largest part of the intramural consumption and costs (60%). In the total study population, the mean LOS was 5.1 days at the intensive care unit (ICU) and 6.3 days at the ward. For mild, moderate, and severe TBI, mean LOS was, respectively, 1.8, 8.9, and 13.5 days at the ICU and 4.5, 10.1, and 10.3 days at the ward. Other large contributors to the total costs were rehabilitation (19%) and intracranial surgeries (8%). Total costs increased with higher age and greater trauma severity (mild; €3,800 [IQR €1,400-14,000], moderate; €37,800 [IQR €14,900-€74,200], severe; €60,400 [IQR €24,400-€112,700]). The adjusted analysis showed that female patients had lower costs than male patients (odds ratio (OR) 0.80 [CI 0.75-1.85]). Increasing TBI severity was associated with higher costs, OR 1.46 (confidence interval [CI] 1.31-1.63) and OR 1.67 [CI 1.52-1.84] for moderate and severe patients, respectively. A worse pre-morbid overall health state, increasing age and more severe systemic trauma, expressed in the Injury Severity Score (ISS), were also significantly associated with higher costs. Intramural costs of TBI are significant and are profoundly driven by hospitalization. Costs increased with trauma severity and age, and male patients incurred higher costs. Reducing LOS could be targeted with advanced care planning, in order to provide cost-effective care.
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Affiliation(s)
- Z.L. Rana Kaplan
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jeroen T.J.M. van Dijck
- Department of Neurosurgery, University Neurosurgical Center Holland (UNCH), Leiden University Medical Center & Haaglanden Medical Center & HAGA Teaching Hospital, Leiden/The Hague, The Netherlands
| | - Dana Pisică
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hester F. Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ewout W. Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marek Majdan
- Institute for Global Health and Epidemiology, Department of Public Health, Trnava University, Trnava, Slovakia
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Xu L, Wang Z, Wu T, Zhao M, Wu Y, Huang Y, Chen J, Sharma A, Sharma HS. Innovative emergency strategies for patients with severe traumatic brain injury: An IoT-based resource integration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 171:301-316. [PMID: 37783560 DOI: 10.1016/bs.irn.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Severe traumatic brain injury patients are in critical condition, and rapid rescue is very important for prognosis. Currently, the resuscitation process is complex and it is difficult to get to the operating room quickly to target treatment. We present a new strategy based on the Internet of Things system to integrate complex first aid procedures for efficient and comprehensive rescuing of patients with severe traumatic brain injury. This system includes three modules: human sign monitoring equipment, emergency transport equipment, and a network diagnosis and treatment progress control center. The system not only supports the streamlining of rescue procedures but also transmits the patient's status and optimal treatment strategies in real-time by using an advanced Internet of Things system. After deploying the system in a hospital, we conducted a validation study to evaluate its feasibility and superiority in clinical use. The preliminary results of the study show that this system can significantly shorten the treatment time, which may help the prognosis of severe traumatic brain injury patients.
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Affiliation(s)
- Longbiao Xu
- Department of Neurosurgery, The Third Affiliated Hospital of Zhejiang Chinese Medical University, P.R. China
| | - Zhe Wang
- Linping Hospital of Traditional Chinese Medicine, Hangzhou City, Zhejiang Province, China
| | - Tianya Wu
- Department of Neurosurgery, Zhuji Affiliated Hospital of Shaoxing University, Zhuji People's Hospital of Zhejiang Province, P.R. China
| | - Ming Zhao
- Department of Neurosurgery, Zhuji Affiliated Hospital of Shaoxing University, Zhuji People's Hospital of Zhejiang Province, P.R. China
| | - Ying Wu
- Department of Neurosurgery, Zhuji Affiliated Hospital of Shaoxing University, Zhuji People's Hospital of Zhejiang Province, P.R. China
| | - Yubo Huang
- The Third School of Clinical Medicine, Zhejiang Chinese Medical University, P.R. China
| | - Jie Chen
- Department of Neurosurgery, Zhuji Affiliated Hospital of Shaoxing University, Zhuji People's Hospital of Zhejiang Province, P.R. China
| | - Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Dept. of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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Stojsavljević A, Lakićević N, Pavlović S. Does Lead Have a Connection to Autism? A Systematic Review and Meta-Analysis. TOXICS 2023; 11:753. [PMID: 37755763 PMCID: PMC10536388 DOI: 10.3390/toxics11090753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023]
Abstract
Environmental pollutants, particularly toxic trace metals with neurotoxic potential, have been related to the genesis of autism. One of these metals that stands out, in particular, is lead (Pb). We conducted an in-depth systematic review and meta-analysis of peer-reviewed studies on Pb levels in biological materials retrieved from autistic children (cases) and neurotypical children (controls) in this work. A systematic review was conducted after the careful selection of published studies according to established criteria to gain a broad insight into the higher or lower levels of Pb in the biological materials of cases and controls, and the findings were then strengthened by a meta-analysis. The meta-analysis included 17 studies (hair), 13 studies (whole blood), and 8 studies (urine). The overall number of controls/cases was 869/915 (hair), 670/755 (whole blood), and 344/373 (urine). This meta-analysis showed significantly higher Pb levels in all three types of biological material in cases than in controls, suggesting a higher body Pb burden in autistic children. Thus, environmental Pb exposure could be related to the genesis of autism. Since no level of Pb can be considered safe, the data from this study undoubtedly point to the importance of regularly monitoring Pb levels in autistic children.
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Affiliation(s)
- Aleksandar Stojsavljević
- Innovative Centre, Faculty of Chemistry, University of Belgrade, Studentski Trg 12–16, 11000 Belgrade, Serbia
| | - Novak Lakićević
- Clinical Centre of Montenegro, Clinic for Neurosurgery, Ljubljanska bb, 81000 Podgorica, Montenegro;
| | - Slađan Pavlović
- Institute for Biological Research “Siniša Stanković”—National Institute of the Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11060 Belgrade, Serbia;
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Maleki MS, Mazaheri SA, Hosseini SH, Majdabadi HA, Poursadeqiyan M, Faghihi A, Naderi Z, Bardsiri TI, Khedri B, Amanat N, Khajehnasiri F, Ivanbagha R. Epidemiology of Traumatic Brain Injury in Iran: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1818-1831. [PMID: 38033848 PMCID: PMC10682591 DOI: 10.18502/ijph.v52i9.13565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/15/2023] [Indexed: 12/02/2023]
Abstract
Background Traumatic brain injury (TBI) is one of leading cause of death and disability in Iran that has serious consequences on people's health. Understanding of epidemiology of TBI can be helpful for policy making in health care management. Therefore, this study aimed to examine the epidemiology of TBI in Iran. Methods PubMed, Web of Science, Scopus, Google scholar, and internal databases including, SID, Magiran, and IranMedex were searched to identify the relevant published studies up to Feb 2022. Moreover, the references list of key studies was scanned to find more records. The Joanna Briggs Institute (JBI) tool was used to assess the quality of included studies. The Excel and Comprehensive Meta-Analysis software were to analyze the data. Results Overall, 23,446 patients from 15 studies were included in the study. The overall mean age of the patients was 31.36 ± 0.13 yr (95%CI: 31.10 to 31.61). The majority of the patients were male (74.37%), with a male to female ratio of 3:1. The incidence rate of TBI was 15.3 to 144 per 100,000 population. The mortality rate of TBI was estimated to be 10.4% (95%CI: 5% to 19%). The most common causes of injury were road traffic accidents (RTAs) (60%; 95%CI: 49% to 70%), and falling (20%; 95%CI: 16% to 26%), respectively. The most frequent type of head injury was subdural hematoma. Conclusion Our findings highlight that appropriate control and prevention strategies should be focused on male, road traffic accidents, and the group under 40 yr.
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Affiliation(s)
- Mohsen Saheban Maleki
- Department of Anesthesia, Clinical Research Developmental Unit Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
| | | | - Seyed Hossein Hosseini
- Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mohsen Poursadeqiyan
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Aboalfazl Faghihi
- Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zeinab Naderi
- Department of Nursing, Sirjan School of Medical Sciences, Sirjan, Iran
| | | | - Behzad Khedri
- Department of Social Work, Social Studies Faculty, Hanze University of Applied Science, Groningen, Netherlands
| | - Nasir Amanat
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Farahnaz Khajehnasiri
- Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Ivanbagha
- Department of Midwifery, School of Nursing, Tabriz University of Medical Sciences, Tabriz, Iran
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Alvsåker K, Hanoa R, Olasveengen TM. Selecting patients for early interdisciplinary rehabilitation during neurointensive care after moderate to severe traumatic brain injury. Acta Anaesthesiol Scand 2023; 67:1069-1078. [PMID: 37259274 DOI: 10.1111/aas.14285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/05/2023] [Accepted: 05/18/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Early interdisciplinary rehabilitation (EIR) in neurointensive care is a limited resource reserved for patients with moderate to severe traumatic brain injury (TBI) believed to profit from treatment. We evaluated how key parameters related to injury severity and patient characteristics were predictive of receiving EIR, and whether these parameters changed over time. METHODS Among 1003 adult patients with moderate to severe TBI admitted over 72 h to neurointensive care unit during four time periods between 2005 and 2020, EIR was given to 578 and standard care to 425 patients. Ten selection criteria thought to best represent injury severity and patient benefit were evaluated (Glasgow Coma Scale, Head Abbreviated Injury Scale, New-Injury-Severity-Scale, intracranial pressure monitoring, neurosurgery, age, employment, Charlson Comorbidity Index, severe psychiatric disease, and chronic substance abuse). RESULTS In multivariate regression analysis, patients who were employed (adjOR 1.99 [95% CI 1.41, 2.80]), had no/mild comorbidity (adjOR 3.15 [95% CI 1.72, 5.79]), needed neurosurgery, had increasing injury severity and were admitted by increasing time period were more likely to receive EIR, whereas receiving EIR was less likely with increasing age (adjOR 0.97 [95% CI 0.96, 0.98]) and chronic substance abuse. Overall predictive ability of the model was 71%. Median age and comorbidity increased while employment decreased from 2005 to 2020, indicating patient selection became less restrictive with time. CONCLUSION Injury severity and need for neurosurgery remain important predictors for receiving EIR, but the importance of age, employment, and comorbidity have changed over time. Moderate prediction accuracy using current clinical criteria suggest unrecognized factors are important for patient selection.
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Affiliation(s)
- Kristin Alvsåker
- Postoperative and Intensive Care Department, Oslo University Hospital, Oslo, Norway
- Department of Physical medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Rolf Hanoa
- Neurosurgical Department, Oslo University Hospital, Oslo, Norway
| | - Theresa M Olasveengen
- Department of Anaesthesia and Intensive Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Janković T, Pilipović K. Single Versus Repetitive Traumatic Brain Injury: Current Knowledge on the Chronic Outcomes, Neuropathology and the Role of TDP-43 Proteinopathy. Exp Neurobiol 2023; 32:195-215. [PMID: 37749924 PMCID: PMC10569144 DOI: 10.5607/en23008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023] Open
Abstract
Traumatic brain injury (TBI) is one of the most important causes of death and disability in adults and thus an important public health problem. Following TBI, secondary pathophysiological processes develop over time and condition the development of different neurodegenerative entities. Previous studies suggest that neurobehavioral changes occurring after a single TBI are the basis for the development of Alzheimer's disease, while repetitive TBI is considered to be a contributing factor for chronic traumatic encephalopathy development. However, pathophysiological processes that determine the evolvement of a particular chronic entity are still unclear. Human post-mortem studies have found combinations of amyloid, tau, Lewi bodies, and TAR DNA-binding protein 43 (TDP-43) pathologies after both single and repetitive TBI. This review focuses on the pathological changes of TDP-43 after single and repetitive brain traumas. Numerous studies have shown that TDP-43 proteinopathy noticeably occurs after repetitive head trauma. A relatively small number of available preclinical research on single brain injury are not in complete agreement with the results from the human samples, which makes it difficult to draw specific conclusions. Also, as TBI is considered a heterogeneous type of injury, different experimental trauma models and injury intensities may cause differences in the cascade of secondary injury, which should be considered in future studies. Experimental and post-mortem studies of TDP-43 pathobiology should be carried out, preferably in the same laboratories, to determine its involvement in the development of neurodegenerative conditions after one and repetitive TBI, especially in the context of the development of new therapeutic options.
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Affiliation(s)
- Tamara Janković
- Department of Basic and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
| | - Kristina Pilipović
- Department of Basic and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Rijeka, Rijeka 51000, Croatia
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