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Roh H, Kim W, Hwang SY, Lee MS, Kim JH. Altered pattern of theta and gamma oscillation to visual stimuli in patients with postconcussion syndrome. J Neurophysiol 2024; 131:1240-1249. [PMID: 38691013 DOI: 10.1152/jn.00253.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 03/18/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024] Open
Abstract
Although many patients with mild traumatic brain injury (mTBI) suffer from postconcussional syndrome (PCS) including abnormal emotional responses, most conventional imaging studies fail to detect any causative brain lesion. We hypothesized that event-related electroencephalography (EEG) recordings with time-frequency analysis would show a distinguishable pattern in patients with mTBI with PCS compared with normal healthy controls. EEG signals were collected from a total of 18 subjects: eight patients with mTBI with PCS and 10 healthy control subjects. The signals were recorded while the subjects were presented with affective visual stimuli, including neutral, pleasant, and unpleasant emotional cues. Event-related spectral perturbation analysis was performed to calculate frontal midline theta activity and posterior midline gamma activity, followed by statistical analysis to identify whether patients with mTBI with PCS have distinct patterns of theta or gamma oscillations in response to affective stimuli. Compared with the healthy control group, patients with mTBI with PCS did not show a significant increase in the power of frontal theta activity in response to the pleasant stimuli, indicating less susceptibility toward pleasant cues. Moreover, the patient group showed attenuated gamma oscillatory activity, with no clear alteration in gamma oscillations in response to either pleasant or unpleasant cues. This study demonstrates that patients with mTBI with PCS exhibited altered patterns of oscillatory activities in the theta and gamma bands in response to affective visual stimuli compared with the normal control group. The current finding implicates that these distinguishable patterns of brain oscillation may represent the mechanism behind various psychiatric symptoms in patients with mTBI.NEW & NOTEWORTHY Patients with mild traumatic brain injury (mTBI) with postconcussional syndrome (PCS) exhibited altered patterns of changes in oscillatory activities in the theta and gamma bands in response to visual affective stimuli. Distinguishable patterns of brain oscillation may represent the mechanism behind various psychiatric symptoms in patients with mTBI.
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Affiliation(s)
- Haewon Roh
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Won Kim
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Soon-Young Hwang
- The Department of Biostatistics, Korea University of Medicine, Seoul, Korea
| | - Moon Soo Lee
- The Department of Psychiatry, Guro Hospital, Korea University of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- The Department of Neurosurgery, Guro Hospital, Korea University of Medicine, Seoul, Korea
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Ray S, Luke J, Kreitzer N. Patient-centered mild traumatic brain injury interventions in the emergency department. Am J Emerg Med 2024; 79:183-191. [PMID: 38460465 DOI: 10.1016/j.ajem.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) results in 2.5 million emergency department (ED) visits per year in the US, with mild traumatic brain injury (mTBI) accounting for 90% of cases. There is considerable evidence that many experience chronic symptoms months to years later. This population is rarely represented in interventional studies. Management of adult mTBI in the ED has remained unchanged, without consensus of therapeutic options. The aim of this review was to synthesize existing literature of patient-centered ED treatments for adults who sustain an mTBI, and to identify practices that may offer promise. METHODS A systematic review was conducted using the PubMed and Cochrane databases, while following PRISMA guidelines. Studies describing pediatric patients, moderate to severe TBI, or interventions outside the ED were excluded. Two reviewers independently performed title and abstract screening. A third blinded reviewer resolved discrepancies. The Mixed Methods Appraisal Tool (MMAT) was employed to assess the methodological quality of the studies. RESULTS Our search strategy generated 1002 unique titles. 95 articles were selected for full-text screening. The 26 articles chosen for full analysis were grouped into one of the following intervention categories: (1) predictive models for Post-Concussion Syndrome (PCS), (2) discharge instructions, (3) pharmaceutical treatment, (4) clinical protocols, and (5) functional assessment. Studies that implemented a predictive PCS model successfully identified patients at highest risk for PCS. Trials implementing discharge related interventions found the use of video discharge instructions, encouragement of daily light exercise or bed rest, and text messaging did not significantly reduce mTBI symptoms. The use of electronic clinical practice guidelines (eCPG) and longer leaves of absence from work following injury reduced symptoms. Ondansetron was shown to reduce nausea in mTBI patients. Studies implementing ED Observation Units found significant declines in inpatient admissions and length of hospital stay. The use of tablet-based tasks was found to be superior to many standard cognitive assessments. CONCLUSION Validated instruments are available to aid clinicians in identifying patients at risk for PCS or serious cognitive impairment. EDOU management and evidence-based modifications to discharge instructions may improve mTBI outcomes. Additional research is needed to establish the therapeutic value of medications and lifestyle changes for the treatment of mTBI in the ED.
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Affiliation(s)
- Sarah Ray
- University of Cincinnati School of Medicine, USA
| | - Jude Luke
- University of Cincinnati School of Medicine, USA
| | - Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati, USA.
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Meyer CM, Mensch J, Battle N, Yeargin SW. Knowledge and Attitudes of Concussion Reporting Behavior Intentions in Parents of Youth Recreational Football Players. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:218-226. [PMID: 37040134 DOI: 10.1080/02701367.2023.2189444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/26/2023] [Indexed: 06/19/2023]
Abstract
Purpose: This study: (1) Described the knowledge, attitudes, and reported behavior intentions of young recreational football players' parents toward concussion. (2) Investigated associations of the previous variables with parent demographics. Materials and Methods: A cross-sectional design utilized an online platform to survey parents of children (8-14 yrs.) in three youth football leagues in the southern United States. Demographics collected included items such as sex or concussion history. Knowledge was assessed via true/false items, with higher scores (0-20) representing greater concussion understanding. 4-point Likert scales were used to describe parents attitudes (1 = not at all, 4 = very much), confidence in intended recognition/reporting (1 = not-confident, 4 = extremely confident), and agreement with intended reporting behaviors (1 = strong- disagreement, 4 = strong-agreement). Descriptive statistics were calculated for demographics. Mann-Whitney U test or Kruskal-Wallis Tests examined survey responses across demographics. Results: Respondents (n = 101) were primarily female (64.4%), white (81.2%), and participated in contact sport (83.2%). Parents averaged 15.9 ± 1.4 on concussion knowledge, with only 34.7% (n = 35) of parents scoring > 17/20. Statements that received the lowest average agreement (3.29/4) regarding reporting intent were related to emotional symptoms. Some parents (n = 42, 41.6%) reported low confidence in recognizing symptoms of a concussion in their child. Parent demographics did not have clinically significant associations with survey responses, with 6/7 demographic variables resulting in no statistical significance (p > .05). Conclusions: Although one-third of parents attained high knowledge scores, several reported low confidence in recognizing concussion symptoms in their children. Parents scored lower in agreement with removing their child from play when concussion symptoms were subjective. Youth sports organizations providing concussion education to parents should consider these results when revising their materials.
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Criado-Marrero M, Ravi S, Bhaskar E, Barroso D, Pizzi MA, Williams L, Wellington CL, Febo M, Abisambra JF. Age dictates brain functional connectivity and axonal integrity following repetitive mild traumatic brain injuries. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.25.577316. [PMID: 38328104 PMCID: PMC10849649 DOI: 10.1101/2024.01.25.577316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Traumatic brain injuries (TBI) present a major public health challenge, demanding an in-depth understanding of age-specific signs and vulnerabilities. Aging not only significantly influences brain function and plasticity but also elevates the risk of hospitalizations and death following repetitive mild traumatic brain injuries (rmTBIs). In this study, we investigate the impact of age on brain network changes and white matter properties following rmTBI employing a multi-modal approach that integrates resting-state functional magnetic resonance imaging (rsfMRI), graph theory analysis, diffusion tensor imaging (DTI), and Neurite Orientation Dispersion and Density Imaging (NODDI). Utilizing the CHIMERA model, we conducted rmTBIs or sham (control) procedures on young (2.5-3 months old) and aged (22-month-old) male and female mice to model high risk groups. Functional and structural imaging unveiled age-related reductions in communication efficiency between brain regions, while injuries induced opposing effects on the small-world index across age groups, influencing network segregation. Functional connectivity analysis also identified alterations in 79 out of 148 brain regions by age, treatment (sham vs. rmTBI), or their interaction. Injuries exerted pronounced effects on sensory integration areas, including insular and motor cortices. Age-related disruptions in white matter integrity were observed, indicating alterations in various diffusion directions (mean, radial, axial diffusivity, fractional anisotropy) and density neurite properties (dispersion index, intracellular and isotropic volume fraction). Inflammation, assessed through Iba-1 and GFAP markers, correlated with higher dispersion in the optic tract, suggesting a neuroinflammatory response in aged animals. These findings provide a comprehensive understanding of the intricate interplay between age, injuries, and brain connectivity, shedding light on the long-term consequences of rmTBIs.
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Meyer EJ, Correa ET, Monuteaux MC, Mannix R, Hatoun J, Vernacchio L, Lyons TW. Patterns and Predictors of Health Care Utilization After Pediatric Concussion: A Retrospective Cohort Study. Acad Pediatr 2024; 24:51-58. [PMID: 37148968 DOI: 10.1016/j.acap.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To characterize types, duration, and intensity of health care utilization following pediatric concussion and to identify risk factors for increased post-concussion utilization. METHODS A retrospective cohort study of children 5 to 17 years old diagnosed with acute concussion at a quaternary center pediatric emergency department or network of associated primary care clinics. Index concussion visits were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. We analyzed patterns of health care visits 6 months before and after the index visit using interrupted time-series analyses. The primary outcome was prolonged concussion-related utilization, defined as having ≥1 follow-up visits with a concussion diagnosis more than 28 days after the index visit. We used logistic regressions to identify predictors of prolonged concussion-related utilization. RESULTS Eight hundred nineteen index visits (median [interquartile range] age, 14 [11-16] years; 395 [48.2%] female) were included. There was a spike in utilization during the first 28 days after the index visit compared to the pre-injury period. Premorbid headache/migraine disorder (adjusted odds ratio (aOR) 2.05, 95% confidence interval [CI] 1.09-3.89) and top quartile pre-injury utilization (aOR 1.90, 95% CI 1.02-3.52) predicted prolonged concussion-related utilization. Premorbid depression/anxiety (aOR 1.55, 95% CI 1.31-1.83) and top quartile pre-injury utilization (aOR 2.29, 95% CI 1.95-2.69) predicted increased utilization intensity. CONCLUSIONS Health care utilization is increased during the first 28 days after pediatric concussion. Children with premorbid headache/migraine disorders, premorbid depression/anxiety, and high baseline utilization are more likely to have increased post-injury health care utilization. This study will inform patient-centered treatment but may be limited by incomplete capture of post-injury utilization and generalizability.
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Affiliation(s)
- Erin J Meyer
- Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass.
| | - Emily Trudell Correa
- Pediatric Physicians' Organization at Children's (ET Correa, J Hatoun, and L Vernacchio), Wellesley, Mass
| | - Michael C Monuteaux
- Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass
| | - Rebekah Mannix
- Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass
| | - Jonathan Hatoun
- Pediatric Physicians' Organization at Children's (ET Correa, J Hatoun, and L Vernacchio), Wellesley, Mass; Department of Pediatrics (J Hatoun and L Vernacchio), Boston Children's Hospital and Harvard Medical School, Mass
| | - Louis Vernacchio
- Pediatric Physicians' Organization at Children's (ET Correa, J Hatoun, and L Vernacchio), Wellesley, Mass; Department of Pediatrics (J Hatoun and L Vernacchio), Boston Children's Hospital and Harvard Medical School, Mass
| | - Todd W Lyons
- Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass
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Chou TY, Huang YL, Leung W, Brown CN, Kaminski TW, Norcross MF. Does prior concussion lead to biomechanical alterations associated with lateral ankle sprain and anterior cruciate ligament injury? A systematic review and meta-analysis. Br J Sports Med 2023; 57:1509-1515. [PMID: 37648411 DOI: 10.1136/bjsports-2023-106980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To determine whether individuals with a prior concussion exhibit biomechanical alterations in balance, gait and jump-landing tasks with and without cognitive demands that are associated with risk of lateral ankle sprain (LAS) and anterior cruciate ligament (ACL) injury. DESIGN Systematic review and meta-analysis. DATA SOURCES Five electronic databases (Web of Science, Scopus, PubMed, SPORTDiscus and CiNAHL) were searched in April 2023. ELIGIBILITY CRITERIA Included studies involved (1) concussed participants, (2) outcome measures of spatiotemporal, kinematic or kinetic data and (3) a comparison or the data necessary to compare biomechanical variables between individuals with and without concussion history or before and after a concussion. RESULTS Twenty-seven studies were included involving 1544 participants (concussion group (n=757); non-concussion group (n=787)). Individuals with a recent concussion history (within 2 months) had decreased postural stability (g=0.34, 95% CI 0.20 to 0.49, p<0.001) and slower locomotion-related performance (g=0.26, 95% CI 0.11 to 0.41, p<0.001), both of which are associated with LAS injury risk. Furthermore, alterations in frontal plane kinetics (g=0.41, 95% CI 0.03 to 0.79, p=0.033) and sagittal plane kinematics (g=0.30, 95% CI 0.11 to 0.50, p=0.002) were observed in individuals approximately 2 years following concussion, both of which are associated with ACL injury risk. The moderator analyses indicated cognitive demands (ie, working memory, inhibitory control tasks) affected frontal plane kinematics (p=0.009), but not sagittal plane kinematics and locomotion-related performance, between the concussion and non-concussion groups. CONCLUSION Following a recent concussion, individuals display decreased postural stability and slower locomotion-related performance, both of which are associated with LAS injury risk. Moreover, individuals within 2 years following a concussion also adopt a more erect landing posture with greater knee internal adduction moment, both of which are associated with ACL injury risk. While adding cognitive demands to jump-landing tasks affected frontal plane kinematics during landing, the altered movement patterns in locomotion and sagittal plane kinematics postconcussion persisted regardless of additional cognitive demands. PROSPERO REGISTRATION NUMBER CRD42021248916.
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Affiliation(s)
- Tsung-Yeh Chou
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Yu-Lun Huang
- Department of Physical Education and Sport, National Taiwan Normal University, Taipei, Taiwan
| | - Willie Leung
- Department of Health Sciences and Human Performance, The University of Tampa, Tampa, Florida, USA
| | - Cathleen N Brown
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Marc F Norcross
- College of Health, Corvallis, Oregon State University, Corvallis, Oregon, USA
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Theis J, Chen AM, Burgher AP, Greenspan LD, Morgenstern A, Salzano AD, Yap TP, Scheiman M, Roberts TL. Ocular motor disorders in children and adults with mTBI: a scoping review protocol. BMJ Open 2023; 13:e073656. [PMID: 37857540 PMCID: PMC10603508 DOI: 10.1136/bmjopen-2023-073656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Ocular motor function is susceptible to neurological injury because it requires a large portion of brain circuitry including every lobe of the brain, brainstem, thalamus, basal ganglia, cerebellum, cranial nerves and visual tracts. While reports of a high frequency of ocular motor dysfunctions after mild traumatic brain injury (mTBI) span multidisciplinary journals, there is no scoping review of the signs, diagnostic assessments and criteria, and appropriate management of ocular motor disorders post-mTBI. Post-mTBI ocular motor dysfunction has been reported to respond to active treatment. The objective of this scoping review is to map the available evidence on the diagnostic assessment and treatment modalities currently used in the management of mTBI-related ocular motor disorders in children and adults. This scoping review also aims to identify gaps in the current literature and provide suggestions for future research. METHODS AND ANALYSIS This review will include populations with reported concussion and/or mTBI without restrictions on age, race, sex or time since injury. The review will evaluate the reported symptoms related to ocular motor dysfunction, types of assessments and diagnostic criteria used, reported treatments, and the level of evidence supporting the reported treatments. This review will exclude literature on brain injury of non-traumatic aetiology and moderate/severe traumatic brain injury. Ocular motor dysfunction after mTBI appears in journals across multiple disciplines. Thus, multiple databases will be evaluated including Pubmed, Embase, PEDro, OVID, Clinical Key, Google Scholar and REHABDATA. Literature will be searched from inception to present day. Evidence sources will include experimental study designs including randomised controlled trials, non-randomised controlled trials and interrupted time-series. Additionally, analytical observational studies including prospective and retrospective cohort studies, case series, cross-sectional studies and clinical practice guidelines will be considered for inclusion. Data will be extracted on clinical presentation, frequency, assessment, diagnostic criteria management strategies and outcomes of concussion and mTBI-related ocular motor disorders. ETHICS AND DISSEMINATION This scoping review will use data from existing publications and does not require ethical approval by an institutional review board. Results will be disseminated through publication in a peer-reviewed scientific journal and presented at relevant conferences and as part of future workshops with professionals involved with diagnosis and management of patients with mTBI.
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Affiliation(s)
- Jacqueline Theis
- Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences F Edward Hébert School of Medicine, Bethesda, Maryland, USA
- Concussion Care Centre of Virginia, Richmond, Virginia, USA
| | - Angela M Chen
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, USA
| | - Allegra P Burgher
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, USA
| | - Lynn D Greenspan
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, USA
| | - Andrew Morgenstern
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Aaron D Salzano
- College of Optometry, Pacific University, Forest Grove, Oregon, USA
| | | | - Mitchell Scheiman
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Stanford, California, USA
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Sakthivel R, Criado-Marrero M, Barroso D, Braga IM, Bolen M, Rubinovich U, Hery GP, Grudny MM, Koren J, Prokop S, Febo M, Abisambra JF. Fixed Time-Point Analysis Reveals Repetitive Mild Traumatic Brain Injury Effects on Resting State Functional Magnetic Resonance Imaging Connectivity and Neuro-Spatial Protein Profiles. J Neurotrauma 2023; 40:2037-2049. [PMID: 37051703 PMCID: PMC10541943 DOI: 10.1089/neu.2022.0464] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Repetitive mild traumatic brain injuries (rmTBIs) are serious trauma events responsible for the development of numerous neurodegenerative disorders. A major challenge in developing diagnostics and treatments for the consequences of rmTBI is the fundamental knowledge gaps of the molecular mechanisms responsible for neurodegeneration. It is both critical and urgent to understand the neuropathological and functional consequences of rmTBI to develop effective therapeutic strategies. Using the Closed-Head Impact Model of Engineered Rotational Acceleration, or CHIMERA, we measured neural changes following injury, including brain volume, diffusion tensor imaging, and resting-state functional magnetic resonance imaging coupled with graph theory and functional connectivity analyses. We determined the effect of rmTBI on markers of gliosis and used NanoString-GeoMx to add a digital-spatial protein profiling analysis of neurodegenerative disease-associated proteins in gray and white matter regions. Our analyses revealed aberrant connectivity changes in the thalamus, independent of microstructural damage or neuroinflammation. We also identified distinct changes in the levels of proteins linked to various neurodegenerative processes including total and phospho-tau species and cell proliferation markers. Together, our data show that rmTBI significantly alters brain functional connectivity and causes distinct protein changes in morphologically intact brain areas.
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Affiliation(s)
- Ravi Sakthivel
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Marangelie Criado-Marrero
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Daylin Barroso
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Isadora M. Braga
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Mackenzie Bolen
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Uriel Rubinovich
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, Florida, USA
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Gabriela P. Hery
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, Florida, USA
- Department of Pathology, University of Florida, Gainesville, Florida, USA
| | - Matteo M. Grudny
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - John Koren
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - Stefan Prokop
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, Florida, USA
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
- Department of Pathology, University of Florida, Gainesville, Florida, USA
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Marcelo Febo
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Jose Francisco Abisambra
- Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, Florida, USA
- Department of Neuroscience, University of Florida, Gainesville, Florida, USA
- McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
- Brain Injury Rehabilitation and Neuroresilience (BRAIN) Center, University of Florida, Gainesville, Florida, USA
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Smith JA, Nguyen T, Davis BC, Lahiri DK, Hato T, Obukhov AG, White FA. Propranolol treatment during repetitive mild traumatic brain injuries induces transcriptomic changes in the bone marrow of mice. Front Neurosci 2023; 17:1219941. [PMID: 37817806 PMCID: PMC10561692 DOI: 10.3389/fnins.2023.1219941] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/25/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction There are 1.5 million new mild traumatic brain injuries (mTBI) annually in the US, with many of the injured experiencing long-term consequences lasting months after the injury. Although the post injury mechanisms are not well understood, current knowledge indicates peripheral immune system activation as a causal link between mTBI and long-term side effects. Through a variety of mechanisms, peripheral innate immune cells are recruited to the CNS after TBI to repair and heal the injured tissue; however, the recruitment and activation of these cells leads to further inflammation. Emerging evidence suggests sympathetic nervous system (SNS) activity plays a substantial role in the recruitment of immune cells post injury. Methods We sought to identify the peripheral innate immune response after repeated TBIs in addition to repurposing the nonselective beta blocker propranolol as a novel mTBI therapy to limit SNS activity and mTBI pathophysiology in the mouse. Mice underwent repetitive mTBI or sham injury followed by i.p. saline or propranolol. Isolated mRNA derived from femur bone marrow of mice was assayed for changes in gene expression at one day, one week, and four weeks using Nanostring nCounter® stem cell characterization panel. Results Differential gene expression analysis for bone marrow uncovered significant changes in many genes following drug alone, mTBI alone and drug combined with mTBI. Discussion Our data displays changes in mRNA at various timepoints, most pronounced in the mTBI propranolol group, suggesting a single dose propranolol injection as a viable future mTBI therapy in the acute setting.
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Affiliation(s)
- Jared A. Smith
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tyler Nguyen
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brittany C. Davis
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Debomoy K. Lahiri
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Takashi Hato
- Department of Medicine, Indiana University, Indianapolis, IN, United States
| | - Alexander G. Obukhov
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Fletcher A. White
- Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN, United States
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Malik S, Alnaji O, Malik M, Gambale T, Farrokhyar F, Rathbone MP. Inflammatory cytokines associated with mild traumatic brain injury and clinical outcomes: a systematic review and meta-analysis. Front Neurol 2023; 14:1123407. [PMID: 37251220 PMCID: PMC10213278 DOI: 10.3389/fneur.2023.1123407] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Mild traumatic brain injuries (mTBIs) trigger a neuroinflammatory response, which leads to perturbations in the levels of inflammatory cytokines, resulting in a distinctive profile. A systematic review and meta-analysis were conducted to synthesize data related to levels of inflammatory cytokines in patients with mTBI. The electronic databases EMBASE, MEDLINE, and PUBMED were searched from January 2014 to December 12, 2021. A total of 5,138 articles were screened using a systematic approach based on the PRISMA and R-AMSTAR guidelines. Of these articles, 174 were selected for full-text review and 26 were included in the final analysis. The results of this study demonstrate that within 24 hours, patients with mTBI have significantly higher levels of Interleukin-6 (IL-6), Interleukin-1 Receptor Antagonist (IL-1RA), and Interferon-γ (IFN-γ) in blood, compared to healthy controls in majority of the included studies. Similarly one week following the injury, patients with mTBI have higher circulatory levels of Monocyte Chemoattractant Protein-1/C-C Motif Chemokine Ligand 2 (MCP-1/CCL2), compared to healthy controls in majority of the included studies. The results of the meta-analysis also confirmed these findings by demonstrating significantly elevated blood levels of IL-6, MCP-1/CCL2, and Interleukin-1 beta (IL-1β) in the mTBI population compared to healthy controls (p < 0.0001), particularly in the acute stages (<7 days). Furthermore, it was found that IL-6, Tumor Necrosis Factor-alpha (TNF-α), IL-1RA, IL-10, and MCP-1/CCL2 were associated with poor clinical outcomes following the mTBI. Finally, this research highlights the lack of consensus in the methodology of mTBI studies that measure inflammatory cytokines in the blood, and also provides direction for future mTBI research.
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Affiliation(s)
- Shazia Malik
- Neurosciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Omar Alnaji
- Faculty of Life Sciences, McMaster University, Hamilton, ON, Canada
| | - Mahnoor Malik
- Bachelor of Health Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Teresa Gambale
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Forough Farrokhyar
- Department of Surgery and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Michel P. Rathbone
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, ON, Canada
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Valente JH, Anderson JD, Paolo WF, Sarmiento K, Tomaszewski CA, Haukoos JS, Diercks DB, Diercks DB, Anderson JD, Byyny R, Carpenter CR, Friedman B, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Kaji A, Kwok H, Lo BM, Mace SE, Moran M, Promes SB, Shah KH, Shih RD, Silvers SM, Slivinski A, Smith MD, Thiessen MEW, Tomaszewski CA, Trent S, Valente JH, Wall SP, Westafer LM, Yu Y, Cantrill SV, Finnell JT, Schulz T, Vandertulip K. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Mild Traumatic Brain Injury: Approved by ACEP Board of Directors, February 1, 2023 Clinical Policy Endorsed by the Emergency Nurses Association (April 5, 2023). Ann Emerg Med 2023; 81:e63-e105. [PMID: 37085214 PMCID: PMC10617828 DOI: 10.1016/j.annemergmed.2023.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
This 2023 Clinical Policy from the American College of Emergency Physicians is an update of the 2008 “Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute Setting.” A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following questions: 1) In the adult emergency department patient presenting with minor head injury, are there clinical decision tools to identify patients who do not require a head computed tomography? 2) In the adult emergency department patient presenting with minor head injury, a normal baseline neurologic examination, and taking an anticoagulant or antiplatelet medication, is discharge safe after a single head computed tomography? and 3) In the adult emergency department patient diagnosed with mild traumatic brain injury or concussion, are there clinical decision tools or factors to identify patients requiring follow-up care for postconcussive syndrome or to identify patients with delayed sequelae after emergency department discharge? Evidence was graded and recommendations were made based on the strength of the available data. Widespread and consistent implementation of evidence-based clinical recommendations is warranted to improve patient care.
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12
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Zimmer L, McDade C, Beyhaghi H, Purser M, Textoris J, Krause A, Blanc E, Pavlov V, Earnshaw S. Cost-Effectiveness of Blood-Based Brain Biomarkers for Screening Adults with Mild Traumatic Brain Injury in the French Health Care Setting. J Neurotrauma 2023; 40:706-719. [PMID: 36267001 PMCID: PMC10061334 DOI: 10.1089/neu.2022.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Two blood-based brain biomarker tests such as the combination of glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 (GFAP+UCH-L1) or S100B have potential to reduce the need for head computed tomography (CT) scanning in patients with mild traumatic brain injury (mTBI). We assessed the clinical and economic impact of using GFAP+UCH-L1 versus CT scan and GFAP+UCH-L1 versus S100B to screen adults with suspected mTBI presenting to an emergency department (ED). A decision model was developed to estimate costs and health outcomes of GFAP+UCH-L1, CT scan, and S100B associated with these screening protocols. Model parameters were extracted from peer-reviewed articles, clinical guidelines, and expert opinion. Analysis was performed from a French health care system perspective (costs in 2020 euros). In the model, patients with a positive biomarker receive a CT scan to confirm the presence of intracranial lesions (ICLs). Depending on clinical state and biomarker and CT results, patients were discharged immediately, kept for observation in the ED, admitted for in-hospital stay and observation, or admitted for surgical management. Incorrect test results may lead to delayed treatment and poor outcomes or overtreatment. GFAP+UCH-L1 use was associated with an overall decrease in CT scans when compared with CT screening or S100B use (325.42 and 46.43 CTs per 1000 patients, respectively). The use of GFAP+UCH-L1 resulted in modest cost savings when compared with CT scanning and with S100B. In all cases, use of GFAP+UCH-L1 marginally improved quality-adjusted life-years (QALYs) and outcomes. Thus, screening with GFAP+UCH-L1 reduced the need for CT scans when compared with systematic CT scan screening or use of S100B while maintaining similar costs and health outcomes.
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Affiliation(s)
| | - Cheryl McDade
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | | | - Molly Purser
- RTI Health Solutions, Research Triangle Park, North Carolina, USA
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13
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Ou W, Zhang Q, He J, Shao X, Yang Y, Wang X. Hospitalization costs of injury in elderly population in China: a quantile regression analysis. BMC Geriatr 2023; 23:143. [PMID: 36918769 PMCID: PMC10013238 DOI: 10.1186/s12877-023-03729-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/04/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Trauma in the elderly is gradually growing more prevalent as the aging population increases over time. The purpose of this study is to assess hospitalization costs of the elderly trauma population and analyze the association between those costs and the features of the elderly trauma population. METHODS In a retrospective analysis, data on trauma patients over 65 who were admitted to the hospital for the first time due to trauma between January 2017 and March 2022 was collected from a tertiary comprehensive hospital in Baotou. We calculated and analyzed the hospitalization cost components. According to various therapeutic approaches, trauma patients were divided into two subgroups: non-surgical patients (1320 cases) and surgical patients (387 cases). Quantile regression was used to evaluate the relationship between trauma patients and hospitalization costs. RESULTS This study comprised 1707 trauma patients in total. Mean total hospitalization costs per patient were ¥20,741. Patients with transportation accidents incurred the highest expenditures among those with external causes of trauma, with a mean hospitalization cost of ¥24,918, followed by patients with falls at ¥19,809 on average. Hospitalization costs were dominated by medicine costs (¥7,182 per capita). According to the quantile regression results, all trauma patients' hospitalization costs were considerably increased by length of stay, surgery, the injury severity score (16-24), multimorbidity, thorax injury, and blood transfusion. For non-surgical patients, length of stay, multimorbidity, and the injury severity score (16-24) were all substantially linked to higher hospitalization costs. For surgical patients, length of stay, injury severity score (16-24), and hip and thigh injuries were significantly associated with greater hospitalization costs. CONCLUSIONS Using quantile regression to identify factors associated with hospitalization costs could be helpful for addressing the burden of injury in the elderly population. Policymakers may find these findings to be insightful in lowering hospitalization costs related to injury in the elderly population.
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Affiliation(s)
- Wenjing Ou
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China
- Baotou Central Hospital, Baotou, 014040, Inner Mongolia, China
| | - Qin Zhang
- Shengjing Hospital of China Medical University, Shenyang, 110001, China
| | - Junlin He
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China
| | - Xinye Shao
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China
| | - Yang Yang
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China
| | - Xin Wang
- College of Health Management, China Medical University, Shenyang, 110122, Liaoning, China.
- Research Center for Health Development-Liaoning New Type Think Tank for University, China Medical University, Shenyang, 110122, Liaoning, China.
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14
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Basch CH, Ethan D, Fera J, Kollia B, Basch CE. Micromobility Vehicles, Obstructions, and Rider Safety Behaviors in New York City Bike Lanes. J Community Health 2023; 48:522-527. [PMID: 36745357 PMCID: PMC9900529 DOI: 10.1007/s10900-023-01197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
Micromobility vehicles (MMVs) have become increasingly popular, particularly in urban areas where infrastructure has improved in recent years to facilitate their use. The purpose of this study was to observe protected bike lanes in 10 zones of Manhattan, NYC to: (1) describe the MMVs in bike lanes by type, phone and helmet use; and (2) document MMV users' responses to obstructions. Approximately 1 in 4 of all riders (260/998) were wearing a helmet. Fewer than 2% were observed using a phone while moving. Fewer than 9% of Citi Bike users were wearing a helmet. In contrast, over one-third of non-Citi Bike users were wearing a helmet (228 of 670, 34.03%). This difference was determined to be significant by a chi-squared test (a = 0.05) with a p-value less than 0.0001. Of the 988 MMVs observed in this study, 398 (40.28%) were motorized and 590 (59.72%) were non-motorized. A similar proportion of users of motorized riders versus non-motorized vehicles were wearing a helmet (28.14%, 112/398 versus 24.41%, 144/590). A total of 232 riders (23.50%) encountered an obstruction in their bike lane. Of these obstructions in a bike lane, 82.33% (191/232) were a car/vehicle and 17.67% (41/232) was garbage. A large majority of riders (87.93%) reacted by riding into the traffic lane. These findings suggest that further research and local education, enforcement, and legislative efforts are needed to examine and implement best practices in the safe operation of MMVs, decreasing bike lane obstructions, promoting helmet use, and raising awareness of MMV legislation.
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Affiliation(s)
- Corey H Basch
- Department of Public Health, William Paterson University, University Hall, 07470, Wayne, NJ, USA.
| | - Danna Ethan
- Department of Health Promotion and Nutrition Sciences , Lehman College, The City University of New York, 10468, Bronx, NY, USA
| | - Joseph Fera
- Department of Mathematics, Lehman College, The City University of New York, 10468, Bronx, NY, USA
| | - Betty Kollia
- Department of Communication Disorders & Sciences, William Paterson University, 07470, Wayne, NJ, USA
| | - Charles E Basch
- Department of Health and Behavior Studies, Teachers College, Columbia University, 10027, NY, USA
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15
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Moley JP, Norman JL, Coccaro EF. Personality disorder and mild traumatic brain injury. Personal Ment Health 2022; 16:331-337. [PMID: 35598165 PMCID: PMC9675684 DOI: 10.1002/pmh.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022]
Abstract
Mild traumatic brain injury (mTBI) poses risk to the neurocognitive, emotional, and financial well-being of affected individuals. While aggression and impulsivity have been examined in relation to mTBI, little work has been done to evaluate the relationship between history of mTBI and personality disorder (PD). The authors examined the associations between history of mTBI and PD in a control group without history of mTBI (N = 1189) and individuals with history of mTBI (N = 267). Results demonstrated that any PD diagnosis is a significant risk factor for mTBI (p < 0.001). Cluster B diagnoses, particularly borderline and antisocial PD, were independently significant risk factors for mTBI. These data suggest a role for screening for a history of mTBI in patients with PDs and associated traits.
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Affiliation(s)
- James P Moley
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Joshua L Norman
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
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16
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Hoek AE, Geraerds AJLM, Rood PPM, Joosten M, Dippel DWJ, van Beeck EF, van den Hengel L, Dijkstra B, Papathanasiou D, van Rijssel D, van den Hamer M, Schuit SCE, Burdorf A, Haagsma JA, Polinder S. The Effect of Written and Video Discharge Instructions After Mild Traumatic Brain Injury on Healthcare Costs and Productivity Costs. J Head Trauma Rehabil 2022; 37:E231-E241. [PMID: 34320553 DOI: 10.1097/htr.0000000000000720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare healthcare and productivity costs between patients with mild traumatic brain injury (mTBI) who received verbal discharge instructions only and patients who received an additional flyer with or without video instructions. SETTING Emergency departments (EDs) of 6 hospitals in the Netherlands. PARTICIPANTS In total, 1155 adult patients with mTBI (384 with verbal instructions; 771 with additional flyer with or without video instructions) were included. DESIGN Cost study with comparison between usual care and intervention. METHODS Medical and productivity costs up to 3 months after presentation at the ED were compared between mTBI patients with usual care and mTBI patients who received the intervention. RESULTS Mean medical costs per mTBI patient were slightly higher for the verbal instructions-only cohort (€337 vs €315), whereas mean productivity costs were significantly higher for the flyer/video cohort (€1625 vs €899). Higher productivity costs were associated with higher working age, injury severity, and postconcussion symptoms. CONCLUSION This study showed that the implementation of flyer (and video) discharge instructions for patients with mTBI who present at the ED increased reports of postconcussion symptoms and reduced medical costs, whereas productivity costs were found to be higher for the working population in the first 3 months after the sustained head injury.
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Affiliation(s)
- Amber E Hoek
- Departments of Emergency Medicine (Drs Hoek, Rood, Joosten, and Haagsma), Public Health (Drs Geraerds, van Beeck, Burdorf, Haagsma and Polinder), Neurology (Drs Dippel), and Internal Medicine (Dr Schuit), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Emergency Medicine, Franciscus Gasthuis, Rotterdam, the Netherlands (Dr van den Hengel); Department of Emergency Medicine, Dijklanderziekenhuis, Hoorn, the Netherlands (Dr Dijkstra); Department of Emergency Medicine, Haaglanden Medical Center, the Hague, the Netherlands (Dr Papathanasiou); Department of Emergency Medicine, Reinier de Graaf, Delft, the Netherlands (Dr van Rijssel); and Department of Emergency Medicine, Admiraal de Ruyter Hospital, Goesthe Netherlands (Dr van den Hamer)
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17
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Nanwa N, Wong V, Thompson AMS. Impact of Timing of Mental Health Interventions for Mild Traumatic Brain Injury Patients: A 10-year Matched Cohort Study of Workers' Compensation Claims. J Occup Environ Med 2022; 64:458-464. [PMID: 35761423 DOI: 10.1097/jom.0000000000002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of timing of mental health interventions in workers' compensation claims for mild traumatic brain injury (MTBI). METHODS A 10-year matched retrospective cohort study of MTBI claims. Cases who started treatment within 3 months of the date of injury were hard matched to cases who started treatment more than 3 months after the date of injury. Outcomes were incremental cost difference and loss of earnings benefit duration 1 year after first intervention. RESULTS Seventeen percent (17%) of patients received mental health interventions. The early mental health intervention group had lower mean costs (incremental difference$1580 [95% CI: $5718 to $2085]) and shorter durations of disability (off loss of earnings) (59.2% versus 46.6%, NS). Sensitivity and stratified analyses demonstrated the same trend. CONCLUSIONS Early mental health interventions for MTBI patients may lead to reduced health care costs and shorter durations of disability.
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Affiliation(s)
- Natasha Nanwa
- From the Workplace Safety and Insurance Board, Ontario, Canada (Dr Nanwa, Dr Wong, Dr Thompson), Faculty of Medicine, University of Toronto, Ontario Canada (Dr Thompson), Dalla Lana School of Public Health, University of Toronto, Ontario, Canada (Dr Thompson)
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18
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The potential role of renin-angiotensin system in mild traumatic brain injury. Neurol Sci 2022; 43:3353-3359. [DOI: 10.1007/s10072-021-05856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022]
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"Can differences in hospitalised mild traumatic brain injury (mTBI) outcomes at 12 months be predicted?". Acta Neurochir (Wien) 2022; 164:1435-1443. [PMID: 35348896 DOI: 10.1007/s00701-022-05183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To identify risk factors for poor outcome one year post-mild traumatic brain injury (mTBI). DESIGN This study was a prospective observational study using consecutive adult hospital admissions with mTBI. SUBJECTS A total of 869 consecutive mTBI patients were enrolled in this study. METHODS All patients were reviewed by the specialist TBI rehabilitation team at six weeks and one year following mTBI. Demographic and injury data collected included: age, gender, TBI severity and Glasgow Coma Scale (GCS). At twelve months, global outcome was assessed by the Extended Glasgow Outcome Score (GOSE) and participation restriction by the Rivermead Head Injury Follow-up Questionnaire (RHFUQ) via semi-structured interview. An ordinal regression (OR) was used to identify associated factors for poor GOSE outcome and a linear regression for a poor RHFUQ outcome. RESULTS In the GOSE analysis, lower GCS (p < 0.001), medical comorbidity (p = 0.027), depression (p < 0.001) and male gender (p = 0.008) were identified as risk factors for poor outcome. The RHFUQ analysis identified: lower GCS (p = 0.002), female gender (p = 0.001) and injuries from assault (p = 0.003) were variables associated with worse social functioning at one year. CONCLUSION mTBI is associated with a significant impact upon the physical health and psychosocial function of affected individuals. The results of this study demonstrate that differences in mTBI outcome can be identified at twelve months post-mTBI and that certain features, particularly GCS, are associated with poorer outcomes.
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Allen JH, Yengo-Kahn AM, Vittetoe KL, Greeno A, Owais Abdul Ghani M, Unni P, Lovvorn HN, Bonfield CM. The impact of helmet use on neurosurgical care and outcomes after pediatric all-terrain vehicle and dirt bike crashes: a 10-year single-center experience. J Neurosurg Pediatr 2022; 29:106-114. [PMID: 34638104 DOI: 10.3171/2021.6.peds21225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE All-terrain vehicle (ATV) and dirt bike crashes frequently result in traumatic brain injury. The authors performed a retrospective study to evaluate the role of helmets in the neurosurgical outcomes of pediatric patients involved in ATV and dirt bike crashes who were treated at their institution during the last decade. METHODS The authors analyzed data on all pediatric patients involved in ATV or dirt bike crashes who were evaluated at a single regional level I pediatric trauma center between 2010 and 2019. Patients were excluded if the crash occurred in a competition (n = 70) or if helmet status could not be determined (n = 18). Multivariable logistic regression was used to analyze the association of helmet status with the primary outcomes of 1) neurosurgical consultation, 2) intracranial injury (including skull fracture), and 3) moderate or severe traumatic brain injury (MSTBI) and to control for literature-based, potentially confounding variables. RESULTS In total, 680 patients were included (230 [34%] helmeted patients and 450 [66%] unhelmeted patients). Helmeted patients were more frequently male (81% vs 66%). Drivers were more frequently helmeted (44.3%) than passengers (10.5%, p < 0.001). Head imaging was performed to evaluate 70.9% of unhelmeted patients and 48.3% of helmeted patients (p < 0.001). MSTBI (8.0% vs 1.7%, p = 0.001) and neurosurgical consultation (26.2% vs 9.1%, p < 0.001) were more frequent among unhelmeted patients. Neurosurgical injuries, including intracranial hemorrhage (16% vs 4%, p < 0.001) and skull fracture (18% vs 4%, p < 0.001), were more common in unhelmeted patients. Neurosurgical procedures were required by 2.7% of unhelmeted patients. One helmeted patient (0.4%) required placement of an intracranial pressure monitor, and no other helmeted patients required neurosurgical procedures. After adjustment for age, sex, driver status, vehicle type, and injury mechanism, helmet use significantly reduced the odds of neurosurgical consultation (OR 0.250, 95% CI 0.140-0.447, p < 0.001), intracranial injury (OR 0.172, 95% CI 0.087-0.337, p < 0.001), and MSTBI (OR 0.244, 95% CI 0.079-0.758, p = 0.015). The unadjusted absolute risk reduction provided by helmet use equated to a number-needed-to-helmet of 6 riders to prevent 1 neurosurgical consultation, 4 riders to prevent 1 intracranial injury, and 16 riders to prevent 1 MSTBI. CONCLUSIONS Helmet use remains problematically low among young ATV and dirt bike riders, especially passengers. Expanding helmet use among these children could significantly reduce the rates of intracranial injury and MSTBI, as well as the subsequent need for neurosurgical procedures. Promoting helmet use among recreational ATV and dirt bike riders must remain a priority for neurosurgeons, public health officials, and injury prevention professionals.
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Affiliation(s)
| | | | | | - Amber Greeno
- 3Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Purnima Unni
- 3Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harold N Lovvorn
- 3Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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21
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Edmunds K, Scuffham P, Newton RU, Galvão DA, Tuffaha H. Exercise in preventing falls for men with prostate cancer: a modelled cost-utility analysis. Support Care Cancer 2022; 30:5037-5046. [PMID: 35201385 PMCID: PMC9046330 DOI: 10.1007/s00520-022-06900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment. The purpose of this paper is to determine the cost-effectiveness of exercise in preventing falls and fractures for this high-risk population in Australia. METHODS A decision analytic model was constructed to evaluate the cost utility of an exercise intervention compared to usual care from a health system perspective. The intervention comprised two 1-h sessions of supervised exercise per week over 1 year for men with non-metastatic PCa receiving curative radiation therapy and ADT. A Markov model simulated the transition between five health states: (1) at risk of falling; (2) at recurrent risk of falling; (3) fracture (minor or major); (4) non-fracture injury (minor or major); and (5) death. Model inputs including transition probabilities and utility scores were obtained from published meta-analyses, and costs were drawn from Australian data sources (e.g. Medical Benefits Schedule). The model time horizon was 3 years, and costs and effects were discounted at 5% annual rate. Costs and quality-adjusted life years (QALYs) were aggregated and compared between the intervention and control to calculate incremental net monetary benefit (iNMB). Uncertainty in the results was explored using deterministic and probabilistic sensitivity analyses (PSA). RESULTS At a willingness-to-pay of AU$50,000 per QALY, the exercise intervention dominated, as it was less costly and more effective than usual care. The iNMB was $3010 per patient. The PSA showed a 58% probability the intervention was cost-effective. CONCLUSION This is the first modelled economic evaluation of exercise for men with PCa. Our results suggest supervised exercise is cost-effective in reducing the risks of falls and fractures in this population.
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Affiliation(s)
- Kim Edmunds
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Paul Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
| | - Haitham Tuffaha
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, QLD, 4072, Australia
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22
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Lee H, Yang Y, Xu J, Ware JB, Liu B. Use of Magnetic Resonance Imaging in Acute Traumatic Brain Injury Patients is Associated with Lower Inpatient Mortality. J Clin Imaging Sci 2021; 11:53. [PMID: 34754593 PMCID: PMC8571198 DOI: 10.25259/jcis_148_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: While magnetic resonance imaging (MRI) has higher sensitivity than computed tomography for certain types of traumatic brain injury (TBI), it remains unknown whether the increased detection of intracranial injuries leads to improved clinical outcomes in acute TBI patients, especially given the resource requirements involved in performing MRI. We leveraged a large national patient database to examine associations between brain MRI utilization and inpatient clinical outcomes in hospitalized TBI patients. Material and Methods: The National Inpatient Sample database was queried to find 3,075 and 340,090 hospitalized TBI patients with and without brain MRI, respectively, between 2012 and 2014 in the United States. Multivariate regression analysis was performed to independently evaluate the association between brain MRI utilization and inpatient mortality rate, complications, and resource requirements. Results: The MRI group had a lower unadjusted mortality rate of 0.75% compared to 2.54% in the non-MRI group. On multivariate regression analysis, inpatient brain MRI was independently associated with lower mortality (adjusted OR 0.32, 95% CI 0.12–0.86), as well as higher rates of intracranial hemorrhage (adjusted OR 2.20, 95% CI 1.27–3.81) and non-home discharge (adjusted OR 1.33, 95% CI 1.07–1.67). Brain MRI was independently associated with 3.4 days (P < 0.001) and $8,934 (P < 0.001) increase in the total length and cost of hospital stay, respectively. Conclusion: We present the first evidence that inpatient brain MRI in TBI patients is associated with lower inpatient mortality, but with increased hospital resource utilization and likelihood of non-home discharge.
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Affiliation(s)
- Hwan Lee
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yifeng Yang
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jiehui Xu
- Division of Biostatistics, New York University Grossman School of Medicine, New York, United States
| | - Jeffrey B Ware
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Baogiong Liu
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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23
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Rose SC, Anderson W, Feinberg D, Ganesh A, Green L, Jaffee M, Kaplen M, Lorincz M, De Luigi A, Patel D, Tsao JW, Lee E, Webb A. Quality Improvement in Neurology: Concussion Quality Measurement Set. Neurology 2021; 97:537-542. [PMID: 34321361 DOI: 10.1212/wnl.0000000000012537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/10/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sean C Rose
- Nationwide Childrens Hospital and The Ohio State University, Columbus, OH
| | | | | | | | - Lauren Green
- University of Southern California, Los Angeles, CA
| | | | | | | | | | | | | | - Erin Lee
- American Academy of Neurology, Minneapolis, MN
| | - Adam Webb
- Emory University School of Medicine, Decatur, GA
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24
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Delmonico RL, Theodore BR, Sandel ME, Armstrong MA, Camicia M. Prevalence of depression and anxiety disorders following mild traumatic brain injury. PM R 2021; 14:753-763. [PMID: 34156769 DOI: 10.1002/pmrj.12657] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 04/06/2021] [Accepted: 06/02/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies have identified an association between traumatic brain injuries and the development of psychiatric disorders in general. However, these studies were subject to limitations that demonstrate the need for a study of a large, clearly defined mild traumatic brain injury (mTBI) population within an integrated healthcare system. OBJECTIVE To determine the prevalence and relative risk of postinjury affective disorders over 4 years following mTBI. DESIGN Cohort study of mTBI cases and matched controls, over a 4-year period. SETTING An integrated healthcare delivery system in California. PATIENTS A total of 9428 adult health plan members diagnosed with mTBI from 2000-2007 and enrolled in the year before injury, during which no TBI was ascertained. Control participants included 18,856 individuals selected based on the following criteria: Two unexposed health plan members per each mTBI-exposed patient were randomly selected and individually matched for age, gender, race/ethnicity, and medical comorbidities. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A diagnosis of affective disorder (depressive, anxiety, and adjustment disorders) in the 4 years after mTBI or the reference date, determined according to the International Classification of Diseases, Ninth Revision, Clinical Modification as well as the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. RESULTS Affective disorders were most prominent during the first 12 months with 23% following mTBI and 14% in the control group. Four-year aggregate adjusted odds ratios for having an affective disorder following mTBI were 1.2 (95% CI: 1.1, 1.2; p < .001) and 1.5 (95% CI: 1.5, 1.6; p < .001) for patients with and without prior affective disorders, respectively. CONCLUSION mTBI was associated with a significantly increased risk of having subsequent affective disorders. Screening for and addressing affective disorders at earlier stages following the injury is an important step to avoid persisting conditions that may pose a barrier to full recovery.
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Affiliation(s)
- Richard L Delmonico
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, California, USA
| | - Brian R Theodore
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, California, USA
| | - M Elizabeth Sandel
- School of Medicine, University of California, Davis, Sacramento, California, USA
| | | | - Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo Medical Center, Vallejo, California, USA
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25
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Abstract
BACKGROUND Traumatic brain injury (TBI) is a serious public health problem in the United States. Each year, TBIs substantially contribute to health care costs, which vary by severity. This is important to consider given the variability in recovery time by severity. RESEARCH DESIGN This study quantifies the annual incremental health care costs of nonfatal TBI in 2016 for the US population covered by a private health insurance, Medicaid, or Medicare health plan. This study uses MarketScan and defines severity with the abbreviated injury scale for the head and neck region. Nonfatal health care costs were compared by severity. RESULTS The estimated 2016 overall health care cost attributable to nonfatal TBI among MarketScan enrollees was $40.6 billion. Total estimated annual health care cost attributable to TBI for low severity TBIs during the first year postinjury were substantially higher than costs for middle and high severity TBIs among those with private health insurance and Medicaid. CONCLUSIONS This study presents economic burden estimates for TBI that underscore the importance of developing strategies to prevent TBIs, regardless of severity. Although middle and high severity TBIs were more costly at the individual level, low severity TBIs, and head injuries diagnosed as "head injury unspecified" resulted in higher total estimated annual health care costs attributable to TBI.
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Affiliation(s)
| | - Lara DePadilla
- Overdose Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA
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26
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Moyron RB, Vallejos PA, Fuller RN, Dean N, Wall NR. Neuroimaging and advanced research techniques may lead to improved outcomes in military members suffering from traumatic brain injury. Trauma Surg Acute Care Open 2021; 6:e000608. [PMID: 33490604 PMCID: PMC7797256 DOI: 10.1136/tsaco-2020-000608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022] Open
Abstract
Recent military conflicts in Iraq and Afghanistan have resulted in the significant increase in blast-related traumatic brain injury (TBI), leading to increased Department of Defense interest in its potential long-term effects ranging from the mildest head injuries termed subconcussive trauma to the most debilitating termed chronic traumatic encephalopathy (CTE). Most patients with mild TBI will recover quickly while others report persistent symptoms called postconcussive syndrome. Repeated concussive and subconcussive head injuries result in neurodegenerative conditions that may hinder the injured for years. Fundamental questions about the nature of these injuries and recovery remain unanswered. Clinically, patients with CTE present with either affective changes or cognitive impairment. Genetically, there have been no clear risk factors identified. The discovery that microglia of the cerebral cortex discharged small extracellular vesicles in the injured and adjacent regions to a TBI may soon shed light on the immediate impact injury mechanisms. The combination of neuroimaging and advanced research techniques may, one day, fill critical knowledge gaps and lead to significant TBI research and treatment advancements.
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Affiliation(s)
- Ron B Moyron
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Paul A Vallejos
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Ryan N Fuller
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Natasha Dean
- Department of Biology, La Sierra University, Riverside, California, USA
| | - Nathan R Wall
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
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27
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Yengo-Kahn AM, Kelly PD, Liles DC, McKeithan LJ, Grisham CJ, Khan MS, Lee T, Kuhn AW, Bonfield CM, Zuckerman SL. The cost of a single concussion in American high school football: a retrospective cohort study. Concussion 2020; 5:CNC81. [PMID: 33204493 PMCID: PMC7653506 DOI: 10.2217/cnc-2020-0012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Aim: The potential financial burden of American football-related concussions (FRC) is unknown. Our objective was to describe the healthcare costs associated with an FRC and determine factors associated with increased costs. Methodology/results: A retrospective cohort study of concussed high school football players presenting between November 2017 and March 2020 was undertaken; 144 male high school football players were included. Total costs were about $115,000, for an average direct healthcare cost of $800.10/concussion. Visiting the emergency department (β = 502.29, 95% CI: 105.79–898.61; p = 0.01), the initial post-concussion symptom scale score (β = 0.39, 95% CI: 0.11–0.66; p = 0.01) and a post-concussion syndrome diagnosis (β = 670.37, 95% CI: 98.96–1241.79; p = 0.02) were each independently associated with total costs. Conclusion: A granular understanding of cost-driving factors associated with FRC is the first step in understanding the cost–effectiveness of prevention and treatment methods. The healthcare costs, or the costs incurred by the healthcare system, associated with a single concussion in American high school football are unknown. We reviewed the records of 144 high school football players who received concussion care at our sport concussion center and calculated the direct healthcare costs associated with the appointments, imaging studies and therapies received, when applicable. We found that each concussion results in about $800 of healthcare system spending. A few factors were associated with greater costs, including visiting the emergency department and having symptoms for over 1 month. Furthermore, the more symptoms an athlete had at their first clinic visit, the higher total cost of care. Understanding these costs can potentially help clinicians and researchers determine the best ways to maximize care while minimizing the costs.
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Affiliation(s)
- Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - David C Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lydia J McKeithan
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,School of Medicine, Vanderbilt University, Nashville, TN 37232, USA
| | - Candace J Grisham
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,School of Medicine, Vanderbilt University, Nashville, TN 37232, USA
| | | | - Timothy Lee
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Andrew W Kuhn
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Orthopedic Surgery, Washington University in St Louis, St Louis, MO 63110, USA
| | - Christopher M Bonfield
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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28
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Martha SR, Chen KF, Lin Y, Thompson HJ. Plasma Phospholipid Metabolites Associate With Functional Outcomes Following Mild Traumatic Brain Injury in Older Adults. Biol Res Nurs 2020; 23:127-135. [PMID: 32696677 DOI: 10.1177/1099800420942889] [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: 11/17/2022]
Abstract
OBJECTIVE To compare differences using a metabolomics approach in older adults (≥55) with mild traumatic brain injury (mTBI) to control adults and to identify a signature profile related to functional outcome 3-6 months post-injury. METHODS We performed metabolomics analysis using LC-MS of untargeted aqueous metabolites on plasma samples taken from a parent prospective cohort study. Older adults with mTBI (n = 14) were purposively sampled to include participants with worsening (decrease in GOS-E of at least 1 level) and improved (increase in GOS-E of at least 1 level) outcomes from 3 to 6 months. The data were analyzed using PLS-DA with VIP scores, Random Forest, and spline fit between the different groups as a function of time for exposure on outcome. RESULTS Separation of comparisons were seen at 24 hours (negative ionization) and 6 months (positive ionization), revealing two metabolites of interest, phosphatidylcholine and phosphatidylethanolamine. Phosphatidylcholine levels were higher in those with mTBI compared to controls (p < 0.05), while lower concentration of phosphatidylethanolamine was seen in those with mTBI compared to controls (p < 0.05). Phosphatidylinositol-3,4,5-trisphosphate was significant in those with mTBI compared to controls (n = 10) based on improved (n = 6) versus worsened (n = 8) outcomes from 3 to 6 months. CONCLUSION We identified plasma metabolites related to phospholipid metabolism in older adults following mTBI and associated with long-term functional outcome. These findings may underly pathological mechanisms of outcome differences in older adults who experience mTBI.
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Affiliation(s)
- Sarah R Martha
- Omics and Symptom Science Training Program in Biobehavioral Nursing and Health Informatics Department, School of Nursing, 7284University of Washington, Seattle, WA, USA
| | - Kuan-Fu Chen
- Department of Pharmaceutics, School of Pharmacy, 7284University of Washington, Seattle WA, USA
| | - Yvonne Lin
- Department of Pharmaceutics, School of Pharmacy, 7284University of Washington, Seattle WA, USA
| | - Hilaire J Thompson
- Biobehavioral Nursing and Health Informatics Department, School of Nursing and Harborview Injury Prevention and Research Center, 7284University of Washington, Seattle, WA, USA
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29
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Identifying Novel Embedded Performance Validity Test Formulas Within the Repeatable Battery for the Assessment of Neuropsychological Status: a Simulation Study. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09382-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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30
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Ciarlone SL, Statz JK, Goodrich JA, Norris JN, Goforth CW, Ahlers ST, Tschiffely AE. Neuroendocrine function and associated mental health outcomes following mild traumatic brain injury in OEF‐deployed service members. J Neurosci Res 2020; 98:1174-1187. [DOI: 10.1002/jnr.24604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/31/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Stephanie L. Ciarlone
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
- The Henry M. Jackson Foundation Inc. Bethesda MD USA
| | - Jonathan K. Statz
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
- The Henry M. Jackson Foundation Inc. Bethesda MD USA
| | - Jessica A. Goodrich
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
- The Henry M. Jackson Foundation Inc. Bethesda MD USA
| | - Jacob N. Norris
- Cyber, Science, & Technology Department Space and Naval Warfare Systems Center Pacific San Diego CA USA
| | - Carl W. Goforth
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
- Department of Surgery Uniformed Services University of the Health Sciences Bethesda MD USA
| | - Stephen T. Ahlers
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
| | - Anna E. Tschiffely
- Neurotrauma Department Naval Medical Research Center Silver Spring MD USA
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31
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Lace JW, Grant AF, Ruppert P, Kaufman DAS, Teague CL, Lowell K, Gfeller JD. Detecting noncredible performance with the neuropsychological assessment battery, screening module: A simulation study. Clin Neuropsychol 2019; 35:572-596. [DOI: 10.1080/13854046.2019.1694703] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- John W. Lace
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | - Alex F. Grant
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | - Phillip Ruppert
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University, St. Louis, MO, USA
| | | | - Carson L. Teague
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
| | - Kimberly Lowell
- Department of Psychology, Saint Louis University, St. Louis, MO, USA
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