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Giovanis E, Menon M, Perali F. Disability specific equivalence scales: a case-control approach applied to the cost of acquired brain injuries. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:643-672. [PMID: 35608742 DOI: 10.1007/s10754-022-09332-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
This study estimates the household costs resulting from acquired brain injuries in terms of a reduction in the standard of living. The application uses primary data collected in the Verona and Florence provinces of Italy integrating highly detailed health information with information about consumption, income, wealth, time-use and relational well-being describing the standard of living. In general, the estimates of disability costs in previous studies are obtained from survey data without a specific focus on individuals with disabilities but collect information on the general health status. In contrast, this study exploits highly detailed information on a sample of "cases" with a disability, whose intensity is measured by the highly precise European quality of life measure-5 domain-5 (EQ-5D) instrument, to be compared with a sample of "control" formed by households without disabled members. The disability scales have been estimated using a Structural Equation Modelling (SEM) based procedure. We then implement interpersonal comparisons on the health income dimension in a theoretically plausible way, testing the independence hypothesis of equivalence scales. Our study finds that on average disabled households need an additional amount of about €1800 per month to reach the same standard of livings as the non-disabled households corresponding to a scale of 1.78.
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Affiliation(s)
- Eleftherios Giovanis
- Faculty of Economics and Administrative Sciences, Department of International Trade and Business, İzmir Bakırçay University, Menemen, 35665, Izmir, Turkey.
| | - Martina Menon
- Department of Economics, University of Verona, Via Cantarane 24, 37129, Verona, Italy
| | - Federico Perali
- Department of Economics, University of Verona, Via Cantarane 24, 37129, Verona, Italy
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Huang S, Dipnall JF, Gabbe BJ, Giummarra MJ. Pain and mental health symptom patterns and treatment trajectories following road trauma: a registry-based cohort study. Disabil Rehabil 2022; 44:8029-8041. [PMID: 34871122 DOI: 10.1080/09638288.2021.2008526] [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: 01/18/2023]
Abstract
PURPOSE This study aimed to characterise recovery from pain and mental health symptoms, and identify whether treatment use facilitates recovery. METHODS Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry participants without neurotrauma who had transport injury claims with the Transport Accident Commission from 2007 to 2014 were included (n = 5908). Latent transition analysis of pain Numeric Rating Scale, SF-12, and EQ-5D-3L pain and mental health items from 6 to 12 months, and 12 to 24 months post-injury were used to identify symptom transitions. RESULTS Four transition groups were identified: transition to low problems by 12-months; transition to low problems at 24-months; stable low problems; and no transition from problems. Group-based trajectory modelling of pain and mental health treatments found three treatment trajectories: low/no treatment, a moderate treatment that declined to low treatment 3-12 months post-injury, and increasing treatment over time. Predictors of pain and mental health recovery transitions, identified using multinomial logistic regression, were primarily found to be non-modifiable socioeconomic and health-related characteristics (e.g., higher education, working pre-injury, and not having comorbidities), and low treatment trajectories. CONCLUSIONS Targeted and collaborative rehabilitation should be considered for people at risk of persistent pain or mental health symptoms to optimise their recovery, particularly patients with socioeconomic disadvantage.IMPLICATIONS FOR REHABILITATIONTwo-thirds of people experience pain and/or mental health within the first 24-months after hospitalization for road trauma, of whom only 6-7% recover by 12-months, and a further 6% recover by 24-months post-injury.There were three main trajectories of administrative records of treatments received in the first two years after injury: 76 and 83% had low treatment, 18 and 12% had moderate then declining treatment levels, and 6 and 5% had stable high treatment for pain or mental health, respectively.People who recovered from pain or mental health symptoms generally had lower treatment and higher socioeconomic position, highlighting that coordinated rehabilitation care should be prioritized for people living with socioeconomic disadvantage.
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Affiliation(s)
- Sherry Huang
- Institute for Social Neuroscience, ISN Psychology, Ivanhoe, Australia
| | - Joanna F Dipnall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,School of Medicine, Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Melita J Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield, Australia
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Neupane R, Yadav DK, Raut S, Kafle P. Auto-Craniotomy With Leaves Implantation on the Surface of the Brain Following a Road Traffic Accident. Cureus 2022; 14:e31631. [DOI: 10.7759/cureus.31631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
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Life Expectancy of 1-Year Survivors of Traumatic Brain Injury, 1988-2019: Updated Results From the TBI Model Systems. Arch Phys Med Rehabil 2021; 103:176-179. [PMID: 34462114 DOI: 10.1016/j.apmr.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/28/2021] [Accepted: 05/18/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To update the life expectancy estimates according to age, sex, mobility, and feeding skills reported in the 2015 study of Brooks et al. To examine trends in survival over the past decade. DESIGN Observational cohort study. SETTING Poisson regression and life table analysis applied to long-term follow-up data on United States (US) Traumatic Brain Injury (TBI) Model Systems patients recorded in the national database. Functional mobility and feeding skills were assessed with FIM. PARTICIPANTS A total of 14,803 persons with TBI during the years 1988-2019 who underwent inpatient rehabilitation and provided at least 1 long-term assessment of functional skills 1 year or more postinjury (N=14,803). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Survival, mortality rates, and life expectancy. RESULTS Life expectancy was lower than that of the age- and sex-matched general population. Older age and severity of functional impairments were risk factors for mortality (both P<.0001 in regression models). Among ambulatory individuals, mortality was 51% (95% confidence interval, 35%-69%) higher in men than women. Life expectancy of 20-year-old women who walked well (FIM ambulation score 7) was 55 (SE=0.8) additional years to age 75, representing a reduction of 6.9 years from the normal general population figure. For 20-year-old men who walked well, the life expectancy was 49 (SE=0.5) additional years, representing a reduction of 8.1 years from normal. Life expectancies for men and women who did not walk and were fed by others were much lower. There was no significant change in mortality rates during the study period (hazard ratio, 1.008; P=.07). CONCLUSIONS There has been no significant change in the long-term survival of persons with TBI in the US since the late 1980s. The life expectancies reported here are similar to those reported in the 2015 study of Brooks et al, although they are more precise because of the larger sample size and longer follow-up.
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Chan V, Hurst M, Petersen T, Liu J, Mollayeva T, Colantonio A, Sutton M, Escobar MD. A population-based sex-stratified study to understand how health status preceding traumatic brain injury affects direct medical cost. PLoS One 2020; 15:e0240208. [PMID: 33048973 PMCID: PMC7553294 DOI: 10.1371/journal.pone.0240208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/23/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To understand how pre-injury health status present five-years preceding traumatic brain injury (TBI) affects direct medical cost two years post-injury. METHODS Patients age ≥19 years in the emergency department (ED) or acute care for a TBI between April 1, 2007 and March 31, 2014 in Ontario, Canada (N = 55,669) were identified from population-based health administrative data. Forty-three factors of pre-injury health status (i.e., comorbidities and personal, social, and environmental factors) that were internally validated for the TBI population were assessed in this study. The outcome of interest was direct medical cost within two years of discharge. Sex-specific multivariable linear regressions were conducted to understand the associations between direct medical cost within two years of discharge and pre-injury health status. RESULTS Patients who received care in the ED (81.9% of total sample) incurred a median cost of $2,492/male patient (average $12,342/patient) and $3,508/female patient (average $65,285/patient) within two years of injury; 37 pre-injury factors were significantly associated with increased direct medical costs. Patients who first received care for their TBI in acute care (18.1%) incurred a median cost of $25,081/male patient (average $63,060/patient) and $30,277/female patient (average $65,285/patient) within two years of injury; 21 factors were significantly associated with increased direct medical costs. Among more prevalent factors, those associated with increased medical cost by at least 50% included mental health disorders, substance abuse, disorders or medical conditions frequently observed among the elderly, cardiovascular disorders, stroke and emergencies involving the brain, metabolic disorders and abdominal symptoms, conditions and symptoms of abdomen and pelvis, genitourinary disorders and disorders of prostate, and pulmonary abdominal and other emergencies. CONCLUSIONS Direct medical costs two years post-TBI differed significantly between patients with and without adverse pre-existing health status. Interdisciplinary teams to promote early identification of pre-existing health conditions and appropriate management and integration of these conditions in TBI care across the continuum of healthcare may be opportunities to reduce direct medical costs post-injury.
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Affiliation(s)
- Vincy Chan
- KITE-Toronto Rehab, University Health Network, Toronto, Ontario, Canada
- * E-mail:
| | - Mackenzie Hurst
- KITE-Toronto Rehab, University Health Network, Toronto, Ontario, Canada
| | - Tierza Petersen
- KITE-Toronto Rehab, University Health Network, Toronto, Ontario, Canada
| | - Jingqian Liu
- KITE-Toronto Rehab, University Health Network, Toronto, Ontario, Canada
| | - Tatyana Mollayeva
- KITE-Toronto Rehab, University Health Network, Toronto, Ontario, Canada
| | - Angela Colantonio
- KITE-Toronto Rehab, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell Sutton
- KITE-Toronto Rehab, University Health Network, Toronto, Ontario, Canada
| | - Michael D. Escobar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Excess Mortality Among Adults Hospitalized With Traumatic Brain Injury in Australia: A Population-Based Matched Cohort Study. J Head Trauma Rehabil 2020; 34:E1-E9. [PMID: 30418322 DOI: 10.1097/htr.0000000000000445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify and describe excess mortality attributable to traumatic brain injury (TBI) during the 12 months after hospitalization. DESIGN Population-based matched cohort study using linked hospital and mortality data. SETTING Australia. PARTICIPANTS Individuals 18 years and older who were hospitalized with a principal diagnosis of TBI in 2009 (n = 6929) and matched noninjured individuals randomly selected from the electoral roll (n = 6929). MAIN MEASURES Survival distributions were compared using a Kaplan-Meier plot with a log-rank test. Mortality rate ratios (MRRs) were computed using Cox proportional hazard regression with and without controlling for demographic characteristics and preexisting health status. RESULTS Individuals with TBI experienced significantly worse survival during the 12 months after hospitalization (χ = 640.9, df = 1, P < .001), and were more than 7.5 times more likely to die compared with their noninjured counterparts (adjusted MRR, 7.76; 95% confidence interval, 6.07-9.93). TBI was likely to be a contributory factor in 87% of deaths in the TBI cohort. Excess mortality was higher among males, younger age groups, and those with more severe TBI. CONCLUSION Excess mortality is high among individuals hospitalized with TBI and most deaths are attributable to the TBI. Increased primary and secondary preventive efforts are warranted to reduce the mortality burden of TBI.
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Phyland RK, McKay A, Olver J, Walterfang M, Hopwood M, Hicks AJ, Mortimer D, Ponsford JL. Use of olanzapine to treat agitation in traumatic brain injury: study protocol for a randomised controlled trial. Trials 2020; 21:662. [PMID: 32690072 PMCID: PMC7370410 DOI: 10.1186/s13063-020-04553-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background Agitation is common in the early stages of recovery from traumatic brain injury (TBI), when patients are in post-traumatic amnesia (PTA). Agitation is associated with risk of harm to patients and caregivers. Recent guidelines recommend that agitation during PTA is managed using environmental modifications. Agitation is also frequently treated pharmacologically, with the use of atypical antipsychotics such as olanzapine among the most common. This is despite a lack of well-designed studies to support the use of antipsychotics within this context. This study will be a double-blind, placebo-controlled randomised controlled trial. We will examine the efficacy, safety, cost-effectiveness and outcomes associated with the use of olanzapine for reducing agitation in patients in PTA following TBI over and above recommended environmental management. Methods Fifty-eight TBI rehabilitation inpatients who are in PTA and are agitated will receive olanzapine or placebo for the duration of PTA. All participants will additionally receive optimal environmental management for agitation. Measures of agitation, PTA and health will be undertaken at baseline. Treatment administration will begin at a dose of 5 mg daily and may be escalated to a maximum dose of 20 mg per day. Throughout the treatment period, agitation and PTA will be measured daily, and adverse events monitored weekly. Efficacy will be assessed by treatment group comparison of average Agitated Behaviour Scale scores during PTA. Participants will cease treatment upon emergence from PTA. Agitation levels will continue to be monitored for a further 2 weeks, post-treatment measures of health will be undertaken and cognitive and functional status will be assessed. Level of agitation and functional health will be assessed at hospital discharge. At 3 months post-discharge, functional outcomes and health service utilisation will be measured. Discussion This trial will provide crucial evidence to inform the management of agitation in patients in PTA following TBI. It will provide guidance as to whether olanzapine reduces agitation over and above recommended environmental management or conversely whether it increases or prolongs agitation and PTA, increases length of inpatient hospitalisation and impacts longer term cognitive and functional outcomes. It will also speak to the safety and cost-effectiveness of olanzapine use in this population. Trial registration ANZCTR ACTRN12619000284167. Registered on 25 February 2019
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Affiliation(s)
- Ruby K Phyland
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia. .,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia. .,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia.
| | - Adam McKay
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia.,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia.,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia.,Department of Psychology, Epworth HealthCare, 29 Erin Street, Richmond, Victoria, 3121, Australia
| | - John Olver
- Rehabilitation Medicine, Epworth HealthCare, 89 Bridge Rd, Richmond, Victoria, 3121, Australia
| | - Mark Walterfang
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North Block, Grattan Street, Parkville, Victoria, 3052, Australia.,Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, 3050, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, 30 Royal Parade, Parkville, Victoria, 3052, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Level 1 North Block, Grattan Street, Parkville, Victoria, 3052, Australia.,Albert Road Clinic Professorial Psychiatry Unit, University of Melbourne, 31 Albert Rd, Melbourne, Victoria, 3004, Australia
| | - Amelia J Hicks
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia.,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia.,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia
| | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Building H, Level 5, Caulfield Campus, Clayton, Victoria, 3145, Australia
| | - Jennie L Ponsford
- Monash Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia.,School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Road, Clayton, Victoria, 3800, Australia.,Turner Institute for Brain and Mental Health, Monash University, Level 5, 18 Innovation Walk, Clayton Campus, Clayton, Victoria, 3800, Australia
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Gates TM, Baguley IJ, Nott MT, Simpson GK. External causes of death after severe traumatic brain injury in a multicentre inception cohort: clinical description and risk factors. Brain Inj 2019; 33:821-829. [PMID: 30958696 DOI: 10.1080/02699052.2019.1600020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To characterize the clinical profile of patients dying from external causes (EC) following severe traumatic brain injury (TBI). Design and Methods: Data from 2545 patients forming the NSW-BIRP inception cohort discharged from post-acute inpatient rehabilitation between 1 July 1990 and 1 October 2007 were retrospectively reviewed. Standardized mortality ratios (SMRs) were calculated for EC sub-categories. Demographic, clinical and rehabilitation service factors were compared between deaths from EC, deaths from other causes (OC), and non-deceased. Clinical profiles of EC sub-categories were analysed descriptively. Results: Overall, patients with TBI were 5.2x more likely to die from EC relative to the general population. Risk of death was elevated in all EC sub-categories examined, with the largest risks relating to other accidental threats to breathing (SMR = 33.0; 95%CI = 13.79-60.45) and falls (SMR = 14.3; 95%CI = 5.01-28.39). The EC group were younger, more likely to have pre-injury psychiatric histories, less severe injuries, greater functional independence, and die earlier than the OC group. There was considerable heterogeneity in the clinical profiles of patients dying from different EC sub-categories. Conclusions: EC constitutes one of the largest causes of mortality following TBI in patients surviving beyond the post-acute phase. Potential implications for risk modification and prevention of premature and avoidable deaths are discussed.
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Affiliation(s)
- Thomas M Gates
- a Liverpool Brain Injury Rehabilitation Unit , Liverpool Hospital , Sydney , New South Wales , Australia
| | - Ian J Baguley
- b Brain Injury Rehabilitation Service , Westmead Hospital , Sydney , New South Wales , Australia
| | - Melissa T Nott
- c School of Community Health , Charles Sturt University , Albury , New South Wales , Australia
| | - Grahame K Simpson
- a Liverpool Brain Injury Rehabilitation Unit , Liverpool Hospital , Sydney , New South Wales , Australia.,d Brain Injury Rehabilitation Research Group , Ingham Institute of Applied Medical Research , Sydney , New South Wales , Australia.,e John Walsh Centre for Rehabilitation Research, Kolling Institute , University of Sydney , Sydney , New South Wales , Australia
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Kelly ML, Shammassian B, Roach MJ, Thomas C, Wagner AK. Craniectomy and Craniotomy in Traumatic Brain Injury: A Propensity-Matched Analysis of Long-Term Functional and Quality of Life Outcomes. World Neurosurg 2018; 118:e974-e981. [PMID: 30048790 DOI: 10.1016/j.wneu.2018.07.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report the comprehensive long-term functional and quality of life outcomes after craniectomy (CE) and craniotomy (CO) in individuals with traumatic brain injury (TBI). METHODS Information on all individuals with TBI who had undergone CE or CO were extracted from the TBI Model Systems database from 2002 to 2012. A 1:1 propensity matching with replacement technique was used to balance the baseline characteristics across groups. The matched sample was analyzed for outcomes during hospitalization, acute rehabilitation, and ≤2 years of follow-up. RESULTS We identified 1470 individuals who had undergone CE or CO. Individuals undergoing CE compared with CO demonstrated a longer length of stay in the hospital (median, 22 vs. 18 days; P < 0.0001) and acute rehabilitation (median 26 vs. 21 days; P < 0.0001). Individuals with CE had required rehospitalization more often by the 1-year follow-up point (39% vs. 25%; P < 0.0001) for reasons other than cranioplasty, including seizures (12% vs. 8%; P < 0.0001), neurologic events (i.e., hydrocephalus; 9% vs. 4%; P < 0.0001), and infections (10% vs 6%; P < 0.0001). Individuals with CE had significantly greater impairment using the Glasgow Outcome Scale-Extended, required more supervision, and were less likely to be employed at 1 and 2 years after TBI. No difference was observed in the satisfaction with life scale scores at 2 years. The Kaplan-Meier mortality estimates at 1 and 2 years showed no differences between the 2 groups (hazard ratio, 0.57; P = 0.4). CONCLUSION In a matched cohort, individuals undergoing CE compared with CO after TBI had a longer length of stay, decreased functional status, and more rehospitalizations. The survival at 2 years and the satisfaction with life scale scores were similar.
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Affiliation(s)
- Michael L Kelly
- Department of Neurosurgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.
| | - Berje Shammassian
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mary Jo Roach
- Center for Healthcare Research and Policy, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Charles Thomas
- Center for Healthcare Research and Policy, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, Neuroscience, Safar Center for Resuscitation Research, Center for Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Lu J, Roe C, Sigurdardottir S, Andelic N, Forslund M. Trajectory of Functional Independent Measurements during First Five Years after Moderate and Severe Traumatic Brain Injury. J Neurotrauma 2018; 35:1596-1603. [PMID: 29466920 PMCID: PMC6016092 DOI: 10.1089/neu.2017.5299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A better understanding of long-term functional recovery process for patients with traumatic brain injury (TBI) facilitates effective rehabilitations. The aim of this study was to classify and characterize patients with moderate-to-severe TBI based on their functional trajectories up to 5 years post-injury. The study included 121 patients with moderate-to-severe TBIs (International Classification of Diseases, Tenth Revision [ICD-10], S06.0-S06.9), 16-55 years of age, and admitted at Trauma Referral Hospital within 24 h of injury between 2005 and 2007. Demographics and injury characteristics were documented at the admission, and functional status was recorded at 3 months and 1 and 5 years post-injury using Functional Independence Measure motor (FIM-M) and cognitive (FIM-C) subscales. We used group-based trajectory models to classify patients' functional trajectories over a 5-year period. For FIM-M, three trajectories were identified: 8.2% of patients showed stable low recovery (13.6 ± 1.5, 17.9 ± 8.8, and 21.0 ± 17.9), 9.2% elevated good recovery (35.8 ± 14.5, 75.5 ± 12.4, and 85.5 ± 8.1), and 82.6% stable good recovery (89.0 ± 3.6, 90.3 ± 1.9, and 90.8 ± 1.0) at the three follow-up points, respectively. For FIM-C, four trajectories were revealed: 4.1% of patients showed stable low recovery (5.0 ± 0, 5.0 ± 0, and 5.0 ± 0), 12.6% delayed moderate recovery (8.9 ± 3.5, 20.6 ± 4.6, and 28.3 ± 3.8), 28.7% elevated good recovery (27.0 ± 3.8, 30.4 ± 7.3, and 31.1 ± 2.3), and 54.6% stable good recovery (32.8 ± 2.3, 34.6 ± 1.0, and 34.7 ± 1.0). The results suggest that three FIM-M and four FIM-C trajectories described various patterns of functional recovery 5 years after moderate-to-severe TBI, with stable good recovery being the most common trajectory. Identifying and characterizing the trajectory memberships should enable targeted rehabilitation programs, inform patient-centered care, and improve long-term outcomes.
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Affiliation(s)
- Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, Virginia
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Roe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solrun Sigurdardottir
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marit Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway
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Owens PW, Lynch NP, O'Leary DP, Lowery AJ, Kerin MJ. Six-year review of traumatic brain injury in a regional trauma unit: demographics, contributing factors and service provision in Ireland. Brain Inj 2018; 32:900-906. [PMID: 29683734 DOI: 10.1080/02699052.2018.1466366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) represents a significant burden of care for acute surgical services, particularly in the absence of on-site neurosurgical cover or sufficient post-acute rehabilitation facilities. We examine factors contributing to TBI, prolonged lengths of stay (LoS) and implications for hospital resources. Long-term outcomes are assessed. METHODS This is a retrospective cohort study of patients admitted to a regional trauma unit with TBI from 2008 to 2013. Patients with LoS > 48 h were assessed. Demographic, clinical and longitudinal mortality data were collected using electronic clinical and radiological systems and chart review. RESULTS A total of 690 patients presented with TBI from 2008 to 2013; 213 patients with LoS > 48 h were assessed. One hundred and thirty (61%) were male. Mean age was 56 years (±SD 24). Mechanical fall was the most frequent injury mechanism (n = 120/213, 56%). Twenty-five per cent were associated with alcohol consumption; these were more likely to be male, involved in an Road Traffic Accident (RTA) or assault and necessitate transfer to a neurosurgical unit (p < 0.001, p = 0.029, p < 0.001, p = 0.05). A total of 112 patients(53%) had a prolonged LoS (>2 weeks). Mean LoS was 20 days (±SD 35), increasing to 39 days for patients requiring neurosurgical intervention. The 12-month all-cause mortality rate was 12%. CONCLUSIONS TBIs result in significant utilisation of acute inpatient bed days. Improved rehabilitation services and strategies to reduce acute hospital LoS are warranted.
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Affiliation(s)
- Patrick W Owens
- a Department of Surgery , University Hospital Galway , Galway , Ireland.,b Discipline of Surgery , Lambe Institute for Translational Research, NUI Galway , Galway , Ireland
| | - Noel P Lynch
- a Department of Surgery , University Hospital Galway , Galway , Ireland.,b Discipline of Surgery , Lambe Institute for Translational Research, NUI Galway , Galway , Ireland
| | - Donal P O'Leary
- a Department of Surgery , University Hospital Galway , Galway , Ireland.,b Discipline of Surgery , Lambe Institute for Translational Research, NUI Galway , Galway , Ireland
| | - Aoife J Lowery
- a Department of Surgery , University Hospital Galway , Galway , Ireland.,b Discipline of Surgery , Lambe Institute for Translational Research, NUI Galway , Galway , Ireland
| | - Michael J Kerin
- a Department of Surgery , University Hospital Galway , Galway , Ireland.,b Discipline of Surgery , Lambe Institute for Translational Research, NUI Galway , Galway , Ireland
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Theadom A, Starkey N, Barker-Collo S, Jones K, Ameratunga S, Feigin V. Population-based cohort study of the impacts of mild traumatic brain injury in adults four years post-injury. PLoS One 2018; 13:e0191655. [PMID: 29385179 PMCID: PMC5791998 DOI: 10.1371/journal.pone.0191655] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/09/2018] [Indexed: 11/22/2022] Open
Abstract
There is increasing evidence that some people can experience persistent symptoms for up to a year following mild TBI. However, few longitudinal studies of mild TBI exist and the longer-term impact remains unclear. The purpose of this study is to determine if there are long-term effects of mild traumatic brain injury (TBI) four-years later. Adults (aged ≥16 years) identified as part of a TBI incidence study who experienced a mild-TBI four-years ago (N = 232) were compared to age-sex matched controls (N = 232). Sociodemographic variables, prior TBI and symptoms were assessed at the time of injury. Four years post-injury participants completed the Rivermead Post-Concussion Symptom Questionnaire, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index and the Participation Assessment with Recombined Tools. Analysis of covariance was used to compare differences between TBI cases four years post-injury and controls, controlling for prior TBI and depression. A multiple regression model was used to identify the predictors of increased symptoms and reduced participation. The mild-TBI sample experienced significantly increased self-reported cognitive symptoms (F = 19.90, p = <0.01) four years post-injury than controls. There were no differences between the groups for somatic (F = 0.02, p = 0.89) or emotional symptoms (F = 0.31, p = 0.58). Additionally, the mild-TBI group reported significantly poorer community participation across all three domains: productivity (F = 199.07, p = <0.00), social relations (F = 13.93, p = <0.00) and getting out and about (F = 364.69, p = <0.00) compared to controls. A regression model accounting for 41% of the variance in cognitive symptoms in TBI cases revealed a history of TBI, receiving acute medical attention and baseline cognitive symptoms, sleep quality, anxiety and depression were predictive of outcome. The results indicate that whilst somatic and emotional symptoms resolve over time, cognitive symptoms can become persistent and that mild TBI can impact longer-term community participation. Early intervention is needed to reduce the longer-term impact of cognitive symptoms and facilitate participation.
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Affiliation(s)
- Alice Theadom
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
- * E-mail:
| | - Nicola Starkey
- Department of Psychology, University of Waikato, Knighton Road, Waikato, New Zealand
| | | | - Kelly Jones
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
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Abstract
OBJECTIVES Evaluation of life expectancy (LE) post traumatic brain injury (TBI) is important for planning services for patients and for dealing with medico-legal aspects. We hypothesized that LE for patients who survived 2 years post injury is equal to that of the general population (GP). METHODS A cohort of 279 patients was assembled during a 5-year period and was followed for 22-27 years. During follow-up, 32 patients (11.5%) died, creating a huge censored data (88.5%). Analyses included standard mortality ratio (SMR), Kaplan-Meier method (KM), Cox proportional hazards regression analysis (PH) and calculations of life expectancy. RESULTS About 77% of the patients were under 35 years of age at injury. This age cut-off point yielded differences for survival longevity by χ2 tests (p < 0.0001), by KM analysis (p < 0.0001) and by Cox PH regression analysis (p < 0.0001, HR = 13.95). SMR for the entire cohort was 1.86. Shortening of LE in comparison with the GP is 3.58 years. Estimated shortening of LE by severity for mild, moderate and severe injury were -0.51, 4.11 and 13.77 years, respectively. CONCLUSIONS Patients with mild TBI have a LE similar to the GP, and a reduction in LE was closely related to moderate and severe brain injury.
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Affiliation(s)
- Zeev Groswasser
- a TBI Research Unit, Loewenstein Rehabilitation Hospital, Raanana, Clalit Health Services, and Sackler Faculty of Medicine , Tel-Aviv University , Israel
| | - Israela Peled
- a TBI Research Unit, Loewenstein Rehabilitation Hospital, Raanana, Clalit Health Services, and Sackler Faculty of Medicine , Tel-Aviv University , Israel
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Acute and subacute microRNA dysregulation is associated with cytokine responses in the rodent model of penetrating ballistic-like brain injury. J Trauma Acute Care Surg 2017; 83:S145-S149. [DOI: 10.1097/ta.0000000000001475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Patterns of health care use of injured adults: A population-based matched cohort study. Injury 2017; 48:1393-1399. [PMID: 28442203 DOI: 10.1016/j.injury.2017.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/03/2017] [Accepted: 04/12/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Healthcare use by traumatically injured individuals prior to and subsequent to their injury are not often explored for different types of injuries. This study aims to describe health care use 12 months preceding and 12 months following a traumatic injury by injury type and injury severity. METHOD Hospital and mortality data from three Australian states were linked in a population-based matched cohort study. Individuals ≥18 years who had an injury-related hospital admission in 2009 were identified as the injured cohort. A comparison cohort of non-injured people, matched 1:1 on age, gender and postcode of residence, was randomly selected from the electoral roll. Twelve-month pre- and post-index injury health service use was examined. Rates, adjusted rate ratios and attributable risk proportions were calculated by injury type and severity. RESULTS The injury cohort experienced higher 12-month pre- and post-injury hospital admissions than the non-injured group. By 6 to 7 months post-injury, the injury cohort had largely returned to their pre-injury health service use levels, except for injuries involving dislocations, sprains and strains and injury to nerves and spinal cord. Hip fracture (17.69 per 100 person-months) and poisoning (16.09 per 100 person-months) had the highest rates of post-injury hospitalisation in the injured cohort. The adjusted rate ratios (ARR) for post-injury hospitalisation were highest for poisoning (ARR: 3.77; 95% CI: 3.38-4.21) and injury to nerves and spinal cord (ARR: 2.73; 95% CI: 2.27-3.28). Poisoning also had the highest ARR for post-injury LOS (ARR: 5.31; 95% CI: 4.51-6.27). CONCLUSIONS After sustaining a traumatic injury, many individuals are readmitted to hospital and require ongoing care up to 12 months post-injury. That injured individuals post-injury largely return to their pre-index injury hospital use by 6 to 7 months could imply a return to pre-injury function and/or that other measures of health service use should be explored. Trauma services should consider long-term follow-up and support services for seriously injured patients post-hospital discharge.
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Taylor BC, Hagel Campbell E, Nugent S, Bidelspach DE, Kehle-Forbes SM, Scholten J, Stroupe KT, Sayer NA. Three Year Trends in Veterans Health Administration Utilization and Costs after Traumatic Brain Injury Screening among Veterans with Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:2567-2574. [PMID: 28482747 DOI: 10.1089/neu.2016.4910] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Examination of trends in Veterans Health Administration (VHA) healthcare utilization and costs among veterans with mild traumatic brain injury (mTBI) is needed to inform policy, resource allocation, and treatment planning. The objective of this study was to assess the patterns of VHA healthcare utilization and costs in the 3 years following TBI screening among veterans with mTBI, compared with veterans without TBI. A retrospective cohort study of veterans who underwent TBI screening in fiscal year 2010 was conducted. We used VHA healthcare utilization and associated costs by categories of care to compare veterans diagnosed with mTBI (n = 7318) with those who screened negative (n = 75,294) and those who screened positive but had TBI ruled out (n = 3324). Utilization and costs were greatest in year 1, dropped in year 2, and then leveled off. mTBI diagnosis was associated with high rates of utilization. Each year, healthcare costs for those with mTBI were two to three times higher than for those who screened negative, and 20-25% higher than for those who screened positive but had TBI ruled out. A significant proportion of healthcare use and costs for veterans with mTBI were associated with mental health service utilization. The relatively high rate of VHA utilization and costs associated with mTBI over time demonstrates the importance of long-term planning to meet these veterans' needs. Identifying and engaging patients with mTBI in effective mental health treatments should be considered a critical component of treatment planning.
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Affiliation(s)
- Brent C Taylor
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota.,2 Department of Medicine, University of Minnesota , Minneapolis, Minnesota.,3 Division of Epidemiology and Community Health, University of Minnesota , Minneapolis, Minnesota
| | - Emily Hagel Campbell
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Sean Nugent
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Douglas E Bidelspach
- 4 Physical Medicine and Rehabilitation Services, Veterans Health Administration, VA Medical Center , Lebanon , Pennsylvania.,5 Physical Medicine and Rehabilitation Program Office , Department of Veterans Affairs, Washington, DC
| | - Shannon M Kehle-Forbes
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota.,2 Department of Medicine, University of Minnesota , Minneapolis, Minnesota
| | - Joel Scholten
- 5 Physical Medicine and Rehabilitation Program Office , Department of Veterans Affairs, Washington, DC.,6 Department of Physical Medicine and Rehabilitation, Washington DC VA Medical Center , Washington, DC
| | - Kevin T Stroupe
- 7 Center of Innovation for Complex Chronic Healthcare , Hines VA Hospital, Hines, Illinois.,8 Department of Public Health Sciences, Loyola University Chicago , Maywood, Illinois
| | - Nina A Sayer
- 1 Center for Chronic Disease Outcomes Research , Department of Veterans Affairs Health Care System, Minneapolis, Minnesota.,2 Department of Medicine, University of Minnesota , Minneapolis, Minnesota.,9 Department of Psychiatry, University of Minnesota , Minneapolis, Minnesota
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Harbinson M, Zarshenas S, Cullen NK. Long-Term Functional and Psychosocial Outcomes After Hypoxic-Ischemic Brain Injury: A Case-Controlled Comparison to Traumatic Brain Injury. PM R 2017; 9:1200-1207. [PMID: 28512065 DOI: 10.1016/j.pmrj.2017.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/13/2017] [Accepted: 04/16/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite the increasing rate of survival from hypoxic-ischemic brain injury (HIBI), there is a paucity of evidence on the long-term functional outcomes after inpatient rehabilitation among these nontrauma patients compared to patients with traumatic brain injury (TBI). OBJECTIVES To compare functional and psychosocial outcomes of patients with HIBI to those of case-matched patients with TBI 4-11 years after brain insult. DESIGN Retrospective, matched case-controlled study. METHODS Data at the time of rehabilitation admission and discharge were collected as part of a larger acquired brain injury (ABI) database at Toronto Rehabilitation Institute (TRI) between 1999 and 2009. This study consisted of 11 patients with HIBI and 11 patients with TBI that attended the neuro-rehabilitation day program at TRI during a similar time frame and were matched on age, admission Functional Independence Measure (FIM) scores, and acute care length of stay (ALOS). At 4-11 years following brain insult, patients were reassessed using the FIM, Disability Rating Scale (DRS), Personal Health Questionnaire Depression Scale (PHQ-9), and the Mayo-Portland Adaptability Inventory 4 (MPAI-4). RESULTS At follow-up, patients with HIBI had significantly lower FIM motor and cognitive scores than patients with TBI (75.3 ± 20.6 versus 88.1 ± 4.78, P < .05, and 25.5 ± 5.80 versus 32.7 ± 2.54, P <.05, respectively) despite having a similar time frame postinsult (ie, 4-11 years). In addition, there were significant differences in motor and total FIM change from admission to follow-up between HIBI and TBI patients (P < .05). Patients with HIBI also had significantly lower scores on the DRS, PHQ-9, and total MPAI-4 at follow-up (P < .05). CONCLUSIONS The study results suggest that patients with HIBI achieve less long-term functional improvements compared to patients with TBI. Further research is warranted to compare the components of inpatient rehabilitation while adjusting for demographics and clinical characteristics between these 2 groups of patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Meredith Harbinson
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada(∗)
| | - Sareh Zarshenas
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada(†)
| | - Nora K Cullen
- Brain and Spine Program, Toronto Rehabilitation Institute-University Health Network, Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; West Park Healthcare Centre, 82 Buttonwood Ave, Toronto, ON M6M 2J5, Canada(‡).
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Tardif PA, Moore L, Boutin A, Dufresne P, Omar M, Bourgeois G, Bonaventure PL, Kuimi BLB, Turgeon AF. Hospital length of stay following admission for traumatic brain injury in a Canadian integrated trauma system: A retrospective multicenter cohort study. Injury 2017; 48:94-100. [PMID: 27839794 DOI: 10.1016/j.injury.2016.10.042] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/18/2016] [Accepted: 10/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is the leading cause of disability in children and young adults and costs CAD$3 billion annually in Canada. Stakeholders have expressed the urgent need to obtain information on resource use for TBI to improve the quality and efficiency of acute care in this patient population. We aimed to assess the components and determinants of hospital and ICU LOS for TBI admissions. METHODS We performed a retrospective multicenter cohort study on 11,199 adults admitted for TBI between 2007 and 2012 in an inclusive Canadian trauma system. Our primary outcome measure was index hospital LOS (admission to the hospital with the highest designation level). Index LOS was compared to total LOS (all consecutive admissions related to the injury). Expected LOS was calculated by matching TBI admissions to all-diagnosis hospital admissions by age, gender, and year of admission. LOS determinants were identified using multilevel linear regression. RESULTS Geometric mean total LOS was 1day longer than geometric mean index LOS (12.6 versus 11.7 days). Observed index and ICU LOS were respectively 4.2days and 2.5days longer than that expected according to all-diagnosis admissions. The six most important determinants of LOS were discharge destination, severity of concomitant injuries, extracranial complications, GCS, TBI severity, and mechanical ventilation, accounting for 80% of explained variation. CONCLUSIONS Results of this multicenter retrospective cohort study suggest that hospital and ICU LOS for TBI admissions are 56% and 119% longer than expected according to all-diagnosis admissions, respectively. In addition, hospital LOS is underestimated when only the index visit is considered and is largely influenced by discharge destination and extracranial complications, suggesting that improvements could be achieved with better discharge planning and interventions targeting prevention of in-hospital complications. This study highlights the importance of considering TBI patients as a distinct population when allocating resources or planning quality improvement interventions.
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Affiliation(s)
- Pier-Alexandre Tardif
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Lynne Moore
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Amélie Boutin
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Philippe Dufresne
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Madiba Omar
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Social and Preventative Medicine, Université Laval, Québec (QC), Canada.
| | - Gilles Bourgeois
- Institut National d'Excellence en Santé et en Services Sociaux, Montréal, Québec, Canada.
| | - Paule Lessard Bonaventure
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Neurological Sciences, Division of Neurosurgery, Université Laval, Québec (QC), Canada.
| | - Brice Lionel Batomen Kuimi
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada.
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Université Laval, Québec (QC), Canada; Department of Anesthesiology, Division of Critical Care Medicine, Université Laval, Québec (QC), Canada.
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Ramli R, Oxley J. Motorcycle helmet fixation status is more crucial than helmet type in providing protection to the head. Injury 2016; 47:2442-2449. [PMID: 27645615 DOI: 10.1016/j.injury.2016.09.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/12/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In Malaysia, motorcyclists continue to outnumber other road users in injuries and deaths. The objective of this study was to determine the association between helmet fixation and helmet type with head injury and severity of head injury among Malaysian motorcyclists. METHODS The study design was a prospective cross-sectional study. The participants involved injured motorcyclists who were admitted in five selected hospitals in Klang Valley, Malaysia. Participants who sustained head injury were selected as the cases while those with injury below the neck (IBN) were selected as the controls. Questionnaire comprising motorcyclist, vehicle, helmet and crash factors was examined. Diagnoses of injuries were obtained from the participants' medical records. RESULTS The total subjects with head injuries were 404 while those with IBN were 235. Majority of the cases (76.2%) and controls (80.4%) wore the half-head and open-face helmets, followed by the tropical helmets (5.4% and 6.0% of the cases and controls, respectively). Full-face helmets were used by 1.2% of the cases and 4.7% of the controls. 5.7% of the cases and 6.0% of the controls did not wear a helmet. 32.7% of the cases and 77.4% of the controls had their helmets fixed. Motorcyclists with ejected helmets were five times as likely to sustain head injury [adjusted odds ratio, AOR 5.73 (95% CI 3.38-9.73)] and four times as likely to sustain severe head injury [AOR of 4.83 (95% CI 2.76-8.45)]. The half head and open face helmets had AOR of 0.24 (95% CI 0.10-0.56) for severe head injury when compared to motorcyclists who did not wear a helmet. CONCLUSION Helmet fixation is more effective than helmet type in providing protection to the motorcyclists.
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Affiliation(s)
- Roszalina Ramli
- Department of Oral and Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Jennie Oxley
- Monash Injury Research Institute (MIRI), Monash University, Victoria, Australia.
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Wright CJ, Zeeman H, Biezaitis V. Holistic Practice in Traumatic Brain Injury Rehabilitation: Perspectives of Health Practitioners. PLoS One 2016; 11:e0156826. [PMID: 27270604 PMCID: PMC4894634 DOI: 10.1371/journal.pone.0156826] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/22/2016] [Indexed: 11/24/2022] Open
Abstract
Given that the literature suggests there are various (and often contradictory) interpretations of holistic practice in brain injury rehabilitation and multiple complexities in its implementation (including complex setting, discipline, and client-base factors), this study aimed to examine the experiences of practitioners in their conceptualization and delivery of holistic practice in their respective settings. Nineteen health practitioners purposively sampled from an extensive Brain Injury Network in Queensland, Australia participated in individual interviews. A systematic text analysis process using Leximancer qualitative analysis program was undertaken, followed by manual thematic analysis to develop overarching themes. The findings from this study have identified several items for future inter-professional development that will not only benefit the practitioners working in brain injury rehabilitation settings, but the patients and their families as well.
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Affiliation(s)
- Courtney J. Wright
- School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
- RECOVER Injury Research Centre, Griffith University, Meadowbrook, QLD, Australia
| | - Heidi Zeeman
- School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
- RECOVER Injury Research Centre, Griffith University, Meadowbrook, QLD, Australia
| | - Valda Biezaitis
- ROBIN Team, Mater Children’s Hospital, South Brisbane, QLD, Australia
- Improving Treatment of Disease, Mater Research, South Brisbane, QLD, Australia
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Saverino C, Swaine B, Jaglal S, Lewko J, Vernich L, Voth J, Calzavara A, Colantonio A. Rehospitalization After Traumatic Brain Injury: A Population-Based Study. Arch Phys Med Rehabil 2016; 97:S19-25. [DOI: 10.1016/j.apmr.2015.04.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/15/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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Brooks JC, Shavelle RM, Strauss DJ, Hammond FM, Harrison-Felix CL. Long-Term Survival After Traumatic Brain Injury Part I: External Validity of Prognostic Models. Arch Phys Med Rehabil 2015; 96:994-999.e2. [DOI: 10.1016/j.apmr.2015.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/14/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
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Cranial vault trauma and selective mortality in medieval to early modern Denmark. Proc Natl Acad Sci U S A 2015; 112:1721-6. [PMID: 25624493 DOI: 10.1073/pnas.1412511112] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
To date, no estimates of the long-term effect of cranial vault fractures on the risk of dying have been generated from historical or prehistoric skeletons. Excess mortality provides a perspective on the efficacy of modern treatment, as well as the human cost of cranial injuries largely related to interpersonal violence in past populations. Three medieval to early modern Danish skeletal samples are used to estimate the effect of selective mortality on males with cranial vault injuries who survived long enough for bones to heal. The risk of dying for these men was 6.2 times higher than it was for their uninjured counterparts, estimated through a simulation study based on skeletal observations. That is about twice the increased risk of dying experienced by modern people with traumatic brain injuries. The mortality data indicate the initial trauma was probably often accompanied by brain injury. Although the latter cannot be directly observed in skeletal remains, it can be inferred through the relative risks of dying. The ability to identify the effects of selective mortality in this skeletal sample indicates it must be taken into account in paleopathological research. The problem is analogous to extrapolating from death register data to modern communities, so epidemiological studies based on mortality data have the same inherent possibility of biases as analyses of ancient skeletons.
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Accelerated death rate in population-based cohort of persons with traumatic brain injury. J Head Trauma Rehabil 2015; 29:E8-E19. [PMID: 23835874 DOI: 10.1097/htr.0b013e3182976ad3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the influence of preexisting heart, liver, kidney, cancer, stroke, and mental health problems and examine the influence of low socioeconomic status on mortality after discharge from acute care facilities for individuals with traumatic brain injury. PARTICIPANTS Population-based retrospective cohort study of 33695 persons discharged from acute care hospital with traumatic brain injury in South Carolina, 1999-2010. MAIN MEASURES Days elapsing from the dates of injury to death established the survival time (T). Data were censored at the 145th month. Multivariable Cox regression was used to examine the independent effect of the variables on death. Age-adjusted cumulative probability of death for each chronic disease of interest was plotted. RESULTS By the 70th month of follow-up, rate of death was accelerated from 10-fold for heart diseases to 2.5-fold for mental health problems. Adjusted hazard ratios for diseases of the heart (2.13), liver-renal (3.25), cancer (2.64), neurological diseases and stroke (2.07), diabetes (1.89), hypertension (1.43), and mental health problems (1.59) were highly significant (each with P < .001). Compared with persons with private insurance, the hazard ratio was significantly elevated with Medicaid (1.67), Medicare (1.54), and uninsured (1.27) (each with P < .001). CONCLUSION Specific chronic diseases strongly influenced postdischarge mortality after traumatic brain injury. Low socioeconomic status as measured by the type of insurance elevated the risk of death.
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Mathias JL, Harman-Smith Y, Bowden SC, Rosenfeld JV, Bigler ED. Contribution of psychological trauma to outcomes after traumatic brain injury: assaults versus sporting injuries. J Neurotrauma 2014; 31:658-69. [PMID: 24228916 DOI: 10.1089/neu.2013.3160] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clinical research into outcomes after traumatic brain injury (TBI) frequently combines injuries that have been sustained through different causes (e.g., car accidents, assaults, and falls), the effect of which is not well understood. This study examined the contribution of injury-related psychological trauma—which is more commonly associated with specific types of injuries—to outcomes after nonpenetrating TBI in order to determine whether it may be having a differential effect in samples containing mixed injuries. Data from three groups that were prospectively recruited for two larger studies were compared: one that sustained a TBI as a result of physical assaults (i.e., psychologically traumatizing) and another as a result of sporting injuries (i.e., nonpsychologically traumatizing), as well as an orthopedic control group (OC). Psychosocial and emotional (postconcussion symptoms, injury-related stress, and depression), cognitive (memory, abstract reasoning, problem solving, and verbal fluency), and functional (general outcome; resumption of home, social, and work roles) outcomes were all assessed. The TBI(assault) group reported significantly poorer psychosocial and emotional outcomes and higher rates of litigation (criminal rather than civil) than both the TBI(sport) and OC groups approximately 6 months postinjury, but there were no differences in the cognitive or functional outcomes of the three groups. The findings suggest that the cause of a TBI may assist in explaining some of the differences in outcomes of people who have seemingly comparable injuries. Involvement in litigation and the cause of an injury may also be confounded, which may lead to the erroneous conclusion that litigants have poorer outcomes.
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Harrison-Felix C, Pretz C, Hammond FM, Cuthbert JP, Bell J, Corrigan J, Miller AC, Haarbauer-Krupa J. Life Expectancy after Inpatient Rehabilitation for Traumatic Brain Injury in the United States. J Neurotrauma 2014; 32:1893-901. [PMID: 25057965 DOI: 10.1089/neu.2014.3353] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study characterized life expectancy after traumatic brain injury (TBI). The TBI Model Systems (TBIMS) National Database (NDB) was weighted to represent those ≥16 years of age completing inpatient rehabilitation for TBI in the United States (US) between 2001 and 2010. Analyses included Standardized Mortality Ratios (SMRs), Cox regression, and life expectancy. The US mortality rates by age, sex, race, and cause of death for 2005 and 2010 were used for comparison purposes. Results indicated that a total of 1325 deaths occurred in the weighted cohort of 6913 individuals. Individuals with TBI were 2.23 times more likely to die than individuals of comparable age, sex, and race in the general population, with a reduced average life expectancy of 9 years. Independent risk factors for death were: older age, male gender, less-than-high school education, previously married at injury, not employed at injury, more recent year of injury, fall-related TBI, not discharged home after rehabilitation, less functional independence, and greater disability. Individuals with TBI were at greatest risk of death from seizures; accidental poisonings; sepsis; aspiration pneumonia; respiratory, mental/behavioral, or nervous system conditions; and other external causes of injury and poisoning, compared with individuals in the general population of similar age, gender, and race. This study confirms prior life expectancy study findings, and provides evidence that the TBIMS NDB is representative of the larger population of adults receiving inpatient rehabilitation for TBI in the US. There is an increased risk of death for individuals with TBI requiring inpatient rehabilitation.
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Affiliation(s)
| | | | - Flora M Hammond
- 2 Rehabilitation Hospital of Indiana , Indianapolis, India na
| | | | - Jeneita Bell
- 3 Traumatic Brain Injury Team, Health Systems and Trauma Systems Branch, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Altanta, Georgia
| | - John Corrigan
- 4 Department of Physical Medicine and Rehabilitation, Ohio State University , Columbus, Ohio
| | - A Cate Miller
- 5 National Institute on Disability and Rehabilitation Research , United States Department of Education, Washington, DC
| | - Juliet Haarbauer-Krupa
- 3 Traumatic Brain Injury Team, Health Systems and Trauma Systems Branch, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Altanta, Georgia
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Long-term survival after traumatic brain injury: a population-based analysis controlled for nonhead trauma. J Head Trauma Rehabil 2014; 29:E1-8. [PMID: 23381021 DOI: 10.1097/htr.0b013e318280d3e6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the contribution of co-occurring nonhead injuries to hazard of death after traumatic brain injury (TBI). PARTICIPANTS A random sample of Olmsted County, Minnesota, residents with confirmed TBI from 1987 through 1999 was identified. DESIGN Each case was assigned an age- and sex-matched, non-TBI "regular control" from the population. For "special cases" with accompanying nonhead injuries, 2 matched "special controls" with nonhead injuries of similar severity were assigned. MEASURES Vital status was followed from baseline (ie, injury date for cases, comparable dates for controls) through 2008. Cases were compared first with regular controls and second with regular or special controls, depending on case type. RESULTS In total, 1257 cases were identified (including 221 special cases). For both cases versus regular controls and cases versus regular or special controls, the hazard ratio was increased from baseline to 6 months (10.82 [2.86-40.89] and 7.13 [3.10-16.39], respectively) and from baseline through study end (2.92 [1.74-4.91] and 1.48 [1.09-2.02], respectively). Among 6-month survivors, the hazard ratio was increased for cases versus regular controls (1.43 [1.06-2.15]) but not for cases versus regular or special controls (1.05 [0.80-1.38]). CONCLUSIONS Among 6-month survivors, accounting for nonhead injuries resulted in a nonsignificant effect of TBI on long-term mortality.
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Sareen J. Posttraumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:460-7. [PMID: 25565692 PMCID: PMC4168808 DOI: 10.1177/070674371405900902] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 05/01/2014] [Indexed: 01/19/2023]
Abstract
During the last 30 years, there has been a substantial increase in the study of posttraumatic stress disorder (PTSD). Several high-profile traumatic events, such as the wars in Afghanistan and Iraq, and the terrorist attacks of September 11 on the World Trade Center, have led to a greater public interest in the risk and protective factors for PTSD. In this In Review paper, I discuss some of the important advances in PTSD. The paper provides a concise review of the evolution of PTSD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, impact of PTSD in the community, an overview of the established risk factors for developing PTSD, and assessment and treatment. Throughout the paper, controversies and clinical implications are discussed.
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Affiliation(s)
- Jitender Sareen
- Professor of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Population-based incidence and 5-year survival for hospital-admitted traumatic brain and spinal cord injury, Western Australia, 2003-2008. J Neurol 2014; 261:1726-34. [PMID: 24952617 DOI: 10.1007/s00415-014-7411-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
This study aimed at analysing first-time hospitalisations for traumatic brain injury (TBI) and spinal cord injury (SCI) in Western Australia (WA), in terms of socio-demographic profile, cause of injury, relative risks and survival, using tabular and regression analyses of linked hospital discharge and mortality census files and comparing results with published standardised mortality rates (SMRs) for TBI. Participants were all 9,114 first hospital admissions for TBI or SCI from 7/2003 to 6/2008, linked to mortality census data through 12/2008, and the main outcome measures were number of cases by cause, SMRs in hospital and post-discharge by year through year 5. Road crashes accounted for 34 % of hospitalised TBI and 52 % of hospitalised SCI. 8,460 live TBI discharges experienced 580 deaths during 24,494 person-years of follow-up. The life-table expectation of deaths in the cohort was 164. Post-discharge SMRs were 7.66 in year 1, 3.86 in year 2 and averaged 2.31 in years 3 through 5. 317 live SCI discharges experienced 18 deaths during 929 years of follow-up. Post-discharge SMRs were 7.36 in year 1 and a fluctuating average of 2.13 in years 2 through 5. Use of data from model systems does not appear to yield biased SMRs. Similarly no systematic variation was observed between all-age studies and the more numerous studies that focused on those aged 14 to 16 and older. Based on two studies, SMRs for TBI, however, may be higher in year 2 post-discharge in Australia than elsewhere. That possibility and its cause warrant exploration. Expanding public TBI/SCI compensation in WA from road crash to all causes might triple TBI compensation and double SCI compensation.
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Munce SEP, Laan RV, Levy C, Parsons D, Jaglal SB. Systems analysis of community and health services for acquired brain injury in Ontario, Canada. Brain Inj 2014; 28:1042-51. [DOI: 10.3109/02699052.2014.890744] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Collie A, Prang KH. Patterns of healthcare service utilisation following severe traumatic brain injury: an idiographic analysis of injury compensation claims data. Injury 2013; 44:1514-20. [PMID: 23566704 DOI: 10.1016/j.injury.2013.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 03/04/2013] [Accepted: 03/10/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The rate and extent of recovery after severe traumatic brain injury (TBI) is heterogeneous making prediction of likely healthcare service utilisation (HSU) difficult. Patterns of HSU derived from nomothetic samples do not represent the diverse range of outcomes possible within this patient group. Group-based trajectory model is a semi-parametric statistical technique that seeks to identify clusters of individuals whose outcome (however measured) follows a similar pattern of change over time. AIM To identify and characterise patterns of HSU in the 5-year period following severe TBI. METHODS Detailed healthcare treatment payments data in 316 adults with severe TBI (Glasgow Coma Scale score 3-8) from the transport accident compensation system in the state of Victoria, Australia was accessed for this analysis. A semi-parametric group-based trajectory analytical technique for longitudinal data was applied to monthly observation counts of HSU data to identify distinct clusters of participants' trajectories. Comparison between trajectory groups on demographic, injury, disability and compensation relevant outcomes was undertaken. RESULTS Four distinct patterns (trajectories) of HSU were identified in the sample. The first trajectory group comprised 27% of participants and displayed a rapid decrease in HSU in the first year post-injury. The second group comprised 24% of participants and showed a sharp peak in HSU during the first 12 months post-injury followed by a decline over time. The third group comprised 32% of participants and showed a slight peak in HSU in the first few months post-injury and then a slow decline over time. The fourth group comprised 17% of participants and displayed a steady rise in HSU up to 30 months post-injury, followed by a gradual decline to a level consistent with that received in the first months post-injury. Significant differences were observed between groups on factors such as age, injury severity, and use of disability services. CONCLUSIONS There is substantial variation in patterns of HSU following severe TBI. Idiographic analysis can provide rich information for describing and understanding the resources required to help people with TBI.
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Affiliation(s)
- A Collie
- Institute for Safety Compensation and Recovery Research, Monash University, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Australia.
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Andruszkow H, Urner J, Deniz E, Probst C, Grün O, Lohse R, Frink M, Hildebrand F, Zeckey C. Subjective impact of traumatic brain injury on long-term outcome at a minimum of 10 years after trauma- first results of a survey on 368 patients from a single academic trauma center in Germany. Patient Saf Surg 2013; 7:32. [PMID: 24112807 PMCID: PMC3853225 DOI: 10.1186/1754-9493-7-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/07/2013] [Indexed: 11/22/2022] Open
Abstract
Background Traumatic Brain Injury (TBI) may lead to significant impairments in personal, social and professional life. However, knowledge of the influence on long-term outcome after TBI is sparse. We therefore aimed to investigate the subjective effects of TBI on long-term outcome at a minimum of 10 years after trauma in one of the largest study populations in Germany. Methods The current investigation represents a retrospective cohort study at a level I trauma center including physical examination or standardized questionnaires of patients with mild, moderate or severe isolated TBI with a minimum follow-up of 10 years. We investigated the subjective physical, psychological and social outcome evaluating the Glasgow Outcome Scale, short-form 12, and social as well as vocational living circumstances. Results 368 patients aged 0 to 88 years were included. Patients with severe TBI were younger compared to patients with moderate or mild TBI (p < 0.05). Patients with severe TBI lived more often as single after the trauma impact. A significantly worse outcome was associated with higher severity of TBI resulting in an increased incidence of mental disability. A professional decline was analyzed in case of severe TBI resulting in significant loss of salary. Conclusions The severity of TBI significantly influenced the subjective social and living conditions. Subjective mental and physical outcome as well as professional life depended on the severity of TBI 10 years after the injury.
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Affiliation(s)
- Hagen Andruszkow
- Department for Trauma and Reconstructive Surgery, University Hospital Aachen, Pauwelsstraße 30, Aachen 52074 Germany.
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McLean AM, Jarus T, Hubley AM, Jongbloed L. Associations between social participation and subjective quality of life for adults with moderate to severe traumatic brain injury. Disabil Rehabil 2013; 36:1409-18. [DOI: 10.3109/09638288.2013.834986] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Does additional head trauma affect the long-term outcome after upper extremity trauma in multiple traumatized patients: is there an additional effect of traumatic brain injury? Clin Orthop Relat Res 2013; 471:2899-905. [PMID: 23657878 PMCID: PMC3734407 DOI: 10.1007/s11999-013-3031-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Musculoskeletal injuries are common in patients with multiple trauma resulting in pain, functional deficits, and disability. Traumatic brain injuries (TBIs) are common in severely injured patients potentially resulting in neurological impairment and permanent disability that would add to that from the musculoskeletal injuries. However, it is unclear to what degree the combination affects impairment. QUESTIONS/PURPOSES We therefore asked whether added upper extremity injuries or TBI worsened the functional, psychological, and vocational status in multiple trauma patients. METHODS We retrospectively reviewed 281 patients with multiple trauma: 229 with upper extremity injuries but without TBI (Group I), 32 with concomitant upper extremity injuries and TBI (Group II), and 20 with TBI but no upper extremity injuries (Group III). We assessed patients with the Glasgow Outcome Score (GOS), Hannover Score for Polytrauma Outcome, SF-12 (Physical Component Summary Score and Mental Component Summary Score), medical aid requirements, need of psychological support, and vocational living circumstances. The minimum followup was 10 years (median, 17.5 years; range, 10-28 years). RESULTS Additional TBI in multiple trauma patients led to reduced function (GOS: Group I: 4.9 ± 0.2, Group II: 4.5 ± 0.7, Group III: 4.5 ± 0.8) resulting in vocational restrictions (job change: Group I: 74%, Group II: 91%, Group III: 90%). The combination of upper extremity and TBIs did not result in worse long-term scores compared with TBI alone. CONCLUSIONS Rehabilitation and social reintegration in multiple trauma patients with TBI requires particular emphasis to minimize disability and vocational isolation. Musculoskeletal injuries should not be neglected to ensure the maximum extremity function given the impaired cognitive functions after TBI.
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Brooks JC, Strauss DJ, Shavelle RM, Paculdo DR, Hammond FM, Harrison-Felix CL. Long-term disability and survival in traumatic brain injury: results from the National Institute on Disability and Rehabilitation Research Model Systems. Arch Phys Med Rehabil 2013; 94:2203-9. [PMID: 23872079 DOI: 10.1016/j.apmr.2013.07.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 07/02/2013] [Accepted: 07/05/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To document long-term survival in 1-year survivors of traumatic brain injury (TBI); to compare the use of the Disability Rating Scale (DRS) and FIM as factors in the estimation of survival probabilities; and to investigate the effect of time since injury and secular trends in mortality. DESIGN Cohort study of 1-year survivors of TBI followed up to 20 years postinjury. Statistical methods include standardized mortality ratio, Kaplan-Meier survival curve, proportional hazards regression, and person-year logistic regression. SETTING Postdischarge from rehabilitation units. PARTICIPANTS Population-based sample of persons (N=7228) who were admitted to a TBI Model Systems facility and survived at least 1 year postinjury. These persons contributed 32,505 person-years, with 537 deaths, over the 1989 to 2011 study period. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Survival. RESULTS Survival was poorer than that of the general population (standardized mortality ratio=2.1; 95% confidence interval, 1.9-2.3). Age, sex, and functional disability were significant risk factors for mortality (P<.001). FIM- and DRS-based proportional hazards survival models had comparable predictive performance (C index: .80 vs .80; Akaike information criterion: 11,005 vs 11,015). Time since injury and current calendar year were not significant predictors of long-term survival (both P>.05). CONCLUSIONS Long-term survival prognosis in TBI depends on age, sex, and disability. FIM and DRS are useful prognostic measures with comparable statistical performance. Age- and disability-specific mortality rates in TBI have not declined over the last 20 years. A survival prognosis calculator is available online (http://www.LifeExpectancy.org/tbims.shtml).
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Life expectancy following rehabilitation: a NIDRR Traumatic Brain Injury Model Systems study. J Head Trauma Rehabil 2013; 27:E69-80. [PMID: 23131972 DOI: 10.1097/htr.0b013e3182738010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize overall and cause-specific mortality and life expectancy among persons who have completed inpatient traumatic brain injury rehabilitation and to assess risk factors for mortality. DESIGN Prospective cohort study. SETTING The Traumatic Brain Injury Model Systems. PARTICIPANTS A total of 8573 individuals injured between 1988 and 2009, with survival status per December 31, 2009, determined. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Standardized mortality ratio (SMR), life expectancy, cause of death. RESULTS SMR was 2.25 overall and was significantly elevated for all age groups, both sexes, all race/ethnic groups (except Native Americans), and all injury severity groups. SMR decreased as survival time increased but remained elevated even after 10 years postinjury. SMR was elevated for all cause-of-death categories but especially so for seizures, aspiration pneumonia, sepsis, accidental poisonings, and falls. Life expectancy was shortened an average of 6.7 years. Multivariate Cox regression showed age at injury, sex, race/ethnic group, marital status and employment status at the time of injury year of injury, preinjury drug use, days unconscious, functional independence and disability on rehabilitation discharge, and comorbid spinal cord injury to be independent risk factors for death. CONCLUSION There is an increased risk of death after moderate or severe traumatic brain injury. Risk factors and causes of death have been identified that may be amenable to intervention.
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Sareen J, Erickson J, Medved MI, Asmundson GJG, Enns MW, Stein M, Leslie W, Doupe M, Logsetty S. Risk factors for post-injury mental health problems. Depress Anxiety 2013; 30:321-7. [PMID: 23408506 DOI: 10.1002/da.22077] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/04/2013] [Accepted: 01/18/2013] [Indexed: 11/09/2022] Open
Abstract
Serious nonfatal physical injuries and burns are common occurrences that can have substantial implications for personal, social, and occupational functioning. Such injuries are frequently associated with significant mental health issues, and compromised quality of life and well-being. The purpose of this review is to summarize the current literature on physical, psychological, and social risk factors for mental health issues post-injury and to contextualize findings using Engel's biopsychosocial framework. We distinguish between pre-injury, injury-related, and post-injury risk factors for mental health problems. Female sex, history of mental health problems or trauma, type of injury, and level of pain are among the strong risk factors for mental health problems post-injury. We highlight inconsistent findings in the literature, identify directions for future research, and explore the implications of the risk factors identified for treatment and prevention.
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Affiliation(s)
- Jitender Sareen
- Departments of Psychiatry, Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Abstract
BACKGROUND Age is an important prognostic indicator of outcomes following traumatic brain injuries. This study examines how outcomes for traumatic brain injuries in the acute care setting have changed during a recent 10-year period. METHODS Population-level data broken down by age group was obtained from the Agency for Healthcare Research and Quality Web site for the years 2000 to 2009. Linear regression was used to determine trends in age-specific discharge volume, mortality rate, discharge disposition, and cost. Population and cost estimates were adjusted using census data and consumer price index. RESULTS It was found that discharges for intracranial injuries have been increasing, with the most marked increase in the population older than 65 years, which cannot be accounted for by population age distribution changes. There were overall improvements in outcomes including decreased in-hospital mortality rates for all age groups and increased home discharges for those 18 to 44 years and older than 85 years. This came at an average annual cost increase of $1,071 dollars per patient. CONCLUSION Acute care outcomes for intracranial injuries have been improving at a cost of $1,071 per patient per year. LEVEL OF EVIDENCE Economic and decision analysis, level IV.
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Chen A, Bushmeneva K, Zagorski B, Colantonio A, Parsons D, Wodchis WP. Direct cost associated with acquired brain injury in Ontario. BMC Neurol 2012; 12:76. [PMID: 22901094 PMCID: PMC3518141 DOI: 10.1186/1471-2377-12-76] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 07/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acquired Brain Injury (ABI) from traumatic and non traumatic causes is a leading cause of disability worldwide yet there is limited research summarizing the health system economic burden associated with ABI. The objective of this study was to determine the direct cost of publicly funded health care services from the initial hospitalization to three years post-injury for individuals with traumatic (TBI) and non-traumatic brain injury (nTBI) in Ontario Canada. METHODS A population-based cohort of patients discharged from acute hospital with an ABI code in any diagnosis position in 2004 through 2007 in Ontario was identified from administrative data. Publicly funded health care utilization was obtained from several Ontario administrative healthcare databases. Patients were stratified according to traumatic and non-traumatic causes of brain injury and whether or not they were discharged to an inpatient rehabilitation center. Health system costs were calculated across a continuum of institutional and community settings for up to three years after initial discharge. The continuum of settings included acute care emergency departments inpatient rehabilitation (IR) complex continuing care home care services and physician visits. All costs were calculated retrospectively assuming the government payer's perspective. RESULTS Direct medical costs in an ABI population are substantial with mean cost in the first year post-injury per TBI and nTBI patient being $32132 and $38018 respectively. Among both TBI and nTBI patients those discharged to IR had significantly higher treatment costs than those not discharged to IR across all institutional and community settings. This tendency remained during the entire three-year follow-up period. Annual medical costs of patients hospitalized with a brain injury in Ontario in the first follow-up year were approximately $120.7 million for TBI and $368.7 million for nTBI. Acute care cost accounted for 46-65% of the total treatment cost in the first year overwhelming all other cost components. CONCLUSIONS The main finding of this study is that direct medical costs in ABI population are substantial and vary considerably by the injury cause. Although most expenses occur in the first follow-up year ABI patients continue to use variety of medical services in the second and third year with emphasis shifting over time from acute care and inpatient rehabilitation towards homecare physician services and long-term institutional care. More research is needed to capture economic costs for ABI patients not admitted to acute care.
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Affiliation(s)
- Amy Chen
- Toronto Rehabilitation Institute, Toronto, ON, Canada
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Prang KH, Ruseckaite R, Collie A. Healthcare and disability service utilization in the 5-year period following transport-related traumatic brain injury. Brain Inj 2012; 26:1611-20. [DOI: 10.3109/02699052.2012.698790] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Leibson CL, Brown AW, Hall Long K, Ransom JE, Mandrekar J, Osler TM, Malec JF. Medical care costs associated with traumatic brain injury over the full spectrum of disease: a controlled population-based study. J Neurotrauma 2012; 29:2038-49. [PMID: 22414023 DOI: 10.1089/neu.2010.1713] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Data on traumatic brain injury (TBI) economic outcomes are limited. We used Rochester Epidemiology Project (REP) resources to estimate long-term medical costs for clinically-confirmed incident TBI across the full range of severity after controlling for pre-existing conditions and co-occurring injuries. All Olmsted County, Minnesota, residents with diagnoses indicative of potential TBI from 1985-2000 (n=46,114) were identified, and a random sample (n=7175) was selected for medical record review to confirm case status, and to characterize as definite (moderate/severe), probable (mild), or possible (symptomatic) TBI. For each case, we identified one age- and sex-matched non-TBI control registered in REP in the same year (±1 year) as case's TBI. Cases with co-occurring non-head injuries were assessed for non-head-injury severity and assigned similar non-head-injury-severity controls. The 1145 case/control pairs for 1988-2000 were followed until earliest death/emigration of either member for medical costs 12 months before and up to 6 years after baseline (i.e., injury date for cases and comparable dates for controls). Differences between case and control costs were stratified by TBI severity, as defined by evidence of brain injury; comparisons used Wilcoxon signed-rank plus multivariate modeling (adjusted for pre-baseline characteristics). From baseline until 6 years, each TBI category exhibited significant incremental costs. For definite and probable TBI, most incremental costs occurred within the first 6 months; significant long-term incremental medical costs were not apparent among 1-year survivors. By contrast, cost differences between possible TBI cases and controls were not as great within the first 6 months, but were substantial among 1-year survivors. Although mean incremental costs were highest for definite cases, probable and possible cases accounted for>90% of all TBI events and 66% of total incremental costs. Preventing probable and possible events might facilitate substantial reductions in TBI-associated medical care costs.
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Affiliation(s)
- Cynthia L Leibson
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, 200 First Street, S.W. Rochester, MN 55905, USA.
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Zeckey C, Hildebrand F, Pape HC, Mommsen P, Panzica M, Zelle BA, Alexander Sittaro N, Lohse R, Krettek C, Probst C. Head injury in polytrauma—Is there an effect on outcome more than 10 years after the injury? Brain Inj 2011; 25:551-9. [DOI: 10.3109/02699052.2011.568036] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Himanen L, Portin R, Hämäläinen P, Hurme S, Hiekkanen H, Tenovuo O. Risk factors for reduced survival after traumatic brain injury: a 30-year follow-up study. Brain Inj 2011; 25:443-52. [PMID: 21401369 DOI: 10.3109/02699052.2011.556580] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To evaluate risk factors for reduced survival in subjects with traumatic brain injury (TBI). PARTICIPANTS AND METHODS A retrospective follow-up of three decades included 192 subjects with TBI. Cognitive testing was carried out on average 2 years after the injury (at mean age of 39.0 years), during the years 1966-1972. Cox's regression and logistic regression analyses were used and the survival of the subjects was compared with the general population using the standardized mortality ratio (SMR). RESULTS Reduced survival was significantly associated with age at injury (p < 0.001) and vocational outcome (p = 0.003). Vocational outcome in turn was associated with age (p = 0.010), TBI severity (p < 0.001), cognitive impairment (p = 0.010), later TBIs (p = 0.007) and alcohol abuse (p = 0.015). Mortality in the younger patient group (age at death <40 years) was higher than in the general population (SMR 4.50, 95% CI = 2.02-10.01). CONCLUSIONS A reduced working ability, influenced by age-, injury- and lifestyle-related factors, is associated with long-term survival after TBI. The mortality among younger patients is high, a finding which should be considered when planning the care after TBI.
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Affiliation(s)
- Leena Himanen
- Department of Neurology, Turku University Hospital, Turku, Finland.
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Ramanathan DM, Wardecker BM, Slocomb JE, Hillary FG. Dispositional optimism and outcome following traumatic brain injury. Brain Inj 2011; 25:328-37. [PMID: 21314277 DOI: 10.3109/02699052.2011.554336] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Despite vast literature examining the predictors of patient outcome following traumatic brain injury (TBI), the complicated relationship between personality and psychological, cognitive and functional outcomes remains poorly understood. The present study examined the relationship between the personality trait of dispositional optimism (DO) and outcome after moderate and severe TBI in the context of a proposed theoretical model. METHODS Forty-five individuals who had sustained moderate-to-severe TBI were recruited through mailings and completed the Symptom Checklist Questionnaire-90 Revised (SCL-90-R), the Telephone Interview for Cognitive Status (TICS), the Craig Handicap Assessment Reporting Technique (CHART) and the Life Orientation Test-Revised (LOT-R). Analyses were conducted to test a model predicting the relationship between personality and patient outcome after TBI. RESULTS DO was significantly correlated with psychological distress, but did not predict functional outcome. In addition, two significant mediating relationships were demonstrated: (1) psychological distress was shown to mediate the relationship between dispositional optimism and cognitive ability and (2) cognitive ability mediated the relationship between psychological distress and functional outcome. CONCLUSION These findings illustrate that higher levels of DO in individuals sustaining moderate-to-severe TBI are related to better psychological functioning which in turn predicts improved cognitive and functional outcomes.
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Affiliation(s)
- Deepa M Ramanathan
- Psychology Department, The Pennsylvania State University, University Park, PA 16802, USA.
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Therapeutic targets for neuroprotection and/or enhancement of functional recovery following traumatic brain injury. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2011; 98:85-131. [PMID: 21199771 DOI: 10.1016/b978-0-12-385506-0.00003-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Traumatic brain injury (TBI) is a significant public health concern. The number of injuries that occur each year, the cost of care, and the disabilities that can lower the victim's quality of life are all driving factors for the development of therapy. However, in spite of a wealth of promising preclinical results, clinicians are still lacking a therapy. The use of preclinical models of the primary mechanical trauma have greatly advanced our knowledge of the complex biochemical sequela that follow. This cascade of molecular, cellular, and systemwide changes involves plasticity in many different neurochemical systems, which represent putative targets for remediation or attenuation of neuronal injury. The purpose of this chapter is to highlight some of the promising molecular and cellular targets that have been identified and to provide an up-to-date summary of the development of therapeutic compounds for those targets.
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Huang SJ, Ho HL, Yang CC. Longitudinal outcomes of patients with traumatic brain injury: A preliminary study. Brain Inj 2010; 24:1606-15. [DOI: 10.3109/02699052.2010.523056] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Soo C, Tate RL, Aird V, Allaous J, Browne S, Carr B, Coulston C, Diffley L, Gurka J, Hummell J. Validity and responsiveness of the care and needs scale for assessing support needs after traumatic brain injury. Arch Phys Med Rehabil 2010; 91:905-12. [PMID: 20510982 DOI: 10.1016/j.apmr.2009.11.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 11/09/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the validity and responsiveness of the Care and Needs Scale (CANS), which was designed to assess support needs of people with traumatic brain injury (TBI). DESIGN Two samples of community clients (n=38, n=30) were recruited to examine concurrent, convergent/divergent, and discriminant validity. The ability of the CANS to detect change over a 6-month period from the time of inpatient rehabilitation discharge (predictive validity and responsiveness) was investigated in a third sample of 40 rehabilitation inpatients. SETTING Two Brain Injury Rehabilitation Units in Sydney, Australia. PARTICIPANTS People (N=108) aged between 16 and 70 years admitted for rehabilitation after TBI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The CANS, Supervision Rating Scale, FIM, Sydney Psychosocial Reintegration Scale, and Disability Rating Scale. RESULTS Evidence for concurrent validity was shown with fair to moderate correlation coefficients between the CANS and measures of supervision, functional independence, and psychosocial functioning (absolute value, r(s)=.43-.68; P<.01). Support for convergent and divergent validity was provided by correlation coefficients that were higher for measures tapping similar constructs (absolute value, r(s)=46; P<.01) but lower for measures of dissimilar constructs (absolute value, r(s)=.07-.26; not significant). In addition, the CANS discriminated between levels of injury severity, functional independence, and overall functioning (P<.01). In terms of predictive validity and responsiveness, CANS scores at inpatient rehabilitation discharge predicted the participant's functioning 6 months later. CONCLUSIONS These results show the CANS is a valid and responsive tool and, together with its previously shown reliability, is suitable for routine application in clinical and research practice.
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Affiliation(s)
- Cheryl Soo
- Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
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Long-term survival after severe TBI: clinical and forensic aspects. PROGRESS IN BRAIN RESEARCH 2009. [DOI: 10.1016/s0079-6123(09)17709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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