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Valtiala E, Roine I, Cruzeiro ML, Peltola H, Pelkonen T. Seizures, focal neurological signs, and pneumococcal aetiology associate with impaired consciousness in childhood bacterial meningitis. Acta Paediatr 2024; 113:1644-1652. [PMID: 38511552 DOI: 10.1111/apa.17217] [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: 12/21/2023] [Revised: 03/09/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
AIM A low Glasgow Coma Scale Score (GCS) on admission is a known predictor of poor outcome from childhood bacterial meningitis. In turn, the factors associated with the admission GCS are less known. Our aim was to identify them, both for clinical alerts of reserved prognosis and to find potential targets for intervention. METHODS This study is a secondary analysis of data collected prospectively in Angola and in Latin America between 1996 and 2007. Children with bacterial meningitis were examined on hospital admission and their GCS was assessed using the age-adjusted scale. Associations between on-admission GCS and host clinical factors were examined. RESULTS A total of 1376 patients with confirmed bacterial meningitis were included in the analysis (609 from Latin America and 767 from Angola). The median GCS was 13 for all patients (12 in Angola and 13 in Latin America). In the multivariate analysis, in the areas combined, seizures, focal neurological signs, and pneumococcal aetiology associated with GCS <13, as did treatment delay in Latin America. CONCLUSION Besides pneumococcal aetiology, we identified characteristics, easily registrable on admission, which are associated with a low GCS in childhood bacterial meningitis. Of these, expanding pneumococcal vaccinations and treatment delays could be modified.
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Affiliation(s)
- Ester Valtiala
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Irmeli Roine
- Faculty of Medicine, University Diego Portales, Santiago, Chile
| | | | - Heikki Peltola
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuula Pelkonen
- Hospital Pediátrico David Bernardino, Luanda, Angola
- Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- New Children's Hospital, Pediatric Research Center, Helsinki, Finland
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Morán Gallego FJ, Sanchez Casado M, López de Toro Martin Consuegra I, Marina Martinez L, Alvarez Fernandez J, Sánchez Carretero MJ. Evaluation of the last 2 decades in the characteristics of presentation, management and prognosis of serious spontaneous intracerebral hemorrhage in a third level hospital. NEUROCIRUGIA (ENGLISH EDITION) 2024; 35:169-176. [PMID: 38295901 DOI: 10.1016/j.neucie.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/12/2023] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To analyze the change in the characteristics of presentation, evolution and treatment in the ICU, as well as the functional evolution at 12 months of spontaneous intracranial hemorrhages (ICHs) treated in an ICU reference center. PATIENT AND METHODS Descriptive, retrospective study in a Neurocritical Reference Hospital. All admissions of patients with HICE during three periods are studied: 1999-2001 (I), 2015-2016 (II) and 2020-2021 (III). Evolution in the three periods of demographic variables, baseline characteristics of the patients, clinical variables and characteristics of bleeding, evolutionary data in the ICU are studied. At one year we assessed the GOS scale (Glasgow Outcome Score) according to whether they had a poor (GOS 1-3) or good (GOS 4-5) prognosis. RESULTS 300 admitted patients, distributed in periods: I: 28.7%, II: 36.3% and III: 35%. 56.7% were males aged 66 (55.5-74) years; ICH score 2 (1-3). The ICU stay was 5 (2-14) days with a mortality of 36.8%. GOS 1-3 a year in 67.3% and GOS 4-5 in 32.7%. Comparing the three periods, we observed a higher prevalence in women, and the presence of cardiovascular factors; no changes in etiology; in relation to the location, it increases cerebellar hemorrhage and in the brainstem. Although the severity was greater, the stay in the ICU, the use of invasive mechanical ventilation and tracheostomy were lower. Open surgery has decreased its use by 50%. Mortality continues to be high, stagnating in the ICU at 35% and entails a high degree of disability one year after assessment. CONCLUSIONS Severe ICH is a complex pathology that has changed some characteristics in the last two decades, with more severe patients, with more cardiovascular history and a greater predominance of brainstem and cerebellar hemorrhage. Despite the increase in severity, better parameters during the ICU stay, with open surgery used 50% less. Mortality remains stagnant at 35% with high disability per year.
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3
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Orscelik A, Musmar B, Matsukawa H, Ismail M, Elawady SS, Assad S, Cunningham C, Sowlat MM, Spiotta AM. Optimal Timing of Microsurgical Treatment for Ruptured Arteriovenous Malformations: A Systematic Review and Meta-Analysis. Neurosurgery 2024:00006123-990000000-01230. [PMID: 38912816 DOI: 10.1227/neu.0000000000003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/19/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The timing of microsurgical treatment (MST) for ruptured brain arteriovenous malformations (bAVM) is a contentious issue in the literature. This study aimed to investigate the impact of MST timing on outcomes in patients with ruptured bAVMs, considering MST with and without preoperative endovascular treatment (EVT). METHOD Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a comprehensive search was conducted across multiple databases, yielding 15 studies meeting the inclusion criteria. The timing was defined as the duration from the rupture of bAVM to the MST. The patients were divided into 4 different groups based on MST timing: <48 hours, <1 week, <2 weeks, and <1 month. The primary outcome was favorable outcome defined as a modified Rankin Scale score of 0 to 2 or a Glasgow Outcome Scale score of 4 to 5 in the last clinical follow-up. Secondary outcomes included periprocedural mortality and complete excision. RESULTS MST time >48 hours were associated with a significantly higher favorable outcome rate (odds ratio: 9.71, 95% Cl: 3.09-30.57, P < .01) and a lower mortality rate (OR: 0.15, 95% Cl: 0.02-0.88, P = .04) compared with MST timing ≤48 hours. After exclusion of patients who underwent MST with preoperative EVT, MST time >48 hours had a significantly higher rate of favorable outcome (OR: 9.39, 95% CI: 2.53-34.89, P < .01). CONCLUSION This meta-analysis suggests that delayed surgical intervention beyond 48 hours may be associated with improved favorable outcomes in patients who underwent MST with and without preoperative EVT for ruptured bAVMs.
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Affiliation(s)
- Atakan Orscelik
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Basel Musmar
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Mustafa Ismail
- College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Sameh Samir Elawady
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Salman Assad
- Department of Neurology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Conor Cunningham
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohamed Mahdi Sowlat
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Division of Neuroendovascular Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Sanders WR, Barber JK, Temkin NR, Foreman B, Giacino JT, Williamson T, Edlow BL, Manley GT, Bodien YG. Recovery Potential in Patients Who Died After Withdrawal of Life-Sustaining Treatment: A TRACK-TBI Propensity Score Analysis. J Neurotrauma 2024. [PMID: 38739032 DOI: 10.1089/neu.2024.0014] [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: 05/14/2024] Open
Abstract
Among patients with severe traumatic brain injury (TBI), there is high prognostic uncertainty but growing evidence that recovery of independence is possible. Nevertheless, families are often asked to make decisions about withdrawal of life-sustaining treatment (WLST) within days of injury. The range of potential outcomes for patients who died after WLST (WLST+) is unknown, posing a challenge for prognostic modeling and clinical counseling. We investigated the potential for survival and recovery of independence after acute TBI in patients who died after WLST. We used Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) data and propensity score matching to pair participants with WLST+ to those with a similar probability of WLST (based on demographic and clinical characteristics), but for whom life-sustaining treatment was not withdrawn (WLST-). To optimize matching, we divided the WLST- cohort into tiers (Tier 1 = 0-11%, Tier 2 = 11-27%, Tier 3 = 27-70% WLST propensity). We estimated the level of recovery that could be expected in WLST+ participants by evaluating 3-, 6-, and 12-month Glasgow Outcome Scale-Extended (GOSE) and Disability Rating Scale outcomes in matched WLST- participants. Of 90 WLST+ participants (80% male, mean [standard deviation; SD] age = 59.2 [17.9] years, median [IQR] days to WLST = 5.4 [2.2, 11.7]), 80 could be matched to WLST- participants. Of 56 WLST- participants who were followed at 6 months, 31 (55%) died. Among survivors in the overall sample and survivors in Tiers 1 and 2, more than 30% recovered at least partial independence (GOSE ≥4). In Tier 3, recovery to GOSE ≥4 occurred at 12 months, but not 6 months, post-injury. These results suggest a substantial proportion of patients with TBI and WLST may have survived and achieved at least partial independence. However, death or severe disability is a common outcome when the probability of WLST is high. While further validation is needed, our findings support a more cautious clinical approach to WLST and more complete reporting on WLST in TBI studies.
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Affiliation(s)
- William R Sanders
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Jason K Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Yelena G Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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Arki K, Degen C, Gruber P, Cioccari L. A Rare Case of a Good Neurological Outcome following Traumatic Foix-Chavany-Marie Syndrome. Case Rep Crit Care 2024; 2024:6652867. [PMID: 38766550 PMCID: PMC11101244 DOI: 10.1155/2024/6652867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Traumatic brain injury (TBI) can have profound acute and chronic effects, leading to permanent disabilities and diminished quality of life. Pseudobulbar palsy and its infrequent subtype, Foix-Chavany-Marie Syndrome (FCMS), represent rare complications of TBI, manifesting as deficits in craniofacial motor function and automatic-voluntary dissociation. We present a case of a 58-year-old male who developed FCMS following severe TBI from a cycling accident. Initial imaging revealed extensive brain injury with subsequent development of FCMS characterised by bilateral cranial nerve dysfunction, notably facio-pharyngo-glosso-masticatory diplegia with preserved automatic motor function. This case contributes to the limited literature on traumatic FCMS, highlighting its distinct clinical features and potential for favourable outcomes compared to nontraumatic cases. Early recognition and comprehensive management, including supportive therapy and addressing underlying conditions, are paramount for optimising patient outcomes.
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Affiliation(s)
- Katalin Arki
- Department of Intensive Care Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Degen
- Department of Intensive Care Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Gruber
- Department of Diagnostic and Interventional Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Cioccari
- Department of Intensive Care Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Lule H, Mugerwa M, Ssebuufu R, Kyamanywa P, Bärnighausen T, Posti JP, Wilson ML. Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident-Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55297. [PMID: 38713507 PMCID: PMC11109866 DOI: 10.2196/55297] [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: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. OBJECTIVE This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident-related injuries in an African low-resource setting. METHODS This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident-related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. RESULTS The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. CONCLUSIONS This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. TRIAL REGISTRATION Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55297.
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Affiliation(s)
- Herman Lule
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Micheal Mugerwa
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Patrick Kyamanywa
- Mother Kevin Postgraduate Medical School, Uganda Martyr's University, Nkozi, Uganda
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of Heidelberg, Heidelberg, Germany
| | - Jussi P Posti
- Neurocentre, Department of Neurosurgery and Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of Heidelberg, Heidelberg, Germany
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7
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Findlay MC, Bounajem MT, Kim RB, Henson JC, Azab MA, Cutler CB, Khan M, Brandon C, Budohoski KP, Rennert RC, Couldwell WT. Subtemporal Approach for the Treatment of Ruptured and Unruptured Distal Basilar Artery Aneurysms: Is There a Contemporary Use? Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01154. [PMID: 38690880 DOI: 10.1227/ons.0000000000001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/07/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Distal basilar artery aneurysms (DBAs) are high-risk lesions for which endovascular treatment is preferred because of their deep location, yet indications for open clipping nonetheless remain. The subtemporal approach allows for early proximal control and direct visualization of critical posterior perforating arteries, especially for posterior-projecting aneurysms. Our objective was to describe our clinical experience with the subtemporal approach for clipping DBAs in the evolving endovascular era. METHODS This was a retrospective, single-institution case series of patients with DBAs treated with microsurgery over a 21-year period (2002-2023). Demographic, clinical, and surgical data were collected for analysis. RESULTS Twenty-seven patients underwent clipping of 11 ruptured and 16 unruptured DBAs with a subtemporal approach (24 female; mean age 53 years). Ten patients had expanded craniotomies for treatment of additional aneurysms. The aneurysm occlusion rate was 100%. Good neurological outcomes as defined by the modified Rankin Scale score ≤2 and Glasgow Outcome Scale score ≥4 were achieved in 21/27 patients (78%). Two patients died before hospital discharge, one from vasospasm-induced strokes and another from an intraoperative myocardial infarction. CONCLUSION These results demonstrate that microsurgical clip ligation of DBAs using the subtemporal approach remains a viable option for complex lesions not amenable to endovascular management.
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Affiliation(s)
| | - Michael T Bounajem
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert B Kim
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - J Curran Henson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mohammed A Azab
- Biomedical Sciences, Boise State University, Boise, Idaho, USA
| | - Christopher B Cutler
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Majid Khan
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Cameron Brandon
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Karol P Budohoski
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert C Rennert
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
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8
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Tang L, Guo Y, Shu C, Peng X, Qiu S, Li R, Liu P, Wei H, Liao S, Du Y, Guo D, Gao N, Zeng QL, Liu X, Ji F. Neurological manifestations and risk factors associated with poor prognosis in hospitalized children with Omicron variant infection. Eur J Pediatr 2024; 183:2353-2363. [PMID: 38429545 DOI: 10.1007/s00431-024-05495-6] [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: 12/12/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024]
Abstract
There are increasing reports of neurological manifestation in children with coronavirus disease 2019 (COVID-19). However, the frequency and clinical outcomes of in hospitalized children infected with the Omicron variant are unknown. The aim of this study was to describe the clinical characteristics, neurological manifestations, and risk factor associated with poor prognosis of hospitalized children suffering from COVID-19 due to the Omicron variant. Participants included children older than 28 days and younger than 18 years. Patients were recruited from December 10, 2022 through January 5, 2023. They were followed up for 30 days. A total of 509 pediatric patients hospitalized with the Omicron variant infection were recruited into the study. Among them, 167 (32.81%) patients had neurological manifestations. The most common manifestations were febrile convulsions (n = 90, 53.89%), viral encephalitis (n = 34, 20.36%), epilepsy (n = 23, 13.77%), hypoxic-ischemic encephalopathy (n = 9, 5.39%), and acute necrotizing encephalopathy (n = 6, 3.59%). At discharge, 92.81% of patients had a good prognosis according to the Glasgow Outcome Scale (scores ≥ 4). However, 7.19% had a poor prognosis. Eight patients died during the follow-up period with a cumulative 30-day mortality rate of 4.8% (95% confidence interval (CI) 1.5-8.1). Multivariate analysis revealed that albumin (odds ratio 0.711, 95% CI 0.556-0.910) and creatine kinase MB (CK-MB) levels (odds ratio 1.033, 95% CI 1.004-1.063) were independent risk factors of poor prognosis due to neurological manifestations. The area under the curve for the prediction of poor prognosis with albumin and CK-MB was 0.915 (95%CI 0.799-1.000), indicating that these factors can accurately predict a poor prognosis. Conclusion: In this study, 32.8% of hospitalized children suffering from COVID-19 due to the Omicron variant infection experienced neurological manifestations. Baseline albumin and CK-MB levels could accurately predict poor prognosis in this patient population. What is Known: • Neurological injury has been reported in SARS-CoV-2 infection; compared with other strains, the Omicron strain is more likely to cause neurological manifestations in adults. • Neurologic injury in adults such as cerebral hemorrhage and epilepsy has been reported in patients with Omicron variant infection. What is New: • One-third hospitalized children with Omicron infection experience neurological manifestations, including central nervous system manifestations and peripheral nervous system manifestations. • Albumin and CK-MB combined can accurately predict poor prognosis (AUC 0.915), and the 30-day mortality rate of children with Omicron variant infection and neurological manifestations was 4.8%.
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Affiliation(s)
- Li Tang
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Yuxin Guo
- Department of Infectious Diseases, the Second Affiliated Hospital Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi, China
| | - Chang Shu
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Xiaokang Peng
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Sikai Qiu
- Department of Infectious Diseases, the Second Affiliated Hospital Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi, China
| | - Ruina Li
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Pan Liu
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Huijing Wei
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Shan Liao
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Yali Du
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Dandan Guo
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China
| | - Ning Gao
- Department of Infectious Diseases, the Second Affiliated Hospital Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi, China
| | - Qing-Lei Zeng
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, No. 1, Eastern Jianshe Road, Zhengzhou, 450052, Henan, China.
| | - Xiaoguai Liu
- Department of Infectious Diseases, Xi'an Jiaotong University Affiliated Children's Hospital, No. 69 Xi Ju Yuan Alley, Xi'an, 710003, Shaanxi, China.
| | - Fanpu Ji
- Department of Infectious Diseases, the Second Affiliated Hospital Xi'an Jiaotong University, No.157 Xi Wu Road, Xi'an, 710004, Shaanxi, China.
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University) Ministry of Education of China, Xi'an, China.
- National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
- Shaanxi Provincial Clinical Medical Research Center of Infectious Diseases, Xi'an, Shaanxi, China.
- Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Shaanxi, China.
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9
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Labib MA, Catapano JS, Inoue M, Kupanoff KM, Singh R, Abramov I, Scherschinski L, Srinivasan VM, Youn TS, Spetzler RF, Lawton MT. External Validation of the Modified Southwestern Aneurysm Severity Index in the Barrow Ruptured Aneurysm Trial Surgical Cohort. Neurosurgery 2024:00006123-990000000-01147. [PMID: 38682903 DOI: 10.1227/neu.0000000000002959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/30/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Predicting functional outcomes after surgical management of ruptured aneurysms is essential. This study sought to validate the modified Southwestern Aneurysm Severity Index (mSASI), which predicts functional outcomes 1 year after treatment. METHODS The surgical arm of a randomized controlled trial, the Barrow Ruptured Aneurysm Trial, was used to validate the mSASI model. mSASI scores incorporating the Hunt and Hess scale, Non-Neurological American Society of Anesthesiologists Physical Classification Status, imaging findings, and other modifiers were assigned and evaluated against the Glasgow Outcome Scale (GOS) score at 1 year. The model's performance was assessed for discrimination and calibration. Similar evaluations were constructed using the modified Rankin Scale (mRS) as the 1-year functional outcome measurement. Long-term outcomes (3, 6, 10 years) were also evaluated. RESULTS Of 280 clinical trial patients treated surgically, 242 met the inclusion criteria. The mean age was 54.1 ± 12.9 years; 31% were men. Favorable GOS score (4-5) and mRS score (0-2) at 1 year were observed in 73.6% and 66.1% of patients, respectively. The mSASI model predicted unfavorable GOS score at 1 year with fair to good discrimination (area under the curve = 0.75, 95% CI = 0.68-0.82) and accurate calibration (R2 = 0.98). Similar results were obtained when mRS was used as the outcome measure (area under the curve = 0.75, 95% CI = 0.68-0.82; R2 = 0.95). CONCLUSION The mSASI model was externally validated in our cohort to predict functional outcomes using the GOS or mRS scores 1 year after surgery. This index may be used for prognosticating outcomes of patients undergoing surgery for ruptured aneurysms at short-term and long-term intervals.
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Affiliation(s)
- Mohamed A Labib
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Mizuho Inoue
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Kristina M Kupanoff
- Department of Trauma/Acute Care and General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Rohin Singh
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Phoenix, Arizona, USA
| | - Irakliy Abramov
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Teddy S Youn
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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10
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Amiri M, Raimondo F, Fisher PM, Cacic Hribljan M, Sidaros A, Othman MH, Zibrandtsen I, Bergdal O, Fabritius ML, Hansen AE, Hassager C, Højgaard JLS, Jensen HR, Knudsen NV, Laursen EL, Møller JE, Nersesjan V, Nicolic M, Sigurdsson ST, Sitt JD, Sølling C, Welling KL, Willumsen LM, Hauerberg J, Larsen VA, Fabricius ME, Knudsen GM, Kjærgaard J, Møller K, Kondziella D. Multimodal Prediction of 3- and 12-Month Outcomes in ICU Patients with Acute Disorders of Consciousness. Neurocrit Care 2024; 40:718-733. [PMID: 37697124 PMCID: PMC10959792 DOI: 10.1007/s12028-023-01816-z] [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: 05/10/2023] [Accepted: 07/21/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND In intensive care unit (ICU) patients with coma and other disorders of consciousness (DoC), outcome prediction is key to decision-making regarding prognostication, neurorehabilitation, and management of family expectations. Current prediction algorithms are largely based on chronic DoC, whereas multimodal data from acute DoC are scarce. Therefore, the Consciousness in Neurocritical Care Cohort Study Using Electroencephalography and Functional Magnetic Resonance Imaging (i.e. CONNECT-ME; ClinicalTrials.gov identifier: NCT02644265) investigates ICU patients with acute DoC due to traumatic and nontraumatic brain injuries, using electroencephalography (EEG) (resting-state and passive paradigms), functional magnetic resonance imaging (fMRI) (resting-state) and systematic clinical examinations. METHODS We previously presented results for a subset of patients (n = 87) concerning prediction of consciousness levels in the ICU. Now we report 3- and 12-month outcomes in an extended cohort (n = 123). Favorable outcome was defined as a modified Rankin Scale score ≤ 3, a cerebral performance category score ≤ 2, and a Glasgow Outcome Scale Extended score ≥ 4. EEG features included visual grading, automated spectral categorization, and support vector machine consciousness classifier. fMRI features included functional connectivity measures from six resting-state networks. Random forest and support vector machine were applied to EEG and fMRI features to predict outcomes. Here, random forest results are presented as areas under the curve (AUC) of receiver operating characteristic curves or accuracy. Cox proportional regression with in-hospital death as a competing risk was used to assess independent clinical predictors of time to favorable outcome. RESULTS Between April 2016 and July 2021, we enrolled 123 patients (mean age 51 years, 42% women). Of 82 (66%) ICU survivors, 3- and 12-month outcomes were available for 79 (96%) and 77 (94%), respectively. EEG features predicted both 3-month (AUC 0.79 [95% confidence interval (CI) 0.77-0.82]) and 12-month (AUC 0.74 [95% CI 0.71-0.77]) outcomes. fMRI features appeared to predict 3-month outcome (accuracy 0.69-0.78) both alone and when combined with some EEG features (accuracies 0.73-0.84) but not 12-month outcome (larger sample sizes needed). Independent clinical predictors of time to favorable outcome were younger age (hazard ratio [HR] 1.04 [95% CI 1.02-1.06]), traumatic brain injury (HR 1.94 [95% CI 1.04-3.61]), command-following abilities at admission (HR 2.70 [95% CI 1.40-5.23]), initial brain imaging without severe pathological findings (HR 2.42 [95% CI 1.12-5.22]), improving consciousness in the ICU (HR 5.76 [95% CI 2.41-15.51]), and favorable visual-graded EEG (HR 2.47 [95% CI 1.46-4.19]). CONCLUSIONS Our results indicate that EEG and fMRI features and readily available clinical data predict short-term outcome of patients with acute DoC and that EEG also predicts 12-month outcome after ICU discharge.
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Affiliation(s)
- Moshgan Amiri
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Federico Raimondo
- Brain and Behaviour, Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Patrick M Fisher
- Neurobiology Research Unit, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Melita Cacic Hribljan
- Department of Neurophysiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Annette Sidaros
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Neurophysiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marwan H Othman
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ivan Zibrandtsen
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Neurophysiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ove Bergdal
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Maria Louise Fabritius
- Department of Neuroanaesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Joan Lilja S Højgaard
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Helene Ravnholt Jensen
- Department of Neuroanaesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Vendelbo Knudsen
- Department of Neuroanaesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Emilie Lund Laursen
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Vardan Nersesjan
- Biological and Precision Psychiatry, Copenhagen Research Center for Mental Health, Copenhagen University Hospital, Copenhagen, Denmark
| | - Miki Nicolic
- Department of Neurophysiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sigurdur Thor Sigurdsson
- Department of Neuroanaesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jacobo D Sitt
- Institut du Cerveau - Paris Brain Institute, Inserm, Centre nationl de la recherche scientifique, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Hôpital de La Pitié Salpêtrière, Paris, France
| | - Christine Sølling
- Department of Neuroanaesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Karen Lise Welling
- Department of Neuroanaesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lisette M Willumsen
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - John Hauerberg
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Ejler Fabricius
- Department of Neurophysiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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11
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Bhattacharyay S, Beqiri E, Zuercher P, Wilson L, Steyerberg EW, Nelson DW, Maas AIR, Menon DK, Ercole A. Therapy Intensity Level Scale for Traumatic Brain Injury: Clinimetric Assessment on Neuro-Monitored Patients Across 52 European Intensive Care Units. J Neurotrauma 2024; 41:887-909. [PMID: 37795563 PMCID: PMC11005383 DOI: 10.1089/neu.2023.0377] [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: 10/06/2023] Open
Abstract
Intracranial pressure (ICP) data from traumatic brain injury (TBI) patients in the intensive care unit (ICU) cannot be interpreted appropriately without accounting for the effect of administered therapy intensity level (TIL) on ICP. A 15-point scale was originally proposed in 1987 to quantify the hourly intensity of ICP-targeted treatment. This scale was subsequently modified-through expert consensus-during the development of TBI Common Data Elements to address statistical limitations and improve usability. The latest 38-point scale (hereafter referred to as TIL) permits integrated scoring for a 24-h period and has a five-category, condensed version (TIL(Basic)) based on qualitative assessment. Here, we perform a total- and component-score analysis of TIL and TIL(Basic) to: 1) validate the scales across the wide variation in contemporary ICP management; 2) compare their performance against that of predecessors; and 3) derive guidelines for proper scale use. From the observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study, we extract clinical data from a prospective cohort of ICP-monitored TBI patients (n = 873) from 52 ICUs across 19 countries. We calculate daily TIL and TIL(Basic) scores (TIL24 and TIL(Basic)24, respectively) from each patient's first week of ICU stay. We also calculate summary TIL and TIL(Basic) scores by taking the first-week maximum (TILmax and TIL(Basic)max) and first-week median (TILmedian and TIL(Basic)median) of TIL24 and TIL(Basic)24 scores for each patient. We find that, across all measures of construct and criterion validity, the latest TIL scale performs significantly greater than or similarly to all alternative scales (including TIL(Basic)) and integrates the widest range of modern ICP treatments. TILmedian outperforms both TILmax and summarized ICP values in detecting refractory intracranial hypertension (RICH) during ICU stay. The RICH detection thresholds which maximize the sum of sensitivity and specificity are TILmedian ≥ 7.5 and TILmax ≥ 14. The TIL24 threshold which maximizes the sum of sensitivity and specificity in the detection of surgical ICP control is TIL24 ≥ 9. The median scores of each TIL component therapy over increasing TIL24 reflect a credible staircase approach to treatment intensity escalation, from head positioning to surgical ICP control, as well as considerable variability in the use of cerebrospinal fluid drainage and decompressive craniectomy. Since TIL(Basic)max suffers from a strong statistical ceiling effect and only covers 17% (95% confidence interval [CI]: 16-18%) of the information in TILmax, TIL(Basic) should not be used instead of TIL for rating maximum treatment intensity. TIL(Basic)24 and TIL(Basic)median can be suitable replacements for TIL24 and TILmedian, respectively (with up to 33% [95% CI: 31-35%] information coverage) when full TIL assessment is infeasible. Accordingly, we derive numerical ranges for categorising TIL24 scores into TIL(Basic)24 scores. In conclusion, our results validate TIL across a spectrum of ICP management and monitoring approaches. TIL is a more sensitive surrogate for pathophysiology than ICP and thus can be considered an intermediate outcome after TBI.
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Affiliation(s)
- Shubhayu Bhattacharyay
- Division of Anaesthesia, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Erta Beqiri
- Brain Physics Laboratory, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | - Ewout W. Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - David W. Nelson
- Department of Physiology and Pharmacology, Section for Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - 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
| | - David K. Menon
- Division of Anaesthesia, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Ari Ercole
- Division of Anaesthesia, Division of Neurosurgery, University of Cambridge, Cambridge, United Kingdom
- Cambridge Center for Artificial Intelligence in Medicine, Cambridge, United Kingdom
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12
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Ling Y, Wen X, Tang J, Tao Z, Sun L, Xin H, Luo B. Effect of topographic comparison of electroencephalographic microstates on the diagnosis and prognosis prediction of patients with prolonged disorders of consciousness. CNS Neurosci Ther 2024; 30:e14421. [PMID: 37679900 PMCID: PMC10915977 DOI: 10.1111/cns.14421] [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: 04/11/2023] [Revised: 07/19/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
AIMS The electroencephalography (EEG) microstates are indicative of fundamental information processing mechanisms, which are severely damaged in patients with prolonged disorders of consciousness (pDoC). We aimed to improve the topographic analysis of EEG microstates and explore indicators available for diagnosis and prognosis prediction of patients with pDoC, which were still lacking. METHODS We conducted EEG recordings on 59 patients with pDoC and 32 healthy controls. We refined the microstate method to accurately estimate topographical differences, and then classify and forecast the prognosis of patients with pDoC. An independent dataset was used to validate the conclusion. RESULTS Through optimized topographic analysis, the global explained variance (GEV) of microstate E increased significantly in groups with reduced levels of consciousness. However, its ability to classify the VS/UWS group was poor. In addition, the optimized GEV of microstate E exhibited a statistically significant decrease in the good prognosis group as opposed to the group with a poor prognosis. Furthermore, the optimized GEV of microstate E strongly predicted a patient's prognosis. CONCLUSION This technique harmonizes with the existing microstate analysis and exhibits precise and comprehensive differences in microstate topography between groups. Furthermore, this method has significant potential for evaluating the clinical prognosis of pDoC patients.
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Affiliation(s)
- Yi Ling
- Department of Neurology, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Xinrui Wen
- Department of Neurology, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Jianghui Tang
- Zhejiang Provincial Key Laboratory of Pancreatic DiseaseZhejiang University School of Medicine First Affiliated HospitalHangzhouChina
| | - Zhengde Tao
- Department of NeurologyFirst People's Hospital of WenlingZhejiangChina
| | - Liping Sun
- Department of Neurology, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Hailiang Xin
- Department of RehabilitationHangzhou Mingzhou Brain Rehabilitation HospitalHangzhouChina
| | - Benyan Luo
- Department of Neurology, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
- The MOE Frontier Science Center for Brain Science and Brain‐Machine IntegrationZhejiang UniversityHangzhouChina
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13
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Roberts CJ, Barber J, Temkin NR, Dong A, Robertson CS, Valadka AB, Yue JK, Markowitz AJ, Manley GT, Nelson LD. Clinical Outcomes After Traumatic Brain Injury and Exposure to Extracranial Surgery: A TRACK-TBI Study. JAMA Surg 2024; 159:248-259. [PMID: 38091011 PMCID: PMC10719833 DOI: 10.1001/jamasurg.2023.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/04/2023] [Indexed: 12/17/2023]
Abstract
Importance Traumatic brain injury (TBI) is associated with persistent functional and cognitive deficits, which may be susceptible to secondary insults. The implications of exposure to surgery and anesthesia after TBI warrant investigation, given that surgery has been associated with neurocognitive disorders. Objective To examine whether exposure to extracranial (EC) surgery and anesthesia is related to worse functional and cognitive outcomes after TBI. Design, Setting, and Participants This study was a retrospective, secondary analysis of data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a prospective cohort study that assessed longitudinal outcomes of participants enrolled at 18 level I US trauma centers between February 1, 2014, and August 31, 2018. Participants were 17 years or older, presented within 24 hours of trauma, were admitted to an inpatient unit from the emergency department, had known Glasgow Coma Scale (GCS) and head computed tomography (CT) status, and did not undergo cranial surgery. This analysis was conducted between January 2, 2020, and August 8, 2023. Exposure Participants who underwent EC surgery during the index admission were compared with participants with no surgery in groups with a peripheral orthopedic injury or a TBI and were classified as having uncomplicated mild TBI (GCS score of 13-15 and negative CT results [CT- mTBI]), complicated mild TBI (GCS score of 13-15 and positive CT results [CT+ mTBI]), or moderate to severe TBI (GCS score of 3-12 [m/sTBI]). Main Outcomes and Measures The primary outcomes were functional limitations quantified by the Glasgow Outcome Scale-Extended for all injuries (GOSE-ALL) and brain injury (GOSE-TBI) and neurocognitive outcomes at 2 weeks and 6 months after injury. Results A total of 1835 participants (mean [SD] age, 42.2 [17.8] years; 1279 [70%] male; 299 Black, 1412 White, and 96 other) were analyzed, including 1349 nonsurgical participants and 486 participants undergoing EC surgery. The participants undergoing EC surgery across all TBI severities had significantly worse GOSE-ALL scores at 2 weeks and 6 months compared with their nonsurgical counterparts. At 6 months after injury, m/sTBI and CT+ mTBI participants who underwent EC surgery had significantly worse GOSE-TBI scores (B = -1.11 [95% CI, -1.53 to -0.68] in participants with m/sTBI and -0.39 [95% CI, -0.77 to -0.01] in participants with CT+ mTBI) and performed worse on the Trail Making Test Part B (B = 30.1 [95% CI, 11.9-48.2] in participants with m/sTBI and 26.3 [95% CI, 11.3-41.2] in participants with CT+ mTBI). Conclusions and Relevance This study found that exposure to EC surgery and anesthesia was associated with adverse functional outcomes and impaired executive function after TBI. This unfavorable association warrants further investigation of the potential mechanisms and clinical implications that could inform decisions regarding the timing of surgical interventions in patients after TBI.
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Affiliation(s)
- Christopher J. Roberts
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Athena Dong
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | | | - Alex B. Valadka
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - John K. Yue
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, San Francisco, California
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
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14
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Robba C, Graziano F, Picetti E, Åkerlund C, Addis A, Pastore G, Sivero M, Rebora P, Galimberti S, Stocchetti N, Maas A, Menon DK, Citerio G. Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes-an analysis of CENTER-TBI data. Intensive Care Med 2024; 50:371-384. [PMID: 38376517 PMCID: PMC10955000 DOI: 10.1007/s00134-024-07324-8] [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: 10/14/2023] [Accepted: 01/13/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE We analysed the impact of early systemic insults (hypoxemia and hypotension, SIs) on brain injury biomarker profiles, acute care requirements during intensive care unit (ICU) stay, and 6-month outcomes in patients with traumatic brain injury (TBI). METHODS From patients recruited to the Collaborative European neurotrauma effectiveness research in TBI (CENTER-TBI) study, we documented the prevalence and risk factors for SIs and analysed their effect on the levels of brain injury biomarkers [S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and protein Tau], critical care needs, and 6-month outcomes [Glasgow Outcome Scale Extended (GOSE)]. RESULTS Among 1695 TBI patients, 24.5% had SIs: 16.1% had hypoxemia, 15.2% had hypotension, and 6.8% had both. Biomarkers differed by SI category, with higher S100B, Tau, UCH-L1, NSE and NfL values in patients with hypotension or both SIs. The ratio of neural to glial injury (quantified as UCH-L1/GFAP and Tau/GFAP ratios) was higher in patients with hypotension than in those with no SIs or hypoxia alone. At 6 months, 380 patients died (22%), and 759 (45%) had GOSE ≤ 4. Patients who experienced at least one SI had higher mortality than those who did not (31.8% vs. 19%, p < 0.001). CONCLUSION Though less frequent than previously described, SIs in TBI patients are associated with higher release of neuronal than glial injury biomarkers and with increased requirements for ICU therapies aimed at reducing intracranial hypertension. Hypotension or combined SIs are significantly associated with adverse 6-month outcomes. Current criteria for hypotension may lead to higher biomarker levels and more negative outcomes than those for hypoxemia suggesting a need to revisit pressure targets in the prehospital settings.
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Affiliation(s)
- Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Francesca Graziano
- Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Cecilia Åkerlund
- Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Alberto Addis
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- NeuroIntensive Care Unit, Neuroscience Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Giuseppe Pastore
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Mattia Sivero
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paola Rebora
- Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Stefania Galimberti
- Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Nino Stocchetti
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplant, Milan University, Milan, Italy
| | - Andrew Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
| | - David K Menon
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- NeuroIntensive Care Unit, Neuroscience Department, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy.
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15
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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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Siy HFC, Gimenez MLA. Amantadine for functional improvement in patients with traumatic brain injury: A systematic review with meta-analysis and trial sequential analysis. BRAIN & SPINE 2024; 4:102773. [PMID: 38465280 PMCID: PMC10924175 DOI: 10.1016/j.bas.2024.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
Introduction TBIs contribute in over one-third of injury-related deaths with mortality rates as high as 50% in trauma centers serving the most severe TBI. The effect of TBI on mortality is about 10% across all ages. Amantadine hydrochloride is one of the most commonly prescribed medications for patients undergoing inpatient neurorehabilitation who have disorders of consciousness.6 It is a dopamine (DA) receptor agonist and a N-Methyl-D-aspartate (NMDA) receptor antagonist via dopamine release and dopamine reuptake inhibition. The current study will synthesize the current available evidence and show the effect of Amantadine in functional improvement after TBI. Research question Does Amantadine have an effect on functional improvement of TBI patients? Material and methods This systematic review included all randomized placebo-controlled trials that compare the use of Amantadine versus placebo for functional improvement of patients after TBI. Outcome measures included DRS, GCS and/or GOS scores. Results Three studies with a total of 281 patients were included in the quantitative analyses. GRADE assessments show that there was a high certainty of evidence for functional improvement in terms of DRS scores. Discussion and conclusion Evidence of this review show that the use of Amantadine may have a beneficial effect on functional outcome in moderate to severe traumatic brain injuries among adult patients. Given the still-limited body of knowledge, more relevant studies must be made exploring the impact of Amantadine therapies on promoting functional recovery within the brain injury rehabilitation care continuum, with the goals of achieving larger sample sizes and establishing the early- or later-treatment beneficial effects.
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Riparbelli AC, Capion T, Møller K, Mathiesen TI, Olsen MH, Forsse A. Critical ICP thresholds in relation to outcome: Is 22 mmHg really the answer? Acta Neurochir (Wien) 2024; 166:63. [PMID: 38315234 PMCID: PMC10844356 DOI: 10.1007/s00701-024-05929-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: 10/18/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Intensive care for patients with traumatic brain injury (TBI) aims, among other tasks, at avoiding high intracranial pressure (ICP), which is perceived to worsen motor and cognitive deficits and increase mortality. International recommendations for threshold values for ICP were increased from 20 to 22 mmHg in 2016 following the findings in a study by Sorrentino et al., which were based on an observational study of patients with TBI of averaged ICP values. We aimed to reproduce their approach and validate the findings in a separate cohort. METHODS Three hundred thirty-one patients with TBI were included and categorised according to survival/death and favourable/unfavourable outcome at 6 months (based on Glasgow Outcome Score-Extended of 6-8 and 1-5, respectively). Repeated chi-square tests of survival and death (or favourable and unfavourable outcome) vs. high and low ICP were conducted with discrimination between high and low ICP sets at increasing values (integers) between 10 and 35 mmHg, using the average ICP for the entire monitoring period. The ICP limit returning the highest chi-square score was assumed to be the threshold with best discriminative ability. This approach was repeated after stratification by sex, age, and initial Glasgow Coma Score (GCS). RESULTS An ICP limit of 18 mmHg was found for both mortality and unfavourable outcome for the entire cohort. The female and the low GCS subgroups both had threshold values of 18 mmHg; for all other subgroups, the threshold varied between 16 and 30 mmHg. According to a multiple logistic regression analysis, age, initial GCS, and average ICP are independently associated with mortality and outcome. CONCLUSIONS Using identical methods and closely comparable cohorts, the critical thresholds for ICP found in the study by Sorrentino et al. could not be reproduced.
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Affiliation(s)
- Agnes C Riparbelli
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Tenna Capion
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Neuroanesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences SUND, University of Copenhagen, Copenhagen, Denmark
| | - Tiit I Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences SUND, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Markus H Olsen
- Department of Neuroanesthesiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Axel Forsse
- Department of Neurosurgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Fujiwara G, Okada Y, Shiomi N, Sakakibara T, Yamaki T, Hashimoto N. Derivation of Coagulation Phenotypes and the Association with Prognosis in Traumatic Brain Injury: A Cluster Analysis of Nationwide Multicenter Study. Neurocrit Care 2024; 40:292-302. [PMID: 36977962 DOI: 10.1007/s12028-023-01712-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The pathogenesis and pathophysiology of traumatic coagulopathy during traumatic brain injury is not well understood, and the appropriate treatment strategy for this condition has not been established. This study aimed to evaluate the coagulation phenotypes and their effect on prognosis in patients with isolated traumatic brain injury. METHODS In this multicenter cohort study, we retrospectively analyzed data from the Japan Neurotrauma Data Bank. Adults with isolated traumatic brain injury (head abbreviated injury scale > 2; abbreviated injury scale of any other trauma < 3) who were registered in the Japan Neurotrauma Data Bank were included in this study. The primary outcome was the association of coagulation phenotypes with in-hospital mortality. Coagulation phenotypes were derived using k-means clustering with coagulation markers, including prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (FBG), and D-dimer (DD) on arrival at the hospital. Multivariable logistic regression analyses were conducted to calculate the adjusted odds ratios of coagulation phenotypes with their 95% confidence intervals (CIs) for in-hospital mortality. RESULTS In total, 556 patients were enrolled and five coagulation phenotypes were identified. The median (interquartile range) score for the Glasgow Coma Scale was 6 (4-9). Cluster A (n = 129) had the closest to normal coagulation values; cluster B (n = 323) had a mild high DD phenotype; cluster C (n = 30) had a prolonged PT-INR phenotype with a higher frequency of antithrombotic medication in elderly patients than in younger patients; cluster D (n = 45) had a low amount of FBG, high DD, and prolonged APTT phenotype with a high incidence of skull fracture; and cluster E (n = 29) had a low amount of FBG and extremely high DD phenotype with high energy trauma and a high incidence of skull fracture. In the multivariable logistic regression analysis, the association of clusters B, C, D, and E with in-hospital mortality yielded the corresponding adjusted odds ratios of 2.17 (95% CI 1.22-3.86), 2.61 (95% CI 1.01-6.72), 10.0 (95% CI 4.00-25.2), and 24.1 (95% CI 7.12-81.3), respectively, relative to cluster A. CONCLUSIONS This multicenter, observational study identified five different coagulation phenotypes of traumatic brain injury and showed associations of these phenotypes with in-hospital mortality.
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Affiliation(s)
- Gaku Fujiwara
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc, 2-4-1, Ohashi, Ritto, Shiga, Japan.
| | - Yohei Okada
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan
| | - Naoto Shiomi
- Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Ritto, Shiga, Japan
| | | | - Tarumi Yamaki
- Department of Neurosurgery, Kyoto Kujo Hospital, Kyoto, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Yin AA, He YL, Zhang X, Fei Z, Lin W, Song BQ. Machine learning models for predicting in-hospital outcomes after non-surgical treatment among patients with moderate-to-severe traumatic brain injury. J Clin Neurosci 2024; 120:36-41. [PMID: 38181552 DOI: 10.1016/j.jocn.2023.11.015] [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: 11/07/2023] [Indexed: 01/07/2024]
Abstract
AIM This study aims to develop prediction models for in-hospital outcomes after non-surgical treatment among patients with moderate-to-severe traumatic brain injury (TBI). METHOD We conducted a retrospective review of patients hospitalized for moderate-to-severe TBI in our department from 2011 to 2020. Five machine learning (ML) algorithms and the conventional logistic regression (LR) model were employed to predict in-hospital mortality and the Glasgow Outcome Scale (GOS) functional outcomes. These models utilized clinical and routine blood data collected upon admission. RESULTS This study included a total of 196 patients who received only non-surgical treatment after moderate-to-severe TBI. When predicting mortality, ML models achieved area under the curve (AUC) values of 0.921 to 0.994 using clinical and routine blood data, and 0.877 to 0.982 using only clinical data. In comparison, LR models yielded AUCs of 0.762 and 0.730 respectively. When predicting the GOS outcome, ML models achieved AUCs of 0.870 to 0.915 using clinical and routine blood data, and 0.858 to 0.927 using only clinical data. In comparison, the LR model yielded AUCs of 0.798 and 0.787 respectively. Repeated internal validation showed that the contributions of routine blood data for prediction models may depend on different prediction algorithms and different outcome measurements. CONCLUSION The study reported ML-based prediction models that provided rapid and accurate predictions on short-term outcomes after non-surgical treatment among patients with moderate-to-severe TBI. The study also highlighted the superiority of ML models over conventional LR models and proposed the complex contributions of routine blood data in such predictions.
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Affiliation(s)
- An-An Yin
- Department of Plastic and Reconstructive Surgery, Craniomaxillofacial Surgery Group, Xijing Hospital, Fourth Military Medical University, Xi'an, China; Shaanxi Provincial Key Laboratory of Clinic Genetics, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ya-Long He
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xi Zhang
- Department of Plastic and Reconstructive Surgery, Craniomaxillofacial Surgery Group, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhou Fei
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Lin
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Bao-Qiang Song
- Department of Plastic and Reconstructive Surgery, Craniomaxillofacial Surgery Group, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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Landré S, Ader F, Epaulard O, Tattevin P, Stahl JP, Mailles A. Encephalitis in HIV-negative immunodeficient patients: a prospective multicentre study, France, 2016 to 2019. Euro Surveill 2024; 29:2300046. [PMID: 38333938 PMCID: PMC10853978 DOI: 10.2807/1560-7917.es.2024.29.6.2300046] [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: 01/13/2023] [Accepted: 06/01/2023] [Indexed: 02/10/2024] Open
Abstract
BackgroundData on infectious encephalitis in immunodeficient (ID) individuals are scarce. This population may present with atypical clinical symptoms, be infected by uncommon pathogens and develop poor outcomes.AimWe aimed to describe the epidemiology of infectious encephalitis among HIV-negative ID patients.MethodsPatients from the ENCEIF (Etude Nationale de Cohorte des Encéphalites Infectieuses en France) prospective cohort meeting criteria for infectious encephalitis between January 2016 and December 2019 were included. We compared clinical presentation, magnetic resonance imaging (MRI) results, biological results, infection causes and outcome of ID patients with immunocompetent (IC) patients using Pearson's chi-squared test and Student's t-test. We carried out logistic regression to assess the role of immunodeficiency as risk factor for poor outcome.ResultsID patients (n = 58) were older (mean 72 vs 59 years), had higher prevalence of diabetes (26% vs 12%), pre-existing neurological disorders (12% vs 5%) and higher case-fatality rate (23.6% vs 5.6%) compared to IC patients (n = 436). Varicella zoster virus was the primary cause of encephalitis in ID patients (this aetiology was more frequent in ID (25.9%) than in IC patients (11.5%)), with herpes simplex virus second (22.4% in ID patients vs 27.3% in IC patients). Immunodeficiency was an independent risk factor for death or major sequelae (odds ratio: 3.41, 95%CI: 1.70-6.85).ConclusionsVaricella zoster virus is the most frequent cause of infectious encephalitis in ID patients. Immunodeficiency is a major risk factor for poor outcome. ID encephalitis patients should benefit from stringent investigation of cause and early empiric treatment.
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Affiliation(s)
- Sophie Landré
- University Claude Bernard Lyon 1, Hospices Civils de Lyon, Infectious disease department, Lyon, France
| | - Florence Ader
- University Claude Bernard Lyon 1, Hospices Civils de Lyon, Infectious disease department, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, France
| | - Olivier Epaulard
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- University Grenoble Alpes, Infectious diseases department, Grenoble, France
| | - Pierre Tattevin
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- Infectious diseases department, CHU Pontchaillou, Rennes, France
| | - Jean Paul Stahl
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- University Grenoble Alpes, Infectious diseases department, Grenoble, France
| | - Alexandra Mailles
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- Santé Publique France, Saint-Maurice, France
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Tinti L, Lawson T, Molteni E, Kondziella D, Rass V, Sharshar T, Bodien YG, Giacino JT, Mayer SA, Amiri M, Muehlschlegel S, Venkatasubba Rao CP, Vespa PM, Menon DK, Citerio G, Helbok R, McNett M. Research considerations for prospective studies of patients with coma and disorders of consciousness. Brain Commun 2024; 6:fcae022. [PMID: 38344653 PMCID: PMC10853976 DOI: 10.1093/braincomms/fcae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to disorders of consciousness. Despite advances in these disease-related forms, there remains uncertainty about whether disorders of consciousness are a disease-agnostic unitary entity with a common mechanism, prognosis or treatment response paradigm. Our knowledge of disorders of consciousness has also been hampered by heterogeneity of study designs, variables, and outcomes, leading to results that are not comparable for evidence synthesis. The different backgrounds of professionals caring for patients with disorders of consciousness and the different goals at different stages of care could partly explain this variability. The Prospective Studies working group of the Neurocritical Care Society Curing Coma Campaign was established to create a platform for observational studies and future clinical trials on disorders of consciousness and coma across the continuum of care. In this narrative review, the author panel presents limitations of prior observational clinical research and outlines practical considerations for future investigations. A narrative review format was selected to ensure that the full breadth of study design considerations could be addressed and to facilitate a future consensus-based statement (e.g. via a modified Delphi) and series of recommendations. The panel convened weekly online meetings from October 2021 to December 2022. Research considerations addressed the nosographic status of disorders of consciousness, case ascertainment and verification, selection of dependent variables, choice of covariates and measurement and analysis of outcomes and covariates, aiming to promote more homogeneous designs and practices in future observational studies. The goal of this review is to inform a broad community of professionals with different backgrounds and clinical interests to address the methodological challenges imposed by the transition of care from acute to chronic stages and to streamline data gathering for patients with disorders of consciousness. A coordinated effort will be a key to allow reliable observational data synthesis and epidemiological estimates and ultimately inform condition-modifying clinical trials.
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Affiliation(s)
- Lorenzo Tinti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy
| | - Thomas Lawson
- Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Erika Molteni
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EU, UK
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Verena Rass
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck 6020, Austria
| | - Tarek Sharshar
- Neuro-Intensive Care Medicine, Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris 75006, France
| | - Yelena G Bodien
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Stephan A Mayer
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY 10595, USA
| | - Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen 2100, Denmark
| | - Susanne Muehlschlegel
- Department of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke’s Medical Center, Houston, TX 77030, USA
| | - Paul M Vespa
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge CB2 1TN, UK
| | - Giuseppe Citerio
- NeuroIntensive Care, IRCSS Fondazione San Gerardo dei Tintori, Monza 20900, Italy
- School of Medicine and Surgery, Università Milano Bicocca, Milan 20854, Italy
| | - Raimund Helbok
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck 6020, Austria
- Department of Neurology, Johannes Kepler University, Linz 4040, Austria
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH 43210, USA
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Jarosz K, Kojder K, Skonieczna-Żydecka K, Andrzejewska A, Sołek-Pastuszka J, Jurczak A. The Effects of Neuromonitoring and Cerebrolysin Administration on Outcomes in Patients with Traumatic Brain Injury-An Interventional Pilot Study. J Clin Med 2024; 13:353. [PMID: 38256487 PMCID: PMC10816546 DOI: 10.3390/jcm13020353] [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: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is one of the most common causes of death and an important burden to the worldwide healthcare system and society. There is a lack of guidelines for types of monitoring or neuroprotective therapy. The aim of this pilot study was to assess its feasibility and, furthermore, to evaluate the impact of Cerebrolysin on the following clinical outcomes: length of stay, Glasgow Outcome Scale (GOS) and mortality. METHODS A cohort of 56 patients was included in this non-randomised, real-time, pre-post-interventional study. The patients were assessed with the Glasgow Coma Scale (GCS) and divided into two groups: severe (GCS < 8) and non-severe (GCS > 8). After the radiological examination (CT scan), the patients were qualified for an immediate neurosurgical procedure if needed. The patients were admitted to the intensive care unit, where a standardised protocol for TBI treatment was implemented. Additional neuromonitoring was applied. RESULTS There were 56 patients (19 females; 33.9%), of which 41 were considered severe cases; the patients were allocated to the Cerebrolysin (n = 25) or control groups (n = 31). In a generalised linear model (GLM) approach, the use of Cerebrolysin was associated with a decrease in the probability of death in non-severe patients (by 0.333 (standard error (SE) = 0.157, p = 0.034)) but not in severe patients (estimate (Est.) = -0.115, SE = 0.127, p = 0.364). Patients who received Cerebrolysin and who were neuromonitored had favourable outcomes and better survival rates. CONCLUSIONS A multimodal treatment approach with monitoring and Cerebrolysin may have a beneficial effect on patients with less severe TBIs; however, the present study has multiple limitations, and further research is needed.
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Affiliation(s)
- Konrad Jarosz
- Anesthesiology and Intensive Care, University Hospital no. 1 Unii Lubelskiej, 71-252 Szczecin, Poland; (K.J.); (K.K.); (J.S.-P.)
| | - Klaudyna Kojder
- Anesthesiology and Intensive Care, University Hospital no. 1 Unii Lubelskiej, 71-252 Szczecin, Poland; (K.J.); (K.K.); (J.S.-P.)
| | | | - Agata Andrzejewska
- Anesthesiology and Intensive Care, University Hospital no. 1 Unii Lubelskiej, 71-252 Szczecin, Poland; (K.J.); (K.K.); (J.S.-P.)
| | - Joanna Sołek-Pastuszka
- Anesthesiology and Intensive Care, University Hospital no. 1 Unii Lubelskiej, 71-252 Szczecin, Poland; (K.J.); (K.K.); (J.S.-P.)
| | - Anna Jurczak
- Department of Specialist Nursery, Pomeranian Medical University, Zolnierska 48, 71-210 Szczecin, Poland;
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Gu T, Pan J, Chen L, Li K, Wang L, Zou Z, Shi Q. Association of inflammatory cytokines expression in cerebrospinal fluid with the severity and prognosis of spontaneous intracerebral hemorrhage. BMC Neurol 2024; 24:7. [PMID: 38167007 PMCID: PMC10759732 DOI: 10.1186/s12883-023-03487-x] [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: 09/07/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To investigate the potential diagnostic and prognostic implications of inflammatory cytokine levels in the cerebrospinal fluid (CSF) of patients with spontaneous intracerebral hemorrhage (SICH) upon their initial hospital admission. METHODS Our cohort included 100 patients diagnosed with acute SICH, presenting to the Department of Neurosurgery. Additionally, we recruited 50 individuals without central nervous system (CNS) pathology, treated concurrently at our facility, as controls. CSF samples, collected upon hospital entry, were quantitatively assessed for 10 inflammatory cytokines using the Mesoscale Discovery Platform (MSD, Rockville, MD, USA) electrochemiluminescence technology, followed by validation through enzyme-linked immunosorbent assay (ELISA). RESULTS We observed a marked elevation of IL-6, IL-8, IL-10, and TNF-α in the CSF of the SICH subgroup compared to controls. Higher Glasgow Coma Scale (GCS) scores in SICH patients corresponded with lower CSF concentrations of IL-6, IL-8, IL-10, and TNF-α, indicating an inverse relationship. Notably, CSF inflammatory cytokine levels were consistently higher in SICH patients with hydrocephalus than in those without. Increases in IL-6, IL-8, IL-10, and TNF-α in the CSF were notably more pronounced in the poor prognosis group (Glasgow Outcome Scale, GOS 1-3) compared to those with a favorable prognosis (GOS 4-5). The AUC values for these cytokines in predicting SICH prognosis were 0.750, 0.728, 0.717, and 0.743, respectively. CONCLUSIONS Initial CSF levels of IL-6, IL-8, IL-10, and TNF-α upon admission provide significant insights into the severity of neural damage and are robust indicators for prognosis in SICH patients.
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Affiliation(s)
- Tianyan Gu
- Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
| | - Jingyu Pan
- Medical College of Shihezi University, Shihezi, Xinjiang, 832000, China
| | - Ling Chen
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China
| | - Kai Li
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China
| | - Li Wang
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China
| | - Zhihao Zou
- Department of Neurosurgery, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China.
| | - Qinghai Shi
- Clinical Laboratory Diagnostic Center, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, 830000, China.
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Yan J, Zha F, Zhou J, Zhou J, Zhao J, Zhang Q, Long J, Hou D, Song Z, Wang Y. Combining HD-tDCS with music stimulation for patients with prolonged disorders of consciousness: Study protocol for an RCT trial. NeuroRehabilitation 2024; 54:495-504. [PMID: 38457160 PMCID: PMC11091638 DOI: 10.3233/nre-230282] [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: 11/06/2023] [Accepted: 01/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Patients with prolonged disorders of consciousness (pDOC) pose significant challenges to healthcare workers due to their severe motor impairments and limited interaction with the environment. Non-invasive brain stimulation such as high-definition transcranial direct current stimulation (HD-tDCS) and music stimulation show promise in awakening this population. OBJECTIVE In this study, we present a protocol aiming at investigating the efficacy of combined HD-tDCS and music stimulation in awakening patients with pDOC through a single-blind, randomized controlled trial. METHODS Ninety patients with pDOC will be randomly divided into three groups: active HD-tDCS with music stimulation, active HD-tDCS, and sham HD-tDCS. All participants will receive 20 treatment sessions over a period of 10 days and the Coma Recovery Scale-Revised, Glasgow Outcome Scale and electroencephalogram will be used as assessment measures to evaluate their level of consciousness throughout the study. Adverse events and complications will be recorded during treatment. Within-group pre-post comparisons and between-group efficacy comparisons will be conducted to identify the most effective intervention approach. Statistical analysis will be performed using SPSS software with a significance level set at P < 0.05. CONCLUSION The pursuit of awakening therapy for patients with pDOC remains a clinical research challenge. This study protocol is designed with the aim of introducing an innovative non-pharmacological approach which combined HD-tDCS and music stimulation to facilitate the reinstatement of consciousness in patients with pDOC.
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Affiliation(s)
- Jie Yan
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fubing Zha
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Juan Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Jing Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Jingpu Zhao
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Qingfang Zhang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jianjun Long
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Dianrui Hou
- Department of Rehabilitation, Nan’ao People’s Hospital of Shenzhen, Dapeng New District, Shenzhen, China
| | - Zhenhua Song
- Department of Rehabilitation Medicine, Haikou Hospital Affiliated to Xiangya Medical College of Central South University, Haikou, China
| | - Yulong Wang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
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Nagy L, Morgan RD, Collins RA, Kharbat AF, Garza J, Belirgen M. Impact of timing of decompressive craniectomy on outcomes in pediatric traumatic brain injury. Surg Neurol Int 2023; 14:436. [PMID: 38213457 PMCID: PMC10783660 DOI: 10.25259/sni_472_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: 06/04/2023] [Accepted: 11/16/2023] [Indexed: 01/13/2024] Open
Abstract
Background Decompressive craniectomy (DC) can be utilized in the management of severe traumatic brain injury (TBI). It remains unclear if timing of DC affects pediatric patient outcomes. Further, the literature is limited in the risk assessment and prevention of complications that can occur post DC. Methods This is a retrospective review over a 10-year period across two medical centers of patients ages 1 month-18 years who underwent DC for TBI. Patients were stratified as acute (<24 h) and subacute (>24 h) based on timing to DC. Primary outcomes were Glasgow outcome scale (GOS) at discharge and 6-month follow-up as well as complication rates. Results A total of 47 patients fit the inclusion criteria: 26 (55.3%) were male with a mean age of 7.87 ± 5.87 years. Overall, mortality was 31.9% (n = 15). When evaluating timing to DC, 36 (76.6%) patients were acute, and 11 (23.4%) were subacute. Acute DC patients presented with a lower Glasgow coma scale (5.02 ± 2.97) compared to subacute (8.45 ± 4.91) (P = 0.030). Timing of DC was not associated with GOS at discharge (P = 0.938), 3-month follow-up (P = 0.225), 6-month follow-up (P = 0.074), or complication rate (P = 0.505). The rate of posttraumatic hydrocephalus following DC for both groups was 6.4% (n = 3). Conclusion Although patients selected for the early DC had more severe injuries at presentation, there was no difference in outcomes. The optimal timing of DC requires a multifactorial approach considered on a case-by-case basis.
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Affiliation(s)
- Laszlo Nagy
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Ryan D. Morgan
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Reagan A. Collins
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Abdurrahman F. Kharbat
- Department of Neurosurgery, University of Oklahoma, Oklahoma City, Oklahoma, United States
| | - John Garza
- Department of Mathematics, University of Texas Permian Basin, Odessa, Texas, United States
| | - Muhittin Belirgen
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
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Chekrouni N, Kroon M, Drost EHGM, van Soest TM, Bijlsma MW, Brouwer MC, van de Beek D. Characteristics and prognostic factors of bacterial meningitis in the intensive care unit: a prospective nationwide cohort study. Ann Intensive Care 2023; 13:124. [PMID: 38055180 DOI: 10.1186/s13613-023-01218-6] [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: 09/29/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients with bacterial meningitis can be severely ill necessitating intensive care unit (ICU) treatment. Here, we describe clinical features and prognostic factors of adults with bacterial meningitis admitted to the ICU in a nationwide prospective cohort study. METHODS We prospectively assessed clinical features and outcome of adults (age > 16 years) with community-acquired bacterial meningitis included in the MeninGene study between March 1, 2006 and July 1, 2022, that were initially admitted to the ICU. We identified independent predictors for initial ICU admission and for unfavourable outcome (Glasgow Outcome Scale score between 1-4) by multivariable logistic regression. RESULTS A total of 2709 episodes of bacterial meningitis were included, of which 1369 (51%) were initially admitted to the ICU. We observed a decrease in proportion of patients being admitted to the ICU during the Covid-19 pandemic in 2020 (decreased to 39%, p = 0.004). Median age of the 1369 patients initially admitted to the ICU was 61 years (IQR 49-69), and the rates of unfavourable outcome (47%) and mortality (22%) were high. During the Covid-19 pandemic, we observed a trend towards an increase in unfavourable outcome. Prognostic factors predictive for initial ICU admission were younger age, immunocompromised state, male sex, factors associated with pneumococcal meningitis, and those indicative of systemic compromise. Independent predictors for unfavourable outcome in the initial ICU cohort were advanced age, admittance to an academic hospital, cranial nerve palsies or seizures on admission, low leukocyte count in blood, high C-reactive protein in blood, low CSF: blood glucose ratio, listerial meningitis, need for mechanical ventilation, circulatory shock and persistent fever. 204 of 1340 episodes (15%) that were initially not admitted to the ICU were secondarily transferred to the ICU. The rates of unfavourable outcome (66%) and mortality (30%) in this group were high. CONCLUSIONS The majority of patients with community-acquired bacterial meningitis are admitted to the ICU, and the unfavourable outcome and mortality rates of these patients remain high. Patients that are initially admitted to non-ICU wards but secondarily transferred to the ICU also had very high rates of unfavourable outcome.
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Affiliation(s)
- Nora Chekrouni
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Merel Kroon
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Evelien H G M Drost
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Thijs M van Soest
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Merijn W Bijlsma
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Amsterdam UMC, Department of Neurology, University of Amsterdam, Amsterdam Neuroscience, Meibergdreef, PO Box 22660, 1100DD, Amsterdam, The Netherlands.
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Snider SB, Temkin NR, Barber J, Edlow BL, Giacino JT, Hammond FM, Izzy S, Kowalski RG, Markowitz AJ, Rovito CA, Shih SL, Zafonte RD, Manley GT, Bodien YG. Predicting Functional Dependency in Patients with Disorders of Consciousness: A TBI-Model Systems and TRACK-TBI Study. Ann Neurol 2023; 94:1008-1023. [PMID: 37470289 PMCID: PMC10799195 DOI: 10.1002/ana.26741] [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: 03/28/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE It is not currently possible to predict long-term functional dependency in patients with disorders of consciousness (DoC) after traumatic brain injury (TBI). Our objective was to fit and externally validate a prediction model for 1-year dependency in patients with DoC ≥ 2 weeks after TBI. METHODS We included adults with TBI enrolled in TBI Model Systems (TBI-MS) or Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) studies who were not following commands at rehabilitation admission or 2 weeks post-injury, respectively. We fit a logistic regression model in TBI-MS and validated it in TRACK-TBI. The primary outcome was death or dependency at 1 year post-injury, defined using the Disability Rating Scale. RESULTS In the TBI-MS Discovery Sample, 1,960 participants (mean age 40 [18] years, 76% male, 68% white) met inclusion criteria, and 406 (27%) were dependent 1 year post-injury. In a TBI-MS held out cohort, the dependency prediction model's area under the receiver operating characteristic curve was 0.79 (95% CI 0.74-0.85), positive predictive value was 53% and negative predictive value was 86%. In the TRACK-TBI external validation (n = 124, age 40 [16] years, 77% male, 81% white), the area under the receiver operating characteristic curve was 0.66 (0.53, 0.79), equivalent to the standard IMPACTcore + CT score (p = 0.8). INTERPRETATION We developed a 1-year dependency prediction model using the largest existing cohort of patients with DoC after TBI. The sensitivity and negative predictive values were greater than specificity and positive predictive values. Accuracy was diminished in an external sample, but equivalent to the IMPACT model. Further research is needed to improve dependency prediction in patients with DoC after TBI. ANN NEUROL 2023;94:1008-1023.
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Affiliation(s)
- Samuel B. Snider
- Division of Neurocritical Care, Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Brian L. Edlow
- Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery and Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Joseph T. Giacino
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA USA
| | - Flora M. Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Saef Izzy
- Division of Neurocritical Care, Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Robert G. Kowalski
- Departments of Neurosurgery and Neurology, University of Colorado School of Medicine, Aurora CO, USA
| | | | - Craig A. Rovito
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA USA
| | - Shirley L. Shih
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA USA
| | - Ross D. Zafonte
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA USA
| | - Geoffrey T. Manley
- Department of Neurological Surgery, UCSF, San Francisco, CA USA
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA
| | - Yelena G. Bodien
- Harvard Medical School, Boston, MA, USA
- Center for Neurotechnology and Neurorecovery and Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA USA
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Dresch Vascouto H, Melo HM, de Oliveira Thais MER, Schwarzbold ML, Lin K, Pizzol FD, Kupek E, Walz R. Cognitive Performance of Brazilian Patients With Favorable Outcomes After Severe Traumatic Brain Injury: A Prospective Study. Am J Phys Med Rehabil 2023; 102:1070-1075. [PMID: 37204939 DOI: 10.1097/phm.0000000000002279] [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: 05/21/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the cognitive performance of patients with favorable outcomes, determined by the Glasgow Outcome Scale, 1 yr after hospital discharge due to severe traumatic brain injury. DESIGN This was a prospective case-control study. From 163 consecutive adult patients with severe traumatic brain injury included in the study, 73 patients had a favorable outcome (Glasgow Outcome Scale score of 4 or 5) 1 yr after hospital discharge and were eligible for the cognitive evaluation, of which 28 completed the evaluations. The latter were compared with 44 healthy controls. RESULTS The average loss of cognitive performance among participants with traumatic brain injury varied between 13.35% and 43.49% compared with the control group. Between 21.4% and 32% of the patients performed below the 10th percentile on three language tests and two verbal memory tests, whereas 39% to 50% performed below this threshold on one language test and three memory tests. Longer hospital stay, older age, and lower education were the most important predictors of worse cognitive performance. CONCLUSION One year after a severe traumatic brain injury, a significant proportion of Brazilian patients with the favorable outcome determined by Glasgow Outcome Scale still showed significant cognitive impairment in verbal memory and language domains.
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Affiliation(s)
- Helena Dresch Vascouto
- From the Center for Applied Neuroscience (CeNAp), Department of Clinical Medicine, University Hospital-UFSC (HU-UFSC) (HDV, HMM, MLS, KL, RW), Graduate Program in Neuroscience (HDV, HMM, MERdOT, RW), Graduate Program in Medical Sciences (MERdOT, MLS, KL, RW), Psychiatry Unit, Department of Internal Medicine, University Hospital (HU) (MLS), Neurology Unit, Department of Internal Medicine, University Hospital-UFSC (HU-UFSC) (KL, RW), and Department of Public Health (EK), Federal University of Santa Catarina (UFSC), Florianópolis/SC; and Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, Health Sciences Unit, University of South Santa Catarina, Santa Catarina, Brazil (FDP)
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Qiu W, Li W, Xu K, Zhu G, Luo H, Deng Y, Qin Z, Zeng K, Wei Y, Lin X. Prognostic significance of fibrinogen and neutrophil/lymphocyte ratio score and D-dimer/Albumin ratio for prognosis in patients with aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2023; 32:107338. [PMID: 37690163 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107338] [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: 04/10/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Recent research indicates that systemic inflammation significantly affects the overall prognosis of individuals with aneurysmal subarachnoid hemorrhage. To delve deeper into this issue, a retrospective study was undertaken. The study aimed to investigate the relationship between fibrinogen and neutrophil/lymphocyte ratio scores, D-dimer/Albumin ratios, and the Glasgow Outcome Scale at 6 months post-discharge for patients with aSAH. METHODS A retrospective analysis was conducted on 321 patients who experienced aneurysmal subarachnoid hemorrhage. These patients were monitored using the Glasgow Outcome Scale six months after being discharged from Huizhou Central People's Hospital. Patients with GOS scores between 1 and 3 were classified as having a poor prognosis, while those with scores ranging from 4 to 5 were considered to have a good prognosis. To create distinct sets, patients were randomly divided into both training and validation groups. The best cut-off value for the D-dimer/Albumin ratio was established through ROC curves, and the scores for fibrinogen and the neutrophil/lymphocyte ratio were calculated. Utilizing multivariate logistic regression analysis, independent risk factors linked to an unfavorable prognosis in aSAH patients were identified. A nomogram model was developed and validated based on these findings, providing an improved approach for evaluating the prognostic influence of risk factors. To gauge the model's predictive performance, several analytical tools such as ROC curves, calibration curves, and decision curve analysis were employed. This comprehensive approach ensured a thorough assessment of the prognostic prediction capabilities of the model. RESULTS Multivariate regression analysis revealed that Age (OR=3.87, 95%CI=1.54-9.73, p=0.004), Pneumonia (OR=3.54, 95%CI=1.41-8.86, p=0.007), WFNS (OR=3.24, 95%CI=1.23-8.54, p=0.017), DAR (OR=2.88, 95%CI=1.13-7.34, p=0.027), and F-NLR (OR=3.12, 95%CI=1.22-7.97, p=0.017) were identified as independent risk factors influencing the prognosis of patients with aSAH. Additionally, the area under the ROC curve was 0.866 (95%CI=0.805-0.927) for the training set and 0.924 (95%CI=0.849-0.999) for the validation set. The calibration curve analysis demonstrated a minor error of 0.02 for the training set and 0.051 for the validation set. Furthermore, both the training set and validation set displayed significant clinical benefits according to the DCA curves, underscoring the meaningful utility of the developed nomogram. CONCLUSIONS Fibrinogen and neutrophil/lymphocyte ratio scores, and the D-dimer/Albumin ratio emerged as significant independent risk factors for prognosticating the outcomes of patients with aSAH. Leveraging these factors, a robust nomogram model was meticulously developed, showcasing its impressive precision in prognostic predictions. These results underscore the promising clinical applicability of these biomarkers as effective prognostic indicators for individuals afflicted by aSAH.
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Affiliation(s)
- Wenjie Qiu
- Guangdong Medical University, Zhanjiang, China
| | - Wencai Li
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Ke Xu
- Guangdong Medical University, Zhanjiang, China
| | - Gang Zhu
- Guangdong Medical University, Zhanjiang, China; Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China.
| | - Honghai Luo
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Yifan Deng
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
| | - Zhongzong Qin
- Department of Neurosurgery, Huizhou Central People's Hospital, Huizhou, China
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Zimmerman A, Elahi C, Hernandes Rocha TA, Sakita F, Mmbaga BT, Staton CA, Vissoci JRN. Machine learning models to predict traumatic brain injury outcomes in Tanzania: Using delays to emergency care as predictors. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002156. [PMID: 37856444 PMCID: PMC10586611 DOI: 10.1371/journal.pgph.0002156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023]
Abstract
Constraints to emergency department resources may prevent the timely provision of care following a patient's arrival to the hospital. In-hospital delays may adversely affect health outcomes, particularly among trauma patients who require prompt management. Prognostic models can help optimize resource allocation thereby reducing in-hospital delays and improving trauma outcomes. The objective of this study was to investigate the predictive value of delays to emergency care in machine learning based traumatic brain injury (TBI) prognostic models. Our data source was a TBI registry from Kilimanjaro Christian Medical Centre Emergency Department in Moshi, Tanzania. We created twelve unique variables representing delays to emergency care and included them in eight different machine learning based TBI prognostic models that predict in-hospital outcome. Model performance was compared using the area under the receiver operating characteristic curve (AUC). Inclusion of our twelve time to care variables improved predictability in each of our eight prognostic models. Our Bayesian generalized linear model produced the largest AUC, with a value of 89.5 (95% CI: 88.8, 90.3). Time to care variables were among the most important predictors of in-hospital outcome in our best three performing models. In low-resource settings where delays to care are highly prevalent and contribute to high mortality rates, incorporation of care delays into prediction models that support clinical decision making may benefit both emergency medicine physicians and trauma patients by improving prognostication performance.
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Affiliation(s)
- Armand Zimmerman
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Cyrus Elahi
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | | | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
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Rainone GJ, Zelmanovich R, Laurent D, Lucke-Wold B. How War Has Shaped Neurosurgery. World Neurosurg 2023; 178:136-144. [PMID: 37506839 DOI: 10.1016/j.wneu.2023.07.100] [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: 07/16/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
Many strides have been made in neurosurgery during times of war, helping to improve the outcomes of patients in dire circumstances. World War I introduced the concepts of early operation for trauma, forward-operating hospitals, and galeal sutures as well as techniques for careful debridement. It laid the groundwork for neurosurgery to become a specialty within medicine as well. World War II brought about the use of expedited medical evacuation, mobile neurosurgical units, improved resuscitation strategies, cranioplasty, and early laminectomy with decompression. The Korean and Vietnam Wars built on concepts from World Wars I and II, helping to establish the importance of watertight dural closure, external drainage systems after cranial trauma, multidisciplinary care, and infection prevention strategies. In the post-Vietnam period, we have seen significant technological advances allowing neurosurgeons to move farther ahead than most throughout history could have imagined. The significance of secondary brain injury, vascular injury, and the underlying pathophysiology of traumatic insults has been elucidated over the years since the Vietnam War, allowing for great advances in the care of our patients. Each major war throughout history has contributed greatly to the specialty of neurosurgery, each with its own innovations culminating in guidelines, strategies, and standards of practice that allow us to deliver the highest standard of care to our patients.
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Affiliation(s)
- Gersham J Rainone
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
| | - Rebecca Zelmanovich
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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Artiaga A, Herman F, Arquizan C, Thouvenot E, Loubet P, Le Moing V, Picot MC, Makinson A. Cerebral vasculitis as a complication of pneumococcal meningitis: A cohort study. Infect Dis Now 2023; 53:104772. [PMID: 37619963 DOI: 10.1016/j.idnow.2023.104772] [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: 04/10/2023] [Revised: 07/27/2023] [Accepted: 08/13/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Cerebral vasculitis (CV) is a severe complication of pneumococcal meningitis (PM); whether dexamethasone use can reduce its occurrence remains to be determined. METHODS This is a retrospective observational bicentric study analyzing all adults with proven PM hospitalized between January 2002 and December 2020 in two tertiary hospitals. Extrapolating from a standardized definition of primary angiitis of the central nervous system, we defined CV as worsened neurological symptoms associated with compatible imaging. All images were analyzed by a radiologist, and two neurologists reviewed all inconclusive cases of suspected CV for adjudication. Factors associated with CV were analyzed, including dexamethasone use. A subgroup analysis was limited to patients with a lumbar puncture at PM diagnosis. RESULTS Among 168 patients with PM, 49 (29.2%) had CV, occurring after a median of 8 days (IQR 5-13) of PM diagnosis. In multivariate analysis (N = 151), initial CRP was associated with CV (OR 1.28 per 50-unit increase, p = 0.003), which was marginally linked with delayed hospital admission more than 48 hours after first symptoms (OR 2.39, p = 0.06) and prior NSAID intake (OR 2.94, p = 0.05). Dexamethasone administration did not impact CV occurrence. In 133 patients having undergone lumbar puncture, CSF protein level > 4.4 g/L (OR 4.50, p = 0.006) was associated with CV. CONCLUSIONS In our cohort, CV was a frequent and severe complication of PM, often occurring in association with unduly delayed medical care, high CRP at admission, and high levels of protein in CSF.
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Affiliation(s)
- Agathe Artiaga
- Infectious and Tropical Diseases Department - University Hospital of Montpellier, France
| | - Fanchon Herman
- Medical Information Department - University Hospital of Montpellier, France
| | - Caroline Arquizan
- Stroke Unit, Department of Neurology, University of Montpellier, France; Paris Descartes University, INSERM 1226, Paris, France
| | - Eric Thouvenot
- Neurology Department - University Hospital of Nimes, France; Functional Genomics Institute, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Paul Loubet
- Infectious and Tropical Diseases Department - University Hospital of Nimes, France; Inserm U1047 University of Montpellier Nimes, France
| | - Vincent Le Moing
- Infectious and Tropical Diseases Department - University Hospital of Montpellier, France; Inserm U1175 University of Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Medical Information Department - University Hospital of Montpellier, France; Clinical Research and Epidemiology Unit, INSERM, Clinical Investigation Centre 1411, University of Montpellier, France
| | - Alain Makinson
- Infectious and Tropical Diseases Department - University Hospital of Montpellier, France; Inserm U1175 University of Montpellier, Montpellier, France.
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Sievert T, Didriksson I, Spångfors M, Lilja G, Blennow K, Zetterberg H, Frigyesi A, Friberg H. Neurofilament light chain on intensive care admission is an independent predictor of mortality in COVID-19: a prospective multicenter study. Intensive Care Med Exp 2023; 11:66. [PMID: 37768470 PMCID: PMC10539241 DOI: 10.1186/s40635-023-00547-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and total-tau protein (tau) are novel blood biomarkers of neurological injury, and may be used to predict outcomes in critical COVID-19. METHODS A prospective multicentre cohort study of 117 consecutive and critically ill COVID-19 patients in six intensive care units (ICUs) in southern Sweden between May and November 2020. Serial NfL, GFAP and tau were analysed in relation to mortality, the Glasgow Outcome Scale Extended (GOSE) and the physical (PCS) and mental (MCS) components of health-related quality of life at one year. RESULTS NfL, GFAP and tau on ICU admission predicted one-year mortality with an area under the curve (AUC) of 0.82 (95% confidence interval [CI] 0.74[Formula: see text]0.90), 0.72 (95% CI 0.62[Formula: see text]0.82) and 0.66 (95% CI 0.54[Formula: see text]0.77). NfL on admission was an independent predictor of one-year mortality (p = 0.039). Low NfL and GFAP values were associated with good PCS ([Formula: see text]45) at one year but not with good MCS ([Formula: see text]45) or GOSE ([Formula: see text]5). CONCLUSIONS NfL on ICU admission was an independent predictor of mortality. High levels of NfL, GFAP and tau were associated with mortality but not with poor GOSE in survivors at one year. Low levels of NfL and GFAP were associated with improved physical health-related quality of life.
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Affiliation(s)
- Theodor Sievert
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, SE-22185 Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, SE-22185 Sweden
| | - Ingrid Didriksson
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, SE-22185 Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, SE-20502 Sweden
| | - Martin Spångfors
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, SE-22185 Sweden
- Department of Anaesthesia and Intensive Care, Kristianstad Hospital, Kristianstad, SE-29133 Sweden
| | - Gisela Lilja
- Department of Neurology, Skåne University Hospital, Lund, SE-22185 Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, SE-43180 Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, SE-43180 Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Mölndal, SE-43180 Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, SE-43180 Sweden
- Department of Neurodegenerative Disease, University College London Institute of Neurology, London, United Kingdom
- United Kingdom Dementia Research Institute, University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, United States of America
| | - Attila Frigyesi
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, SE-22185 Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, SE-22185 Sweden
| | - Hans Friberg
- Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund University, Lund, SE-22185 Sweden
- Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, SE-20502 Sweden
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Shanahan R, Avsar P, Watson C, Moore Z, Patton D, McEvoy NL, Curley G, O'Connor T. The impact of brain tissue oxygenation monitoring on the Glasgow Outcome Scale/Glasgow Outcome Scale Extended in patients with moderate to severe traumatic brain injury: A systematic review. Nurs Crit Care 2023. [PMID: 37735107 DOI: 10.1111/nicc.12973] [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: 10/29/2022] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Traumatic brain injuries (TBIs) are one of the leading causes of death or long-term disability around the world. As a result of improvements in supportive care, patients are surviving more severe insults with more pronounced dependency on their families, hospitals, and long-term care facilities. The introduction of brain tissue oxygenation (PbtO2) monitoring aims to recognize episodes of reduced cerebral perfusion with and without associated increased intracranial pressure (ICP). AIM The aim of this review is to determine the impact of PbtO2 on the Glasgow Outcome Scale/Glasgow Outcome Scale Extended (GOS/GOSE) in patients with moderate to severe TBI. DESIGN Systematic review with narrative and meta-analysis. All original research in which adult patients undergoing PbtO2 were compared with a control group of traditional ICP/cerebral perfusion pressure (CPP) monitoring. Both randomized controlled trials and observational studies were included in this review. METHODS Databases were searched in September 2022. The primary outcome of the review was the impact of PbtO2 monitoring on GOS/GOSE, while secondary outcomes were mortality and length of stay (LOS) in the intensive care unit (ICU). RESULTS Seven studies with a combined number of 770 patients were included in the review. These patients were adults ≥16 years of age. Only two of the studies included found a statistically significant association between PbtO2 monitoring and improved long-term neurological outcomes in patients with TBI (p = .01, p < .01). A meta-analysis of the secondary outcomes identified an associated reduction of mortality in favour of the group treated with PbtO2 monitoring (p < .0001). Results from studies examining LOS in ICU have demonstrated an associated increase of LOS in ICU in patients treated with PbtO2-guided therapy. CONCLUSION From the studies included in this review, only two found a statistically significant association between PbtO2 monitoring and long-term outcomes. It is unclear whether PbtO2 goal-directed therapy has a positive impact on the long-term neurological functions and mortality of patients suffering from TBI. A multicentre randomized controlled trial may provide further evidence, but not necessarily conclusive. RELEVANCE TO CLINICAL PRACTICE Further research is warranted to determine the efficacy of the introduction of this new monitoring system to guide local policy change.
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Affiliation(s)
- Ruth Shanahan
- Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
| | - Pinar Avsar
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chanel Watson
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing & Midwifery, Griffith University, Mount Gravatt, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, UK
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
- Lida Institute, Shanghai, China
- Cardiff University, Cardiff, UK
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Declan Patton
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing & Midwifery, Griffith University, Mount Gravatt, Queensland, Australia
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Natalie L McEvoy
- Department of Anaesthesia and Critical Care, RCSI, Dublin, Ireland
| | - Ger Curley
- Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, Beaumont Hospital, Dublin, Ireland
- Department of Anaesthesia and Critical Care, RCSI, Dublin, Ireland
| | - Tom O'Connor
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing & Midwifery, Griffith University, Mount Gravatt, Queensland, Australia
- Lida Institute, Shanghai, China
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
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G/Michael S, Terefe B, Asfaw MG, Liyew B. Outcomes and associated factors of traumatic brain injury among adult patients treated in Amhara regional state comprehensive specialized hospitals. BMC Emerg Med 2023; 23:109. [PMID: 37726673 PMCID: PMC10510140 DOI: 10.1186/s12873-023-00859-x] [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] [Received: 10/22/2022] [Accepted: 07/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Globally, traumatic brain injury is the leading cause of death and disability which affects more than 69 million individuals a year. OBJECTIVE This study aimed to assess the outcome and associated factors of traumatic brain injury among adult patients treated in Amhara regional state comprehensive specialized hospitals. METHOD Institutional-based cross-sectional study design was conducted from January 1, 2018, to December 30, 2020. A simple random sampling technique was used and a checklist was used to extract data between March 15 and April 15, 2021. The data were entered into Epi-data version 4.2 and exported to SPSS version 25 for analysis after being checked for consistency. Associated variables with outcomes of traumatic brain injury were determined by a binary logistic regression model. The degree of association was interpreted by using AOR and a 95% confidence interval with a p-value less than or equal to 0.05 at 95% CI was considered statistically significant. RESULT In this study road traffic injury was the most frequent cause of traumatic brain injuries among adult patients, accounting for 181 (37.5%), followed by assault, accounting for 117 (24.2%) which affects adult age groups. One-third of the participant had a moderate Glasgow coma scale of 174(36%). Only 128(26.8%) patients arrived within one hour. One hundred sixty, 160 (33.1%) of patients had a mild traumatic brain injury, whereas, 149(36%) of patients had a severe traumatic brain injury. Regarding computerized tomography scans findings, the hematoma was the most common (n = 163, 33.7%). Ninety-one, 91(18.8%) of participants had cerebrospinal fluid otorrhea, and, 92(19%) were diagnosed with a positive battle sign. The overall prevalence of unfavorable outcomes after traumatic brain injury was found to be 35.2% (95%CI (30.8-39.1). Having additional Injury, hypoxia, time to hospital presentation after 24 h, severe Glasgow Coma Scale, moderate Glasgow Coma Scale, tachypnea, bradypnea, and cerebrospinal fluid Othorrhea, were factors associated with unfavorable outcomes. CONCLUSION AND RECOMMENDATION In this study, the overall unfavorable outcome was experienced by about four out of every 10 victims of traumatic brain injury. Time of arrival > 24 h, low Glasgow coma scale, additional injury, Cerebrospinal fluid otorrhea, abnormal respiration, and hypoxia were significant predictors of unfavorable outcomes. To reduce the adverse effects of traumatic brain injury in adults, it is therefore desirable to guarantee safe road traffic flow and improve health care services.
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Affiliation(s)
- Solomon G/Michael
- Department of Surgical Nursing, School of Nursing, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marye Getnet Asfaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX 196, Gondar, Ethiopia
| | - Bikis Liyew
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX 196, Gondar, Ethiopia.
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Etemad LL, Yue JK, Barber J, Nelson LD, Bodien YG, Satris GG, Belton PJ, Madhok DY, Huie JR, Hamidi S, Tracey JX, Coskun BC, Wong JC, Yuh EL, Mukherjee P, Markowitz AJ, Huang MC, Tarapore PE, Robertson CS, Diaz-Arrastia R, Stein MB, Ferguson AR, Puccio AM, Okonkwo DO, Giacino JT, McCrea MA, Manley GT, Temkin NR, DiGiorgio AM. Longitudinal Recovery Following Repetitive Traumatic Brain Injury. JAMA Netw Open 2023; 6:e2335804. [PMID: 37751204 PMCID: PMC10523170 DOI: 10.1001/jamanetworkopen.2023.35804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
Importance One traumatic brain injury (TBI) increases the risk of subsequent TBIs. Research on longitudinal outcomes of civilian repetitive TBIs is limited. Objective To investigate associations between sustaining 1 or more TBIs (ie, postindex TBIs) after study enrollment (ie, index TBIs) and multidimensional outcomes at 1 year and 3 to 7 years. Design, Setting, and Participants This cohort study included participants presenting to emergency departments enrolled within 24 hours of TBI in the prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study (enrollment years, February 2014 to July 2020). Participants who completed outcome assessments at 1 year and 3 to 7 years were included. Data were analyzed from September 2022 to August 2023. Exposures Postindex TBI(s). Main Outcomes and Measures Demographic and clinical factors, prior TBI (ie, preindex TBI), and functional (Glasgow Outcome Scale-Extended [GOSE]), postconcussive (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]), psychological distress (Brief Symptom Inventory-18 [BSI-18]), depressive (Patient Health Questionnaire-9 [PHQ-9]), posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5 [PCL-5]), and health-related quality-of-life (Quality of Life After Brain Injury-Overall Scale [QOLIBRI-OS]) outcomes were assessed. Adjusted mean differences (aMDs) and adjusted relative risks are reported with 95% CIs. Results Of 2417 TRACK-TBI participants, 1572 completed the outcomes assessment at 1 year (1049 [66.7%] male; mean [SD] age, 41.6 [17.5] years) and 1084 completed the outcomes assessment at 3 to 7 years (714 [65.9%] male; mean [SD] age, 40.6 [17.0] years). At 1 year, a total of 60 participants (4%) were Asian, 255 (16%) were Black, 1213 (77%) were White, 39 (2%) were another race, and 5 (0.3%) had unknown race. At 3 to 7 years, 39 (4%) were Asian, 149 (14%) were Black, 868 (80%) were White, 26 (2%) had another race, and 2 (0.2%) had unknown race. A total of 50 (3.2%) and 132 (12.2%) reported 1 or more postindex TBIs at 1 year and 3 to 7 years, respectively. Risk factors for postindex TBI were psychiatric history, preindex TBI, and extracranial injury severity. At 1 year, compared with those without postindex TBI, participants with postindex TBI had worse functional recovery (GOSE score of 8: adjusted relative risk, 0.57; 95% CI, 0.34-0.96) and health-related quality of life (QOLIBRI-OS: aMD, -15.9; 95% CI, -22.6 to -9.1), and greater postconcussive symptoms (RPQ: aMD, 8.1; 95% CI, 4.2-11.9), psychological distress symptoms (BSI-18: aMD, 5.3; 95% CI, 2.1-8.6), depression symptoms (PHQ-9: aMD, 3.0; 95% CI, 1.5-4.4), and PTSD symptoms (PCL-5: aMD, 7.8; 95% CI, 3.2-12.4). At 3 to 7 years, these associations remained statistically significant. Multiple (2 or more) postindex TBIs were associated with poorer outcomes across all domains. Conclusions and Relevance In this cohort study of patients with acute TBI, postindex TBI was associated with worse symptomatology across outcome domains at 1 year and 3 to 7 years postinjury, and there was a dose-dependent response with multiple postindex TBIs. These results underscore the critical need to provide TBI prevention, education, counseling, and follow-up care to at-risk patients.
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Affiliation(s)
- Leila L. Etemad
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - John K. Yue
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Jason Barber
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | - Yelena G. Bodien
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Gabriela G. Satris
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Patrick J. Belton
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Debbie Y. Madhok
- Department of Emergency Medicine, University of California, San Francisco
| | - J. Russell Huie
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Sabah Hamidi
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Joye X. Tracey
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Bukre C. Coskun
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Justin C. Wong
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Esther L. Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Amy J. Markowitz
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Michael C. Huang
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Phiroz E. Tarapore
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | | | | | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- San Francisco Veterans Affairs Healthcare System, San Francisco, California
| | - Ava M. Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joseph T. Giacino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Nancy R. Temkin
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle
| | - Anthony M. DiGiorgio
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Institute of Health Policy Studies, University of California, San Francisco
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Ling Y, Xu C, Wen X, Li J, Gao J, Luo B. Cortical responses to auditory stimulation predict the prognosis of patients with disorders of consciousness. Clin Neurophysiol 2023; 153:11-20. [PMID: 37385110 DOI: 10.1016/j.clinph.2023.06.002] [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: 07/04/2022] [Revised: 05/15/2023] [Accepted: 06/03/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE This study aimed to assess the prognosis of patients with disorders of consciousness (DoC) using auditory stimulation with electroencephalogram (EEG) recordings. METHODS We enrolled 72 patients with DoC in the study, which involved subjecting patients to auditory stimulation while EEG responses were recorded. Coma Recovery Scale-Revised (CRS-R) scores and Glasgow Outcome Scale (GOS) were determined for each patient and followed up for three months. A frequency spectrum analysis was performed on the EEG recordings. Finally, the power spectral density (PSD) index was used to predict the prognosis of patients with DoC based on a support vector machine (SVM) model. RESULTS Power spectral analyses revealed that the cortical response to auditory stimulation showed a decreasing trend with decreasing consciousness levels. Auditory stimulation-induced changes in absolute PSD at the delta and theta bands were positively correlated with the CRS-R and GOS scores. Furthermore, these cortical responses to auditory stimulation had a good ability to discriminate between good and poor prognoses of patients with DoC. CONCLUSIONS Auditory stimulation-induced changes in the PSD were highly predictive of DoC outcomes. SIGNIFICANCE Our findings showed that cortical responses to auditory stimulation may be an important electrophysiological indicator of prognosis in patients with DoC.
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Affiliation(s)
- Yi Ling
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Chuan Xu
- Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Xinrui Wen
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China
| | - Jingqi Li
- Department of Rehabilitation, Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou 311215, China
| | - Jian Gao
- Department of Rehabilitation, Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou 311215, China
| | - Benyan Luo
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China.
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Hauger SL, Borgen IMH, Forslund MV, Kleffelgård I, Andelic N, Løvstad M, Perrin PB, Røe C, Fure SCR. Participation in the Chronic Phase after Traumatic Brain Injury: Variations and Key Predictors. J Clin Med 2023; 12:5584. [PMID: 37685651 PMCID: PMC10488924 DOI: 10.3390/jcm12175584] [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: 08/03/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Participation is of major importance for individuals with traumatic brain injury (TBI). This study evaluates participation over a period of one year among persons with TBI in the chronic phase and explores sociodemographic, psychological, and environmental predictors of levels and trajectories of participation. One hundred and twenty home-living survivors of TBI with persistent injury-related consequences at least two years post-injury who participated in a goal-oriented randomized trial were assessed at baseline and after four and twelve months. Linear mixed-effects model analysis was applied to evaluate height, trajectory slope, and predictors of the Participation Assessment with the Recombined Tools-Objective (PART-O) total score and the subscales Productivity, Social Relations, and Being Out and About. Being married, having a higher education, and having good global functioning predicted more frequent participation. Education, executive- and global functions predicted Productivity, while age and being married predicted Social Relations. Participating in the study during the COVID-19 pandemic had a negative impact on Productivity. Participation was relatively stable over 12 months, with a slight decline, but may be influenced by demographic factors and functional consequences. Rehabilitation services should particularly focus on people with TBI living alone with lower levels of global and executive function.
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Affiliation(s)
- Solveig L. Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Bjørnemyr, Norway;
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0316 Oslo, Norway
| | - Ida M. H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Bjørnemyr, Norway;
- Department of Psychology, Faculty of Social Sciences, University of Oslo, 0316 Oslo, Norway
| | - Paul B. Perrin
- Department of Psychology, School of Data Science, University of Virginia, Charlottesville, VA 22904, USA;
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Silje C. R. Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (I.M.H.B.); (M.V.F.); (I.K.); (N.A.); (C.R.); (S.C.R.F.)
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
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Shukla D, Thombre BD, Baby P, Palaninathan J, Subramanian S, Prathyusha PV, Bhagavatula ID. Validity of Glasgow outcome scale-extended (GOSE) mobile application for assessment of outcome in traumatic brain injury patients. Brain Inj 2023; 37:1215-1219. [PMID: 37269250 DOI: 10.1080/02699052.2023.2218649] [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: 01/31/2023] [Revised: 04/25/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To develop the Glasgow Outcome Scale-Extended (GOSE) mobile application and examine the validity of the application against GOSE scoring based on traditional interview method. METHODS Concurrent validity was determined by comparing two independent raters' scoring for GOSE of 102 patients with traumatic brain injury, who had attended outpatient department of a tertiary neuro hospital. Agreement was assessed between the traditional interview-based pen and paper scoring and algorithm based mobile application scoring of GOSE. RESULTS Agreement was tested using Cohen's kappa, and the analysis revealed near perfect agreement between two raters (0.89) (p < 0.01). CONCLUSION The GOSE mobile application can measure GOSE Score similar to the traditional interview method. This application may help fasten the process of assessing outcome in TBI patients in clinical practice and in research.
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Affiliation(s)
- Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Priya Baby
- College of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jayanthi Palaninathan
- College of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sivakami Subramanian
- College of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - P V Prathyusha
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Indira Devi Bhagavatula
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
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Bhattacharyay S, Caruso PF, Åkerlund C, Wilson L, Stevens RD, Menon DK, Steyerberg EW, Nelson DW, Ercole A. Mining the contribution of intensive care clinical course to outcome after traumatic brain injury. NPJ Digit Med 2023; 6:154. [PMID: 37604980 PMCID: PMC10442346 DOI: 10.1038/s41746-023-00895-8] [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: 03/09/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
Existing methods to characterise the evolving condition of traumatic brain injury (TBI) patients in the intensive care unit (ICU) do not capture the context necessary for individualising treatment. Here, we integrate all heterogenous data stored in medical records (1166 pre-ICU and ICU variables) to model the individualised contribution of clinical course to 6-month functional outcome on the Glasgow Outcome Scale -Extended (GOSE). On a prospective cohort (n = 1550, 65 centres) of TBI patients, we train recurrent neural network models to map a token-embedded time series representation of all variables (including missing values) to an ordinal GOSE prognosis every 2 h. The full range of variables explains up to 52% (95% CI: 50-54%) of the ordinal variance in functional outcome. Up to 91% (95% CI: 90-91%) of this explanation is derived from pre-ICU and admission information (i.e., static variables). Information collected in the ICU (i.e., dynamic variables) increases explanation (by up to 5% [95% CI: 4-6%]), though not enough to counter poorer overall performance in longer-stay (>5.75 days) patients. Highest-contributing variables include physician-based prognoses, CT features, and markers of neurological function. Whilst static information currently accounts for the majority of functional outcome explanation after TBI, data-driven analysis highlights investigative avenues to improve the dynamic characterisation of longer-stay patients. Moreover, our modelling strategy proves useful for converting large patient records into interpretable time series with missing data integration and minimal processing.
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Affiliation(s)
- Shubhayu Bhattacharyay
- Division of Anaesthesia, University of Cambridge, Cambridge, UK.
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Pier Francesco Caruso
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy
| | - Cecilia Åkerlund
- Department of Physiology and Pharmacology, Section for Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Robert D Stevens
- Laboratory of Computational Intensive Care Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - David W Nelson
- Department of Physiology and Pharmacology, Section for Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Cambridge Centre for Artificial Intelligence in Medicine, Cambridge, UK
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Zhang Z, Wang SJ, Chen K, Yin AA, Lin W, He YL. Machine learning algorithms for improved prediction of in-hospital outcomes after moderate-to-severe traumatic brain injury: a Chinese retrospective cohort study. Acta Neurochir (Wien) 2023; 165:2237-2247. [PMID: 37382689 DOI: 10.1007/s00701-023-05647-x] [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] [Received: 01/18/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023]
Abstract
AIM Controversy remains high over the superiority of advanced machine learning (ML) algorithms to conventional logistic regression (LR) in the prediction of prognosis after traumatic brain injury (TBI). This study aimed to compare the performance of ML and LR models in predicting in-hospital prognosis after TBI. METHOD In a single-center retrospective cohort of adult patients hospitalized for moderate-to-severe TBI (Glasgow coma score ≤12) in our hospital from 2011 to 2020, LR and three ML algorithms (XGboost, lightGBM, and FT-transformer) were run to build prediction models for in-hospital mortality and the Glasgow Outcome Scale (GOS) functional outcomes using either all 19 clinical and laboratory features or the 10 non-laboratory ones collected at admission to the neurological intensive care unit. The Shapley (SHAP) value was used for model interpretation. RESULT In total, 482 patients had an in-hospital mortality rate of 11.0%. A total of 23.0% of the patients had good functional scores (GOS ≥ 4) at discharge. All ML models performed better than the LR model in predicting in-hospital prognosis after TBI, among which the lightGBM model showed the best performance: When predicting mortality, the lightGBM model yielded an area under the curve (AUC) of 0.953 using all 19 features (the LR model: 0.813) and an AUC of 0.935 using 10 non-laboratory features (the LR model: 0.803); when predicting GOS functional outcomes, it yielded an AUC of 0.913 using all 19 features (the LR model: 0.832) and an AUC of 0.889 using non-laboratory data (the LR model: 0.818). The SHAP method identified key contributors to explain the lightGBM models. Finally, the integration of the lightGBM models with different prediction purposes was found to provide refined prognostic information, particularly for patients who survived moderate-to-severe TBI. CONCLUSION The study supported the superiority of ML to LR in predicting prognosis after moderate-to-severe TBI and highlighted its potential use for clinical application.
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Affiliation(s)
- Zan Zhang
- School of Electronic and Control Engineering, Chang'an University, Xi'an, 710064, China
| | - Sheng-Ju Wang
- School of Electronic and Control Engineering, Chang'an University, Xi'an, 710064, China
| | - Kun Chen
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Centre, School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China
- Shaanxi Provincial Key Laboratory of Clinic Genetics, Fourth Military Medical University, Xi'an, 710032, China
| | - An-An Yin
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, 710032, China.
| | - Wei Lin
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
| | - Ya-Long He
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
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Blackwell LS, Wali B, Xiang Y, Alawieh A, Sayeed I, Reisner A. Prognostic Value of Plasma Biomarkers S100B and Osteopontin in Pediatric TBI: A Prospective Analysis Evaluating Acute and 6-Month Outcomes after Mild to Severe TBI. Biomedicines 2023; 11:2167. [PMID: 37626664 PMCID: PMC10452243 DOI: 10.3390/biomedicines11082167] [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: 06/14/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Blood based traumatic brain injury (TBI) biomarkers offer additional diagnostic, therapeutic, and prognostic utility. While adult studies are robust, the pediatric population is less well studied. We sought to determine whether plasma osteopontin (OPN) and S100B alone or in combination predict mortality, head Computed tomography (CT) findings, as well as 6-month functional outcomes after TBI in children. This is a prospective, observational study between March 2017 and June 2021 at a tertiary pediatric hospital. The sample included children with a diagnosed head injury of any severity admitted to the Emergency Department. Control patients sustained trauma-related injuries and no known head trauma. Serial blood samples were collected at admission, as well as at 24, 48, and 72 h. Patient demographics, acute clinical symptoms, head CT, and 6-month follow-up using the Glasgow outcome scale, extended for pediatrics (GOSE-Peds), were also obtained. The cohort included 460 children (ages 0 to 21 years) and reflected the race and sex distribution of the population served. Linear mixed effect models and logistic regressions were utilized to evaluate the trajectory of biomarkers over time and predictors of dichotomous outcomes. Both OPN and S100B correlated with injury severity based on GCS. S100B and OPN showed lower AUC values (0.59) in predicting positive head CT. S100B had the largest AUC (0.87) in predicting mortality, as well as 6-month outcomes (0.85). The combination of the two biomarkers did not add meaningfully to the model. Our findings continue to support the utility of OPN as a marker of injury severity in this population. Our findings also show the importance of S100B in predicting mortality and 6-month functional outcomes. Continued work is needed to examine the influence of age-dependent neurodevelopment on TBI biomarker profiles in children.
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Affiliation(s)
- Laura S. Blackwell
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
- Department of Pediatrics, Emory University, Atlanta, GA 30322, USA; (Y.X.); (A.R.)
| | - Bushra Wali
- Department of Emergency Medicine, Emory University, Atlanta, GA 30322, USA;
| | - Yijin Xiang
- Department of Pediatrics, Emory University, Atlanta, GA 30322, USA; (Y.X.); (A.R.)
| | - Ali Alawieh
- Department of Neurosurgery, Emory University, Atlanta, GA 30322, USA;
| | - Iqbal Sayeed
- National Institute of Health, Bethesda, MD 20892, USA;
| | - Andrew Reisner
- Department of Pediatrics, Emory University, Atlanta, GA 30322, USA; (Y.X.); (A.R.)
- Department of Neurosurgery, Emory University, Atlanta, GA 30322, USA;
- Department of Neurosurgery, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
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Wang J, Yin MJ, Wen HC. Prediction performance of the machine learning model in predicting mortality risk in patients with traumatic brain injuries: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2023; 23:142. [PMID: 37507752 PMCID: PMC10385965 DOI: 10.1186/s12911-023-02247-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE With the in-depth application of machine learning(ML) in clinical practice, it has been used to predict the mortality risk in patients with traumatic brain injuries(TBI). However, there are disputes over its predictive accuracy. Therefore, we implemented this systematic review and meta-analysis, to explore the predictive value of ML for TBI. METHODOLOGY We systematically retrieved literature published in PubMed, Embase.com, Cochrane, and Web of Science as of November 27, 2022. The prediction model risk of bias(ROB) assessment tool (PROBAST) was used to assess the ROB of models and the applicability of reviewed questions. The random-effects model was adopted for the meta-analysis of the C-index and accuracy of ML models, and a bivariate mixed-effects model for the meta-analysis of the sensitivity and specificity. RESULT A total of 47 papers were eligible, including 156 model, with 122 newly developed ML models and 34 clinically recommended mature tools. There were 98 ML models predicting the in-hospital mortality in patients with TBI; the pooled C-index, sensitivity, and specificity were 0.86 (95% CI: 0.84, 0.87), 0.79 (95% CI: 0.75, 0.82), and 0.89 (95% CI: 0.86, 0.92), respectively. There were 24 ML models predicting the out-of-hospital mortality; the pooled C-index, sensitivity, and specificity were 0.83 (95% CI: 0.81, 0.85), 0.74 (95% CI: 0.67, 0.81), and 0.75 (95% CI: 0.66, 0.82), respectively. According to multivariate analysis, GCS score, age, CT classification, pupil size/light reflex, glucose, and systolic blood pressure (SBP) exerted the greatest impact on the model performance. CONCLUSION According to the systematic review and meta-analysis, ML models are relatively accurate in predicting the mortality of TBI. A single model often outperforms traditional scoring tools, but the pooled accuracy of models is close to that of traditional scoring tools. The key factors related to model performance include the accepted clinical variables of TBI and the use of CT imaging.
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Affiliation(s)
- Jue Wang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China
| | - Ming Jing Yin
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China
| | - Han Chun Wen
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China.
- Intensive Care Department, Guangxi Medical University First Affiliated Hospital, Ward 1, No. 6 Shuangyong Road, Qingxiu District, Guangxi Zhuang Autonomous Region, Nanning, China.
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McMillan TM, McVean J, Aslam H, Barry SJE. Associations between significant head injury in male juveniles in prison in Scotland UK and cognitive function, disability and crime: A cross sectional study. PLoS One 2023; 18:e0287312. [PMID: 37436964 DOI: 10.1371/journal.pone.0287312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/02/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Although the prevalence of head injury is estimated to be high in juveniles in prison, the extent of persisting disability is unknown and relationships with offending uncertain. This limited understanding makes it difficult to develop effective management strategies and interventions to improve health or reduce recidivism. This study investigates effects of significant head injury (SHI) on cognitive function, disability and offending in juvenile prisoners, and considers relationships with common comorbidities. METHODS This cross-sectional study recruited male juvenile prisoners in Scotland from Her Majesty's Young Offenders Institute (HMYOI) Polmont (detaining approximately 305 of 310 male juveniles in prison in Scotland). To be included juveniles had to be 16 years or older, fluent in English, able to participate in assessment, provide informed consent and not have a severe acute disorder of cognition or communication. Head injury, cognition, disability, history of abuse, mental health and problematic substance use were assessed by interview and questionnaire. RESULTS We recruited 103 (34%) of 305 juvenile males in HMYOI Polmont. The sample was demographically representative of juvenile males in prisons for young offenders in Scotland. SHI was found in 82/103 (80%) and head injury repeated over long periods of time in 69/82 (85%). Disability was associated with SHI in 11/82 (13%) and was significantly associated with mental health problems, particularly anxiety. Group differences on cognitive tests were not found. However the SHI group reported poorer behavioural control on the Dysexecutive Questionnaire and were more often reported for incidents in prison than those without SHI. Characteristics of offending, including violence, did not differ between groups. CONCLUSIONS Although SHI is highly prevalent in juvenile prisoners, associated disability was relatively uncommon. There was no evidence for differences in cognitive test performance or offending in juveniles with and without SHI. However, signs of poorer behavioural control and greater psychological distress in juveniles with SHI suggest that they may be at greater risk of recidivism and of potentially becoming lifelong offenders. This implies a need for remedial programmes for juvenile prisoners to take account of persisting effects of SHI on mental health and self-control and education and to improve their understanding of the effects of SHI reduce the likelihood of cumulative effects from further SHI.
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Affiliation(s)
- T M McMillan
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, United Kingdom
| | - Julia McVean
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, United Kingdom
| | - Hira Aslam
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, United Kingdom
| | - Sarah J E Barry
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
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Hammond FM, Ketchum JM, Patni VV, Nejadnik B, Bates D, Weintraub AH. Determining the Minimally Clinically Important Difference for the Disability Rating Scale in Persons With Chronic Traumatic Brain Injury. Neurotrauma Rep 2023; 4:447-457. [PMID: 37475977 PMCID: PMC10354728 DOI: 10.1089/neur.2023.0038] [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: 07/22/2023] Open
Abstract
The Extended Glasgow Outcome Scale (GOSE) is accepted as the primary outcome measure in registrational studies for traumatic brain injury (TBI). The Disability Rating Scale (DRS) is used to assess functional progress from initial acute injury, through rehabilitation and reintegration into the community and life. For these reasons, the DRS is an alternative measure for assessing meaningful global outcomes in chronic TBI. The objective of this study was to determine the minimally clinically important difference (MCID) for the DRS in chronic TBI, by determining the magnitude of DRS change associated with the MCID for the GOSE of 1 point. This study is a retrospective analysis of the multi-center, prospective, longitudinal, Traumatic Brain Injury Model Systems National Database of persons with outcomes at 1, 2, and 5 years and every 5 years thereafter post-injury. Spearman's correlations for dynamic and static relationships between the DRS and GOSE were significant. For the 1-point MCID for the GOSE, the dynamic MCID estimate for the DRS of a -0.68-point change was calculated as the mean DRS change associated with the difference of the GOSE score between year 1 and year 2 (score range, 3-8), using all persons in the study (n = 11,102), whereas the exploratory static MCID estimate for the DRS of -1.28 points was calculated from the slope of the best-fit line between the DRS and GOSE at year 1 follow-up (score range, 3-8; n = 13,415). The final MCID for the DRS was calculated by using the triangulation method (i.e., the arithmetic mean of the dynamic and exploratory static MCID estimates), which resulted in a -1.0-point change. The significant correlation between the DRS and GOSE has allowed for the establishment of a -1.0-point MCID for the DRS, which supports the use of the DRS as an alternative primary outcome measure for chronic TBI research studies, including clinical trials.
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Affiliation(s)
- Flora M. Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica M. Ketchum
- Traumatic Brain Injury Model Systems National Data and Statistical Center, Craig Hospital, Englewood, Colorado, USA
| | | | | | | | - Alan H. Weintraub
- Rocky Mountain Regional Brain Injury System and University of Colorado School of Medicine, Englewood, Colorado, USA
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Pakdaman H, Gharagozli K, Karamiani F, Shamsi Goushki M, Moini S, Sobhanian A, Maghsoudlu F, Esfandani A, Hosseini MH, Amini Harandi A. MLC901 in hypoxic-ischemic brain injury patients: A double-blind, randomized placebo-controlled pilot study. Medicine (Baltimore) 2023; 102:e33914. [PMID: 37335674 DOI: 10.1097/md.0000000000033914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Hypoxic-ischemic brain injury (HIBI) is a disabling consequence of cardiopulmonary resuscitation, which has no direct treatment except supportive care. Many studies have used pharmacological agents to reduce or stop this disability. MLC901 is a traditional Chinese medicine showing neuroprotective and regenerative effects on focal and global ischemia in previous animal and human studies. We designed an experimental, randomized, double-blind, placebo-controlled study to analyze MLC901 efficacy in HIBI patients. METHODS In a randomized, placebo-controlled trial, 35 patients with HIBI were randomly designated to receive either MLC901 or placebo capsules 3 times per day over 6 months. We assessed the 2 groups by modified Rankin Scale and Glasgow Outcome Scale at baseline, and follow-up visits in 3rd month, and 6th-month after injury. RESULTS Thirty-one patients completed this study. There was no significant difference in baseline characteristics between the 2 groups as regards age, gender, time of resuscitation, the interval between injury and start of the intervention, and the length of intensive care unit stay. Both the placebo and intervention groups improved during the investigation. However, the Glasgow Outcome Scale and modified Rankin Scale scales were significantly improved in the MLC901 group compared to the placebo after 6 months (P < .05) with close to no adverse effects. No major side effect was reported. CONCLUSION MLC901 has shown, compared to placebo, a statistically better improvement at 6 months in neurological functions of patients with HIBI.
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Affiliation(s)
- Hossein Pakdaman
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bernetti A, Ruggiero M, Ruiu P, Napoli M, D’Urzo R, Mancuso A, Mariani F, Tota L, Agostini F, Mangone M, Paoloni M. Analysis and Report of the Physical and Rehabilitation Medicine Evaluation Activity in Patients Admitted to Acute Care Setting: An Observational Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6039. [PMID: 37297646 PMCID: PMC10252334 DOI: 10.3390/ijerph20116039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/01/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Disability (both temporary and transitory, or definitive) might occur for the first time in a given patient after an acute clinical event. It is essential, whenever indicated, to undergo a Physical Medicine and Rehabilitation assessment to detect disability and any need for rehabilitation early. Although access to rehabilitation services varies from country to country, it should always be governed by a PRM prescription. OBJECTIVE The aim of the present observational retrospective study is to describe consultancy activity performed by PRM specialists in a university hospital in terms of requests' typology, clinical questions, and rehabilitation setting assignment. METHODS Multiple parameters were analyzed (clinical condition, patient's socio-family background, and rehabilitation assessment scale scores) and a correlation analysis was performed between the analyzed characteristics and both the different clinical conditions and the assigned rehabilitation setting. RESULTS PRM evaluations of 583 patients from 1 May 2021 to 30 June 2022 were examined. Almost half of the total sample (47%) presented disability due to musculoskeletal conditions with a mean age of 76 years. The most frequently prescribed settings were home rehabilitation care, followed by intensive rehabilitation and long-term care rehabilitation. CONCLUSIONS Our results suggest the high public health impact of musculoskeletal disorders, followed by neurological disorders. This is, however, without forgetting the importance of early rehabilitation to prevent other types of clinical conditions such as cardiovascular, respiratory, or internal diseases from leading to motor disability and increasing costs.
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Affiliation(s)
- Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Marco Ruggiero
- Physical and Rehabilitation Medicine, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Pierangela Ruiu
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Martina Napoli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Rossella D’Urzo
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Annalisa Mancuso
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Flavio Mariani
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Luigi Tota
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
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Panunzi S, Lucca LF, De Tanti A, Cava F, Romoli A, Formisano R, Scarponi F, Estraneo A, Frattini D, Tonin P, Piergentilli I, Pioggia G, De Gaetano A, Cerasa A. Modeling outcome trajectories in patients with acquired brain injury using a non-linear dynamic evolution approach. Sci Rep 2023; 13:6295. [PMID: 37072538 PMCID: PMC10113248 DOI: 10.1038/s41598-023-33560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
This study describes a dynamic non-linear mathematical approach for modeling the course of disease in acquired brain injury (ABI) patients. Data from a multicentric study were used to evaluate the reliability of the Michaelis-Menten (MM) model applied to well-known clinical variables that assess the outcome of ABI patients. The sample consisted of 156 ABI patients admitted to eight neurorehabilitation subacute units and evaluated at baseline (T0), 4 months after the event (T1) and at discharge (T2). The MM model was used to characterize the trend of the first Principal Component Analysis (PCA) dimension (represented by the variables: feeding modality, RLAS, ERBI-A, Tracheostomy, CRS-r and ERBI-B) in order to predict the most plausible outcome, in terms of positive or negative Glasgow outcome score (GOS) at discharge. Exploring the evolution of the PCA dimension 1 over time, after day 86 the MM model better differentiated between the time course for individuals with a positive and negative GOS (accuracy: 85%; sensitivity: 90.6%; specificity: 62.5%). The non-linear dynamic mathematical model can be used to provide more comprehensive trajectories of the clinical evolution of ABI patients during the rehabilitation period. Our model can be used to address patients for interventions designed for a specific outcome trajectory.
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Affiliation(s)
- Simona Panunzi
- CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, Rome, Italy
| | | | | | - Francesca Cava
- Rehabilitation Institute Montecatone, Montecatone, Imola, BO, Italy
| | | | - Rita Formisano
- Neurorehabilitation 2 Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Federico Scarponi
- Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, PG, Italy
| | - Anna Estraneo
- IRCCS- Don Carlo Gnocchi Foundation, Florence, Italy
| | - Diana Frattini
- Department of Rehabilitation, Vimercate Hospital, Vimercate, MB, Italy
| | | | - Ilaria Piergentilli
- CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, Rome, Italy
| | - Giovanni Pioggia
- IRIB-CNR, Institute for Biomedical Research and Innovation, National Research Council, 98164, Messina, Italy
| | - Andrea De Gaetano
- CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, Rome, Italy
- IRIB-CNR, Institute for Biomedical Research and Innovation, National Research Council, 98164, Messina, Italy
- Department of Biomatics, Óbuda University, Budapest, Hungary
| | - Antonio Cerasa
- S. Anna Institute, Crotone, Italy.
- IRIB-CNR, Institute for Biomedical Research and Innovation, National Research Council, 98164, Messina, Italy.
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036, Arcavacata, CS, Italy.
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Laic RAG, Verheyden J, Bruyninckx D, Lebegge P, Sloten JV, Depreitere B. Profound prospective assessment of radiological and functional outcome 6 months after TBI in elderly. Acta Neurochir (Wien) 2023; 165:849-864. [PMID: 36922467 DOI: 10.1007/s00701-023-05546-1] [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: 01/17/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Recovery after traumatic brain injury (TBI) in older adults is usually affected by the presence of comorbidities, leading to more severe sequelae in this age group than in younger patients. However, there are only few reports that prospectively perform in-depth assessment of outcome following TBI in elderly. OBJECTIVE This study aims at documenting structural brain characteristics and functional outcome and quality of life in elderly patients 6 months after TBI and comparing these data with healthy volunteers undergoing the same assessments. METHODS Thirteen TBI patients ≥ 65 years old, admitted to the University Hospitals Leuven (Belgium), between 2019 and 2022 due to TBI, including all injury severities, and a group of 13 healthy volunteers with similar demographic characteristics were prospectively included in the study. At admission, demographic, injury, and CT scan data were collected in our database. Six months after the accident, a brain MRI scan and standardized assessments of frailty, sleep quality, cognitive function, motor function, and quality of life were conducted. RESULTS A total of 13 patients and 13 volunteers were included in the study, with a median age of 74 and 73 years, respectively. Nine out of the 13 patients presented with a mild TBI. The patient group had a significantly higher level of frailty than the control group, presenting a mean Reported Edmonton Frailty Scale score of 5.8 (SD 2.7) vs 0.7 (SD 1.1) (p < 0.01). No statistically significant differences were found between patient and control brain volumes, fluid attenuated inversion recovery white matter hyperintensity volumes, number of lesions and blackholes, and fractional anisotropy values. Patients demonstrated a significantly higher median reaction time in the One Touch Stockings of Cambridge (22.3 s vs 17.6, p = 0.03) and Reaction Time (0.5 s vs 0.4 s, p < 0.01) subtests in the Cambridge Neuropsychological Test Automated Battery. Furthermore, patients had a lower mean score on the first Box and Blocks test with the right hand (46.6 vs 61.7, p < 0.01) and a significantly higher mean score in the Timed-Up & Go test (13.1 s vs 6.2 s, p = 0.02) and Timed Up & Go with cognitive dual task (16.0 s vs 10.2 s, p < 0.01). Substantially lower QOLIBRI total score (60.4 vs 85.4, p < 0.01) and QOLIBRI-OS total score (53.8 vs 88.5, p < 0.01) were also observed in the patients' group. CONCLUSION In this prospective study, TBI patients ≥ 65 years old when compared with elder controls showed slightly worse cognitive performance and poorer motor function, higher fall risk, but a substantially reduced QoL at 6 months FU, as well as significantly higher frailty, even when the TBI is classified as mild. No statistically significant differences were found in structural brain characteristics on MRI. Future studies with larger sample sizes are needed to refine the impact of TBI versus frailty on function and QoL in elderly.
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Nguyen A, Nguyen A, Hsu TI, Lew HD, Gupta N, Nguyen B, Mandavalli A, Diaz MJ, Lucke-Wold B. Neutrophil to Lymphocyte Ratio as a Predictor of Postoperative Outcomes in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Diseases 2023; 11:diseases11010051. [PMID: 36975600 PMCID: PMC10047119 DOI: 10.3390/diseases11010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/05/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
(1) Introduction: Traumatic brain injury (TBI) is a leading cause of injury and mortality worldwide, carrying an estimated cost of $38 billion in the United States alone. Neutrophil to lymphocyte ratio (NLR) has been investigated as a standardized biomarker that can be used to predict outcomes of TBI. The aim of this review was to determine the prognostic utility of NLR among patients admitted for TBI. (2) Methods: A literature search was conducted in PubMed, Scopus, and Web of Science in November 2022 to retrieve articles regarding the use of neutrophil to lymphocyte ratio (NLR) as a prognostic measure in traumatic brain injury (TBI) patients. Inclusion criteria included studies reporting outcomes of TBI patients with associated NLR values. Exclusion criteria were studies reporting only non-primary data, those insufficiently disaggregated to extract NLR data, and non-English or cadaveric studies. The Newcastle-Ottawa Scale was utilized to assess for the presence of bias in included studies. (3) Results: Following the final study selection 19 articles were included for quantitative and qualitative analysis. The average age was 46.25 years. Of the 7750 patients, 73% were male. Average GCS at presentation was 10.51. There was no significant difference in the NLR between surgical vs. non-surgical cohorts (SMD 2.41 95% CI −1.82 to 6.63, p = 0.264). There was no significant difference in the NLR between bleeding vs. non-bleeding cohorts (SMD 4.84 95% CI −0.26 to 9.93, p = 0.0627). There was a significant increase in the NLR between favorable vs. non-favorable cohorts (SMD 1.31 95% CI 0.33 to 2.29, p = 0.0090). (4) Conclusions: Our study found that NLR was only significantly predictive for adverse outcomes in TBI patients and not surgical treatment or intracranial hemorrhage, making it nonetheless an affordable alternative for physicians to assess patient prognosis.
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Affiliation(s)
- Andrew Nguyen
- College of Medicine, University of Florida, Gainesville, FL 32601, USA
| | - Alexander Nguyen
- College of Medicine, University of Florida, Gainesville, FL 32601, USA
| | - Timothy I. Hsu
- School of Medicine, University of California, Irvine, CA 92617, USA
| | - Harrison D. Lew
- College of Medicine, University of Florida, Gainesville, FL 32601, USA
| | - Nithin Gupta
- School of Medicine, Campbell University, Lillington, NC 27546, USA
| | - Brandon Nguyen
- Alix School of Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - Akhil Mandavalli
- College of Medicine, University of Florida, Gainesville, FL 32601, USA
| | - Michael J. Diaz
- College of Medicine, University of Florida, Gainesville, FL 32601, USA
- Correspondence:
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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