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Lau JS, Lust CAC, Lecques JD, Hillyer LM, Mountjoy M, Kang JX, Robinson LE, Ma DWL. n-3 PUFA ameliorate functional outcomes following repetitive mTBI in the fat-1 mouse model. Front Nutr 2024; 11:1410884. [PMID: 39070251 PMCID: PMC11272621 DOI: 10.3389/fnut.2024.1410884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose Repeated mild traumatic brain injuries (mTBI) are a continuing healthcare concern worldwide, given its potential for enduring adverse neurodegenerative conditions. Past research suggests a potential protective effect of n-3 polyunsaturated fatty acids (PUFA) in experimental models of mTBI. The aim of this study was to investigate whether the neuroprotective benefits of n-3 PUFA persist following repetitive weight drop injury (WDI). Methods Male fat-1 mice (n = 12), able to endogenously convert n-6 PUFA to n-3 PUFA, and their wild type (WT) counterparts (n = 12) were maintained on a 10% w/w safflower diet. At 9-10 weeks of age, both groups received one mild low-impact WDI on the closed cranium daily, for three consecutive days. Following each WDI, time to righting reflex and seeking behaviour were measured. Neurological recovery, cognitive, motor, and neurobehavioural outcomes were assessed using the Neurological Severity Score (NSS) over 7 days (168 h) post-last WDI. Brains were assessed for cerebral microhemorrhages by Prussian blue and cellular damage by glial fibrillary acidic protein (GFAP) staining. Results Fat-1 mice exhibited significantly faster righting reflex and seeking behaviour time, and lower mean NSS scores and at all post-WDI time points (p ≤ 0.05) compared to WT mice. Immunohistochemistry showed no significant difference in presence of cerebral microhemorrhage however, fat-1 mice had significantly lower GFAP staining in comparison to WT mice (p ≤ 0.05). Conclusion n-3 PUFA is effective in restoring cognitive, motor, and behavioural function after repetitive WDI, which may be mediated through reduced cellular damage of the brain.
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Affiliation(s)
- Jessi S. Lau
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Cody A. C. Lust
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | | | - Lyn M. Hillyer
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Margo Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Jing X. Kang
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Lindsay E. Robinson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - David W. L. Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
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Chiollaz AC, Pouillard V, Habre C, Seiler M, Romano F, Spigariol F, Ritter Schenk C, Korff C, Maréchal F, Wyss V, Gruaz L, Montaner J, Manzano S, Sanchez JC. Diagnostic potential of IL6 and other blood-based inflammatory biomarkers in mild traumatic brain injury among children. Front Neurol 2024; 15:1432217. [PMID: 39055316 PMCID: PMC11270961 DOI: 10.3389/fneur.2024.1432217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Objectives Inflammatory biomarkers, as indicators of biological states, provide a valuable approach for accurate and reproducible measurements, crucial for the effective management of mild traumatic brain injury (mTBI) in pediatric patients. This study aims to assess the diagnostic utility of blood-based inflammatory markers IL6, IL8, and IL10 in children with mTBI, including those who did not undergo computed tomography (CT) scans. Methods A prospective multicentric cohort study involving 285 pediatric mTBI patients was conducted, stratified into CT-scanned and non-CT-scanned groups within 24 h post-trauma, alongside 74 control subjects. Biomarker levels were quantitatively analyzed using ELISA. Sensitivity and specificity metrics were calculated to determine the diagnostic efficacy of each biomarker. Results A total of 223 mTBI patients (78%) did not undergo CT scan examination but were kept in observation for symptoms monitoring at the emergency department (ED) for more than 6 h (in-hospital-observation patients). Among CT-scanned patients (n = 62), 14 (23%) were positive (CT+). Elevated levels of IL6 and IL10 were found in mTBI children compared to controls. Within mTBI patients, IL6 was significantly increased in CT+ patients compared to both CT- and in-hospital-observation patients. No significant differences were observed for IL8 among the compared groups. IL6 yielded a specificity of 48% in identifying CT- and in-hospital-observation patients, with 100% sensitivity in excluding all CT+ cases. These performances were maintained whether IL6 was measured within 6 h or within 24 h after the trauma. Conclusion The inflammatory marker IL6 emerges as a robust biomarker, showing promising stratification value for pediatric mTBI patients undergoing CT scans or staying in observation in a pediatric ED.
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Affiliation(s)
- Anne-Cécile Chiollaz
- Department of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Virginie Pouillard
- Pediatric Neurology Unit, Department of the Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| | - Céline Habre
- Division of Radiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Michelle Seiler
- Department of Pediatric Emergency, University Children's Hospital Zurich, Zürich, Switzerland
| | - Fabrizio Romano
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Spigariol
- Department of Pediatric Emergency, Neuchâtel Hospital (RHNE), Neuchâtel, Switzerland
| | | | - Christian Korff
- Pediatric Neurology Unit, Department of the Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| | - Fabienne Maréchal
- Platform of Pediatric Clinical Research, Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland
| | - Verena Wyss
- Department of Pediatric Emergency, University Children's Hospital Zurich, Zürich, Switzerland
| | - Lyssia Gruaz
- Department of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Joan Montaner
- Neurovascular Research Group, Institute of Biomedicine of Seville, IBiS/Virgen Macarena University Hospital/CSIC/University of Seville, Seville, Spain
| | - Sergio Manzano
- Department of Pediatric Emergency, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Charles Sanchez
- Department of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Menditto VG, Rossetti G, Sampaolesi M, Buzzo M, Pomponio G. Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department. J Clin Med 2024; 13:3669. [PMID: 38999235 PMCID: PMC11242576 DOI: 10.3390/jcm13133669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric. We reviewed the most recent evidence on these topics and explored other clinically relevant aspects, such as the promising role of dosing brain biomarkers, the strategies to assess the extent of anticoagulation, and the indications of reversals and tranexamic acid administration, in cases of mild TBI or as a bridge to neurosurgery. The appropriate timing of anticoagulant resumption was also discussed. Finally, we obtained an insight into the economic burden of TBI in patients on oral anticoagulants, and future directions on the management of this subpopulation of TBI patients were proposed. In this article, at the end of each section, a "take home message" is stated.
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Affiliation(s)
- Vincenzo G Menditto
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giulia Rossetti
- Internal Medicine, Santa Croce Hospital AST1 Pesaro Urbino, 61032 Fano, Italy
| | - Mattia Sampaolesi
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Marta Buzzo
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giovanni Pomponio
- Clinica Medica, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
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Guil Sànchez J. [Traumatic brain injury in patients over 65 years of age attended in the emergency department, characteristics and complications]. Rev Esp Geriatr Gerontol 2024; 59:101494. [PMID: 38583410 DOI: 10.1016/j.regg.2024.101494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/27/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Ageing is associated with an increased risk of falls and trauma. The aim of the study was to assess the characteristics of patients over 65 years of age who consulted the ED for traumatic brain injury (TBI) in 2022, their relationship with cognitive impairment, functional dependence, use of oral antiplatelet/anticoagulant drugs and complications. MATERIALS AND METHODS Retrospective study conducted from 1 January to 31 December 2022. Demographic data were collected: age, sex, origin; cardiovascular risk factors; cognitive impairment using the Pfeiffer questionnaire; physical disability according to the Barthel Index; number of drugs; use of antiplatelet and oral anticoagulant (OAC); mechanism of fall; performance of cranial X-ray/CT, and presence of complications: intracranial haemorrhage (ICH), death. RESULTS 599 patients were included. The mean age was 82.3±8.2 years. 63.8% were female and 36.2% male. 75.3% were from home, 24.7% from residence. No dementia in 61.4%, moderate-severe dementia in 38.6%. 58.1% were functionally independent, 25.1% had moderate-severe dependence. 85.7% had CVRF: HT 476 (79.5%), dyslipidaemia 354 (59.1%), DM 217 (36.2%), obesity 173 (28.9%), smoking 15 (2.5%). The number of drugs per patient was 9.2±4.3. Polypharmacy was present in 94.7% of patients. 35.9% were taking antiplatelet drugs and 30.2% anticoagulants. Intracranial haemorrhage occurred in 11 (2.3%) patients. Four (0.7%) patients died. CONCLUSIONS The TBI in our study was caused by low-energy trauma in a female patient, without dementia, functionally independent and with polypharmacy. There were few serious complications: 2.3% ICH and 0.7% deaths. 90.1% of ICH occurred in patients on antiplatelet and/or OAC therapy.
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Affiliation(s)
- Josep Guil Sànchez
- Servei d'Urgències de l'Hospital Universitari de Mollet, Fundació Sanitària de Mollet, Mollet del Vallès, Barcelona, España.
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Lander DM, Liu S, Roup CM. Associations Between Auditory Working Memory, Self-Perceived Listening Effort, and Hearing Difficulty in Adults With Mild Traumatic Brain Injury. Ear Hear 2024; 45:695-709. [PMID: 38229218 DOI: 10.1097/aud.0000000000001462] [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: 01/18/2024]
Abstract
OBJECTIVES Mild traumatic brain injury (TBI) can have persistent effects in the auditory domain (e.g., difficulty listening in noise), despite individuals having normal pure-tone auditory sensitivity. Individuals with a history of mild TBI often perceive hearing difficulty and greater listening effort in complex listening situations. The purpose of the present study was to examine self-perceived hearing difficulty, listening effort, and performance on an auditory processing test battery in adults with a history of mild TBI compared with a control group. DESIGN Twenty adults ages 20 to 53 years old participated divided into a mild TBI (n = 10) and control group (n = 10). Perceived hearing difficulties were measured using the Adult Auditory Processing Scale and the Hearing Handicap Inventory for Adults. Listening effort was measured using the National Aeronautics and Space Administration-Task Load Index. Listening effort ratings were obtained at baseline, after each auditory processing test, and at the completion of the test battery. The auditory processing test battery included (1) dichotic word recognition, (2) the 500-Hz masking level difference, (3) the Listening in Spatialized Noise-Sentences test, and (4) the Word Auditory Recognition and Recall Measure (WARRM). RESULTS Results indicated that individuals with a history of mild TBI perceived significantly greater degrees of hearing difficulty and listening effort than the control group. There were no significant group differences on two of the auditory processing tasks (dichotic word recognition or Listening in Spatialized Noise-Sentences). The mild TBI group exhibited significantly poorer performance on the 500-Hz MLD and the WARRM, a measure of auditory working memory, than the control group. Greater degrees of self-perceived hearing difficulty were significantly associated with greater listening effort and poorer auditory working memory. Greater listening effort was also significantly associated with poorer auditory working memory. CONCLUSIONS Results demonstrate that adults with a history of mild TBI may experience subjective hearing difficulty and listening effort when listening in challenging acoustic environments. Poorer auditory working memory on the WARRM task was observed for the adults with mild TBI and was associated with greater hearing difficulty and listening effort. Taken together, the present study suggests that conventional clinical audiometric battery alone may not provide enough information about auditory processing deficits in individuals with a history of mild TBI. The results support the use of a multifaceted battery of auditory processing tasks and subjective measures when evaluating individuals with a history of mild TBI.
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Affiliation(s)
- Devan M Lander
- Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio, USA
| | - Shuang Liu
- Independent Statistical Consultant, Columbus, Ohio, USA
| | - Christina M Roup
- Department of Speech & Hearing Science, The Ohio State University, Columbus, Ohio, USA
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Moore L, Ben Abdeljelil A, Tardif PA, Zemek R, Reed N, Yeates KO, Emery CA, Gagnon IJ, Yanchar N, Bérubé M, Dawson J, Berthelot S, Stang A, Beno S, Beaulieu E, Turgeon AF, Labrosse M, Lauzier F, Pike I, Macpherson A, Freire GC. Clinical Practice Guideline Recommendations in Pediatric Mild Traumatic Brain Injury: A Systematic Review. Ann Emerg Med 2024; 83:327-339. [PMID: 38142375 DOI: 10.1016/j.annemergmed.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/25/2023]
Abstract
STUDY OBJECTIVE Our primary objectives were to identify clinical practice guideline recommendations for children with acute mild traumatic brain injury (mTBI) presenting to an emergency department (ED), appraise their overall quality, and synthesize the quality of evidence and the strength of included recommendations. METHODS We searched MEDLINE, EMBASE, Cochrane Central, Web of Science, and medical association websites from January 2012 to May 2023 for clinical practice guidelines with at least 1 recommendation targeting pediatric mTBI populations presenting to the ED within 48 hours of injury for any diagnostic or therapeutic intervention in the acute phase of care (ED and inhospital). Pairs of reviewers independently assessed overall clinical practice guideline quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. The quality of evidence on recommendations was synthesized using a matrix based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework. RESULTS We included 11 clinical practice guidelines, of which 6 (55%) were rated high quality. These included 101 recommendations, of which 34 (34%) were based on moderate- to high-quality evidence, covering initial assessment, initial diagnostic imaging, monitoring/observation, therapeutic interventions, discharge advice, follow-up, and patient and family support. We did not identify any evidence-based recommendations in high-quality clinical practice guidelines for repeat imaging, neurosurgical consultation, or hospital admission. Lack of strategies and tools to aid implementation and editorial independence were the most common methodological weaknesses. CONCLUSIONS We identified 34 recommendations based on moderate- to high-quality evidence that may be considered for implementation in clinical settings. Our review highlights important areas for future research. This review also underlines the importance of providing strategies to facilitate the implementation of clinical practice guideline recommendations for pediatric mTBI.
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Affiliation(s)
- Lynne Moore
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada.
| | - Anis Ben Abdeljelil
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Social and Preventative Medicine, Université Laval, Québec, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
| | - Roger Zemek
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberts, Canada
| | - Isabelle J Gagnon
- Division of Pediatric Emergency Medicine, McGill University Health Centre, Montréal Children's Hospital, Montréal, Québec, Canada
| | - Natalie Yanchar
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Jennifer Dawson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Simon Berthelot
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada
| | - Antonia Stang
- Pediatrics, Emergency Medicine, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Beno
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Emilie Beaulieu
- Département de Pédiatrie, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Anesthesiology and Critical Care Medicine Université Laval, Québec City, Québec, Canada
| | - Melanie Labrosse
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Québec City, Québec, Canada; Department of Anesthesiology and Critical Care Medicine Université Laval, Québec City, Québec, Canada
| | - Ian Pike
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison Macpherson
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Gabrielle C Freire
- Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences Program, Peter Gilgan Institute for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
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Benedetti S, Benedetti MD, Tomasi D, Palmisano G, Calcagno S, Bianchi S, Giannasi G. In old anticoagulated patients with mild traumatic brain injury, a 24-h observation period should not be recommended without evidence of a clear benefit: a retrospective study of delayed hemorrhagic versus iatrogenic complications. Intern Emerg Med 2024; 19:523-534. [PMID: 37812308 DOI: 10.1007/s11739-023-03435-0] [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: 06/08/2022] [Accepted: 09/11/2023] [Indexed: 10/10/2023]
Abstract
Mild traumatic brain injury (mTBI) is a common cause of admission to the Emergency Department (ED). Many patients are elderly on oral anticoagulant therapy (OAT) at increased risk of immediate and delayed intracranial hemorrhage (ICH). To investigate the frequency of delayed ICH (DICH) in old patients with mTBI in OAT and the occurrence of complications related to the ED stay. In this single-center retrospective study, we recruited all patients in OAT aged 65 and over, admitted for mTBI to the ED of our Hospital in Florence from March 2019 to February 2021. Clinical variables were collected and cranial computed tomography (CT) scans reviewed. The primary outcome was the frequency of DICH occurring within 30 days since the trauma after a first negative CT. Secondary outcomes included need of neurosurgical intervention and death for DICH, and hospital-related complications. Statistical analyses were conducted using IBM SPSS Statistics (version 22). Among 363 enrolled patients, there were 31 acute ICH (8.5%) at the first CT scan, while in the 316 negative included patients, 10 DICH (3.2%) were identified. Among the latter, no neurosurgical treatment, or death due to ICH occurred. Overall, 25 cases (6.9%) had iatrogenic complications during the 24-h observation period, often serious, such as respiratory failure after sedation due to restlessness, or COVID-19 infection. The low frequency of DICH and the occurrence of several iatrogenic complications suggest that the risk-benefit ratio of a 24-h ED observation is not advantageous in elderly with mTBI.
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Affiliation(s)
- Saverio Benedetti
- Emergency Department, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Azienda Ospedaliera Toscana Centro, Florence, Italy.
| | - Maria Donata Benedetti
- Neurologia Clinica, Dipartimento di Neuroscienze, Università degli Studi di Verona, Biomedicina e Movimento, Verona, Italy
| | - Domenico Tomasi
- Radiology Department, Azienda Ospedaliera Toscana Centro, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Florence, Italy
| | - Giulia Palmisano
- Emergency Department, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Azienda Ospedaliera Toscana Centro, Florence, Italy
| | - Stefano Calcagno
- Emergency Department, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Azienda Ospedaliera Toscana Centro, Florence, Italy
| | - Simone Bianchi
- Emergency Department, Azienda Ospedaliera Toscana Centro, S. Maria Nuova Hospital, U.O. Medicina d'Urgenza, Florence, Italy
| | - Gianfranco Giannasi
- Emergency Department, San Giovanni di Dio Hospital, U.O. Medicina d'Urgenza, Azienda Ospedaliera Toscana Centro, Florence, Italy
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Menditto VG, Moretti M, Babini L, Sampaolesi M, Buzzo M, Montillo L, Raponi A, Riccomi F, Marcosignori M, Rocchi M, Pomponio G. Minor head injury in anticoagulated patients: Outcomes and analysis of clinical predictors. A prospective study. Am J Emerg Med 2024; 76:105-110. [PMID: 38056055 DOI: 10.1016/j.ajem.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The optimal management of patients taking oral anticoagulants who experience minor head injury (MHI) is unclear. The availability of validated protocols and reliable predictors of prognosis would be of great benefit. We investigated clinical factors as predictors of clinical outcomes and intracranial injury (ICI). METHODS We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan. The primary outcome was the occurrence of MHI-related death or re-admission to ED at day +30. The secondary outcome was the rate of delayed ICI (dICI), defined as second positive CT scan after a first negative CT scan. We assessed some clinical predictors derived from guidelines and clinical prediction rules as potential risk factors for the outcomes. RESULTS 450 patients with a negative first CT scan who underwent a second CT scan composed our 'study population'. The rate of the primary outcome was 4%. The rate of the secondary outcome was 4.7%. Upon univariate and multivariate analysis no statistically significant predictors for the outcomes were found. CONCLUSIONS Previous retrospective studies showed a lot of negative predictive factors for anticoagulated patients suffering a minor head injury. In our prospective study no clinical factors emerged as predictors of poor clinical outcomes and dICI. So, even if we confirmed a low rate of adverse outcomes, the best management of these patients in ED remains not so clear and future trials are needed.
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Affiliation(s)
- V G Menditto
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Ancona, Italy.
| | - M Moretti
- Medicina di Laboratorio, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - L Babini
- Medicina di Laboratorio, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - M Sampaolesi
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Ancona, Italy
| | - M Buzzo
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Ancona, Italy
| | - L Montillo
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Ancona, Italy
| | - A Raponi
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Ancona, Italy
| | - F Riccomi
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Ancona, Italy
| | - M Marcosignori
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Ancona, Italy
| | - M Rocchi
- Statistica Medica, Dipartimento di Scienze Biomolecolari, Università di Urbino, Urbino, Italy
| | - G Pomponio
- Clinica Medica, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
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9
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Martínez-Rivas JJ, Rodríguez-Lucas F, Planells G, Corrales D, Cocho D. Risk of cerebral hemorrhage in mild traumatic brain injury and antithrombotic treatment. Rev Clin Esp 2023; 223:604-609. [PMID: 37898355 DOI: 10.1016/j.rceng.2023.10.005] [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: 06/04/2023] [Accepted: 09/21/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment. METHOD We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with ≥1 risk factor at admission and at 24 h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed. RESULTS We evaluated 907 patients with a mean age of 73 ± 19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24 h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs 11.9% without treatment, p = 0.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24 h, 3 were asymptomatic and one case that worsened the initial headache. No asymptomatic patient without lesion on initial clinical cranial CT presented at 24 h. CONCLUSIONS Our study suggests that patients with asymptomatic mTBI, without a lesion on the initial cranial CT, would not require the observation period or CT control regardless of antithrombotic treatment or INR level.
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Affiliation(s)
- J J Martínez-Rivas
- Servicio de urgencias, Hospital General de Granollers, Barcelona, Spain.
| | - F Rodríguez-Lucas
- Servicio de urgencias, Hospital General de Granollers, Barcelona, Spain
| | - G Planells
- Servicio de urgencias, Hospital General de Granollers, Barcelona, Spain
| | - D Corrales
- Servicio de urgencias, Hospital General de Granollers, Barcelona, Spain
| | - D Cocho
- Servicio de Neurología, Hospital General de Granollers, Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain
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10
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Rakers SE, Liemburg EJ, van der Horn HJ, de Groot JC, Spikman JM, van der Naalt J. The impact of frontal lesions after mild to moderate traumatic brain injury on frontal network measures. PLoS One 2023; 18:e0287832. [PMID: 38033099 PMCID: PMC10688722 DOI: 10.1371/journal.pone.0287832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 06/14/2023] [Indexed: 12/02/2023] Open
Abstract
To investigate the impact of frontal macro-structural lesions on intrinsic network measures, we examined brain network function during resting-state fMRI in patients with frontal lesions in the subacute phase after mild to moderate traumatic brain injury. Additionally, network function was related to neuropsychological performances. 17 patients with frontal lesions, identified on admission CT after mild to moderate trauma, were compared to 30 traumatic brain injury patients without frontal lesions and 20 healthy controls. Three months post-injury, we acquired fMRI scans and neuropsychological assessments (measuring frontal executive functions and information processing speed). Using independent component analysis, the activity of and connectivity between network components (largely located in the prefrontal cortex) and relations with neuropsychological measures were examined and compared across groups. The analysis yielded five predominantly frontal components: anterior and posterior part of the default mode network, left and right frontoparietal network and salience network. No significant differences concerning fMRI measures were found across groups. However, the frontal lesions group performed significantly worse on neuropsychological tests than the other two groups. Additionally, the frontal lesions group showed a significant positive association of stronger default mode network-salience network connectivity with better executive performances. Our findings suggest that, on fMRI level, frontal network measures are not largely affected by frontal lesions following a mild to moderate traumatic brain injury. Yet, patients with damage to the frontal structures did show poorer executive abilities which might to some degree be related to altered frontal network connectivity between the default mode network and salience network.
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Affiliation(s)
- Sandra E. Rakers
- Department of Clinical Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Edith J. Liemburg
- BCN Neuroimaging Center of the Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harm J. van der Horn
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan Cees de Groot
- Department of Radiology, Medical Imaging Centre, Groningen, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jacoba M. Spikman
- Department of Clinical Neuropsychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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11
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Serner A, Araújo J, Beasley I, Boyce SH, Byrne A, Börjesson M, Geertsema L, Grimm K, Massey A. Video review of the frequency and assessment of head impacts during the FIFA Arab Cup 2021 TM. SCI MED FOOTBALL 2023; 7:331-336. [PMID: 36063104 DOI: 10.1080/24733938.2022.2120629] [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] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
We used injury spotters and video footage review to establish the frequency of head impacts, their characteristics, and the subsequent medical assessment during the FIFA Arab Cup 2021TM. Six defined video signs of potential concussion based on an international consensus were used. A total of 88 head impacts were observed, with a median of 2 (IQR 1.5-4, range 0-7) head impacts per match, of which 44 (50%) resulted in on-pitch medical assessment. The median assessment duration was 51s (IQR 34-65s, range 19-262s). The most common mechanism was head-to-head contact (27% of all impacts and 43% of impacts with medical assessment). Seven head impacts showed video signs of potential concussion: six had one sign and one had two signs. The concussion substitution was used in three incidents. Head impacts during the FIFA Arab Cup were common and a median of 1 head impact per game required an on-pitch medical assessment. Only 8% of the head impacts showed any video sign of potential concussion, and only 3% resulted in a concussion substitution. The medical on-pitch assessments appeared too short (<1 min) to allow an appropriate assessment of all head impacts, indicating a need for further evaluation. Further standardisation of the injury spotter's role in football is recommended.
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Affiliation(s)
- Andreas Serner
- Fédération Internationale de Football Association, Zurich, Switzerland
| | - Joao Araújo
- Sporting Clube de Portugal, Lisbon, Portugal
| | - Ian Beasley
- Centre for Sport and Exercise Medicine, Queen Mary College, University of London, London UK
| | - Stephen H Boyce
- Emergency Department, Glasgow Royal Infirmary, Scottish Football Association, Scottish Institute of Sport, Stirling UK
| | - Alan Byrne
- The Football Association of Ireland, National Sports Campus, Dublin, Ireland
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Center for Health and Performance, Sahlgrenska Academy, Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Katharina Grimm
- Fédération Internationale de Football Association, Zurich, Switzerland
| | - Andrew Massey
- Fédération Internationale de Football Association, Zurich, Switzerland
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12
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Alnawmasi MM, Khuu SK. Deficits in the pupillary response associated with abnormal visuospatial attention allocation in mild traumatic brain injury. J Clin Exp Neuropsychol 2023; 45:855-873. [PMID: 38368620 DOI: 10.1080/13803395.2024.2314727] [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: 02/21/2023] [Accepted: 11/25/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The ability to allocate visual attention is known to be impaired in patients with mild traumatic brain injury (mTBI). In the present study, we investigated a possible neural correlate of this cognitive deficit by examining the pupil response of patients with mTBI whilst performing a modified Posner visual search task. METHOD Two experiments were conducted in which the target location was either not cued (Experiment 1) or cued (Experiment 2). Additionally, in Experiment 2, the type of cue (endogenous vs exogenous cue) and cue validity were treated as independent variables. In both experiments, search efficiency was varied by changing shape similarity between target and distractor patterns. The reaction time required to judge whether the target was present or absent and pupil dilation metrics, particularly the pupil dilation latency (PDL) and amplitude (PDA), were measured. Thirteen patients with chronic mTBI and 21 age-, sex-, and IQ -matched controls participated in the study. RESULTS In Experiment 1, patients with mTBI displayed a similar PDA for both efficient and inefficient search conditions, while control participants had a significantly larger PDA in inefficient search conditions compared to efficient search conditions. As cognitive load is positively correlated with PDA, our findings suggest that mTBI patients were unable to apply more mental effort whilst performing visual search, particularly if the task is difficult when visual search is inefficient. In Experiment 2, when the target location was cued, patients with mTBI displayed no significant pupil dilation response to the target regardless of the efficiency of the search, nor whether the cue was valid or invalid. These results contrasted with control participants, who were additionally sensitive to the validity of the cue in which PDA was smaller for cue-valid conditions than invalid conditions, particularly for efficient search conditions. CONCLUSION Pupillometry provided further evidence of attention allocation deficits following mTBI.
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Affiliation(s)
- Mohammed M Alnawmasi
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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13
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Merino J, Whelan BM, Finch E. Examining the occurrence and outcomes of concussion and mTBI in mixed martial arts athletes: a systematic review. PHYSICIAN SPORTSMED 2023; 51:394-404. [PMID: 35377825 DOI: 10.1080/00913847.2022.2061836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Mixed martial arts (MMA) is a sport growing in popularity around the world. However, many individuals participate in the sport with little understanding of the potential short- and long-term consequences of injuries sustained while participating. Specifically, individuals are placed at a high risk of minor traumatic brain injury (mTBI) and concussive episodes as a result of head injuries incurred during training and competition. AIMS The current review aimed to examine the literature surrounding the occurrence and outcomes of mTBI in MMA athletes to gain a better understanding of these consequences. METHODS Twenty-five studies were identified within the current review, of which 14 examined occurrence of mTBI within the sport setting, and elevenidentified outcomes of injury. RESULTS Overall, studies found that MMA athletes experienced mTBI and concussion to a greater extent than athletes in other sports. Deficits in memory, reaction time and processing speed were identified following occurrence of mTBI; however, several gaps in outcome measurement were identified within the current literature, including a lack of focus on speech and language outcomes. CONCLUSION Future research should examine a wider variety of outcomes to provide a clearer understanding of the consequences of participating in the sport.
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Affiliation(s)
- Joanne Merino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Brooke-Mai Whelan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
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Cipriano A, Turcato G, Park N, Zaboli A, Barbieri G, Riccardi A, Santini M, Lerza R, Bonora A, Ghiadoni L. Minimal is not minor also in patients with mild traumatic brain injury on oral direct anticoagulant therapy. Intern Emerg Med 2023; 18:1533-1541. [PMID: 36869261 DOI: 10.1007/s11739-023-03244-5] [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: 11/10/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
Currently, all patients, regardless of the type of head injury, should undergo a head computerized tomography (CT) if on oral anticoagulant therapy. The aim of the study was to assess the different incidences of intracranial hemorrhage (ICH) between patients with minor head injury (mHI) and patients with mild traumatic brain injury (MTBI) and whether there were differences in the risk of death at 30 days as a result of trauma or neurosurgery. A retrospective multicenter observational study was conducted from January 1, 2016, to February 1, 2020. All patients on DOACs therapy who suffered head trauma and underwent a head CT were extracted from the computerized databases. Patients were divided into two groups MTBI vs mHI all in DOACs treatment. Whether a difference in the incidence of post-traumatic ICH was present was investigated, and pre- and post-traumatic risk factors were compared between the two groups to assess the possible association with ICH risk by propensity score matching. 1425 with an MTBI in DOACs were enrolled. Of these, 80.1% (1141/1425) had an mHI and 19.9% (284/1425) had an MTBI. Of these, 16.5% (47/284) patients with MTBI and 3.3% (38/1141) with mHI reported post-traumatic ICH. After propensity score matching, ICH was consistently found to be more associated with patients with MTBI than with mHI (12.5% vs 5.4%, p = 0.027). Risk factors associated with immediate ICH in mHI patients were high energy impact, previous neurosurgery, trauma above the clavicles, post-traumatic vomiting and headache. Patients on MTBI (5.4%) were found to be more associated with ICH than those with mHI (0.0%, p = 0.002). also when the need for neurosurgery or death within 30 days were considered. Patients on DOACs with mHI have a lower risk of presenting with post-traumatic ICH than patients with MTBI. Furthermore, patients with mHI have a lower risk of death or neurosurgery than patients with MTBI, despite the presence of ICH.
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Affiliation(s)
- Alessandro Cipriano
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gianni Turcato
- Intermediate Care Unit, Department of Internal Medicine, Hospital Alto Vicentino, Santorso, Italy
| | - Naria Park
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012, Merano, Italy.
| | - Greta Barbieri
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Emergency Medicine Department, University of Pisa, Pisa, Italy
| | - Alessandro Riccardi
- Emergency Department, Hospital of San Paolo (ASL N°2 Savonese), Savona, Italy
| | - Massimo Santini
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Roberto Lerza
- Emergency Department, Hospital of San Paolo (ASL N°2 Savonese), Savona, Italy
| | - Antonio Bonora
- Emergency Department, University of Verona, Verona, Italy
| | - Lorenzo Ghiadoni
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Emergency Medicine Department, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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15
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Sibilia F, Custer RM, Irimia A, Sepehrband F, Toga AW, Cabeen RP. Life After Mild Traumatic Brain Injury: Widespread Structural Brain Changes Associated With Psychological Distress Revealed With Multimodal Magnetic Resonance Imaging. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:374-385. [PMID: 37519474 PMCID: PMC10382710 DOI: 10.1016/j.bpsgos.2022.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 01/01/2023] Open
Abstract
Background Traumatic brain injury (TBI) can alter brain structure and lead to onset of persistent neuropsychological symptoms. This study investigates the relationship between brain injury and psychological distress after mild TBI using multimodal magnetic resonance imaging. Methods A total of 89 patients with mild TBI from the TRACK-TBI (Transforming Research and Clinical Knowledge in Traumatic Brain Injury) pilot study were included. Subscales of the Brief Symptoms Inventory 18 for depression, anxiety, and somatization were used as outcome measures of psychological distress approximately 6 months after the traumatic event. Glasgow Coma Scale scores were used to evaluate recovery. Magnetic resonance imaging data were acquired within 2 weeks after injury. Perivascular spaces (PVSs) were segmented using an enhanced PVS segmentation method, and the volume fraction was calculated for the whole brain and white matter regions. Cortical thickness and gray matter structures volumes were calculated in FreeSurfer; diffusion imaging indices and multifiber tracts were extracted using the Quantitative Imaging Toolkit. The analysis was performed considering age, sex, intracranial volume, educational attainment, and improvement level upon discharge as covariates. Results PVS fractions in the posterior cingulate, fusiform, and postcentral areas were found to be associated with somatization symptoms. Depression, anxiety, and somatization symptoms were associated with the cortical thickness of the frontal-opercularis and occipital pole, putamen and amygdala volumes, and corticospinal tract and superior thalamic radiation. Analyses were also performed on the two hemispheres separately to explore lateralization. Conclusions This study shows how PVS, cortical, and microstructural changes can predict the onset of depression, anxiety, and somatization symptoms in patients with mild TBI.
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Affiliation(s)
- Francesca Sibilia
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Rachel M. Custer
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - Farshid Sepehrband
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Arthur W. Toga
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ryan P. Cabeen
- Laboratory of Neuro Imaging, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
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16
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Brand J, McDonald SJ, Gawryluk JR, Christie BR, Shultz SR. Stress and traumatic brain injury: An inherent bi-directional relationship with temporal and synergistic complexities. Neurosci Biobehav Rev 2023; 151:105242. [PMID: 37225064 DOI: 10.1016/j.neubiorev.2023.105242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/04/2023] [Accepted: 05/20/2023] [Indexed: 05/26/2023]
Abstract
Traumatic brain injury (TBI) and stress are prevalent worldwide and can both result in life-altering health problems. While stress often occurs in the absence of TBI, TBI inherently involves some element of stress. Furthermore, because there is pathophysiological overlap between stress and TBI, it is likely that stress influences TBI outcomes. However, there are temporal complexities in this relationship (e.g., when the stress occurs) that have been understudied despite their potential importance. This paper begins by introducing TBI and stress and highlighting some of their possible synergistic mechanisms including inflammation, excitotoxicity, oxidative stress, hypothalamic-pituitary-adrenal axis dysregulation, and autonomic nervous system dysfunction. We next describe different temporal scenarios involving TBI and stress and review the available literature on this topic. In doing so we find initial evidence that in some contexts stress is a highly influential factor in TBI pathophysiology and recovery, and vice versa. We also identify important knowledge gaps and suggest future research avenues that will increase our understanding of this inherent bidirectional relationship and could one day result in improved patient care.
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Affiliation(s)
- Justin Brand
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Jodie R Gawryluk
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Brian R Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Sandy R Shultz
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada; Department of Neuroscience, Monash University, Melbourne, Victoria, Australia; Faculty of Health Sciences, Vancouver Island University, Nanaimo, British Columbia, Canada.
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Marzolla MC, Wijenberg M, Stapert S, Hurks P, Schepers J, van Heugten C. Hypersensitivity to Noise and Light Over 1 Year After Mild Traumatic Brain Injury: A Longitudinal Study on Self-Reported Hypersensitivity and Its Influence on Long-Term Anxiety, Depression, and Quality of Life. J Head Trauma Rehabil 2023; 38:259-267. [PMID: 35997762 DOI: 10.1097/htr.0000000000000813] [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: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate (1) the prevalence of self-reported sensory hypersensitivity (noise [NS] and light [LS]) over 1 year after mild traumatic brain injury (mTBI) in adults and (2) the impact of NS and LS measured 2 weeks after injury on long-term outcomes 12 months postinjury, while controlling for postconcussion symptoms. SETTING Participants were recruited from 6 hospitals in the south of the Netherlands and were tested 4 times (2 weeks, 3 months, 6 months, and 12 months postinjury), using self-report questionnaires. PARTICIPANTS In total, 186 mTBI participants (diagnosed using WHO [World Health Organization]/EFNS [European Federation of Neurological Societies] criteria at the neurology/emergency department) and 181 participants with a minor orthopedic injury in their extremities (control group). DESIGN An observational, longitudinal, multicenter cohort study. MAIN MEASURES NS and LS items (Rivermead Post-Concussion Symptoms Questionnaire) were used as main outcome variables to determine sensory hypersensitivity symptoms. Additional outcomes included anxiety, depression, health-related quality of life (HRQoL), and life satisfaction. RESULTS There was an elevated prevalence of NS and LS between 2 weeks and 3 months after injury in the mTBI group compared with controls. Approximately 3% of mTBI patients had persistent hypersensitivity symptoms during the whole course of the study. At 12 months postinjury, the mTBI and control groups did not differ in the prevalence of persistent hypersensitivity symptoms. There was no evidence of a predictive value of hypersensitivity within 2 weeks postinjury on anxiety, depression, HRQoL, or life satisfaction, 12 months later after controlling for postconcussion symptoms. CONCLUSIONS These results not only confirm the presence of hypersensitivity symptoms after mTBI in the subacute stage but also provide assurance about the small size of the group that experiences persistent symptoms. Furthermore, there was no evidence that early NS and LS are uniquely associated with long-term emotional and quality-of-life outcomes, over and above general levels of postconcussion symptoms.
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Affiliation(s)
- Marilien C Marzolla
- Department of Neuropsychology and Psychopharmacology (Ms Marzolla and Drs Stapert, Hurks, and van Heugten), Section of Teaching and Innovation of Learning (Dr Wijenberg), and Department of Methodology and Statistics (Dr Schepers), Faculty of Psychology and Neuroscience, and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (Dr van Heugten), Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands (Ms Marzolla and Dr van Heugten); Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands (Dr Wijenberg); and Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (Dr Stapert)
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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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Majcen Rosker Z, Kristjansson E, Vodicar M. How well can we detect cervical driven sensorimotor dysfunction in concussion patients? An observational study comparing patients with idiopathic neck pain, whiplash associated disorders and concussion. Gait Posture 2023; 101:21-27. [PMID: 36701850 DOI: 10.1016/j.gaitpost.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Patients with mild traumatic brain injury (mTBI) suffer from sensorimotor impairments. Evidence is emerging that cervical spine plays an important role in mTBI, but it is not known how cervicocephalic kinaesthetic sensibility measured during dynamic unpredictable head movements and measures of position sense, cervical induced postural balance and eye movement control differ between mTBI, whiplash associated disorders (WAD) patients, idiopathic neck pain patients and healthy controls. RESEARCH QUESTION Are cervical sensorimotor deficits present in mTBI patients and do they differ from sensorimotor deficits found in traumatic and nontraumatic neck pain patients and whether they differ from healthy controls. METHODS Twenty idiopathic neck pain patients, 18 WAD, 17 mTBI and 20 healthy controls were enroled in the study. Frequency and velocity of centre of pressure movements were measured during parallel stance in the neutral and neck torsion positions, gain and smooth pursuit neck torsion difference of eye movements during smooth pursuit neck torsion test (SPNTT) and cervicocephalic kinaesthesia using Butterfly and head-to-neutral relocation test. RESULTS Statistically significant differences in postural balance, both tests of cervicocephalic kinaesthesia and SPNTT were observed between healthy controls and all patient groups. No differences were observed between patient groups for SPNTT, Butterfly and head-to-neutral relocation test, but differences were present in postural balance between mTBI and both groups of patients with neck pain disorders. Differences were found in the ML direction for mTBI, but not differences were found for AP direction. SIGNIFICANCE Results of our study show that mTBI present with similar impairment in cervical driven sensorimotor deficits as patients with neck pain disorders, but they differ from healthy individuals. Clinical practice would benefit from identifying cervical spine related sensorimotor impairments in patients with mTBI. This could enable to design more targeted prevention and rehabilitation programs to minimise cervical spine related disorders in concussion patients.
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Affiliation(s)
- Ziva Majcen Rosker
- Faculty of Sport, University of Ljubljana, Gortanova 22, SI-1000 Ljubljana, Slovenia.
| | | | - Miha Vodicar
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Slovenia
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Laufer K, Petek K, Rakusa S, Rakusa M, Rakusa M, Cretnik A. Traumatic Brain Injury during the SARS-CoV-2 Pandemics in Slovenia: A Single Center Study. J Clin Med 2022; 11:jcm11237017. [PMID: 36498592 PMCID: PMC9735714 DOI: 10.3390/jcm11237017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: The SARS-CoV-2 pandemic had a significant impact on the management of traumatic brain injury (TBI). We aimed to compare the clinical characteristics and outcomes of TBI patients before and during the SARS-CoV-2 pandemic.; (2) Methods: We analyzed depicted data from existing medical records on sex, age, mechanism of injury, clinical performance at admission and discharge, neuroimaging, laboratory values at admission, mortality, duration of hospitalization, and referrals after discharge from the traumatology department for all adult patients during the SARS-CoV-2 pandemic and a year before. Variables were compared using the Chi-square or t-test between both groups.; (3) Results: Most patients had mild (n = 477), followed by moderate (11) and severe (11) TBI. Mild TBI was less frequent during the SARS-CoV-2 period (n = 174 vs. n = 303). The incidence of high falls increased during the SARS-CoV-2 period (14.5% vs. 24.7%; p < 0.05) in the group with mild TBI. Patients had similar mean Glasgow Coma Scales (GCS), Glasgow Outcome Scales-Extended (GOSE), and glucose levels at admission before and during the pandemic. Serum ethanol levels were significantly lower during the SARS-CoV-2 period (1.3 ± 0.7 mmol/L vs. 0.7 ± 1.2 mmol/L; p < 0.001). At discharge, the mean GCS was significantly lower (14.7 ± 1.8 vs. 14.1 ± 0.5; p < 0.05) for patients treated during the SARS-CoV-2 period than before the SARS-CoV-2 period. There were no differences in GOSE; (4) Conclusions: our results demonstrated a significant impact of SARS-CoV-2 pandemic on the frequency, mechanism, and consequences of TBI, and may help improve care for our patients.
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Affiliation(s)
- Kevin Laufer
- Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
- Traumatology Department, Divison of Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Karina Petek
- Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
- Division of Neurology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Sofia Rakusa
- Division of Neurology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
| | - Matej Rakusa
- Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Martin Rakusa
- Division of Neurology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Correspondence:
| | - Andrej Cretnik
- Traumatology Department, Divison of Surgery, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
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21
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Tourigny JN, Boucher V, Paquet V, Fortier É, Malo C, Mercier É, Chauny JM, Clark G, Blanchard PG, Carmichael PH, Gariépy JL, D'Astous M, Émond M. External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study. J Neurosurg 2022; 137:782-788. [PMID: 35078154 DOI: 10.3171/2021.10.jns211794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Approximately 10% of patients with mild traumatic brain injury (mTBI) have intracranial bleeding (complicated mTBI) and 3.5% eventually require neurosurgical intervention, which is mostly available at centers with a higher level of trauma care designation and often requires interhospital transfer. In 2018, the Brain Injury Guidelines (BIG) were updated in the United States to guide emergency department care and patient disposition for complicated mild to moderate TBI. The aim of this study was to validate the sensitivity and specificity of the updated BIG (uBIG) for predicting the need for interhospital transfer in Canadian patients with complicated mTBI. METHODS This study took place at three level I trauma centers. Consecutive medical records of patients with complicated mTBI (Glasgow Coma Scale score 13-15) who were aged ≥ 16 years and presented between September 2016 and December 2017 were retrospectively reviewed. Patients with a penetrating trauma and those who had a documented cerebral tumor or aneurysm were excluded. The primary outcome was a combination of neurosurgical intervention and/or mTBI-related death. Sensitivity and specificity analyses were performed. RESULTS A total of 477 patients were included, of whom 8.4% received neurosurgical intervention and 3% died as a result of their mTBI. Forty patients (8%) were classified as uBIG-1, 168 (35%) as uBIG-2, and 269 (56%) as uBIG-3. No patients in uBIG-1 underwent neurosurgical intervention or died as a result of their injury. This translates into a sensitivity for predicting the need for a transfer of 100% (95% CI 93.2%-100%) and a specificity of 9.4% (95% CI 6.8%-12.6%). Using the uBIG could potentially reduce the number of transfers by 6% to 25%. CONCLUSIONS The patients in uBIG-1 could be safely managed at their initial center without the need for transfer to a center with a higher level of neurotrauma care. Although the uBIG could decrease the number of transfers, further refinement of the criteria could improve its specificity.
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Affiliation(s)
- Jean-Nicolas Tourigny
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Valérie Boucher
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
- 6Centre d'excellence sur le vieillissement de Québec, Québec, Canada
| | - Véronique Paquet
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Émile Fortier
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Christian Malo
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Éric Mercier
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
| | | | | | - Pierre-Gilles Blanchard
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
| | | | - Jean-Luc Gariépy
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Myreille D'Astous
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Marcel Émond
- 1Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, Québec, Canada
- 2Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- 3VITAM-Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
- 6Centre d'excellence sur le vieillissement de Québec, Québec, Canada
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22
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Palan F, Chatterjee B. Dendrimers in the context of targeting central nervous system disorders. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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23
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Kahouadji S, Bouillon-Minois JB, Oris C, Durif J, Pereira B, Pinguet J, Rozand A, Schmidt J, Sapin V, Bouvier D. Evaluation of serum neurofilament light in the early management of mTBI patients. Clin Chem Lab Med 2022; 60:1234-1241. [PMID: 35511901 DOI: 10.1515/cclm-2022-0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Serum S100B allows a one-third reduction of computed tomography (CT) scans performed for mild traumatic brain injury (mTBI) patients. In this study, we evaluated the diagnostic performance of serum NF-L in the detection of intracranial lesions induced by mTBI. METHODS One hundred seventy-nine adult mTBI patients presenting to the emergency department of Clermont-Ferrand University Hospital with a Glasgow Coma Scale (GCS) score of 14-15 were included. S100B assays were performed for clinical routine while NF-L samples were stored at -80 °C until analysis. CT scans were performed for patients with S100B levels above the decision threshold of 0.10 μg/L. Later, NF-L and S100B levels were compared to CT scan findings to evaluate the biomarkers' performances. RESULTS The area under the ROC curve (AUC) evaluating the diagnostic ability in the prediction of intracranial lesions was 0.72 (95% CI; 0.58-0.87) for S100B and 0.58 (95% CI; 0.45-0.71) for NF-L, the specificities (at a threshold allowing a 100% sensitivity) were 35.7% for S100B, and 28% for NF-L (p=0.096). AUCs of NF-L and S100B for the identification of patients with neurological disorders were statistically different (p<0.001). The AUCs were 0.87 (95% CI; 0.82-0.93) for NF-L and 0.57 (95% CI; 0.48-0.66) for S100B. There was a poor correlation between NF-L and S100B, and NF-L levels were correlated to patients' age (Spearman coefficient of 0.79). CONCLUSIONS NF-L showed poor performances in the early management of mTBI patients. NF-L levels are strongly correlated to neurodegeneration, whether physiological, age-related, or pathological.
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Affiliation(s)
- Samy Kahouadji
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Charlotte Oris
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Julie Durif
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérémy Pinguet
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Agathe Rozand
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jeannot Schmidt
- Adult Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
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24
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Hadwe SE, Assamadi M, Barrit S, Giannis D, Haidich AB, Goulis DG, Chatzisotiriou A. Delayed intracranial hemorrhage of patients with mild traumatic brain injury under antithrombotics on routine repeat CT scan: a systematic review and meta-analysis. Brain Inj 2022; 36:703-713. [PMID: 35476710 DOI: 10.1080/02699052.2022.2065034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In childhood, traumatic brain injury (TBI) poses the unique challenges of an injury to a developing brain and the dynamic pattern of recovery over time, inflicted TBI and its medicolegal ramifications. The mechanisms of injury vary with age, as do the mechanisms that lead to the primary brain injury. As it is common, and is the leading cause of death and disability in the USA and Canada, prevention is the key, and we may need increased legislation to facilitate this. Despite its prevalence, there is an almost urgent need for research to help guide the optimal management and improve outcomes. Indeed, contrary to common belief, children with severe TBI have a worse outcome and many of the consequences present in teenage years or later. The treatment needs, therefore, to be multifaceted and starts at the scene of the injury and extends into the home and school. In order to do this, the care needs to be multidisciplinary from specialists with a specific interest in TBI and to involve the family, and will often span many decades.
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Affiliation(s)
- Salim El Hadwe
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.,Faculty of Medicine, Department of physiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mouhssine Assamadi
- Department of Neurosurgery, Ibn Tofail Hospital, Université Cadi Ayyad, CHU Mohammed sixth Marrakech, Morocco
| | - Sami Barrit
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Dimitrios Giannis
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Anna-Bettina Haidich
- Medicine and Medical Statistics, Medical School, Aristotle University of ThessalonikiDepartment of Hygiene, Social-Preventive, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Department of Obstetrics and Gynecology, Medical School, Aristotle University of ThessalonikiUnit of Reproductive Endocrinology, 1st, Thessaloniki, Greece
| | - Athanasios Chatzisotiriou
- Faculty of Medicine, Department of physiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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25
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Sheldrake E, Al-Hakeem H, Lam B, Goldstein BI, Wheeler AL, Burke M, Dunkley BT, Reed N, Scratch SE. Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review. Front Neurol 2022; 13:850590. [PMID: 35481264 PMCID: PMC9035995 DOI: 10.3389/fneur.2022.850590] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective:Concussion is a common yet heterogenous injury. Approximately 15–30% of cases present with persistent post-concussion symptoms (PPCS), continuing 4 weeks or more post-injury in children, youth, and adolescents, and 3 months or more in adults. There are known bidirectional links between PPCS and mental health outcomes. The focus of this scoping review is to explore the literature on mental health outcomes in individuals experiencing PPCS. Research objectives were to explore: (1) the mental health outcomes of individuals with PPCS and types of assessments used to identify mental health outcomes this group, and (2) how mental health outcomes compare in terms of similarities and differences among pediatric and adult populations with PPCS.MethodOvid MEDLINE; EMBASE; CINAHL, and PsycInfo databases were searched. After title and abstract screening of 11,920 studies, 481 articles were reviewed. Twenty-five papers met inclusion criteria. Results were organized by mental health outcomes of pediatric and adult populations, separately.ResultsThere was a significantly higher number of studies devoted to adult populations. Of the 25 studies, 19 (76%) focused on adults, while six (24%) focused on adolescents. In adult populations, studies focused on symptoms of: anxiety (n = 2), depression (n = 8), and anxiety and depression (n = 9). Two studies assessed other emotional outcomes (10.5%). Within pediatric populations, an equal number of studies explored symptoms of: anxiety (n = 2), depression (n = 2), and anxiety and depression (n = 2). No studies focused on other emotional outcomes. Studies ranged greatly in methods, design, and control group. Most studies reported higher psychiatric symptoms of anxiety and/or depression in those with PPCS compared to individuals with recovered concussion or healthy controls.DiscussionThis review contributes to the understanding of mental health outcomes in those experiencing PPCS. Mental health and PPCS requires greater attention in pediatric populations, and consider strategies for those experiencing PPCS and mental health impacts. Future studies should consider including a wider range of emotional outcomes in their design, not limited to anxiety and depression. Study results may lead to improvements and research in the identification, assessment, and management of PPCS and mental health.
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Affiliation(s)
- Elena Sheldrake
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- *Correspondence: Elena Sheldrake
| | - Hiba Al-Hakeem
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Brendan Lam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Benjamin I. Goldstein
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Anne L. Wheeler
- Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Matthew Burke
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Benjamin T. Dunkley
- Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Shannon E. Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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26
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Turcato G, Cipriano A, Park N, Zaboli A, Ricci G, Riccardi A, Barbieri G, Gianpaoli S, Guiddo G, Santini M, Pfeifer N, Bonora A, Paolillo C, Lerza R, Ghiadoni L. "Decision tree analysis for assessing the risk of post-traumatic haemorrhage after mild traumatic brain injury in patients on oral anticoagulant therapy". BMC Emerg Med 2022; 22:47. [PMID: 35331163 PMCID: PMC8944105 DOI: 10.1186/s12873-022-00610-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of oral anticoagulant therapy (OAT) alone, regardless of patient condition, is an indication for CT imaging in patients with mild traumatic brain injury (MTBI). Currently, no specific clinical decision rules are available for OAT patients. The aim of the study was to identify which clinical risk factors easily identifiable at first ED evaluation may be associated with an increased risk of post-traumatic intracranial haemorrhage (ICH) in OAT patients who suffered an MTBI. METHODS Three thousand fifty-four patients in OAT with MTBI from four Italian centers were retrospectively considered. A decision tree analysis using the classification and regression tree (CART) method was conducted to evaluate both the pre- and post-traumatic clinical risk factors most associated with the presence of post-traumatic ICH after MTBI and their possible role in determining the patient's risk. The decision tree analysis used all clinical risk factors identified at the first ED evaluation as input predictor variables. RESULTS ICH following MTBI was present in 9.5% of patients (290/3054). The CART model created a decision tree using 5 risk factors, post-traumatic amnesia, post-traumatic transitory loss of consciousness, greater trauma dynamic, GCS less than 15, evidence of trauma above the clavicles, capable of stratifying patients into different increasing levels of ICH risk (from 2.5 to 61.4%). The absence of concussion and neurological alteration at admission appears to significantly reduce the possible presence of ICH. CONCLUSIONS The machine-learning-based CART model identified distinct prognostic groups of patients with distinct outcomes according to on clinical risk factors. Decision trees can be useful as guidance in patient selection and risk stratification of patients in OAT with MTBI.
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Affiliation(s)
- Gianni Turcato
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012, Merano, Italy.
| | - Alessandro Cipriano
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Naria Park
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012, Merano, Italy
| | - Giorgio Ricci
- Emergency Department, University of Verona, Verona, Italy.,Academy of Emergency Medicine and Care (AcEMC), Pavia, Italy
| | - Alessandro Riccardi
- Emergency Department, Hospital of San Paolo (ASL N°2 Savonese), Savona, Italy
| | - Greta Barbieri
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Sara Gianpaoli
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Grazia Guiddo
- Emergency Department, Hospital of San Paolo (ASL N°2 Savonese), Savona, Italy
| | - Massimo Santini
- Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Norbert Pfeifer
- Emergency Department, Hospital of Merano (SABES-ASDAA), Via Rossini 5, 39012, Merano, Italy
| | - Antonio Bonora
- Emergency Department, University of Verona, Verona, Italy
| | - Ciro Paolillo
- Emergency Department, University of Verona, Verona, Italy.,Academy of Emergency Medicine and Care (AcEMC), Pavia, Italy
| | - Roberto Lerza
- Academy of Emergency Medicine and Care (AcEMC), Pavia, Italy.,Emergency Department, Hospital of San Paolo (ASL N°2 Savonese), Savona, Italy
| | - Lorenzo Ghiadoni
- Academy of Emergency Medicine and Care (AcEMC), Pavia, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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27
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Santing J, Lee YX, van der Naalt J, van den Brand C, Jellema K. Mild traumatic brain injury in elderly patients receiving direct oral anticoagulants: A systematic review and meta-analysis. J Neurotrauma 2022; 39:458-472. [DOI: 10.1089/neu.2021.0435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Juliette Santing
- Medisch Centrum Haaglanden Westeinde, 2901, Neurology, Lijnbaan 12, Den Haag, Netherlands, 2501 CK, ,
| | - Ying Xing Lee
- Medisch Centrum Haaglanden Westeinde, 2901, Neurology, Den Haag, Zuid-Holland, Netherlands
| | | | - Crispijn van den Brand
- Haaglanden Medical Center, Department of Emergency Medicine, Lijnbaan 32, The Hague, Zuid-Holland, Netherlands, 2512VA
| | - Korné Jellema
- Medisch Centrum Haaglanden, 2901, Den Haag, Zuid-Holland, Netherlands
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28
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Mohsenian Sisakht A, Karamzade-Ziarati N, Jahanbakhshi A, Shahpasand K, Aghababaei S, Ahmadvand O, Azar M, Fattahi A, Zamanzadeh S. Pathogenic cis p-tau levels in CSF reflects severity of traumatic brain injury. Neurol Res 2022; 44:496-502. [PMID: 34979886 DOI: 10.1080/01616412.2021.2022921] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic brain injury (TBI) is the main cause of death and disability among young people. Following TBI, immune system activation and cytokine release induce kinase activity and hyperphosphorylation of tau protein, a structural molecule in axonal microtubules. The cis configuration of phosphorylated tau at Th231 is extremely neurotoxic and is having a prion nature, spreads to brain areas as well as CSF.We examined the cerebrospinal fluid (CSF) cis p-tau levels in 32 TBI patients and 5 non-TBI controls to find out the correlation with TBI severity. CSF samples were drained 5-7 days after TBI and subjected for ELISA analysis with anti cis p-tau and β-amyloid antibodies.We had no patients with mild TBI, two patients with moderate (6.2%), 23 patients with severe (71.9%), and 7 patients with critical TBI (21.9%). While mean CSF β-amyloid in TBI and control groups did not show a statistically significant difference, the mean CSF cis p-tau level was significantly higher in the TBI group than the control samples. Also, intergroup analysis demonstrated that CSF cis p-tau levels were statistically different according to the head injury severity.Although CSF cis p-tau increased in the TBI patients, β-amyloid did not show a significant difference between patients and controls. Also, we observed an obvious negative correlation between CSF cis p-tau levels and GCS scores. Therefore, future researches on suppression of cis P-tau production or removing previously produced cis P-tau could be a suitable approach in treating TBI in order to prevent tauopathies and future neurodegeneration.
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Affiliation(s)
- Alireza Mohsenian Sisakht
- Department of Neurosurgery, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Najme Karamzade-Ziarati
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Jahanbakhshi
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Koorosh Shahpasand
- Department of Brain and Cognitive Sciences, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology (ACECR), Tehran, Iran
| | - Samareh Aghababaei
- Department of Brain and Cognitive Sciences, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology (ACECR), Tehran, Iran.,Department of Molecular Biology, Faculty of Advance Science and Technology, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Omid Ahmadvand
- Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Maziar Azar
- Department of Neurosurgery, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Fattahi
- Department of Neurosurgery, 7tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Selva Zamanzadeh
- Department of Molecular Biology, Faculty of Advance Science and Technology, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
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29
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Are oral anticoagulants a risk factor for mild traumatic brain injury progression? A single-center experience focused on of direct oral anticoagulants and vitamin K antagonists. Acta Neurochir (Wien) 2022; 164:97-105. [PMID: 34850288 DOI: 10.1007/s00701-021-05066-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Mild traumatic brain injury (TBI) in anticoagulated patients is a common challenge for emergency departments because of lack of appropriate epidemiological data and huge management variability for those under oral anticoagulation therapy. Given the discrepancies between guidelines, the aim of the present study was to quantify the association between oral anticoagulant therapy (either vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC)) and the post-traumatic intracranial hemorrhage worsening compared to admission CT scan. METHODS We included all consecutive records of patients admitted to our emergency department for mild TBI as chief complaint and with a positive admission CT scan. After statistical univariate comparison, cause-specific hazard ratio (HR) and 95% confidence interval (CI) were determined with the use of Cox proportional hazard model. RESULTS In the study period, 4667 patients had a CT scan for mild TBI; 439 (9.4%) were found to have intracranial hemorrhage. Among these patients, 299 (68.1%) were prescribed observation and control CT: 46 (15.38%) were on anticoagulant therapy, 23 (50%) on VKA, and 23 (50%) on DOAC. In multivariate analysis, only oral anticoagulation therapy was significantly associated to an increased risk of intracranial hemorrhage progression (HR 2.58; 95% CI 1.411-4.703; p = .002 and HR 1.9; 95% CI 1.004-3.735; p = .0048 for VKA and DOAC, respectively). Surgery was due to isolated subdural hematoma in 87.5% of cases, to subdural hematoma associated with intraparenchymal hemorrhage in 9.38% and to intraparenchymal hemorrhage only in 3.12%; 13 cases (4.35%) deceased in intensive care unit. CONCLUSIONS In our series, anticoagulation was associated to a significant increase in intracranial progression, leaving the question open as to what this implies in current clinical practice; subdural hematoma was the major finding associated to evolution and surgery. Against this background, further studies are needed to clarify patients' management and DOAC safety profile compared to VKA in mild TBI.
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Bittencourt M, Balart-Sánchez SA, Maurits NM, van der Naalt J. Self-Reported Complaints as Prognostic Markers for Outcome After Mild Traumatic Brain Injury in Elderly: A Machine Learning Approach. Front Neurol 2021; 12:751539. [PMID: 34925214 PMCID: PMC8674199 DOI: 10.3389/fneur.2021.751539] [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: 08/01/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Self-reported complaints are common after mild traumatic brain injury (mTBI). Particularly in the elderly with mTBI, the pre-injury status might play a relevant role in the recovery process. In most mTBI studies, however, pre-injury complaints are neither analyzed nor are the elderly included. Here, we aimed to identify which individual pre- and post-injury complaints are potential prognostic markers for incomplete recovery (IR) in elderly patients who sustained an mTBI. Since patients report many complaints across several domains that are strongly related, we used an interpretable machine learning (ML) approach to robustly deal with correlated predictors and boost classification performance. Pre- and post-injury levels of 20 individual complaints, as self-reported in the acute phase, were analyzed. We used data from two independent studies separately: UPFRONT study was used for training and validation and ReCONNECT study for independent testing. Functional outcome was assessed with the Glasgow Outcome Scale Extended (GOSE). We dichotomized functional outcome into complete recovery (CR; GOSE = 8) and IR (GOSE ≤ 7). In total 148 elderly with mTBI (median age: 67 years, interquartile range [IQR]: 9 years; UPFRONT: N = 115; ReCONNECT: N = 33) were included in this study. IR was observed in 74 (50%) patients. The classification model (IR vs. CR) achieved a good performance (the area under the receiver operating characteristic curve [ROC-AUC] = 0.80; 95% CI: 0.74-0.86) based on a subset of only 8 out of 40 pre- and post-injury complaints. We identified increased neck pain (p = 0.001) from pre- to post-injury as the strongest predictor of IR, followed by increased irritability (p = 0.011) and increased forgetfulness (p = 0.035) from pre- to post-injury. Our findings indicate that a subset of pre- and post-injury physical, emotional, and cognitive complaints has predictive value for determining long-term functional outcomes in elderly patients with mTBI. Particularly, post-injury neck pain, irritability, and forgetfulness scores were associated with IR and should be assessed early. The application of an ML approach holds promise for application in self-reported questionnaires to predict outcomes after mTBI.
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Affiliation(s)
- Mayra Bittencourt
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sebastián A Balart-Sánchez
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Natasha M Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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31
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Isokuortti H, Iverson GL, Posti JP, Ruuskanen JO, Brander A, Kataja A, Nikula M, Öhman J, Luoto TM. Serotonergic Antidepressants and Risk for Traumatic Intracranial Bleeding. Front Neurol 2021; 12:758707. [PMID: 34777229 PMCID: PMC8581291 DOI: 10.3389/fneur.2021.758707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Serotonergic antidepressants may predispose to bleeding but the effect on traumatic intracranial bleeding is unknown. Methods: The rate of intracranial bleeding in patients with antidepressant medication was compared to patients not antidepressants in a cohort of patients with acute head injury. This association was examined by using a consecutive cohort of head trauma patients from a Finnish tertiary center emergency department (Tampere University Hospital, Tampere, Finland). All consecutive (2010-2012) adult patients (n = 2,890; median age = 58; male = 56%, CT-positive = 22%, antithrombotic medication users = 25%, antidepressant users = 10%) who underwent head CT due to head trauma in the emergency department were included. Results: Male gender, GCS <15, older age, and anticoagulation were associated with an increased risk for traumatic intracranial bleeding. There were 17.8% of patients not taking antidepressants and 18.3% of patients on an antidepressant who had traumatic intracranial bleeding (p = 0.830). Among patients who were taking antithrombotic medication, 16.6% of the patients not taking antidepressant medication, and 22.5% of the patients taking antidepressant medication, had bleeding (p = 0.239). In a regression analysis, traumatic intracranial hemorrhage was not associated with antidepressant use. Conclusions: Serotonergic antidepressant use was not associated with an increased risk of traumatic intracranial hemorrhage.
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Affiliation(s)
- Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Center for Health and Rehabilitation Research, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Jussi P Posti
- Department of Neurosurgery, Neurocenter, Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jori O Ruuskanen
- Division of Clinical Neurosciences, Department of Neurology, Turku University Hospital and University of Turku, Turku, Finland.,Medbase Ltd., Turku, Finland
| | - Antti Brander
- Department of Radiology, Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Anneli Kataja
- Department of Radiology, Medical Imaging Centre, Tampere University Hospital, Tampere, Finland
| | - Milaja Nikula
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Juha Öhman
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
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Chojak R, Koźba-Gosztyła M, Pawłowski M, Czapiga B. Deterioration After Mild Traumatic Brain Injury: A Single-Center Experience With Cost Analysis. Front Neurol 2021; 12:588429. [PMID: 34630266 PMCID: PMC8497805 DOI: 10.3389/fneur.2021.588429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Most traumatic brain injuries (TBIs) are mild (GCS score of 13-15). Patients with mild TBI (mTBI) are generally in good condition. In some cases, a neurological deterioration (manifested by a drop of ≥1 point in GCS score) can occur and neurosurgical intervention (NI) may be needed. Because of that, these patients are frequently admitted to a hospital for observation. The aim of our study was to determine the number of patients with mTBI that deteriorate or need NI. We also considered an economic aspect of hospital admissions of these patients. Methods: The study group consisted of 186 adult patients admitted to the neurosurgical department due to mTBI. Patients were divided into three groups according to an initial GCS score. The occurrence of deterioration, need for NI, length of stay (LOS), cost of stay and occurrence of death were analyzed. Results: The deterioration was observed in 7 (3.76%) out of all cases. In 3 (1.61%) of them, the NI was needed. The average LOS was 7.96 days and it was closely linked with an initial GCS score (p < 0.001). The total cost of stay of all patients included in this study was about 1,188,668 PLN (306,357 USD). Conclusion: The deterioration occurred in a small number of patients with mTBI, the need for NI was even less common. Hospitalization of these patients is expensive. Further studies with prognostic model helping decide on admission/discharge are necessary.
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Affiliation(s)
- Rafał Chojak
- Faculty of Medicine, Wrocław Medical University, Wrocław, Poland
| | | | - Mateusz Pawłowski
- Department of Neurosurgery, 4th Military Hospital in Wrocław, Wrocław, Poland
- Department of Nervous System Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Bogdan Czapiga
- Department of Neurosurgery, 4th Military Hospital in Wrocław, Wrocław, Poland
- Department of Nervous System Diseases, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
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Mizu D, Matsuoka Y, Huh JY, Onishi M, Ariyoshi K. Head CT findings and deterioration risk in children with head injuries and Glasgow Coma Scales of 15. Am J Emerg Med 2021; 50:399-403. [PMID: 34481258 DOI: 10.1016/j.ajem.2021.08.060] [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: 05/15/2021] [Revised: 08/07/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Head injuries are an important problem in pediatric emergency care. The majority of head injuries are mild. Even when abnormalities are noted on computed tomography (CT), most patients have good outcomes. We aimed to evaluate the clinical course of pediatric patients who had head injuries and Glasgow Coma Scale (GCS) scores of 15, in whom abnormal findings were noted on head CT, to determine the impact of radiographic features on the need for hospitalization and clinical progression. METHODS We retrospectively examined patients under 15 years of age with isolated mild head injuries, GCS scores of 15, and abnormal CT findings, and visited the emergency department between September 2011 and March 2019. RESULTS Ninety-nine patients were included in the study. The median age was 2 years (0-15 years), and 61 (62%) patients were male. Eighty-six (87%) patients were hospitalized, and the median hospital stay was 1 day (1-10 days). Sixty-eight (69%) patients underwent repeat CT, and 12 (18%) patients showed signs of radiographic progression. These 12 patients had subdural or epidural hematomas, and surgical intervention was required for two patients (2%). In patients with isolated skull fracture or subarachnoid hemorrhage alone, no deterioration was noted radiographically or clinically. CONCLUSION Pediatric head injuries with GCS scores of 15 may rarely require surgical intervention, even when CT shows abnormalities. In particular, patients diagnosed with isolated skull fracture or subarachnoid hemorrhage on CT may not require routine hospitalization. A validation study is needed to confirm the findings of this study.
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Affiliation(s)
- Daisuke Mizu
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan.
| | - Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
| | - Ji-Young Huh
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
| | - Masafumi Onishi
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
| | - Koichi Ariyoshi
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
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Tourigny JN, Paquet V, Fortier É, Malo C, Mercier É, Chauny JM, Clark G, Blanchard PG, Boucher V, Carmichael PH, Gariépy JL, Émond M. Predictors of neurosurgical intervention in complicated mild traumatic brain injury patients: a retrospective cohort study. Brain Inj 2021; 35:1267-1274. [PMID: 34488497 DOI: 10.1080/02699052.2021.1972147] [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: 10/20/2022]
Abstract
OBJECTIVES To determine the predicting demographic, clinical and radiological factors for neurosurgical intervention in complicated mild traumatic brain injury (mTBI) patients. METHODS Design: retrospective multicenter cohort study. Participants: patients aged ≥16 presenting to all level-I trauma centers in Quebec between 09/2016 and 12/2017 with mTBI(GCS 13-15) and complication on initial head CT (intracranial hemorrhage/skull fracture). Procedure: Consecutive medical records were reviewed and separated into two groups: no neurosurgical intervention and neurosurgical intervention (NSI). Main outcome: neurosurgical intervention. Analysis: multiple logistic regression model. RESULTS Four hundred and seventy-eight patients were included and 40 underwent NSI. One patient had radiological deterioration but no clinical deterioration prior to surgery. Subdural hemorrhage ≥4 mm width (OR:3.755 [95% CI:1.290-10.928]) and midline shift (OR:7.507 [95% CI: 3.317-16.989]) increased the risk of NSI. Subarachnoid hemorrhage was associated with a lower risk of NSI (OR:0.312 [95% CI: 0.136-0.713]). All other intracranial hemorrhages were not associated with NSI. CONCLUSION Radiological deterioration was not associated with the incidence of NSI. Subdural hemorrhage and midline shift should be predicting factors for neurosurgery. Some patients with isolated findings such as subarachnoid hemorrhage could be safely managed in their original center without being transferred to a level-I trauma center.
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Affiliation(s)
- Jean-Nicolas Tourigny
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada
| | - Véronique Paquet
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada
| | - Émile Fortier
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada
| | - Christian Malo
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada
| | - Éric Mercier
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada
| | | | | | - Pierre-Gilles Blanchard
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada
| | - Valérie Boucher
- Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada.,Centre d'excellence Sur le Vieillissement de Québec, Québec, Canada
| | | | | | - Marcel Émond
- Département de Médicine Familiale et de Médicine d'urgence, Faculté de Médecine, Université Laval, Québec, Canada.,Chu de Québec - Université Laval, Québec, Canada.,Vitam - Centre de Recherche en Santé Durable, Québec, Canada.,Centre d'excellence Sur le Vieillissement de Québec, Québec, Canada
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Zurlinden T, Savransky A, Everhart DE. Utilizing the BAT-LQ to assess TBI incidence in a college student population. Brain Inj 2021; 35:1229-1234. [PMID: 34436938 DOI: 10.1080/02699052.2021.1972140] [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: 10/20/2022]
Abstract
OBJECTIVE Although the annual number of traumatic brain injuries (TBIs) reported in the US exceeds two million, data suggests that this is an underestimate. The goal of this study was to understand lifetime TBI incidence among a sample of college students. Additionally, this study examined whether a single yes/no question regarding TBI history was sufficient to gather accurate information about TBI incidence in college students. DESIGN Participants were asked a single TBI question and administered the BAT-LQ. MAIN MEASURES The BAT-LQ is a screening tool designed to assess for probable lifetime TBIs. RESULTS Data from 121 participants were analyzed for this study. On the single-question, 24.8% of participants reported experiencing a TBI. However, upon further prompting, 76.8% of all participants reported experiencing a blow to the head accompanied by at least one diagnostic symptom of a TBI, suggesting a probable TBI based on best-practice diagnosis guidelines. CONCLUSION The results of this study suggest that increased education about TBI is warranted to ensure that individuals receive care for probable TBIs, as many individuals likely lack knowledge about what constitutes a TBI diagnosis. Additionally, the results suggest that a single question may not be sufficient to capture true lifetime TBI incidence.
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Affiliation(s)
- Taylor Zurlinden
- Department of Psychology, East Carolina University, Rawl Building, Greenville, North Carolina, USA
| | - Anya Savransky
- Department of Psychology, East Carolina University, Rawl Building, Greenville, North Carolina, USA
| | - D Erik Everhart
- Department of Psychology, East Carolina University, Rawl Building, Greenville, North Carolina, USA
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Chien SC, Tu PH, Liu ZH, Chen CC, Liao CH, Hsieh CH, Fu CY. Neurological deteriorations in mild brain injuries: the strategy of evaluation and management. Eur J Trauma Emerg Surg 2021; 48:2173-2181. [PMID: 34302502 DOI: 10.1007/s00068-021-01753-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Most mild traumatic brain injuries (TBIs) can be treated conservatively. However, some patients deteriorate during observation. Therefore, we tried to evaluate the characteristics of deterioration and requirement for further management in mild TBI patients. METHODS From 1/1/2017 to 12/31/2017, patients with mild TBI and positive results on CT scans of the brain were retrospectively studied. Patients with and without neurological deteriorations were compared. The characteristics of mild TBI patients with further neurological deterioration or the requirement for interventions were delineated. RESULTS One hundred ninety-two patients were enrolled. Twenty-three (12.0%) had neurological deteriorations. The proportions of deterioration occurring within 24 h, 48 h and 72 h were 23.5, 41.2 and 58%, respectively. Deteriorated patients were significantly older than those without neurological deteriorations (69.7 vs. 60.2; p = 0.020). More associated extracranial injuries were observed in deteriorated patients [injury severity score (ISS): 20.2 vs. 15.9; p = 0.005). Significantly higher proportions of intraventricular hemorrhage (8.7 vs. 1.2%; p = 0.018) and multiple lesions (78.3 vs. 53.8%; p = 0.027) were observed on the CT scans of patients with neurological deteriorations. Subset analysis showed that deteriorated patients who required neurosurgical interventions (N = 7) had significantly more initial GCS defects (13 or 14) (71.4 vs. 12.5%; p = 0.005) and more initial decreased muscle power of extremities (85.7 vs. 18.8%; p = 0.002). CONCLUSION More attention should be given to mild TBI patients with older age, GCS defects, decreased muscle power of the extremities, multiple lesions on CT scans and other systemic injuries (high ISS). Most deteriorations occur within 72 h after trauma.
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Affiliation(s)
- Shou-Chi Chien
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Po-Hsun Tu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Chi-Hsun Hsieh
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung Medical College and University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan City, Taiwan.
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Rakers SE, Timmerman ME, Scheenen ME, de Koning ME, van der Horn HJ, van der Naalt J, Spikman JM. Trajectories of Fatigue, Psychological Distress, and Coping Styles After Mild Traumatic Brain Injury: A 6-Month Prospective Cohort Study. Arch Phys Med Rehabil 2021; 102:1965-1971.e2. [PMID: 34217729 DOI: 10.1016/j.apmr.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/11/2021] [Accepted: 06/18/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze fatigue after mild traumatic brain injury (TBI) with latent class growth analysis (LCGA) to determine distinct recovery trajectories and investigate influencing factors, including emotional distress and coping styles. DESIGN An observational cohort study design with validated questionnaires assessing fatigue, anxiety, depression, posttraumatic stress, and coping at 2 weeks and 3 and 6 months postinjury. SETTING Three level 1 trauma centers. PARTICIPANTS Patients with mild TBI (N=456). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Fatigue was measured with the fatigue severity subscale of the Checklist Individual Strength, including 8 items (sum score, 8-56). Subsequently, 3 clinical categories were created: high (score, 40-56), moderate (score, 26-38), and low (score, 8-25). RESULTS From the entire mild TBI group, 4 patient clusters with distinct patterns for fatigue, emotional distress, and coping styles were found with LCGA. Clusters 1 and 2 showed favorable recovery from fatigue over time, with low emotional distress and the predominant use of active coping in cluster 1 (30%) and low emotional distress and decreasing passive coping in cluster 2 (25%). Clusters 3 and 4 showed unfavorable recovery, with persistent high fatigue and increasing passive coping together with low emotional distress in cluster 3 (27%) and high emotional distress in cluster 4 (18%). Patients with adverse trajectories were more often women and more often experiencing sleep disturbances and pain. CONCLUSIONS The prognosis for recovery from posttraumatic fatigue is favorable for 55% of mild TBI patients. Patients at risk for chronic fatigue can be signaled in the acute phase postinjury based on the presence of high fatigue, high passive coping, and, for a subgroup of patients, high emotional distress. LCGA proved to be a highly valuable and multipurpose statistical method to map distinct courses of disease-related processes over time.
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Affiliation(s)
| | | | | | - Myrthe E de Koning
- Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harm J van der Horn
- Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joukje van der Naalt
- Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Prus R, Appelhans O, Logash M, Pokotylo P, Nowicki GJ, Ślusarska B. A Histological and Morphometric Assessment of the Adult and Juvenile Rat Livers after Mild Traumatic Brain Injury. Cells 2021; 10:cells10051121. [PMID: 34066539 PMCID: PMC8148537 DOI: 10.3390/cells10051121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
Traumatic brain injury (TBI) is one of the most severe problems of modern medicine that plays a dominant role in morbidity and mortality in economically developed countries. Our experimental study aimed to evaluate the histological and morphological changes occurring in the liver of adult and juvenile mildly traumatized rats (mTBI) in a time-dependent model. The experiment was performed on 70 adult white rats at three months of age and 70 juvenile rats aged 20 days. The mTBI was modelled by the Impact-Acceleration Model-free fall of weight in the parieto-occipital area. For histopathological comparison, the samples were taken on the 1st, 3rd, 5th, 7th, 14th, and 21st days after TBI. In adult rats, dominated changes in the microcirculatory bed in the form of blood stasis in sinusoidal capillaries and veins, RBC sludge, and adherence to the vessel wall with the subsequent appearance of perivascular and focal leukocytic infiltrates. In juvenile rats, changes in the parenchyma in the form of hepatocyte dystrophy prevailed. In both groups, the highest manifestation of the changes was observed on 5–7 days of the study. On 14–21 days, compensatory phenomena prevailed in both groups. Mild TBI causes changes in the liver of both adult and juvenile rats. The morphological pattern and dynamics of liver changes, due to mild TBI, are different in adult and juvenile rats.
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Affiliation(s)
- Ruslan Prus
- Department of Normal and Pathological Clinical Anatomy, Odessa National Medical University, UA-65000 Odessa, Ukraine; (R.P.); (O.A.)
| | - Olena Appelhans
- Department of Normal and Pathological Clinical Anatomy, Odessa National Medical University, UA-65000 Odessa, Ukraine; (R.P.); (O.A.)
| | - Maksim Logash
- Department of Normal Anatomy, Lviv National Medical University, UA-79010 Lviv, Ukraine;
- Correspondence: ; Tel.: +48-814-486-810
| | - Petro Pokotylo
- Department of Normal Anatomy, Lviv National Medical University, UA-79010 Lviv, Ukraine;
| | - Grzegorz Józef Nowicki
- Department of Family Medicine and Community Nursing, Medical University of Lublin, PL-20-081 Lublin, Poland; (G.J.N.); (B.Ś.)
| | - Barbara Ślusarska
- Department of Family Medicine and Community Nursing, Medical University of Lublin, PL-20-081 Lublin, Poland; (G.J.N.); (B.Ś.)
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Marrone F, Zavatto L, Allevi M, Di Vitantonio H, Millimaggi DF, Dehcordi SR, Ricci A, Taddei G. Management of Mild Brain Trauma in the Elderly: Literature Review. Asian J Neurosurg 2021; 15:809-820. [PMID: 33708648 PMCID: PMC7869288 DOI: 10.4103/ajns.ajns_205_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/14/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose The world population is aging. As direct consequence, geriatric trauma is increasing both in absolute number and in the proportion of annual admissions causing a challenge for the health-care system worldwide. The aim of this review is to delineate the specific and practice rules for the management of mild brain trauma in the elderly. Methods Systematic review of the last 15 years literature on mild traumatic brain injury (nTBI) in elderly patients. Results A total of 68 articles met all eligibility criteria and were selected for the systematic review. We collected 29% high-quality studies and 71% low-quality studies. Conclusion Clinical advices for a comprehensive management are provided. Current outcome data from mTBIs in the elderly show a condition that cannot be sustained in the future by families, society, and health-care systems. There is a strong need for more research on geriatric mild brain trauma addressed to prevent falls, to reduce the impact of polypharmacy, and to define specific management strategies.
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Affiliation(s)
- Federica Marrone
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Luca Zavatto
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Mario Allevi
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Hambra Di Vitantonio
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Soheila Raysi Dehcordi
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Graziano Taddei
- Department of Neurosurgery, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
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40
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Wang KKW, Kobeissy FH, Shakkour Z, Tyndall JA. Thorough overview of ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein as tandem biomarkers recently cleared by US Food and Drug Administration for the evaluation of intracranial injuries among patients with traumatic brain injury. Acute Med Surg 2021; 8:e622. [PMID: 33510896 PMCID: PMC7814989 DOI: 10.1002/ams2.622] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of mortality and morbidity affecting all ages. It remains to be a diagnostic and therapeutic challenge, in which, to date, there is no Food and Drug Administration‐approved drug for treating patients suffering from TBI. The heterogeneity of the disease and the associated complex pathophysiology make it difficult to assess the level of the trauma and to predict the clinical outcome. Current injury severity assessment relies primarily on the Glasgow Coma Scale score or through neuroimaging, including magnetic resonance imaging and computed tomography scans. Nevertheless, such approaches have certain limitations when it comes to accuracy and cost efficiency, as well as exposing patients to unnecessary radiation. Consequently, extensive research work has been carried out to improve the diagnostic accuracy of TBI, especially in mild injuries, because they are often difficult to diagnose. The need for accurate and objective diagnostic measures led to the discovery of biomarkers significantly associated with TBI. Among the most well‐characterized biomarkers are ubiquitin C‐terminal hydrolase‐L1 and glial fibrillary acidic protein. The current review presents an overview regarding the structure and function of these distinctive protein biomarkers, along with their clinical significance that led to their approval by the US Food and Drug Administration to evaluate mild TBI in patients.
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Affiliation(s)
- Kevin K W Wang
- Program for Neurotrauma Neuroproteomics and Biomarkers Research Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry University of Florida Gainesville Florida USA.,Brain Rehabilitation Research Center (BRRC) Malcom Randall VA Medical Center North Florida / South Georgia Veterans Health System Gainesville Florida USA
| | - Firas H Kobeissy
- Department of Emergency Medicine University of Florida Gainesville Florida USA
| | - Zaynab Shakkour
- Department of Biochemistry and Molecular Genetics Faculty of Medicine American University of Beirut Beirut Lebanon
| | - J Adrian Tyndall
- Department of Emergency Medicine University of Florida Gainesville Florida USA
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Nicol B, van Donkelaar P, Mason K, Gainforth H. Using Behavior Change Theory to Understand How to Support Screening for Traumatic Brain Injuries Among Women Who Have Experienced Intimate Partner Violence. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:305-315. [PMID: 34476413 PMCID: PMC8409233 DOI: 10.1089/whr.2020.0097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 05/10/2023]
Abstract
Background: Women who experience intimate partner violence (IPV) are at a high risk for traumatic brain injuries (TBIs). Women's shelters may be an ideal location for TBI screening. Behavior change theory can help understand factors that influence screening at women's shelters and develop interventions to promote screening. Objective: To use behavior change theory to understand the local context of women's shelters, factors influencing screening for TBIs among staff who work at women's shelters, and co-develop intervention recommendations to promote screening of TBIs at women's shelters. Methods: The research was conducted in three phases in partnership with the Kelowna Women's Shelter. In phase 1, participants (staff at women's shelters across Canada) completed an online survey that assessed their current TBI screening behaviors, knowledge of TBIs, and factors influencing screening. In phase 2, participants (staff at women's shelters in the Okanagan) completed an interview regarding the factors that influence screening for TBIs. In both phases, factors were analyzed using the Theoretical Domains Framework. In phase 3, intervention recommendations were co-developed using the Behavior Change Wheel. Results: In phase 1, findings indicate that participants (n = 150) lack skills (mean = 2.1, standard deviation [SD] = 1.9) and knowledge (mean = 2.9, SD = 2.2) with regard to screening and are nervous to screen (mean = 3.0, SD = 2.4) for TBIs. In phase 2, 194 barriers to screening for TBI were extracted from 10 interviews with staff members. Prominent domains included knowledge (37%), beliefs about capabilities (16%), and environmental context and resources (15%). Finally, in phase 3, five intervention recommendations were co-developed for interventions aiming to promote TBI screening in women's shelters. Conclusions: This thesis was the first theory-based study to develop intervention recommendations for promoting screening of TBIs at women's shelters. The recommendations have the potential to increase TBI screening at women's shelters ultimately improving the quality of life of women who have experienced a TBI from IPV.
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Affiliation(s)
- Blake Nicol
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Okanagan, Canada
- *Address correspondence to: Blake Nicol, MSc, School of Health and Exercise Sciences, University of British Columbia, 1147 Research Rd., Kelowna, BC, Canada, V1V 1V7.
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Okanagan, Canada
| | | | - Heather Gainforth
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Okanagan, Canada
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Bittencourt-Villalpando M, van der Horn HJ, Maurits NM, van der Naalt J. Disentangling the effects of age and mild traumatic brain injury on brain network connectivity: A resting state fMRI study. Neuroimage Clin 2020; 29:102534. [PMID: 33360020 PMCID: PMC7770973 DOI: 10.1016/j.nicl.2020.102534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/20/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cognitive complaints are common shortly after mild traumatic brain injury (mTBI) but may persist up to years. Age-related cognitive decline can worsen these symptoms. However, effects of age on mTBI sequelae have scarcely been investigated. METHODS Fifty-four mTBI patients (median age: 35 years, range 19-64 years, 67% male) and twenty age- and sex-matched healthy controls were studied using resting state functional magnetic resonance imaging in the sub-acute phase. Independent component analysis was used to identify intrinsic connectivity networks (ICNs). A multivariate approach was adopted to evaluate the effects of age and group on the ICNs in terms of (static) functional network connectivity (FNC), intensities of spatial maps (SMs) and time-course spectral power (TC). RESULTS We observed significant age-related changes for a) FNC: changes between 10 pairs of ICNs, mostly involving the default mode (DM) and/or the cognitive-control (CC) domains; b) SMs: intensity decrease in clusters across three domains and intensity increase in clusters across two domains, including the CC but not the DM and c) TC: spectral power decrease within the 0-0.15 Hz range and increase within the 0.20-0.25 Hz range for increasing age within networks located in frontal areas, including the anterior DM. Groups only differed for TC within the 0.065-0.10 Hz range in the cerebellar ICN and no age × group interaction effect was found. CONCLUSIONS We showed robust effects of age on connectivity between and within ICNs that are associated with cognitive functioning. Differences between mTBI patients and controls were only found for activity in the cerebellar network, increasingly recognized to participate in cognition. Our results suggest that to allow for capturing the true effects related to mTBI and its effects on cognitive functioning, age should be included as a covariate in mTBI studies, in addition to age-matching groups.
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Affiliation(s)
- M Bittencourt-Villalpando
- University of Groningen, University Medical Center Groningen, Department of Neurology AB51, 9700RB Groningen, The Netherlands.
| | - H J van der Horn
- University of Groningen, University Medical Center Groningen, Department of Neurology AB51, 9700RB Groningen, The Netherlands
| | - N M Maurits
- University of Groningen, University Medical Center Groningen, Department of Neurology AB51, 9700RB Groningen, The Netherlands
| | - J van der Naalt
- University of Groningen, University Medical Center Groningen, Department of Neurology AB51, 9700RB Groningen, The Netherlands
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Kuge A, Kondo R, Mitobe Y, Yamaki T, Sato S, Saito S, Sonoda Y. Delayed acute subdural hematoma treated with endoscopic procedure: A case report. Surg Neurol Int 2020; 11:350. [PMID: 35585890 PMCID: PMC9110380 DOI: 10.25259/sni_529_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Delayed acute subdural hematoma (DASDH) is defined as late onset ASDH with the absence of any abnormal radiological and clinical findings at initial examination. Moreover, this entity is very rare in traumatic brain injury and its mechanism is still unclear. Recently, endoscopic surgery for ASDH has also been performed. In this case, we describe some considerations of the mechanism of DASDH and review previous literature and usefulness of endoscopic surgical procedure for ASDH. Case Description: A 73-year-old man fell at night, and visited a former medical institution by himself. No abnormal neurological finding was detected. Head computed tomography (CT) detected no abnormal finding. He was diagnosed minor head injury and was hospitalized at midnight and discharged after brain magnetic resonance image (MRI) next day. Brain MRI also detected no abnormal findings. Three days later, he visited our hospital himself, because of the severe headache. Neurologically, he had a mild consciousness disturbance and head CT revealed left ASDH. We performed endoscopic evacuation of hematoma under local anesthesia. Then, the clot was evacuated under the endoscopic procedure through dilated burr hole and pulsatile bleeding from the cortical artery was observed, which was considered to be the source of the ASDH. The patient’s consciousness disturbance was improved immediately after surgery and he discharged without neurological deficit. Conclusion: We revealed the source of bleeding of DASDH under endoscopic procedure and described hypothesis and speculation of its cause in our case. DASDH is rare entity, so we need further experiences and more considerations.
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Affiliation(s)
- Atsushi Kuge
- Department of Emergency Medicine Yamagata City Hospital, Saiseikan, Nanokamachi, Yamagata, Japan
- Department of Neurosurgery, Yamagata City Hospital, Saiseikan, Nanokamachi, Yamagata, Japan
| | - Rei Kondo
- Department of Neurosurgery, Yamagata City Hospital, Saiseikan, Nanokamachi, Yamagata, Japan
| | - Yuta Mitobe
- Department of Neurosurgery, Yamagata City Hospital, Saiseikan, Nanokamachi, Yamagata, Japan
| | - Tetsu Yamaki
- Department of Neurosurgery, Yamagata City Hospital, Saiseikan, Nanokamachi, Yamagata, Japan
| | - Shinji Sato
- Department of Neurosurgery, Yamagata City Hospital, Saiseikan, Nanokamachi, Yamagata, Japan
| | - Shinjiro Saito
- Department of Neurosurgery, Yamagata City Hospital, Saiseikan, Nanokamachi, Yamagata, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, School of Medicine, Yamagata University, Kojirakawamachi, Yamagata, Japan
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Kahouadji S, Salamin P, Praz L, Coiffier J, Frochaux V, Durif J, Pereira B, Arlettaz L, Oris C, Sapin V, Bouvier D. S100B Blood Level Determination for Early Management of Ski-Related Mild Traumatic Brain Injury: A Pilot Study. Front Neurol 2020; 11:856. [PMID: 32922357 PMCID: PMC7456809 DOI: 10.3389/fneur.2020.00856] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/07/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Mild traumatic brain injury (mTBI) management in emergency departments is a complex process involving clinical evaluation, laboratory testing, and computerized tomography (CT) scanning. Protein S100B has proven to be a useful blood biomarker for early evaluation of mTBI, as it reduces the required CT scans by one-third. However, to date, the ability of S100B to identify positive abnormal findings in the CT scans of patients suffering from mTBI caused by ski practice has not been investigated. Thus, the primary aim of this study was to investigate the diagnostic performance of S100B as an mTBI management biomarker in patients with ski-related mTBI. Materials and Methods: One hundred and thirty adult mTBI patients presenting to the emergency department of Hôpital du Valais in Sion, Switzerland, with a Glasgow Coma Scale (GCS) score of 13–15 and clinical indication for a CT scan were included in the study. Blood samples for S100B measurement were collected from each patient and frozen in 3-hour post-injury intervals. CT scans were performed for all patients. Later, serum S100B levels were compared to CT scan findings in order to evaluate the biomarker's performance. Results: Of the 130 included cases of mTBI, 87 (70%) were related to ski practice. At the internationally established threshold of 0.1 μg/L, the receiver operating characteristic curve of S100B serum levels for prediction of abnormal CT scans showed 97% sensitivity, 11% specificity, and a 92% negative predictive value. Median S100B concentrations did not differ according to sex, age, or GCS score. Additionally, there was no significant difference between skiers and non-skiers. However, a statistically significant difference was found when comparing the median S100B concentrations of patients who suffered fractures or had polytrauma and those who did not suffer fractures. Conclusion: The performance of S100B in post-mTBI brain lesion screenings seems to be affected by peripheral lesions and/or ski practice. The lack of neurospecificity of the biomarker in this context does not allow unnecessary CT scans to be reduced by one-third as expected.
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Affiliation(s)
- Samy Kahouadji
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pauline Salamin
- Department of Emergency Medicine, Valais Hospital, Sion, Switzerland
| | - Laurent Praz
- Department of Emergency Medicine, Valais Hospital, Sion, Switzerland
| | - Julien Coiffier
- Department of Emergency Medicine, Valais Hospital, Sion, Switzerland
| | - Vincent Frochaux
- Department of Emergency Medicine, Valais Hospital, Sion, Switzerland
| | - Julie Durif
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lionel Arlettaz
- Department of Biology, ICH, Valais Hospital, Sion, Switzerland
| | - Charlotte Oris
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
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45
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Fuller G, Sabir L, Evans R, Bradbury D, Kuczawski M, Mason SM. Risk of significant traumatic brain injury in adults with minor head injury taking direct oral anticoagulants: a cohort study and updated meta-analysis. Emerg Med J 2020; 37:666-673. [PMID: 32900858 DOI: 10.1136/emermed-2019-209307] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/23/2020] [Accepted: 08/13/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients taking direct oral anticoagulants (DOACs) commonly undergo CT head imaging after minor head injury, regardless of symptoms or signs. However, the risk of intracranial haemorrhage (ICH) in such patients is unclear, and further research has been recommended by the UK National Institute for Health and Care Excellence head injury guideline group. METHODS An observational cohort study was performed in the UK South Yorkshire major trauma centre between 26 June and 3 September 2018. Adult patients taking DOACs with minor head injury were prospectively identified, with case ascertainment supplemented by screening of radiology and ED information technology systems. Clinical and outcome data were subsequently collated from patient records. The primary endpoint was adverse outcome within 30 days, comprising: neurosurgery, ICH or death due to head injury. A previously published meta-analysis was updated with the current results and the findings of other recent studies. RESULTS 148 patients with minor head injury were included (GCS 15, n=107, 72%; GCS 14, n=41, 28%). Patients were elderly (median 82 years) and most frequently injured from ground level falls (n=142, 96%). Overall risk of adverse outcome was 3.4% (5/148, 95% CI 1.4% to 8.0%). Five patients had ICH, of whom one died within 30 days. One patient was treated with prothrombin complex concentrate but no patient received critical care management or underwent neurosurgical intervention. Updated random effects meta-analysis, including the current results and two further recent studies, showed a weighted overall risk of adverse outcome of 3.2% (n=29/787, 95% CI 2.0% to 4.4%). CONCLUSIONS The risk of adverse outcome following mild head injury in patients taking DOACs appears low. These findings would support shared patient-clinician decision making, rather than routine imaging, following minor head injury while taking DOACs.
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Affiliation(s)
- Gordon Fuller
- Center for Urgent and Emergency Care Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Lisa Sabir
- Center for Urgent and Emergency Care Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rachel Evans
- Center for Urgent and Emergency Care Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- Emergency Department, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Maxine Kuczawski
- Center for Urgent and Emergency Care Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Suzanne M Mason
- Center for Urgent and Emergency Care Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Coffeng SM, Jacobs B, de Koning ME, Hageman G, Roks G, van der Naalt J. Patients with mild traumatic brain injury and acute neck pain at the emergency department are a distinct category within the mTBI spectrum: a prospective multicentre cohort study. BMC Neurol 2020; 20:315. [PMID: 32847526 PMCID: PMC7450585 DOI: 10.1186/s12883-020-01887-x] [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: 01/03/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute neck pain (ANP) has recently been demonstrated to be a predictor of persistent posttraumatic complaints after mild traumatic brain injury (mTBI). The aim of this study was to determine specific characteristics of patients with ANP following mTBI, their posttraumatic complaints and relationship with functional outcome. METHODS Data from a prospective follow-up study of 922 mTBI patients admitted to the emergency department (ED) in three level-one trauma centres were analysed. Patients were divided into two groups: 156 ANP patients and 766 no acute neck pain (nANP) patients. Posttraumatic complaints were evaluated 2 weeks and 6 months post-injury using standardized questionnaires and functional outcome was evaluated at 6 months with the Glasgow Outcome Scale Extended (GOSE). RESULTS ANP patients were more often female (p < 0.01), younger (38 vs. 47 years, p < 0.01) with more associated acute symptoms at the ED (p < 0.05) compared to nANP patients. More motor vehicle accidents (12% vs. 6%, p = 0.01) and less head wounds (58% vs. 73%, p < 0.01) in ANP patients indicated 'high-energy low-impact' trauma mechanisms. ANP patients showed more posttraumatic complaints 2 weeks and 6 months post-injury (p < 0.05) and more often incomplete recovery (GOSE < 8) was present after 6 months (56% vs. 40%, p = 0.01). CONCLUSIONS MTBI patients with acute neck pain at the ED constitute a distinct group within the mTBI spectrum with specific injury and demographic characteristics. Early identification of this at risk group already at the ED might allow specific and timely treatment to avoid development of incomplete recovery.
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Affiliation(s)
- Sophie M Coffeng
- Department of Emergency Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram Jacobs
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Myrthe E de Koning
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Neurology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gerard Hageman
- Department of Neurology, Hospital Medisch Spectrum Twente, Enschede, The Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth Tweesteden Hospital Tilburg, Tilburg, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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47
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Feddermann-Demont N, Chiampas G, Cowie CM, Meyer T, Nordström A, Putukian M, Straumann D, Kramer E. Recommendations for initial examination, differential diagnosis, and management of concussion and other head injuries in high-level football. Scand J Med Sci Sports 2020; 30:1846-1858. [PMID: 32557913 PMCID: PMC9290574 DOI: 10.1111/sms.13750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/09/2020] [Accepted: 06/04/2020] [Indexed: 12/22/2022]
Abstract
Head injuries can result in substantially different outcomes, ranging from no detectable effect to transient functional impairments to life‐threatening structural lesions. In high‐level international football (soccer) tournaments, on average, one head injury occurs in every third match. Making the diagnosis and determining the severity of a head injury immediately on‐pitch or off‐field is a major challenge for team physicians, especially because clinical signs of a brain injury can develop over several minutes, hours, or even days after the injury. A standardized approach is useful to support team physicians in their decision whether the player should be allowed to continue to play or should be removed from play after head injury. A systematic, football‐specific procedure for examination and management during the first 72 hours after head injuries and a graduated Return‐to‐Football program for high‐level players have been developed by an international group of experts based on current national and international guidelines for the management of acute head injuries. The procedure includes seven stages from the initial on‐pitch examination to the graduated Return‐to‐Football program. Details of the assessments and the consequences of different outcomes are described for each stage. Criteria for emergency management (red flags), removal from play (orange flags), and referral to specialists for further diagnosis and treatment (persistent orange flags) are provided. The guidelines for return to sport after concussion‐type head injury are specified for football. Thus, the present paper presents a comprehensive procedure for team physicians after a head injury in high‐level football.
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Affiliation(s)
- Nina Feddermann-Demont
- University Hospital and University of Zurich, Zurich, Switzerland.,Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Georges Chiampas
- US Soccer Federation, Chicago, IL, USA.,Departments of Emergency and Orthopedics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbruecken, Germany
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Margot Putukian
- University Health Services, Princeton University, Princeton, NJ, USA.,Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dominik Straumann
- University Hospital and University of Zurich, Zurich, Switzerland.,Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Efraim Kramer
- Division of Sports Medicine, University of Pretoria, Pretoria, South Africa
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48
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Bradley SE, Haun J, Powell-Cope G, Haire S, Belanger HG. Qualitative assessment of the use of a smart phone application to manage post-concussion symptoms in Veterans with traumatic brain injury. Brain Inj 2020; 34:1031-1038. [DOI: 10.1080/02699052.2020.1771770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sarah E. Bradley
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Jolie Haun
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Gail Powell-Cope
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Sharon Haire
- Research Service, James A. Haley Veterans’ Hospital, Tampa, Florida, USA
| | - Heather G. Belanger
- Defense and Veterans Brain Injury Center (DVBIC), United States Special Operations Command, Tampa, Florida, USA
- Departments of Psychology, and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
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49
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O'Neill KM, Jean RA, Savetamal A, Dyke A, Prunty R, Stone A, Castillo A, Gregg SC. When to Admit to Observation: Predicting Length of Stay for Anticoagulated Elderly Fall Victims. J Surg Res 2020; 250:156-160. [DOI: 10.1016/j.jss.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/28/2019] [Accepted: 01/19/2020] [Indexed: 11/16/2022]
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50
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Lessard J, Cournoyer A, Chauny JM, Piette É, Paquet J, Daoust R. Can the “important brain injury criteria” predict neurosurgical intervention in mild traumatic brain injury? A validation study. Am J Emerg Med 2020; 38:521-525. [DOI: 10.1016/j.ajem.2019.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 11/27/2022] Open
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