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Gabbe BJ, Keeves J, McKimmie A, Gadowski AM, Holland AJ, Semple BD, Young JT, Crowe L, Ownsworth T, Bagg MK, Antonic-Baker A, Hicks AJ, Hill R, Curtis K, Romero L, Ponsford JL, Lannin NA, O'Brien TJ, Cameron PA, Cooper DJ, Rushworth N, Fitzgerald M. The Australian Traumatic Brain Injury Initiative: Systematic Review and Consensus Process to Determine the Predictive Value of Demographic, Injury Event, and Social Characteristics on Outcomes for People With Moderate-Severe Traumatic Brain Injury. J Neurotrauma 2024. [PMID: 38115598 DOI: 10.1089/neu.2023.0461] [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: 12/21/2023] Open
Abstract
The objective of the Australian Traumatic Brain Injury (AUS-TBI) Initiative is to develop a data dictionary to inform data collection and facilitate prediction of outcomes of people who experience moderate-severe TBI in Australia. The aim of this systematic review was to summarize the evidence of the association between demographic, injury event, and social characteristics with outcomes, in people with moderate-severe TBI, to identify potentially predictive indicators. Standardized searches were implemented across bibliographic databases to March 31, 2022. English-language reports, excluding case series, which evaluated the association between demographic, injury event, and social characteristics, and any clinical outcome in at least 10 patients with moderate-severe TBI were included. Abstracts and full text records were independently screened by at least two reviewers in Covidence. A pre-defined algorithm was used to assign a judgement of predictive value to each observed association. The review findings were discussed with an expert panel to determine the feasibility of incorporation of routine measurement into standard care. The search strategy retrieved 16,685 records; 867 full-length records were screened, and 111 studies included. Twenty-two predictors of 32 different outcomes were identified; 7 were classified as high-level (age, sex, ethnicity, employment, insurance, education, and living situation at the time of injury). After discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous predictors capable of enabling early identification of those at risk for poor outcomes and improved personalization of care through inclusion in routine data collection.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Jemma Keeves
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Ancelin McKimmie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adelle M Gadowski
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew J Holland
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney School of Medicine, Westmead, Australia
| | - Bridgette D Semple
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Jesse T Young
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
- Clinical Sciences Murdoch Children's Research Institute, Parkville, VIC, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Justice Health Group, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Louise Crowe
- Clinical Sciences Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and the Hopkins Centre, Griffith University, Brisbane, Australia
| | - Matthew K Bagg
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Regina Hill
- Regina Hill Effective Consulting Pty. Ltd., Melbourne, VIC, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Illawarra Shoalhaven LHD, Wollongong, NSW, Australia
- George Institute for Global Health, Newtown, NSW, Australia
| | | | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | | | - Melinda Fitzgerald
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin School of Population Health, Curtin University, Bentley, WA, Australia
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Breeding T, Martinez B, Katz J, Nasef H, Santos RG, Zito T, Elkbuli A. The Association Between Gender and Clinical Outcomes in Patients With Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Surg Res 2024; 295:791-799. [PMID: 38157731 DOI: 10.1016/j.jss.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Traumatic brain injuries (TBIs) are a significant cause of morbidity and mortality in the United States. but have a disproportionate impact on patients based on gender. This systematic review and meta-analysis aim to compare gender differences in clinical outcomes between male and female adult trauma patients with moderate and severe TBI. METHODS Studies assessing gender differences in outcomes following TBIs on PubMed, Google Scholar, EMBASE, and ProQuest were searched. Meta-analysis was performed for outcomes including in-hospital mortality, hospital length of stay, intensive care unit length of stay, and Glasgow outcome scale (GOS) at 6 mo. RESULTS Eight studies were included for analysis with 26,408 female and 63,393 male patients. Meta-analysis demonstrated that males had a significantly lower risk of mortality than females (RR: 0.88; 95% CI 0.78, 0.99; P = 0.0001). Females had a shorter hospital length of stay (mean difference -1.4 d; 95% CI - 1.6 d, -1.2 d). No significant differences were identified in intensive care unit length of stay (mean difference -3.0 d; 95% CI -7.0 d, 1.1 d; P = 0.94) or GOS at 6 mo (mean difference 0.2 d; 95% CI -0.9 d, 1.4 d; P = 1). CONCLUSIONS Compared to male patients, female patients with moderate and severe TBI had a significantly higher in-hospital mortality risk. There were no significant differences in long-term outcomes between genders based on GOS at 6 mo. These findings warrant further investigation into the etiology of these gender disparities and their impact on additional clinical outcome measures.
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Affiliation(s)
- Tessa Breeding
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Brian Martinez
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Joshua Katz
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Hazem Nasef
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Radleigh G Santos
- Department of Mathematics, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Tracy Zito
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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von Steinbuechel N, Hahm S, Muehlan H, Arango-Lasprilla JC, Bockhop F, Covic A, Schmidt S, Steyerberg EW, Maas AIR, Menon D, Andelic N, Zeldovich M. Impact of Sociodemographic, Premorbid, and Injury-Related Factors on Patient-Reported Outcome Trajectories after Traumatic Brain Injury (TBI). J Clin Med 2023; 12:jcm12062246. [PMID: 36983247 PMCID: PMC10052290 DOI: 10.3390/jcm12062246] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
Traumatic brain injury (TBI) remains one of the leading causes of death and disability worldwide. To better understand its impact on various outcome domains, this study pursues the following: (1) longitudinal outcome assessments at three, six, and twelve months post-injury; (2) an evaluation of sociodemographic, premorbid, and injury-related factors, and functional recovery contributing to worsening or improving outcomes after TBI. Using patient-reported outcome measures, recuperation trends after TBI were identified by applying Multivariate Latent Class Mixed Models (MLCMM). Instruments were grouped into TBI-specific and generic health-related quality of life (HRQoL; QOLIBRI-OS, SF-12v2), and psychological and post-concussion symptoms (GAD-7, PHQ-9, PCL-5, RPQ). Multinomial logistic regressions were carried out to identify contributing factors. For both outcome sets, the four-class solution provided the best match between goodness of fit indices and meaningful clinical interpretability. Both models revealed similar trajectory classes: stable good health status (HRQoL: n = 1944; symptoms: n = 1963), persistent health impairments (HRQoL: n = 442; symptoms: n = 179), improving health status (HRQoL: n = 83; symptoms: n = 243), and deteriorating health status (HRQoL: n = 86; symptoms: n = 170). Compared to individuals with stable good health status, the other groups were more likely to have a lower functional recovery status at three months after TBI (i.e., the GOSE), psychological problems, and a lower educational attainment. Outcome trajectories after TBI show clearly distinguishable patterns which are reproducible across different measures. Individuals characterized by persistent health impairments and deterioration require special attention and long-term clinical monitoring and therapy.
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Affiliation(s)
- Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
- Correspondence:
| | - Stefanie Hahm
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Holger Muehlan
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Juan Carlos Arango-Lasprilla
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, 907 Floyd Ave., Richmond, VA 23284, USA
| | - Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
| | - Silke Schmidt
- Department Health & Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str. 13, 17489 Greifswald, Germany
| | - Ewout W. Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 RC Leiden, The Netherlands
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, 2650 Edegem, Belgium
| | - David Menon
- Division of Anaesthesia, University of Cambridge/Addenbrooke’s Hospital, Box 157, Cambridge CB2 0QQ, UK
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0450 Oslo, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models, Faculty of Medicine, Univeristy of Oslo, 0373 Oslo, Norway
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany
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Donders J, Vos M. Utility of CVLT-3 response bias as a measure of performance validity after traumatic brain injury. Clin Neuropsychol 2023; 37:91-100. [PMID: 35285406 DOI: 10.1080/13854046.2022.2051152] [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: 02/07/2023]
Abstract
OBJECTIVE We sought to determine the utility of a new performance validity index that was recently proposed. In particular, we wanted to determine if this index would be associated with a specificity of at least .90, a sensitivity of at least .40, and an Area Under the Curve of at least .70 in a traumatic brain injury (TBI) sample. METHOD We used logistic regression to investigate how well this new index could distinguish persons with TBI (n = 148) who were evaluated within 1-36 months after injury. All participants had been classified on the basis of at least two independent performance validity tests as having provided valid performance (n = 128) or invalid performance (n = 20). RESULTS The new performance validity index had acceptable specificity (.96) but had suboptimal sensitivity (.35) and Area Under the Curve (.66). It was concerning that almost half (5/12) of the cases that were identified by this index as providing invalid effort were false positives. Although a slightly more liberal cut-off improved sensitivity, the problem with poor positive predictive power remained. The conventional Forced Choice index had relatively better classification accuracy. CONCLUSION Differences in base rates between the original sample of Martin et al. and the current one most likely affected positive predictive power of the new index. Although their performance validity has excellent specificity, the current results do not support the application of this index in the clinical evaluation of patients with traumatic brain injury when base rates of invalid performance differ markedly from those in the original study.
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Affiliation(s)
- Jacobus Donders
- Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | - Matthew Vos
- Department of Psychology, Calvin College, Grand Rapids, MI, USA
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Zhu P, Hussein NM, Tang J, Lin L, Wang Y, Li L, Shu K, Zou P, Xia Y, Bai G, Yan Z, Ye X. Prediction of Early Mortality Among Children With Moderate or Severe Traumatic Brain Injury Based on a Nomogram Integrating Radiological and Inflammation-Based Biomarkers. Front Neurol 2022; 13:865084. [PMID: 35669876 PMCID: PMC9163313 DOI: 10.3389/fneur.2022.865084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
Abstract
Inflammation-based scores have been increasingly used for prognosis prediction in neurological diseases. This study aimed to investigate the predictive value of inflammation-based scores combined with radiological characteristics in children with moderate or severe traumatic brain injury (MS-TBI). A total of 104 pediatric patients with MS-TBI were retrospectively enrolled and randomly divided into training and validation cohorts at a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of prognosis in pediatric patients with MS-TBI. A prognostic nomogram was constructed, and its predictive performance was validated in both the training and validation cohorts. Sex, admission platelet-to-lymphocyte ratio, and basal cistern status from initial CT findings were identified as independent prognostic predictors for children with MS-TBI in multivariate logistic analysis. Based on these findings, a nomogram was then developed and its concordance index values were 0.918 [95% confidence interval (CI): 0.837-0.999] in the training cohort and 0.86 (95% CI: 0.70-1.00) in the validation cohort, which significantly outperformed those of the Rotterdam, Marshall, and Helsinki CT scores. The proposed nomogram, based on routine complete blood count and initial CT scan findings, can contribute to individualized prognosis prediction and clinical decision-making in children with MS-TBI.
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Affiliation(s)
- Pingyi Zhu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nimo Mohamed Hussein
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jing Tang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lulu Lin
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Wang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lan Li
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kun Shu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pinfa Zou
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yikai Xia
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guanghui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Wenzhou Key Laboratory of Basic Science and Translational Research of Radiation Oncology, Wenzhou, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinjian Ye
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Oyesanya TO, Harris G, Cary MP, Byom L, Yang Q, Bettger JP. Age- and sex-specific predictors of inpatient rehabilitation facility discharge destination for adult patients with traumatic brain injury. Brain Inj 2021; 35:1529-1541. [PMID: 34543111 PMCID: PMC8678183 DOI: 10.1080/02699052.2021.1972453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE : To determine age- and sex-specific predictors of discharge destination among patients with traumatic brain injury (TBI) receiving inpatient rehabilitation facility (IRF) care. DESIGN : Secondary analysis of Uniform Data System for Medical Rehabilitation data. METHODS : Logistic regression of patients (N = 221,961) age ≥18, TBI diagnosis, admitted to IRF between 2002 and 2018. OUTCOME : Discharge destination (subacute vs. home/community settings). RESULTS : Approximately 16% were discharged to subacute vs. 84% home. Younger versus older adults had lower odds of subacute discharge [OR = 0.72; 95% CI: 0.69, 0.76]. Younger females had lower odds of subacute discharge (vs. home) than older females [OR = 0.68; 95% CI: 0.63, 0.74]; younger males had lower odds of subacute discharge (vs. home) than older males [OR = 0.74; 95% CI: 0.70, 0.78]. Younger females versus younger males had lower odds of subacute discharge (vs. home) [OR = 0.83; 95% CI: 0.79, 0.87]. Older females versus older males had lower odds of subacute discharge (vs. home) [OR = 0.93; 95% CI: 0.90, 0.97]. Predictors of discharge destination for age- and sex-stratified groups varied. CONCLUSIONS : Younger (vs. older) and female (vs. male) patients had lower odds of subacute discharge vs. home.
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Affiliation(s)
| | | | | | - Lindsey Byom
- University of North Carolina-Chapel Hill, Department of Allied Health Sciences
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Eliacin J, Yang Z, Kean J, Dixon BE. Characterizing health care utilization following hospitalization for a traumatic brain injury: a retrospective cohort study. Brain Inj 2021; 35:119-129. [PMID: 33356602 DOI: 10.1080/02699052.2020.1861650] [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: 03/02/2020] [Revised: 08/31/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
Objective: The purpose of this study was to characterize health services utilization among individuals hospitalized with a traumatic brain injury (TBI) 1-year post-injury.Methods: Using a retrospective cohort design, adult patients (n = 32, 042) hospitalized with a traumatic brain injury between 2005 and 2014 were selected from a statewide traumatic brain injury registry. Data on health services utilization for 1-year post-injury were extracted from electronic medical and administrative records. Descriptive statistics and logistic regression were used to characterize the cohort and a subgroup of superutilizers of health services.Results: One year after traumatic brain injury, 56% of participants used emergency department services, 80% received inpatient services, and 93% utilized outpatient health services. Superutilizers had ≥3 emergency department visits, ≥3 inpatient admissions, or ≥26 outpatient visits 1-year post-injury. Twenty-six percent of participants were superutilizers of emergency department services, 30% of inpatient services, and 26% of outpatient services. Superutilizers contributed to 81% of emergency department visits, 70% of inpatient visits, and 60% of outpatient visits. Factors associated with being a superutilizer included sex, race, residence, and insurance type.Conclusions: Several patient characteristics and demographic factors influenced patients' healthcare utilization post-TBI. Findings provide opportunities for developing targeted interventions to improve patients' health and traumatic brain injury-related healthcare delivery.
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Affiliation(s)
- Johanne Eliacin
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University - Indianapolis, Indianapolis, USA
- Health Services Research, Regenstrief Institute, Inc., Indianapolis, USA
| | - Ziyi Yang
- Department of Biostatistics, Indiana University-Purdue University - Indianapolis, Indianapolis, USA
| | - Jacob Kean
- Informatics, Decision-Enhancement and Analytic Sciences Center, Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, USA
- Department of Communication Sciences and Disorders, University of Utah School of Medicine, Salt Lake City, USA
| | - Brian E Dixon
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, USA
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Kim LH, Quon JL, Sun FW, Wortman KM, Adamson MM, Harris OA. Traumatic brain injury among female veterans: a review of sex differences in military neurosurgery. Neurosurg Focus 2019; 45:E16. [PMID: 30544324 DOI: 10.3171/2018.9.focus18369] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/10/2018] [Indexed: 11/06/2022]
Abstract
The impact of traumatic brain injury (TBI) has been demonstrated in various studies with respect to prevalence, morbidity, and mortality data. Many of the patients burdened with long-term sequelae of TBI are veterans. Although fewer in number, female veterans with TBI have been suggested to suffer from unique physical, mental, and social challenges. However, there remains a significant knowledge gap in the sex differences in TBI. Increased female representation in the military heralds an increased risk of TBI for female soldiers, and medical professionals must be prepared to address the unique health challenges in the face of changing demographics among the veteran TBI population. In this review, the authors aimed to present the current understanding of sex differences in TBI in the veteran population and suggest directions for future investigations.
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Affiliation(s)
- Lily H Kim
- 1The Defense and Veterans Brain Injury Center, VA Palo Alto Health Care System, Palo Alto.,2Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Jennifer L Quon
- 2Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Felicia W Sun
- 1The Defense and Veterans Brain Injury Center, VA Palo Alto Health Care System, Palo Alto.,3College of Medicine, University of Illinois, Chicago, Illinois
| | - Kristen M Wortman
- 1The Defense and Veterans Brain Injury Center, VA Palo Alto Health Care System, Palo Alto
| | - Maheen M Adamson
- 1The Defense and Veterans Brain Injury Center, VA Palo Alto Health Care System, Palo Alto.,2Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Odette A Harris
- 1The Defense and Veterans Brain Injury Center, VA Palo Alto Health Care System, Palo Alto.,2Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
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9
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Gupte R, Brooks W, Vukas R, Pierce J, Harris J. Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know. J Neurotrauma 2019; 36:3063-3091. [PMID: 30794028 PMCID: PMC6818488 DOI: 10.1089/neu.2018.6171] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is growing recognition of the problem of male bias in neuroscience research, including in the field of traumatic brain injury (TBI) where fewer women than men are recruited to clinical trials and male rodents have predominantly been used as an experimental injury model. Despite TBI being a leading cause of mortality and disability worldwide, sex differences in pathophysiology and recovery are poorly understood, limiting clinical care and successful drug development. Given growing interest in sex as a biological variable affecting injury outcomes and treatment efficacy, there is a clear need to summarize sex differences in TBI. This scoping review presents an overview of current knowledge of sex differences in TBI and a comparison of human and animal studies. We found that overall, human studies report worse outcomes in women than men, whereas animal studies report better outcomes in females than males. However, closer examination shows that multiple factors including injury severity, sample size, and experimental injury model may differentially interact with sex to affect TBI outcomes. Additionally, we explore how sex differences in mitochondrial structure and function might contribute to possible sex differences in TBI outcomes. We propose recommendations for future investigations of sex differences in TBI, which we hope will lead to improved patient management, prognosis, and translation of therapies from bench to bedside.
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Affiliation(s)
- Raeesa Gupte
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
| | - William Brooks
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- The University of Kansas Clinical and Translational Sciences Institute, University of Kansas Medical Center, Kansas City, Kansas
| | - Rachel Vukas
- School of Medicine, Dykes Library of Health Sciences, University of Kansas Medical Center, Kansas City, Kansas
| | - Janet Pierce
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Janna Harris
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas
- Hoglund Brain Center, University of Kansas Medical Center, Kansas City, Kansas
- Address correspondence to: Janna Harris, PhD, Hoglund Brain Imaging Center, MS 1052, 3901 Rainbow Boulevard, Kansas City, KS 66160
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A Repeated Measures Pilot Comparison of Trajectories of Fluctuating Endogenous Hormones in Young Women with Traumatic Brain Injury, Healthy Controls. Behav Neurol 2019; 2019:7694503. [PMID: 30891100 PMCID: PMC6390250 DOI: 10.1155/2019/7694503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 12/20/2022] Open
Abstract
Objective To compare baseline and 72-hour hormone levels in women with traumatic brain injury (TBI) and controls. Setting Hospital emergency department. Participants 21 women ages 18-35 with TBI and 21 controls. Design Repeated measures. Main Measures Serum samples at baseline and 72 hours; immunoassays for estradiol (E2), progesterone (PRO), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and cortisol (CORT); and health history. Results Women with TBI had lower E2 (p = 0.042) and higher CORT (p = 0.028) levels over time. Lower Glasgow Coma Scale (GSC) and OCs were associated with lower FSH (GCS p = 0.021; OCs p = 0.016) and higher CORT (GCS p = 0.001; OCs p = 0.008). Conclusion Acute TBI may suppress E2 and increase CORT in young women. OCs appeared to independently affect CORT and FSH responses. Future work is needed with a larger sample to characterize TBI effects on women's endogenous hormone response to injury and OC use's effects on post-TBI stress response and gonadal function, as well as secondary injury.
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Catecholamines and Paroxysmal Sympathetic Hyperactivity after Traumatic Brain Injury. J Neurotrauma 2017; 34:109-114. [DOI: 10.1089/neu.2015.4364] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
OBJECTIVE Traumatic brain injury (TBI) is the single largest cause of death and disability following injury worldwide. The aim of this study was to determine the demographic, clinical, medical and accident related trends for patients with TBI hospitalized in an urban level 1 Trauma Centre. METHODS Data were retrospectively collected on individuals (n = 5,642) who were admitted to the Traumatic Brain Injury Program of the McGill University Health Centre - Montreal General Hospital from 2000 to 2011. RESULTS Regression analysis showed a significant upward trend in the yearly number of cases as well as an upward trending by year in the proportion of TBI cases aged 70-years-old or more. The Injury Severity Scale scores were positively associated with year indicating a slight increase in injury severity over the years and there was an increase in patient psychological, social and medical premorbid complexity. In addition, the Extended Glasgow Outcome Scale score tended to become more severe over the years. There was a slight decrease in the proportion of discharges home and in the proportion of deaths. CONCLUSIONS These results will help to understand the impact of TBI in an urban Canadian level 1 Trauma Centre. This information should be used to develop public prevention strategies and to educate the community about the risk of TBI especially the risk of falls in the ageing population. These findings can also provide information to help health policy makers plan for future resources.
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Chan V, Mollayeva T, Ottenbacher KJ, Colantonio A. Sex-Specific Predictors of Inpatient Rehabilitation Outcomes After Traumatic Brain Injury. Arch Phys Med Rehabil 2016; 97:772-80. [PMID: 26836952 DOI: 10.1016/j.apmr.2016.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify sex-specific predictors of inpatient rehabilitation outcomes among patients with a traumatic brain injury (TBI) from a population-based perspective. DESIGN Retrospective cohort study. SETTING Inpatient rehabilitation. PARTICIPANTS Patients in inpatient rehabilitation for a TBI within 1 year of acute care discharge between 2008/2009 and 2011/2012 (N=1730, 70% men, 30% women). INTERVENTIONS None. MAIN OUTCOME MEASURES Inpatient rehabilitation length of stay, total FIM score, and motor and cognitive FIM ratings at discharge. RESULTS Sex, as a covariate in multivariable linear regression models, was not a significant predictor of rehabilitation outcomes. Although many of the predictors examined were similar across men and women, sex-specific multivariable models identified some predictors of rehabilitation outcome that are specific for men and women; mechanism of injury (P<.0001) was a significant predictor of functional outcome only among women, whereas comorbidities (P<.0001) was a significant predictor for men only. CONCLUSIONS Predictors of outcomes after inpatient rehabilitation differed by sex, providing evidence for a sex-specific approach in planning and resource allocation for inpatient rehabilitation services for patients with TBI.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - Tatyana Mollayeva
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | | | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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Outcome in Women with Traumatic Brain Injury Admitted to a Level 1 Trauma Center. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:263241. [PMID: 27355011 PMCID: PMC4897563 DOI: 10.1155/2014/263241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/04/2014] [Indexed: 11/28/2022]
Abstract
Background. The aim of this study was to compare acute outcome between men and women after sustaining a traumatic brain injury (TBI). Methods. A total of 5,642 patients admitted to the Traumatic Brain Injury Program of the McGill University Health Centre-Montreal General Hospital between 2000 and 2011 and diagnosed with a TBI were included in the study. The overall percentage of women with TBI was 30.6% (n = 1728). Outcome measures included the length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE), the functional independence measure instrument (FIM), discharge destination, and mortality rate. Results. LOS, GOSE, the FIM ratings, and discharge destination did not show significant differences between genders once controlling for several confounding variables and running the appropriate diagnostic tests (P < 0.05). However, women had less chance of dying during their acute care hospitalization than men of the same age, with the same TBI severity and following the same mechanism of injury. Although gender was a statistically significant predictor, its contribution in explaining variation in mortality was small. Conclusion. More research is needed to better understand gender differences in mortality; as to date, the research findings remain inconclusive.
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Saldanha CJ, Burstein SR, Duncan KA. Induced synthesis of oestrogens by glia in the songbird brain. J Neuroendocrinol 2013; 25:1032-8. [PMID: 23795693 DOI: 10.1111/jne.12067] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/13/2013] [Accepted: 06/18/2013] [Indexed: 12/30/2022]
Abstract
Studies on birds have long provided landmarks and touchstones in the fields of neuroendocrinology, immunology and neuroplasticity. The passerine brain is an excellent model for studying the actions of hormones, including steroids, on a diversity of behavioural endpoints. Oestrogens, for example, have profound effects on avian neuroanatomy and neurophysiology throughout life and, importantly, are synthesised at high levels within neurones of the songbird brain. More recently, aromatisation in another set of neural cells has been identified. Specifically, aromatase expression is induced in astrocytes and radial glia following disruption of the neuropil by multiple forms of perturbation. The avian brain, therefore, can be provided with high levels of oestrogens constitutively or via induction, by aromatisation in neurones and glia, respectively. In this review, we begin with the initial discovery of aromatisation by non-neuronal cells and discuss the mechanisms underlying the induction of aromatase expression in glial cells. We then focus on the emerging interactions between the neuroendocrine and neuroimmune systems with respect to brain injury. Next, we briefly review the extensive literature on the influence of glial aromatisation on neuroplasticity, and end with some recent data on sex differences in the induction of glial aromatase in the zebra finch. Throughout this review, we consider the unanswered questions and future studies that may emerge from these findings.
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Affiliation(s)
- C J Saldanha
- Department of Biology and Psychology, American University, Washington, DC, USA
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Niemeier JP, Marwitz JH, Walker WC, Davis LC, Bushnik T, Ripley DL, Ketchum JM. Are there cognitive and neurobehavioural correlates of hormonal neuroprotection for women after TBI? Neuropsychol Rehabil 2013; 23:363-82. [PMID: 23362827 DOI: 10.1080/09602011.2012.761944] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study examined possible cognitive correlates of hormonal neuroprotection following traumatic brain injury (TBI) using archival neuropsychological findings for 1563 individuals undergoing acute TBI rehabilitation between 1989 and 2002. Presumed age of menopause was based on the STRAW (Stages of Reproductive Aging) staging system (Soules, 2005; Soules et al., 2001) and general linear model (GLM) analysis of performance on neuropsychological testing by participants across gender and age groups (25-34, 35-44, 45-54, and 55-64) was performed. Hypotheses were (1) women with TBI in the oldest age group would have lower scores on neuropsychological tests and functional outcome measures than women in the younger groups, and (2) men in the oldest age group would have higher scores than women of the same age group. Analyses revealed that oldest females had significantly worse Trails B and SDMT written and oral scores than the youngest females. In addition, oldest females had significantly better Trails B, Rey AVLT and SDMT written scores than the oldest males. Possible cohort exposure to hormone replacement therapy, unknown hormonal status at time of testing, and sample-specific injury characteristics may have contributed to these findings.
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Affiliation(s)
- Janet P Niemeier
- Carolinas Rehabilitation, Carolinas Healthcare System, Charlotte, NC 28203, USA.
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Resnick EM, Mallampalli M, Carter CL. Current challenges in female veterans' health. J Womens Health (Larchmt) 2012; 21:895-900. [PMID: 22876756 DOI: 10.1089/jwh.2012.3644] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract Women in the U.S. military are technically barred from serving in combat specialties, positions, or units; however, since Operation Desert Storm, women have served in forward positions in greater numbers. This increased involvement in combat zones has resulted in exposures to trauma, injury, and a myriad of environmental hazards associated with modern war. Some of these hazards present new health risks specifically relevant to women who have been deployed to or recently returned from Iraq or Afghanistan or both. To address this evolving public health concern, the Society for Women's Health Research (SWHR) convened a 1-day interdisciplinary scientific conference, with speakers and attendees from civilian, military, and veteran settings. The purpose of the conference was to reveal the state-of-the-science on the health of the female veteran and to focus attention on recent advances in biomedical research related to female veterans' health. The following topics were discussed: mental health (posttraumatic stress disorder [PTSD] and depression), urogenital health, musculoskeletal health, and traumatic brain injury (TBI).
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Affiliation(s)
- Eileen M Resnick
- Society for Women's Health Research , 1025 Connecticut Avenue NW, Washington, DC 20036, USA.
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Schuett S, Zihl J. Does age matter? Age and rehabilitation of visual field disorders after brain injury. Cortex 2012; 49:1001-12. [PMID: 22622434 DOI: 10.1016/j.cortex.2012.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 04/04/2012] [Accepted: 04/17/2012] [Indexed: 11/25/2022]
Abstract
Homonymous visual field disorders (HVFD) are frequent and disabling consequences of acquired brain injury, particularly in older age. Their rehabilitation is therefore of great importance. Compensatory oculomotor therapy has been found to be effective in improving the associated functional impairments in reading and visual exploration. But older age is commonly considered to adversely affect practice-dependent functional plasticity and, thus, functional and rehabilitation outcome after acquired brain injury. The effect of age in the compensatory treatment of HVFD, however, has never been investigated hitherto. It remains unknown whether age determines not only patients' functional impairments but also the rehabilitation outcome and the required amount of treatment. We therefore present the first study to determine the effect of age in 38 patients with HVFD receiving compensatory oculomotor treatment for their reading and visual exploration impairments. We investigated whether older patients with HVFD (1) show more pronounced impairments and less spontaneous adaptation, (2) show lesser compensatory treatment-related improvement in reading and visual exploration, and (3) require a higher amount of treatment than younger patients. Our main finding is that older patients achieve the same treatment-induced improvements in reading and visual exploration with the same amount of treatment as younger patients; severity of functional impairment also did not differ between older and younger patients, at least in reading. Age does not seem to be a critical factor determining the functional and rehabilitation outcome in the compensatory treatment of HVFD. Older age per se is not necessarily associated with a decline in practice-dependent functional plasticity and adaptation. To the contrary, the effectiveness of compensatory treatment to reduce the functional impairments to a similar extent in younger and older patients with HVFD adds to the growing evidence for a life-long potential for adaptation to the adverse effects of brain injury.
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Affiliation(s)
- Susanne Schuett
- Institute of Applied Psychology, University of Vienna, Vienna, Austria.
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Larson MJ, Farrer TJ, Clayson PE. Cognitive control in mild traumatic brain injury: Conflict monitoring and conflict adaptation. Int J Psychophysiol 2011; 82:69-78. [DOI: 10.1016/j.ijpsycho.2011.02.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 02/24/2011] [Accepted: 02/28/2011] [Indexed: 11/26/2022]
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Relationship between psychiatric disorders and 1-year psychosocial outcome following traumatic brain injury. J Head Trauma Rehabil 2011; 26:79-89. [PMID: 21209565 DOI: 10.1097/htr.0b013e3182036799] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the relationship of psychiatric functioning with psychosocial functioning at 1 year following traumatic brain injury (TBI), after controlling for relevant demographic, injury-related, and concurrent factors. DESIGN Prospective 1-year longitudinal study. PARTICIPANTS Participants were 122 individuals with TBI and 88 proxy informants. SETTING Rehabilitation hospital. MAIN MEASURES The Structured Clinical Interview for DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision)) Axis I Disorders, Hospital Anxiety and Depression Scale, Sydney Psychosocial Reintegration Scale, and Glasgow Outcome Scale--Extended. RESULTS At 1 year postinjury, occupational activities were the area of most change after TBI followed by interpersonal relationships and independent living skills, according to the Sydney Psychosocial Reintegration Scale. The majority of participants were rated as having moderate disability on the Glasgow Outcome Scale--Extended. After controlling for relevant background factors, preinjury, acute postinjury, and concurrent psychiatric disorders were significantly related to 1-year psychosocial outcome. CONCLUSION Screening in the acute postinjury stage for presence of preinjury psychiatric history or current distress may help identify individuals who require more intensive rehabilitation and psychiatric support and more active postdischarge monitoring. Further research exploring potential causal mechanisms for these findings is required.
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Kim YJ. A systematic review of factors contributing to outcomes in patients with traumatic brain injury. J Clin Nurs 2011; 20:1518-32. [PMID: 21453293 DOI: 10.1111/j.1365-2702.2010.03618.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE To review, systematically, factors contributing to outcomes in patients with traumatic brain injury. BACKGROUND Traumatic brain injury is a leading cause of death and disability. Several studies have determined the significant predictors of outcomes after traumatic brain injury. The comprehensive identification of these reliable factors for traumatic brain injury is critical to both clinical practice and research. DESIGN Systematic literature review. METHODS Eligible studies that combined at least two variables to predict outcomes in patient with traumatic brain injury were identified via electronic database searches, footnote chasing and contact with clinical experts. Quality of selected studies was assessed in terms of internal and external validity using 15 questions. Two reviewers independently examined titles, abstracts and whether each met the predefined inclusion criteria. RESULTS A total of 46 studies which met review criteria were finally selected. Most studies satisfied internal validity in terms of validity of research variables and multivariate analysis, but few were validated externally. The following factors were significantly associated with unfavourable outcomes: sociodemographic factors such as older age, male gender, lower level of education; clinical factors such as lower Glasgow Coma Scale score, injury caused by motor vehicle crash, hypotension, hypoxia, increased intracranial pressure, no pupil reaction, hypo- or hyperglycaemia, anaemia, coagulopathy, hypo- or hyperthermia, abnormal level of electrolytes, duration of coma; higher level of computed tomography classification by Marshall category; type of intracerebral lesions. CONCLUSION Further studies on integrating the sociodemographic factors, the course of the clinical condition and a unified CT scoring system, are recommended for the evaluation and improvement of the prognosis of traumatic brain injury. RELEVANCE TO CLINICAL PRACTICE A systematic review of factors contributing to outcome for patients with traumatic brain injury will be invaluable in triage criteria, injury prognostication, care and discharge planning, resource use and patient and family counselling.
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Affiliation(s)
- Young-Ju Kim
- College of Nursing, Sungshin Women's University, Seoul, Korea.
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Saban KL, Smith BM, Collins EG, Pape TLB. Sex Differences in Perceived Life Satisfaction and Functional Status One Year After Severe Traumatic Brain Injury. J Womens Health (Larchmt) 2011; 20:179-86. [DOI: 10.1089/jwh.2010.2334] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karen L. Saban
- Center for Management of Complex Chronic Care, Edward Hines, Jr., Veterans Administration Hospital, Hines, Illinois
- Department of Health Management and Risk Reduction, Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois
| | - Bridget M. Smith
- Center for Management of Complex Chronic Care, Edward Hines, Jr., Veterans Administration Hospital, Hines, Illinois
- Health Services Research Program, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Eileen G. Collins
- Center for Management of Complex Chronic Care, Edward Hines, Jr., Veterans Administration Hospital, Hines, Illinois
- Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Theresa Louise-Bender Pape
- Center for Management of Complex Chronic Care, Edward Hines, Jr., Veterans Administration Hospital, Hines, Illinois
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinburg School of Medicine, Chicago, Illinois
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Graham JE, Radice-Neumann DM, Reistetter TA, Hammond FM, Dijkers M, Granger CV. Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury. Arch Phys Med Rehabil 2010; 91:43-50. [PMID: 20103395 DOI: 10.1016/j.apmr.2009.09.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 08/28/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Graham JE, Radice-Neumann DM, Reistetter TA, Hammond FM, Dijkers M, Granger CV. Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury. OBJECTIVE To assess the influence of sex and age on inpatient rehabilitation outcomes in a large national sample of older adults with traumatic brain injury (TBI). DESIGN Prospective case series. SETTING Eight hundred forty-eight inpatient rehabilitation facilities that subscribe to the Uniform Data System for Medical Rehabilitation. PARTICIPANTS Patients (n=18,413) age 65 years and older admitted for inpatient rehabilitation after TBI from 2005 through 2007. INTERVENTIONS None. MAIN OUTCOME MEASURES Rehabilitation length of stay, discharge FIM motor and cognitive ratings, discharge setting, and scheduled home health services at discharge. RESULTS Mean age +/- SD of the sample was 79+/-7 years, and 47% were women. In multivariable models, higher age was associated with shorter lengths of stay (P<.001), lower discharge FIM motor and cognitive ratings (P<.001), and greater odds of home health services at discharge (P<.001). Women demonstrated shorter lengths of stay (P=.006) and greater odds of being scheduled for home health services at discharge (P<.001) than men. The sex-by-age interaction term was not significant in any outcome model. Sex differences and trends were consistent across the entire age range of the sample. CONCLUSIONS Sex and age patterns in rehabilitation outcomes among older adults with TBI varied by outcome. The current findings related to rehabilitation length of stay may be helpful for facility-level resource planning. Additional studies are warranted to identify the factors associated with returning to home and to assess the long-term benefits of combined inpatient rehabilitation and home health services for older adults with TBI.
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Affiliation(s)
- James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.
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