Injury severity measures for predicting return-to-work after a traumatic brain injury

Depression symptoms reducing return to work: a meta-analysis of prospective studies

Objectives. This study was conducted to estimate the risk of return to work for people who experience symptoms of depression based on the pool of prospective data. Methods. All online articles in PubMed and Scopus which were accessible before November 2019 were searched. The odds ratios of each of the studies were pooled together to obtain an overall odds ratio. The pool of studies was with random effects. The analysis was performed based on the depression symptoms scale, type of disease and duration of follow-up. Two other aspects were examined in the analysis, one being the bias in the publication of studies and the other being the level of heterogeneity that was examined. Results. Thirty-five studies were selected for the meta-analysis. The pooled odds ratio indicates that the odds of return to work in people with depressive symptoms is 31% lower than in those without depressive symptoms. The funnel plot shows that there is asymmetry. The Egger test result was significant (p < 0.001) and there is publication bias. Conclusion. Depression symptoms after sick leave due to physical illness is a risk factor for not returning to work.

Unhelmeted Riding, Drunk Riding, and Unlicensed Riding among Motorcyclists: A Population Study in Taiwan during 2011-2016

This study aimed to investigate the association between drunk riding, unhelmeted riding, unlicensed riding, and running-off-road (ROR) crashes. Multiple logistic regression was used to calculate the adjusted odds ratio (AOR) by using the National Taiwan Traffic Crash Dataset for 2011-2016. The results revealed that unhelmeted riding was associated with 138% (AOR = 2.38; CI (confidence interval) = 2.34-2.42) and 47% (AOR = 1.47; CI = 1.45-1.49) higher risks of drunk riding and unlicensed riding, respectively. The risk of unhelmeted riding increased with blood alcohol concentrations (BACs), and riders with the minimum BAC (0.031-0.05%) had nearly five times (AOR = 4.99; CI = 4.74-5.26) higher odds of unlicensed riding compared with those of riders with a negative BAC. Unhelmeted riding, drunk riding, and unlicensed riding were associated with 1.21 times (AOR = 1.21; CI = 1.13-1.30), 2.38 times (AOR = 2.38; CI = 2.20-2.57), and 1.13 times (AOR = 1.13; CI = 1.06-1.21) higher odds of ROR crashes, respectively. The three risky riding behaviours (i.e., unhelmeted riding, drunk riding, and unlicensed riding) were significantly related to ROR crashes. The risk of unhelmeted riding and ROR crashes increased with BACs.

Living in a reshaped reality: Exploring social participation and self-identity after TBI

Individuals with a moderate to severe traumatic brain injury (TBI) experience substantial changes in their life. This constructivist grounded theory study aimed to develop an explanatory model that explores the impact of changes in social participation and self-identity after sustaining a TBI. Sixteen participants with moderate to severe TBI (mean age = 49.8, 69% male) were recruited, and were on average 16.4 years post-injury (SD = 10.4). Data from semi-structured interviews were analysed thematically. An overarching theme of "living in a reshaped reality" was identified, which depicted how changes in social participation and self-identity influenced ongoing experiences with TBI. Three main themes were generated: (1) "there's nothing that's the same" highlighted the daily challenges individuals faced post-injury, (2) "rebuilding and restarting" described how individuals with TBI navigated through their unfamiliar reality, and (3) "embrace it and run with it" explored participants' reactions towards life with a TBI. An explanatory model was developed, consisting of the overarching theme ("living in a reshaped reality") with the three integrated themes. Future research and clinical practices can build on this understanding to develop programmes to help individuals address their needs in post-injury life.

Return to work after mild traumatic brain injury: association with positive CT and MRI findings

Background

Return to work (RTW) might be delayed in patients with complicated mild traumatic brain injury (MTBI), i.e., MTBI patients with associated traumatic intracranial lesions. However, the effect of different types of lesions on RTW has not studied before. We investigated whether traumatic intracranial lesions detected by CT and MRI are associated with return to work and post-concussion symptoms in patients with MTBI.

Methods

We prospectively followed up 113 adult patients with MTBI that underwent a brain MRI within 3–17 days after injury. Return to work was assessed with one-day accuracy up to one year after injury. Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and Glasgow Outcome Scale Extended (GOS-E) were conducted one month after injury. A Kaplan–Meier log-rank analysis was performed to analyze the differences in RTW.

Results

Full RTW-% one year after injury was 98%. There were 38 patients with complicated MTBI, who had delayed median RTW compared to uncomplicated MTBI group (17 vs. 6 days), and more post-concussion symptoms (median RPQ 12.0 vs. 6.5). Further, RTW was more delayed in patients with multiple types of traumatic intracranial lesions visible in MRI (31 days, n = 19) and when lesions were detected in the primary CT (31 days, n = 24). There were no significant differences in GOS-E.

Conclusions

The imaging results that were most clearly associated with delayed RTW were positive primary CT and multiple types of lesions in MRI. RTW-% of patients with MTBI was excellent and a single intracranial lesion does not seem to be a predictive factor of disability to work.

Exploring Factors That Influence Injured Patients’ Outcomes following Road Traffic Crashes: A Multi-Site Feasibility Study

Background: Injuries arising from Road Traffic Crashes (RTCs) are a major health problem in Saudi Arabia (SA). The purpose of the study was to determine the feasibility of conducting a multi-center research study to explore factors that influence the mortality of RTC-related trauma patients in SA. Methods: A multi-center observational study was undertaken involving both prospective and retrospective data collected from three hospitals. In-hospital patient mortality thirty days post-crash was the primary outcome variable. The feasibility of the study methods including the quality of data were evaluated and pilot results pertaining to factors predicting mortality were examined. Results: The overall mortality rate (n = 572 RTC victims) was (7.5%). A logistic regression model identified four independent predictors of mortality following an RTC: treatment at a non-trauma center-based hospital, SBP ≤ 90 mmHg, GCS ≤ 8, and ISS ≥ 20. With respect to the assessment of the study method’s feasibility, missing data was problematic, especially for variables pertaining to crash characteristics and prehospital care. Conclusions: Collecting multi-center injury data in SA has logistic challenges, predominantly associated with the comparability and completeness of data sets as well as the need for manual screening and data collection at some institutions. Despite these limitations, this study has demonstrated the feasibility of a method that could be utilized in further large nationwide studies to understand and examine the factors that influence injured patients’ outcomes following RTCs.

Toward better measurement of traffic injuries - Comparison of anatomical injury measures in predicting the clinical outcomes in motorcycle crashes

INTRODUCTION

Little evidence exists in the literature regarding the discrimination power of better anatomical injury measures in differentiating clinical outcomes in motorcycle crashes. Furthermore, multiple injuries to different body parts of the rider are seldom analyzed. This study focuses on comparing anatomical injury measures such as the injury severity score (ISS) and the new injury severity score (NISS) in capturing injuries of multiple injured riders and examining the discriminatory capabilities of the ISS and NISS in predicting clinical outcomes post motorcycle crash.

METHODS

The study harnessed unique and comprehensive injury data on 322 riders from the US DOT Federal Highway Administration's Motorcycle Crash Causation Study (MCCS). Detailed exploratory analysis is performed and discrete/ordered statistical models are estimated for three clinical outcomes: mortality risk, trauma risk, and trauma status.

RESULTS

Around 9% of the riders died and 45% of the riders had injuries. Around 36% of the riders were hospitalized, disabled, or institutionalized. While a very strong dependence was found between ISS and NISS, ISS underestimated injuries sustained by riders. Statistical models for mortality risk revealed that a unit increase in the ISS and NISS was correlated with a 1.18 and 1.17 times increase in the odds of mortality, respectively. Moreover, a unit increase in ISS and NISS values was correlated with a higher trauma risk by 1.48 and 1.36 times, respectively. Our analysis reveals that the probability of a rider being hospitalized or disabled/institutionalized increases with an increase in the NISS. Conclusions and practical applications: The NISS exhibits significantly better calibration and discriminatory ability in differentiating survivors and non-survivors and in predicting trauma status - underscoring the importance of accounting for microscopic body-part-level injury data in motorcycle crashes. We consider that compared with the KABCO scale, the ISS and NISS are more nuanced scores that can better measure the overall injury intensity and can lead to more targeted countermeasures.

Traumatic Microbleeds in Mild Traumatic Brain Injury Are Not Associated with Delayed Return to Work or Persisting Post-Concussion Symptoms

The main objective of this prospective cohort study was to evaluate whether traumatic microbleeds (TMBs) are a significant prognostic factor of return to work (RTW), post-traumatic symptoms, and overall recovery in patients with mild traumatic brain injury (mTBI). One hundred and thirteen patients with mTBI were recruited from the Helsinki University Hospital emergency units. All patients underwent multi-contrast 3T magnetic resonance imaging (MRI) 3-17 days after mTBI. Patients were evaluated in the Traumatic Brain Injury Outpatient Clinic of Helsinki University Hospital 1 month after injury. Post-concussion symptoms were assessed with the Post-Concussion Symptom Questionnaire (RPQ) and overall recovery was assessed with the Glasgow Outcome Scale Extended (GOS-E). Their time to RTW was continuously measured up to 1 year after TBI. Median RTW was 9 days (interquartile range [IQR] 4-30) after mTBI and full RTW rate after 1 year was 98%. Patients with TMBs (n = 22) did not have more post-concussion symptoms (median RPQ 10.0 vs. 7.0, p = 0.217) or worse overall recovery (58% vs. 56% with GOS-E = 8, p = 0.853) than patients without TMBs (n = 91). There was no significant difference in time to RTW (13.5 vs. 7.0 days, p = 0.063). In this study, patients with TMBs did not have delayed RTW or more post-concussion symptoms than other patients with mTBI. TMBs in mTBI do not seem to be a significant prognostic factor of RTW.

Ethnicity/race and service-connected disability disparities in civilian traumatic brain injury mechanism of injury and VHA health services costs in military veterans: Evidence from a Level 1 Trauma Center and VA Medical Center

Introduction

The objective of this study was to examine the association of military veteran socio-demographics and service-connected disability with civilian mechanism of traumatic brain injury and long-term Veterans Health Administration (VHA) costs.

Methods

We conducted a 17-year retrospective longitudinal cohort study of veterans with a civilian-related traumatic brain injury from a Level 1 Trauma Center between 1999 and 2013, with VHA follow-up through 2016. We merged trauma center VHA data, and used logit to model mechanism of injury, and generalized linear model to model VHA costs.

Results

African American race or Hispanic ethnicity veterans had a higher unadjusted rate of civilian assault/gun as mechanism of injury (15.38%) relative to non-Hispanic White (7.19%). African American race or Hispanic veterans who were discharged from the trauma center with traumatic brain injury and followed in VHA had more than twice the odds of assault/gun (OR 2.47; 95% CI 1.16:5.26), after adjusting for sex, age, and military service-connected disability. Veterans with service-connected disability ≥50% had more than twice the odds of assault/gun (OR 2.48; 95% CI 0.97:6.31). Assault/gun was associated with significantly higher annual VHA costs post-discharge ($16,807; 95% CI 672:32,941) among non-Hispanic White veterans. Military service-connected disability ≥50% was associated with higher VHA costs among both non-Hispanic White ($44,987; 95% CI $17,159:$72,816) and African American race or Hispanic ($37,901; 95% CI $4,543:$71,258) veterans.

Conclusions

We found that African American race or Hispanic veterans had higher adjusted likelihood of assault/gun mechanism of traumatic brain injury, and non-Hispanic White veterans had higher adjusted annual VHA resource costs associated with assault/gun, post trauma center discharge. Veterans with higher than 50% service-connected disability had higher likelihood of assault/gun and higher adjusted annual VHA resource costs. Assault/gun prevention efforts may be indicated within the VHA, especially in minority and service-connected disability veterans. More data from Level 1 Trauma Centers are needed to assess the generalizability of these findings.

Employment status after traumatic brain injury and the effect of concomitant injuries on return to work

PURPOSE

This study aims to describe the employment status and pattern among survivors of traumatic brain injury after motor vehicle accidents, and to explore the effects of demographic, injury variables and concomitant injuries on the employment status .

METHOD

A retrospective analyses of 370 medical reports written for patients who sustained traumatic brain injury from motor vehicle accidents was conducted. To establish the employment pattern, the pre-injury employment history was compared to the latest employment status documented. Types and severity of concomitant injuries were rated according to Abbreviated Injury Scale criteria. All significant variables were further analyzed using logistic regression to explore predictors of employment.

RESULTS

Up to 87% of the patients sustained concomitant injuries, with more than two-thirds (72%) scoring ≤ 2 on the Abbreviated Injury Scale. One hundred and eighty-two patients (49.2%) successfully returned to work. Among those who returned to work, 34% returned to former employment with pre-injury job description. Severity of traumatic brain injury, length of acute hospital stay, ambulation status and cognitive status were found to be significant predictive factors for employment status post traumatic brain injury. Presence of concomitant extremity injuries was found to influence the employment pattern among traumatic brain injury survivors.

CONCLUSION

The return to work rate was somewhat low and was not influenced by presence of concomitant injuries. .

Representation in rehabilitation research of adults with traumatic brain injury and depression: A scoping review

Objective: To determine how well comorbid depression is described, defined, and measured in the rehabilitation literature that pertains to TBI and depression.Method: Scoping review of the rehabilitation sciences literature. Six databases were searched (to October 17, 2018) using the three core concepts of TBI, depression, and rehabilitation, as was for gray literature. Two independent reviewers reviewed documents for eligibility.Results: 3737 records were reviewed and 137 documents were analyzed. Primary studies (n = 126) were most prevalent and of quantitative descriptive design (n = 102). The number of participants with TBI and comorbid depression could only be determined for 81/126 (64%) of primary studies, in which they are the minority (median of 30% of sample). Depression reporting was heterogeneous and individuals with TBI and depression were not analyzed as a subgroup in most studies (n = 68, 55%). Depression self-report instruments are commonly used (14 instruments used in 111 studies). Few studies (n = 14, 19%) have participant samples with discrete severity levels of TBI and depression.Conclusions: Better participant representation and reporting of TBI and depression variables are needed to enhance comparability across studies and improve rehabilitation outcomes.

Development of a modified trauma and injury severity score to predict disability in acute trauma patients

Objective

The Trauma and Injury Severity Score (TRISS) has been used to predict trauma patient mortality and to assess the quality of trauma care systems. The goal of this investigation was to develop a modified trauma-related injury severity score (termed the TRISS-D) for predicting disability in acute trauma patients.

Methods

We used data collected by emergency medical services and entered into the Korea Centers for Disease Control and Prevention severe trauma database. The TRISS-D was based on age category (0–14, 15–54, ≥55 years), the Revised Trauma Score, and the Injury Severity Score. The outcome measures were severe disability and worsening disability. Worsening disability was defined as a lower Glasgow Outcome Scale score at hospital discharge than before the traumatic incident. Two types of cases were examined: those with penetrating or blunt injuries (group 1) and those with severe head injuries (group 2). We assessed the discriminatory power of the TRISS-D by calculating the area under a receiver operating characteristic curve (AUROC).

Results

The database comprised 14,791 patients; overall, 3,757 (25%) had severe disability and 6,018 (41%) had worsening disability. For severe disability, the AUROC (95% confidence interval) for the TRISS-D was 0.948 (0.944–0.952) in group 1 and 0.950 (0.946–0.954) in group 2. The corresponding values for worsening disability were 0.810 (0.803–0.817) and 0.816 (0.809–0.823), respectively.

Conclusion

The TRISS-D showed excellent discriminatory power for severe disability and very good discriminatory power for worsening disability.

Evaluating the combined effect of alcohol-involved and un-helmeted riding on motorcyclist fatalities in Taiwan

BACKGROUND

Alcohol-involved riders tend to engage in other risk-taking behaviours such as un-helmeted riding which could further increases injury severity. The combined effect of alcohol-involved and un-helmeted riding on fatal injuries is rarely investigated. This study investigated the interaction effect between blood alcohol concentration and helmet use on fatal injuries.

METHODS

This study used the National Taiwan Traffic Crash Dataset for the period from 2011 to 2015. Data on road crashes involving a motorcycle and an automobile were extracted and analysed. Multiple logistic regression models were used to calculate the adjusted odds ratio (AOR). We calculated an interaction effect for blood alcohol concentration and helmet use based on STROBE guidelines.

RESULTS

There were a total of 669,292 motorcyclist casualties; among these casualties, 3459 (0.5 %) motorcyclists sustained fatal injuries. Alcohol-involved riders were 9.47 times (AOR = 9.47; 95 % CI = 8.75-10.25) more likely than sober ones to sustain fatal injuries. Alcohol-involved and un-helmeted riders were approximately 18 times (AOR = 18.1; CI: 15.9-20.4) more likely to sustain fatal injuries than sober and helmeted riders. Riders involved in head-on crashes and approach-turn motorcycle crashes had an increased probability of sustaining fatal injuries by 240 % (AOR = 3.4; 95 % CI = 2.91-4.09) and 132 % (AOR = 2.3; 95 % CI = 2.016-2.67), respectively.

CONCLUSIONS

This study found that alcohol-involved riding acts synergistically with un-helmeted riding to increase motorcyclist injury severity.

Early Predictors of Employment Status One Year Post Injury in Individuals with Traumatic Brain Injury in Europe

Sustaining a traumatic brain injury (TBI) often affects the individual’s ability to work, reducing employment rates post-injury across all severities of TBI. The objective of this multi-country study was to assess the most relevant early predictors of employment status in individuals after TBI at one-year post-injury in European countries. Using a prospective longitudinal non-randomized observational cohort (The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project), data was collected between December 2014–2019 from 63 trauma centers in 18 European countries. The 1015 individuals who took part in this study were potential labor market participants, admitted to a hospital and enrolled within 24 h of injury with a clinical TBI diagnosis and indication for a computed tomography (CT) scan, and followed up at one year. Results from a binomial logistic regression showed that older age, status of part-time employment or unemployment at time of injury, premorbid psychiatric problems, and higher injury severity (as measured with higher Injury severity score (ISS), lower Glasgow Coma Scale (GCS), and longer length of stay (LOS) in hospital) were associated with higher unemployment probability at one-year after injury. The study strengthens evidence for age, employment at time of injury, premorbid psychiatric problems, ISS, GCS, and LOS as important predictors for employment status one-year post-TBI across Europe.

Interrelationships Between Post-TBI Employment and Substance Abuse: A Cross-lagged Structural Equation Modeling Analysis

OBJECTIVE

To describe the interrelationship of postinjury employment and substance abuse (SA) among individuals with traumatic brain injury.

DESIGN

Structural equation model (SEM) and logistic regression analytic approach using a merged database of the National Trauma Data Bank (NTDB) and Traumatic Brain Injury Model Systems (TBIMS) National Database, with acute care and rehabilitation hospitalization data and 1, 2, and 5 year follow-up data.

SETTING

United States Level I/II trauma centers and inpatient rehabilitation centers with telephone follow-up.

PARTICIPANTS

Individuals in the TBIMS National Database successfully matched to their NTDB data, aged 18-59 years, with trauma severity, age, sex, employment, and SA data at 1, 2, and/or 5 years postinjury (N=2890).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Employment status (employed/unemployed) and SA (present/absent) at year 1, year 2, and year 5 postinjury.

RESULTS

SEM analysis showed older age at injury predicted lower likelihood of employment at all time points postinjury (βYR1=-0.016; βYR2=-0.006; βYR5=-0.016; all P<.001), while higher injury severity score (ISS) predicted lower likelihood of employment (β=-0.008; P=.027) and SA (β=-0.007; P=.050) at year 1. Male sex predicted higher likelihood of SA at each follow-up (βYR1=0.227; βYR2=0.184; βYR5=0.161; all P<.100). Despite associations of preinjury unemployment with higher preinjury SA, postinjury employment at year 1 predicted SA at year 2 (β=0.118; P=.028). Employment and SA during the previous follow-up period predicted subsequent employment and SA, respectively.

CONCLUSIONS

Employment and SA have unique longitudinal interrelationships and are additionally influenced by age, sex, and ISS. The present work suggests the need for more research on causal, confounding, and mediating factors and appropriate screening and intervention tools that minimize SA and facilitate successful employment-related outcomes.

Effect of motorcycle helmet types on head injuries: evidence from eight level-I trauma centres in Taiwan

Background

Motorcycle full-coverage helmet use may reduce fatalities and head injuries.

Methods

This retrospective cohort study extracted injury data from eight level-I trauma centres in Taiwan and performed a questionnaire survey to investigate injuries sustained by motorcyclists for the period between January 2015 and June 2017.

Results

As many as 725 patients participated in the questionnaire survey and reported their helmet types or phone use during crashes. The results of multivariate logistic models demonstrated that nonstandard helmet (half or open-face helmet) use was associated with an increased risk of head injuries and more severe injuries (injury severity score ≥ 8). Drunk riding and phone use appeared to be two important risk factors for head injuries and increased injury severity. Anaemia was also found to be a determinant of head injuries.”

Conclusions

Compared to full-coverage helmets, nonstandard provide less protection against head injuries and increased injury severity among motorcyclists.

MRI-based measures of intracortical myelin are sensitive to a history of TBI and are associated with functional connectivity

Traumatic brain injuries (TBIs) induce persistent behavioral and cognitive deficits via diffuse axonal injury. Axonal injuries are often examined in vivo using diffusion MRI, which identifies damaged and demyelinated regions in deep white matter. However, TBI patients can exhibit impairment in the absence of diffusion-measured abnormalities, suggesting that axonal injury and demyelination may occur outside the deep white matter. Importantly, myelinated axons are also present within the cortex. Cortical myelination cannot be measured using diffusion imaging, but can be mapped in-vivo using the T1-w/T2-w ratio method. Here, we conducted the first work examining effects of TBI on intracortical myelin in living humans by applying myelin mapping to 46 US Military Veterans with a history of TBI. We observed that myelin maps could be created in TBI patients that matched known distributions of cortical myelin. After controlling for age and presence of blast injury, the number of lifetime TBIs was associated with reductions in the T1-w/T2-w ratio across the cortex, most significantly in a highly-myelinated lateral occipital region corresponding with the human MT+ complex. Further, the T1-w/T2-w ratio in this MT+ region predicted resting-state functional connectivity of that region. By contrast, a history of blast TBI did not affect the T1-w/T2-w ratio in either a diffuse or focal pattern. These findings suggest that intracortical myelin, as measured using the T1-w/T2-w ratio, may be a TBI biomarker that is anatomically complementary to diffusion MRI. Thus, myelin mapping could potentially be combined with diffusion imaging to improve MRI-based diagnostic tools for TBI.

Psychological Intervention in Traumatic Brain Injury Patients

Objective

To provide a brief and comprehensive summary of recent research regarding psychological interventions for patients surviving a traumatic brain injury.

Methods

A bibliographical search was performed in PubMed, Cochrane Library, PsycNET, Scopus, ResearchGate, and Google Scholar online databases. Analysis included distribution by year of publication, age stage of participants (paediatric, adult), location of the research team, study design, type of intervention, and main outcome variables.

Results

The initial search eliciting 1541 citations was reduced to 62 relevant papers. Most publications had adult samples (88.7%). The United States outstands as the country with more research (58.1%); Latin America countries provided no results. Cognitive behavioural therapy (CBT) was the most widely used approach for treatment of (sub)clinical mental disturbances (41.9%). Neuropsychological interventions were scarce (4.8%). Outcome measures included psychiatric disorders (e.g., posttraumatic stress disorder (PTSD), depression, and anxiety) (37.1%), postconcussive symptoms (16.1%), cognitive and functional deficits (48.1%), and social and psychological dimensions (62.9%).

Conclusions

CBT outstands as the preferred therapeutic approach for treating behavioural and emotional disturbances. Also, other related therapies such as dialectical behaviour, mindfulness, and acceptance and commitment therapies have been proposed, and probably in the years to come, more literature regarding their effectiveness will be available. On the other hand, evidence showed that interventions from the field of neuropsychology are minimal if compared with its contribution to assessment. Future research should be aimed at performing studies on more diverse populations (e.g., nonmilitary communities and paediatric and Latin American populations) and at controlling designs to examine the therapeutic efficacy of psychotherapeutic and neurocognitive rehabilitation interventions and compare amelioration by injury severity, age of patients, and clinical profile, in the hopes of creating better guidelines for practitioners.

Evaluation of injuries sustained by motorcyclists in approach-turn crashes in Taiwan

OBJECTIVES

In western countries, a typical car-motorcycle crash occurs at an intersection where a car manoeuvres into the path of an oncoming motorcycle, which involves a car driver violates motorcycle's right of way (ROW). In Taiwan, however, a unique type of crash (approach-turn crash) occurs when a turning (including U-turn) motorcycle frequently infringes upon a car's ROW. The primary objective of this study was to examine injuries sustained by motorcyclists in this unique type of crash.

METHOD

Using the linked data from the National Taiwan Crash Database and the National Health Insurance Research Data from 2003 to 2015, this study examined several anatomical injuries (e.g., head and face, neck, chest and abdomen, spine, and lower extremities), as well as the resulting injury severity (e.g., death within 30 days, hospitalisation, and emergency visit only/outpatient, and length of hospital stay). Variables examined include demographic data (sex, age, alcohol use, license status, and helmet use), vehicle attributes (engine size, type of crash partner, and crash type), road and environmental factors (curvature, crash location, day of week and time of crash). Injuries sustained by motorcyclists in an approach-turn motorcycle-turning crash (motorcycle is a ROW violator) were compared with those sustained by motorcyclists in an approach-turn car-turning crash (car is the ROW violator).

RESULTS

A total of 21,919 motorcyclists were enrolled, of whom 18,041 and 3878 were motorcyclists involved in approach-turn car-turning and motorcycle-turning crashes, respectively. The percentage of death within 30 days; hospitalisation; length of hospital stay; and injuries to the head and face, neck, and chest and abdomen were significantly higher for motorcyclists in approach-turn motorcycle-turning crashes. Results of logistic regression models revealed that riding under the influence of alcohol and riding without a licence were associated with death/hospitalisation, and injuries to particular body regions (head and face, neck, and chest and abdomen). Helmet use was associated with a decreased likelihood of head and face and neck injuries.

CONCLUSION

Motorcyclists tended to be more severely or fatally injured and had increased head and face, neck, and chest and abdomen injuries when they were ROW violators than when their ROWs were violated at an intersection. Efforts to curb drunk riding and unlicensed riding may constitute effective intervention points.

A Detailed Overview of Long-Term Outcomes in Severe Traumatic Brain Injury Eight Years Post-injury

Background and aims: Severe traumatic brain injury is a leading cause of acquired persistent disabilities, and represents an important health and economic burden. However, the determinants of long-term outcome have rarely been systematically studied in a prospective longitudinal study of a homogeneous group of patients suffering exclusively from severe TBI

Methods: Prospective observational study of an inception cohort of adult patients with severe traumatic brain injury in the Parisian area (PariS-TBI). Outcome was assessed with face-to-face interview 8 years after Traumatic Brain Injury, focusing on impairments, activity limitations, and participation restriction.

Results: Five hundred and four patients were included between 2005 and 2007. At 8-year follow-up, 261 patients were deceased, 128 were lost to follow-up, 22 refused to participate, and 86 were finally evaluated. Age, gender, initial injury severity did not significantly differ between evaluated patients and lost to follow-up, but the latter were more frequently students or unemployed. Mean age was 41.9 (SD 13.6), 79% were male, median initial Glasgow Coma Scale Score was 6. The most frequent somatic complaints concerned balance (47.5%), motricity (31%), and headaches (36%), but these were less frequent than cognitive complaints (Memory 71%, Slowness 68%, Concentration 67%). According to the Hospital Anxiety and Depression Scale (HADS), 25 % had a score >8 for anxiety and 23.7% for depression. According to the Extended Glasgow Outcome Scale, 19.8% remained severely disabled, 46.5% moderately disabled, 33.7% had a good recovery. Older age, longer education duration, lower functional status upon intensive care discharge, and more severe 8-year dysexecutive problems were significantly associated with a lower Extended Glasgow Outcome Scale score in multivariable analysis. At 8 years, 48.7% of patients were employed in a productive job. Of those, 38% declared a salary loss since traumatic brain injury. Unemployment was significantly associated with lower 1-year GOSE score and more severe 8-year dysexecutive problems.

Conclusions: These results from an inception cohort study highlight the fact that long-term outcome after severe TBI is determined by a complex combination of injury-related, demographic and neuropsychological factors. Long after the injury, persisting impairments still interfere with social integration, and participation.

Predicting prolonged sick leave among trauma survivors

Many survivors after trauma suffer from long-term morbidity. The aim of this observational cohort study was to develop a prognostic prediction tool for early assessment of full-time sick leave one year after trauma. Potential predictors were assessed combining individuals from a trauma register with national health registers. Two models were developed using logistic regression and stepwise backward elimination. 4458 individuals were included out of which 488 were on sick leave full-time 12 months after the trauma. One comprehensive and one simplified model were developed including nine and seven predictors respectively. Both models showed excellent discrimination (AUC 0.81). The comprehensive model had very good calibration, and the simplified model good calibration. Prediction models can be used to assess post-trauma sick leave using injury-related variables as well as factors not related to the trauma per se. Among included variables, pre-injury sick leave was the single most important predictor for full-time sick leave one year after trauma. These models could facilitate a more efficient use of resources, targeting groups for follow-up interventions to improve outcome. External validation is necessary in order to evaluate generalizability.

Validation of the Nursing Diagnosis "Labile Emotional Control" in Traumatic Brain Injury

OBJECTIVE

To validate the defining characteristics of the nursing diagnosis "labile emotional control" in traumatic brain injury (TBI) outpatients.

DESIGN

This was a descriptive, cross-sectional, quantitative study.

METHODS

Thirty-one Brazilian nurses who were experts in the area of TBI answered a semistructured questionnaire on the diagnosis "labile emotional control" based on NANDA-International (NANDA-I) Taxonomy II (2015-2017) using a Likert-type scale to rate the 13 defining characteristics. Based on Fehring's model, the weighted average of ≥80 was used to define the main characteristic and the mean of ≥0.50 was considered for total content validation.

RESULTS

Out of the 13 defining characteristics of the nursing diagnosis studied, "leaving a social situation" (0.80) and "expression of emotions inconsistent with the triggering factor" (0.81) were classified as principal characteristics, while the 11 others were classified as secondary characteristics. The diagnosis "labile emotional control" obtained a total score of 0.69, which was considered valid according to NANDA-I Taxonomy II.

CONCLUSIONS

Because this is a new diagnosis with subjective characteristics, there is a need to train nurses to recognize the defining characteristics for the diagnosis.

CLINICAL RELEVANCE

The validation of this diagnosis helps nurses understand and identify the subjective characteristics of the emotional impressions expressed by patients with TBI. These defining characteristics will help improve TBI nurses' clinical practice.

Employment Stability in the First 5 Years After Moderate-to-Severe Traumatic Brain Injury

OBJECTIVE

To characterize employment stability and identify predictive factors of employment stability in working-age individuals after moderate-to-severe traumatic brain injury (TBI) that may be clinically addressed.

DESIGN

Longitudinal observational study of an inception cohort from the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) using data at years 1, 2, and 5 post-TBI.

SETTING

Inpatient rehabilitation centers with telephone follow-up.

PARTICIPANTS

Individuals enrolled in the TBIMS-NDB since 2001, aged 18-59, with employment data at 2 or more follow-up interviews at years 1, 2, and 5 (N=5683).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Employment stability, categorized using post-TBI employment data as no paid employment (53.25%), stably (27.20%), delayed (10.24%), or unstably (9.31%) employed.

RESULTS

Multinomial regression analyses identified predictive factors of employment stability, including younger age, white race, less severe injuries, preinjury employment, higher annual earnings, male sex, higher education, transportation independence postinjury, and no anxiety or depression at 1 year post-TBI.

CONCLUSIONS

Employment stability serves as an important measure of productivity post-TBI. Psychosocial, clinical, environmental, and demographic factors predict employment stability post-TBI. Notable predictors include transportation independence as well as the presence of anxiety and depression at year 1 post-TBI as potentially modifiable intervention targets.