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Williams J, Ker K, Roberts I, Shakur-Still H, Miners A. A cost-effectiveness and value of information analysis to inform future research of tranexamic acid for older adults experiencing mild traumatic brain injury. Trials 2022; 23:370. [PMID: 35505387 PMCID: PMC9066715 DOI: 10.1186/s13063-022-06244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tranexamic acid reduces head injury deaths in patients with CT scan evidence of intracranial bleeding after mild traumatic brain injury (TBI). However, the cost-effectiveness of tranexamic acid for people with mild TBI in the pre-hospital setting, prior to CT scanning, is uncertain. A large randomised controlled trial (CRASH-4) is planned to address this issue, but the economic justification for it has not been established. The aim of the analysis was to estimate the likelihood of tranexamic acid being cost-effective given current evidence, the treatment effects required for cost-effectiveness, and the expected value of performing further research. METHODS An early economic decision model compared usual care for mild TBI with and without tranexamic acid, for adults aged 70 and above. The evaluation was performed from a UK healthcare perspective over a lifetime time horizon, with costs reported in 2020 pounds (GBP) and outcomes reported as quality-adjusted life years (QALYs). All analyses used a £20,000 per QALY cost-effectiveness threshold. RESULTS In the base case analysis, tranexamic acid was associated with an incremental cost-effectiveness ratio of £4885 per QALY gained, but the likelihood of it being cost-effective was highly dependent on the all-cause mortality treatment effect. The value of perfect information was £22.4 million, and the value of perfect information for parameters that could be collected in a trial was £21.9 million. The all-cause mortality risk ratio for tranexamic acid and the functional outcomes following TBI had the most impact on cost-effectiveness. CONCLUSIONS There is a high degree of uncertainty in the cost-effectiveness of tranexamic acid for older adults experiencing mild TBI, meaning there is a high value of performing future research in the UK. The value in a global context is likely to be far higher.
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Affiliation(s)
- Jack Williams
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Katharine Ker
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Ian Roberts
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Haleema Shakur-Still
- Clinical Trials Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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History of heart transplantation, the resurgence of DCD heart donations and outcomes following transplantation; the Royal Papworth Experience. Indian J Thorac Cardiovasc Surg 2020; 36:233. [PMID: 32837040 PMCID: PMC7324909 DOI: 10.1007/s12055-020-00960-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
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Lewis KM, De Stavola B, Hardelid P. Geospatial and seasonal variation of bronchiolitis in England: a cohort study using hospital episode statistics. Thorax 2020; 75:262-268. [PMID: 31959729 DOI: 10.1136/thoraxjnl-2019-213764] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rates of hospital admissions for bronchiolitis vary seasonally and geographically across England; however, seasonal differences by area remain unexplored. We sought to describe spatial variation in the seasonality of hospital admissions for bronchiolitis and its association with local demographic characteristics. METHODS Singleton children born in English National Health Service hospitals between 2011 and 2016 (n=3 727 013) were followed up for 1 year. Poisson regression models with harmonic functions to model seasonal variations were used to calculate weekly incidence rates and peak timing of bronchiolitis admissions across English regions and clinical commissioning groups (CCGs). Linear regression was used to estimate the joint association of population density and deprivation with incidence and peak timing of bronchiolitis admissions at the CCG level. RESULTS Bronchiolitis admission rates ranged from 30.9 per 1000 infant-years (95% CI 30.4 to 31.3) in London to 68.7 per 1000 (95% CI 67.9 to 69.5) in the North West. Across CCGs, there was a 5.3-fold variation in incidence rates and the epidemic peak ranged from week 49.3 to 52.2. Admission rates were positively associated with area-level deprivation. CCGs with earlier peak epidemics had higher population densities, and both high and low levels of deprivation were associated with earlier peak timing. CONCLUSIONS Approximately one quarter of the variation in admission rates and two-fifths of the variation in peak timing of hospital admissions for bronchiolitis were explained by local demographic characteristics. Implementation of an early warning system could help to prepare hospitals for peak activity and to time public health messages.
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Affiliation(s)
- Kate Marie Lewis
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Bianca De Stavola
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Pia Hardelid
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
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Khushnood A, Butt TA, Jungschleger J, Henderson P, Smith JH, De Rita F, Nassar M, Page A, Messer S, Large S, Dark JH, Parry G, Reinhardt Z, Hasan A. Paediatric donation after circulatory determined death heart transplantation using donor normothermic regional perfusion and ex situ heart perfusion: A case report. Pediatr Transplant 2019; 23:e13536. [PMID: 31273913 DOI: 10.1111/petr.13536] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/02/2019] [Accepted: 06/06/2019] [Indexed: 12/15/2022]
Abstract
This is a report of a unique DCD paediatric heart transplant whereby normothermic regional perfusion was used to assess DCD heart function after death followed by ex situ heart perfusion of the graft during transportation from donor to recipient hospitals. The DCD donor was a 9-year-old boy weighing 84 kg. The recipient was 7-year-old boy with failing Fontan circulation and weighed 23 kg. It was an ABO-compatible heart transplantation. The DCD heart was reperfused and assessed using normothermic regional perfusion followed by portable ex situ heart perfusion during transportation. The orthotopic heart transplantation was successful with good graft function and no evidence of rejection on endomyocardial biopsy at 30 days post-transplant. At 1-year follow-up, excellent graft function is maintained, and he is attending school with a good quality of life. DCD heart transplantation in children is a promising solution to reducing paediatric waiting times. The case demonstrates the feasibility of using normothermic regional perfusion in the donor and ex situ heart perfusion during graft transportation. This combination allowed a functional assessment whilst minimizing warm ischaemia resulting in a successful outcome. More research and long-term follow-up are needed in order to benefit from the huge potential that paediatric DCD heart transplantation has to offer.
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Affiliation(s)
- Abbas Khushnood
- Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Tanveer A Butt
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jerome Jungschleger
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Paul Henderson
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jonathan H Smith
- Department of Cardiac Anaesthesia and Intensive Care, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Fabrizio De Rita
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Mohamed Nassar
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Aravinda Page
- Department of Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridgeshire, UK
| | - Simon Messer
- Department of Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridgeshire, UK
| | - Stephen Large
- Department of Cardiothoracic Transplantation, Royal Papworth Hospital, Cambridgeshire, UK
| | - John H Dark
- Department of Cardiothoracic Surgery, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Gareth Parry
- Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Zdenka Reinhardt
- Department of Cardiopulmonary Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Asif Hasan
- Department of Cardiothoracic Surgery and Transplantation, Freeman Hospital, Newcastle Upon Tyne, UK
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Walle TA, Tiruneh BT, Bashah DT. Prevalence of head injury and associated factors among trauma patients visiting surgical emergency department of Gondar University Referral Hospital, Northwest Ethiopia 2016. Across-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Wales L, Waite C. Children in Vegetative State and Minimally Conscious State: A Survey of Sensory and Cognitive Intervention. Br J Occup Ther 2016. [DOI: 10.1177/030802260506801102] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is little information available about the management of children in a vegetative state and a minimally conscious state (VS and MCS), including diagnosis, assessment and treatment. This study investigated the intervention of occupational therapists in VS and MCS in the United Kingdom paediatric population. A survey design was used and a postal questionnaire was sent to a group of 892 occupational therapists who were members of a paediatric or a neurological specialist section. Two hundred and seventy-one completed questionnaires were returned and the results of these were analysed. Two hundred and six (76%) of the respondents worked in a rehabilitation setting. Twenty-five occupational therapists who worked with children in VS and MCS completed further questions about their assessments and interventions. The results indicate that children in VS and MCS receive fragmented and inconsistent occupational therapy services. Adult assessments are used with a paediatric population and therapists are not wholly satisfied with their interventions. A core group of occupational therapists involved with this population was identified as a result of this survey. It is suggested that these therapists may be able to form a working party to investigate a consistent therapeutic approach for this complex group of children.
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Amram O, Schuurman N, Pike I, Yanchar NL, Friger M, McBeth PB, Griesdale D. Socio Economic Status and Traumatic Brain Injury amongst Pediatric Populations: A Spatial Analysis in Greater Vancouver. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15594-604. [PMID: 26670241 PMCID: PMC4690945 DOI: 10.3390/ijerph121215009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/06/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
Abstract
Introduction: Within Canada, injuries are the leading cause of death amongst children fourteen years of age and younger, and also one of the leading causes of morbidity. Low Socio Economic Status (SES) seems to be a strong indicator of a higher prevalence of injuries. This study aims to identify hotspots for pediatric Traumatic Brain Injury (TBI) and examines the relationship between SES and pediatric TBI rates in greater Vancouver, British Columbia (BC), Canada. Methods: Pediatric TBI data from the BC Trauma Registry (BCTR) was used to identify all pediatric TBI patients admitted to BC hospitals between the years 2000 and 2013. Spatial analysis was used to identify hotspots for pediatric TBI. Multivariate analysis was used to distinguish census variables that were correlated with rates of injury. Results: Six hundred and fifty three severe pediatric TBI injuries occurred within the BC Lower Mainland between 2000 and 2013. High rates of injury were concentrated in the East, while low rate clusters were most common in the West of the region (more affluent neighborhoods). A low level of education was the main predictor of a high rate of injury (OR = 1.13, 95% CI = 1.03–1.23, p-Value 0.009). Conclusion: While there was a clear relationship between different SES indicators and pediatric TBI rates in greater Vancouver, income-based SES indicators did not serve as good predictors within this region.
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Affiliation(s)
- Ofer Amram
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Ian Pike
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; BC Injury Research and Prevention Unit, Child and Family Research Institute, BC Children's Hospital, Vancouver V6H 3V4, Canada.
| | - Natalie L Yanchar
- Department of Surgery, Dalhousie University, Halifax, NS B3H 4R2, Canada.
| | - Michael Friger
- Faculty of Health Science, Ben Gurion University, Beer Sheva 8410501, Israel.
| | - Paul B McBeth
- Departments of Surgery and Critical Care Medicine, Alberta Health Services, Calgary, AB T6G 2R3, Canada.
| | - Donald Griesdale
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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Gopinath B, Jagnoor J, Harris IA, Nicholas M, Maher CG, Casey P, Blyth F, Sindhusake D, Cameron ID. Comparison of health outcomes between hospitalised and non-hospitalised persons with minor injuries sustained in a road traffic crash in Australia: a prospective cohort study. BMJ Open 2015; 5:e009303. [PMID: 26408286 PMCID: PMC4593145 DOI: 10.1136/bmjopen-2015-009303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This prospective cohort study aimed to investigate whether there are differences in health outcomes among persons with mild or moderate injuries who were hospitalised compared with those not hospitalised following a road traffic crash. SETTING Sydney Metropolitan, New South Wales, Australia. PARTICIPANTS Persons aged ≥18 years involved in a motor vehicle crash were surveyed at baseline (n=364), and at 12 (n=284) and 24 months (n=252). A telephone-administered questionnaire obtained information on a range of socioeconomic, and preinjury and postinjury psychological and heath characteristics of all participants. PRIMARY OUTCOME MEASURE Participants who reported admission to hospital for 24 h or more (but less than 7 days) after the crash were classified as being hospitalised; those admitted for less than 24 h were classified as non-hospitalised. RESULTS Around 1 in 5 participants (19.0%) were hospitalised for ≥24 h after the crash. After adjusting for age and sex, hospitalised participants compared with those not hospitalised had approximately 2.6 units (p=0.01) lower Short Form-12 Physical Component Summary (SF-12 PCS) scores (poorer physical well-being) and approximately 4.9 units lower European Quality of Life visual analogue scale (EQ-VAS) scores (p=0.05), 12 months later. After further adjusting for education level, whiplash, fracture and injury severity score, participants who were hospitalised had approximately 3.3 units lower SF-12 PCS (p=0.04), 12 months later. The association with EQ-VAS did not persist after multivariable adjustment. No significant differences were observed between the 2 groups in health outcomes at 24-month follow-up. CONCLUSIONS These findings indicate that long-term health status is unlikely to be influenced by hospitalisation status after sustaining a mild/moderate injury in a vehicle-related crash.
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Affiliation(s)
- Bamini Gopinath
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jagnoor Jagnoor
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Michael Nicholas
- Pain Management Research Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher G Maher
- George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Petrina Casey
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Pain Management Research Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Doungkamol Sindhusake
- Medical Imaging, Faculty of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Chan V, Thurairajah P, Colantonio A. Defining pediatric traumatic brain injury using International Classification of Diseases Version 10 Codes: a systematic review. BMC Neurol 2015; 15:7. [PMID: 25648197 PMCID: PMC4335539 DOI: 10.1186/s12883-015-0259-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/07/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although healthcare administrative data are commonly used for traumatic brain injury (TBI) research, there is currently no consensus or consistency on the International Classification of Diseases Version 10 (ICD-10) codes used to define TBI among children and youth internationally. This study systematically reviewed the literature to explore the range of ICD-10 codes that are used to define TBI in this population. The identification of the range of ICD-10 codes to define this population in administrative data is crucial, as it has implications for policy, resource allocation, planning of healthcare services, and prevention strategies. METHODS The databases MEDLINE, MEDLINE In-Process, Embase, PsychINFO, CINAHL, SPORTDiscus, and Cochrane Database of Systematic Reviews were systematically searched. Grey literature was searched using Grey Matters and Google. Reference lists of included articles were also searched for relevant studies. Two reviewers independently screened all titles and abstracts using pre-defined inclusion and exclusion criteria. A full text screen was conducted on articles that met the first screen inclusion criteria. All full text articles that met the pre-defined inclusion criteria were included for analysis in this systematic review. RESULTS A total of 1,326 publications were identified through the predetermined search strategy and 32 articles/reports met all eligibility criteria for inclusion in this review. Five articles specifically examined children and youth aged 19 years or under with TBI. ICD-10 case definitions ranged from the broad injuries to the head codes (ICD-10 S00 to S09) to concussion only (S06.0). There was overwhelming consensus on the inclusion of ICD-10 code S06, intracranial injury, while codes S00 (superficial injury of the head), S03 (dislocation, sprain, and strain of joints and ligaments of head), and S05 (injury of eye and orbit) were only used by articles that examined head injury, none of which specifically examined children and youth. CONCLUSION This review provides evidence for discussion on how best to use ICD codes for different goals. This is an important first step in reaching an appropriate definition and can inform future work on reaching consensus on the ICD-10 codes to define TBI for this vulnerable population.
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Affiliation(s)
- Vincy Chan
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Pravheen Thurairajah
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Angela Colantonio
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Acquired Brain Injury Research Lab, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
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Seeley H, Pickard J, Allanson J, Hutchinson P. The epidemiology of a specialist neurorehabilitation clinic: Implications for clinical practice and regional service development. Brain Inj 2014; 28:1559-67. [DOI: 10.3109/02699052.2014.939717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Helen Seeley
- Division of Neurosurgery, University of Cambridge
CambridgeUK
| | - John Pickard
- Division of Neurosurgery, University of Cambridge
CambridgeUK
| | - Judith Allanson
- Department of Neuroscience & Rehabilitation Clinic, Addenbrooke’s Hospital CambridgeUK
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Shivaji T, Lee A, Dougall N, McMillan T, Stark C. The epidemiology of hospital treated traumatic brain injury in Scotland. BMC Neurol 2014; 14:2. [PMID: 24386897 PMCID: PMC3893436 DOI: 10.1186/1471-2377-14-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 12/02/2013] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic Brain Injury (TBI) is an important global public health problem made all the more important by the increased likelihood of disability following a hospital admission for TBI. Understanding those groups most at risk will help inform interventions designed to prevent causes of TBI, such as falls prevention measures. This study identifies the rate of hospitalisation episodes of TBI in Scotland, explores causes of TBI admissions, and trends in hospitalisation episodes by age and gender over a twelve year period using routinely collected hospital data. Methods A retrospective analysis of routine hospital episode data identified records relating to TBI for the twelve years between 1998 and 2009. Descriptive and joinpoint regression analysis were used, average annual percentage changes (AAPC) and annual percentage change (APC) in rates were calculated. Results Between 1998 and 2009 there were 208,195 recorded episodes of continuous hospital care in Scotland as a result of TBI. Almost half (47%) of all TBIs were the result of falls, with marked peaks observed in the very young and the oldest groups. The AAPC of hospitalization episode rates over the study period for boys and girls aged 0-14 were -4.9% (95% CI -3.5 to-6.3) and -4.7% (95% CI -2.6 to -6.8) respectively. This reduction was not observed in older age groups. In women aged 65 and over there was an APC of 3.9% (95% CI 1.2 to 6.6) between 2004 and 2009. Conclusions Hospitalisation for TBI is relatively common in Scotland. The rise in the age-adjusted rate of hospitalisation episodes observed in older people indicates that reduction of TBI should be a public health priority in countries with an ageing population. Public health interventions such as falls prevention measures are well advised and evaluations of such interventions should consider including TBI hospitalisation as an alternative or supplementary outcome measure to fractured neck of femur. Further research is needed to advance understanding of the associations of risk factors with increased incidence of TBI hospital episodes in the elderly population.
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Affiliation(s)
| | | | - Nadine Dougall
- NMAHP Research Unit, School of Nursing, Midwifery & Health, Unit 13 Scion House, University of Stirling, Stirling FK9 4NF, Scotland.
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Vermeij JD, Aslami H, Fluiter K, Roelofs JJ, van den Bergh WM, Juffermans NP, Schultz MJ, Van der Sluijs K, van de Beek D, van Westerloo DJ. Traumatic brain injury in rats induces lung injury and systemic immune suppression. J Neurotrauma 2013; 30:2073-9. [PMID: 23937270 DOI: 10.1089/neu.2013.3060] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Traumatic brain injury (TBI) is frequently complicated by acute lung injury, which is predictive for poor outcome. However, it is unclear whether lung injury develops independently or as a result of mechanical ventilation after TBI. Further, TBI is strongly associated with the development of pneumonia, suggesting a specific vulnerability for the development of nosocomial infections in the lung after TBI. In this study, we evaluated whether indeed pulmonary injury and immune suppression develop spontaneously in an animal model of mild TBI (mTBI). TBI was induced in male PVG rats by closed-head trauma using a weight-drop device. Subsequently, we evaluated the effects of this on the lungs as well as on the excitability of the systemic immune system. Finally, we performed an experiment in which TBI was followed by induction of pneumonitis and evaluated whether TBI affects the severity of subsequent pneumonitis induced by intratracheal instillation of heat-killed Staphylococcus aureus. mTBI resulted in significant lung injury, as evidenced by pulmonary edema, protein leakage to the alveolar compartment, and increased concentrations of interleukin-1 and -6 in broncho alveolar lavage fluid (all p<0.05 vs. sham-treated animals). Further, after TBI, the release of tumor necrosis factor alpha was decreased when whole blood was stimulated ex vivo (p<0.05 TBI vs. sham), indicating systemic immune suppression. When TBI was followed by pneumonitis, the severity of subsequent pneumonitis was not different in rats previously subjected to TBI or sham treatment (p>0.05), suggesting that systemic immune suppression is not translated toward the pulmonary compartment in this specific model. We here show that during mild experimental TBI, acute pulmonary injury, as well as a decrease in the excitability of the systemic immune system, can be observed.
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Affiliation(s)
- Jan-Dirk Vermeij
- 1 Department of Neurology, Academic Medical Center , Amsterdam, the Netherlands
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Oddy M, da Silva Ramos S. The clinical and cost-benefits of investing in neurobehavioural rehabilitation: a multi-centre study. Brain Inj 2013; 27:1500-7. [PMID: 24087973 PMCID: PMC3852231 DOI: 10.3109/02699052.2013.830332] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Primary objective The aim of this study was to investigate the cost-benefits of a residential post-acute neurobehavioural rehabilitation programme and its effects on care needs and social participation of adults with acquired brain injury. Research design Retrospective multi-centre design. Methods and procedures Data on occupation, adaptability and level of support required were collected at admission, discharge and 6-months follow-up. Cost analysis was performed on cost estimates based on level of support. Main outcomes and results Significant gains were observed in all areas of functioning, with individuals progressing towards higher levels of independence and more participation in society upon discharge. Conclusions Cost-benefits of up to £1.13 million were demonstrated for individuals admitted to rehabilitation within a year of sustaining a brain injury and of up to £0.86 million for those admitted more than 1 year after injury. Functional gains and reductions in levels of care required upon discharge were maintained 6 months later. These results demonstrate that post-acute neurobehavioural rehabilitation can have a positive impact on the lives of individuals with brain injury and that the associated costs are off-set by significant savings in the longer-term.
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Affiliation(s)
- Michael Oddy
- Brain Injury Rehabilitation Trust , Horsham, West Sussex , UK
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15
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Nikopoulos CK, Nikopoulou-Smyrni P, Konstantopoulos K. Effects of video modelling on emerging speech in an adult with traumatic brain injury: preliminary findings. Brain Inj 2013; 27:1256-62. [PMID: 23909660 DOI: 10.3109/02699052.2013.809550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE Research has shown that traumatic brain injury (TBI) can affect a person's ability to perform previously learned skills. Dysexecutive syndrome and inattention, for example, alongside a number of other cognitive and behavioural impairments such as memory loss and lack of motivation, significantly affect day-to-day functioning following TBI. This study examined the efficacy of video modelling in emerging speech in an adult male with TBI caused by an assault. RESEARCH DESIGN In an effort to identify functional relations between this novice intervention and the target behaviour, experimental control was achieved by using within-system research methodology, overcoming difficulties of forming groups for such an highly non-homogeneous population. METHODS AND PROCEDURES Across a number of conditions, the participant watched a videotape in which another adult modelled a selection of 19 spoken words. When this modelled behaviour was performed in vivo, then generalization across 76 other words in the absence of a videotape took place. MAIN OUTCOMES AND RESULTS It was revealed that video modelling can promote the performance of previously learned behaviours related to speech, but more significantly it can facilitate the generalization of this verbal behaviour across untrained words. CONCLUSIONS Video modelling could well be added within the rehabilitation programmes for this population.
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Affiliation(s)
- Christos K Nikopoulos
- School of Health Sciences and Social Care, Brunel University, Uxbridge , Middlesex , UK
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Chen CC, Wei ST, Tsaia SC, Chen XX, Cho DY. Cerebrolysin enhances cognitive recovery of mild traumatic brain injury patients: double-blind, placebo-controlled, randomized study. Br J Neurosurg 2013; 27:803-7. [PMID: 23656173 DOI: 10.3109/02688697.2013.793287] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In adults, mild traumatic brain injury (MTBI) frequently results in impairments of cognitive functions which would lead to psychological consequences in the future. Cerebrolysin is a nootropic drug, and can significantly improve cognitive function in patients with Alzheimer's disease and stroke. The purpose of this study was to investigate how Cerebrolysin therapy enhances cognitive recovery for mild traumatic brain injury patients using a double-blinded, placebo-controlled, randomized phase II pilot study. Patients having head injury within 24 h sent to our hospital were screened and recruited if patients were alert and conscious, and had intracranial contusion haemorrhage. From July 2009 to June 2010, totally, thirty-two patients were recruited in the double-blinded, placebo-controlled, and randomized study. Patients were randomized to receive Cerebrolysin (Group A, once daily intravenous infusion of 30 mL Cerebrolysin over a 60-min period for 5 days) or placebo (Group B, same dosage and administration of normal saline as Group A). The primary outcome measures were differences of cognitive function including Mini-Mental Status Examination (MMSE), and Cognitive Abilities Screening Instrument (CASI) scores between baseline and week 1, between baseline and week 4, and between baseline and week 12. Thirty-two patients completed the trial. For Group A, the CASI score difference between baseline and week 12 was 21.0 ± 20.4, a significantly greater change than that of Group B (7.6 ± 12.1) (p = 0.0461). Besides, drawing function (one of the domains of CASI; p = 0.0066) on week 4 and both drawing function (p = 0.0472) and long-term memory (one of the domains of CASI; p = 0.0256) on week 12 were also found to be significantly improved in the patients receiving Cerebrolysin treatment. Our results suggest that Cerebrolysin improves the cognitive function of the MTBI in patients at 3rd month after injury, especially for long-term memory and drawing function.
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Affiliation(s)
- Chun-Chung Chen
- Department of Neurosurgery, China Medical University Hospital , Taichung , Taiwan
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Reuben A, Sampson P, Harris AR, Williams H, Yates P. Postconcussion syndrome (PCS) in the emergency department: predicting and pre-empting persistent symptoms following a mild traumatic brain injury. Emerg Med J 2013; 31:72-7. [DOI: 10.1136/emermed-2012-201667] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Haydon NB. Head injury: audit of a clinical guideline to justify head CT. J Med Imaging Radiat Oncol 2013; 57:161-8. [PMID: 23551773 DOI: 10.1111/1754-9485.12007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/19/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Head injury causes significant morbidity and mortality, and there is contention about which patients to scan. The UK National Health Service Clinical Guideline (CG) 56 provides criteria for selecting patients with clinically important brain injury who may benefit from a head CT scan, while minimising the radiation and economic burden of scanning patients without significant injury. This study aims to audit the documentation of the use of these guidelines in a busy UK trauma hospital and discusses the comparison with an Australian (New South Wales (NSW) ) head injury guideline. METHODS A retrospective cohort study of 480 patients presenting with head injury to the emergency department over 2 months was performed. The patient notes were assessed for documentation of each aspect of the clinical guidelines. Criteria were established to assess the utilisation of the CG 56. A database of clinical data was amalgamated with the head CT scan results for each patient. RESULTS For the UK CG 56, 73% of the criteria were documented, with the least documented being 'signs of basal skull fracture' and 'amnesia of events'. Thirty-two per cent of patients received head CT and of these, 24% (37 patients) were reported to have pathology. Twenty-four patients underwent head CT without clinical justification being documented, none of which had reported pathology on CT. CONCLUSION The study shows that the head injury guidelines are not being fully utilised at a major UK trauma hospital, resulting in 5% of patients being exposed to ionising radiation without apparent documented clinical justification. The NSW guideline has distinct differences to the CG 56, with a more complex algorithm and an absence of specific time frames for head CT completion. The results suggest a need for further education and awareness of head injury clinical guidelines.
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Kool B, Chelimo C, Ameratunga S. Head Injury Incidence and Mortality in New Zealand over 10 Years. Neuroepidemiology 2013; 41:189-97. [DOI: 10.1159/000354782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/31/2013] [Indexed: 11/19/2022] Open
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20
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Wall G, Turner A, Clarke R. Evaluation of neuropsychological rehabilitation following severe traumatic brain injury: a case report. Neurocase 2013; 19:530-41. [PMID: 22856554 DOI: 10.1080/13554794.2012.701642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This case study presents the evaluation of traumatic brain injury rehabilitation for Jane, a 35-year-old woman who sustained a severe traumatic brain injury (TBI). On-going rehabilitation addressed difficulties within a structured neuro-rehabilitative therapeutic milieu and was holistically evaluated. Results showed improvement in mood and quality of life and at the compensatory level for cognition. At the impairment level, many of the affected areas of cognition remained at least below predicted pre-morbid levels. This supports the view that although TBI impairments may be permanent, structured neuro-rehabilitation can be effective through external and compensatory aids. Recording this holistically contributes to evidencing this.
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Affiliation(s)
- Gemma Wall
- a Department of Clinical Neuropsychology , Salford Royal NHS Foundation Trust , Salford , UK
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21
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Lu X, Zhang M, Yang JX, Xu SX, Gan JX. Preliminary Experience of Assessment of Intracranial Lesions by Ultrasound in Multiple Trauma Patients Undergoing Craniectomy. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To explore the feasibility and reliability of B-mode ultrasound for assessment of intracranial lesions in multiple trauma patients who had undergone craniectomy. Design ingle-centre study. Setting A 16-bed emergency intensive care unit (ICU) in the emergency department of 2nd Affiliated Hospital of Zhejiang University School of Medicine from July 2006 to June 2010. Methods We retrospectively analysed 13 multiple trauma patients with severe head injury admitted to the emergency department of 2nd Affiliated Hospital of Zhejiang University School of Medicine. All 13 patients were admitted to the ICU after craniectomy and received mechanical ventilation. Computed tomography (CT) were conducted when patients' consciousness, pupillary size, light reflex changed apparently, or if the bone window tension and the intracranial pressure increased unexpectedly. Head ultrasonography was performed within 2 hours of CT scanning. Results Ultrasonography revealed 18 pathological changes in the 13 patients. CT and a second operation helped to identify 23 pathological changes. The results of B-mode ultrasound were compared with those of CT and the coincidence rate was 78.3%, with no significant difference in the diagnosis of delayed haematoma or midline shift (Kappa=0.898, p<0.05). Conclusions Transcranial ultrasonography may be a useful tool for monitoring post-operation intracranial lesions in multiple trauma patients with severe head injury. It is an effective supplement to CT.
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Abstract
Neurological disorders place a considerable burden upon individuals, their families, and society. Some like stroke are common, while others like amyotrophic lateral sclerosis are much rarer. Some conditions such as multiple sclerosis are reported to vary by latitude, while others such as traumatic brain injury can vary considerably by locality. Depending upon the nature of the lesion, and factors such as time since onset, the consequences to the individual may also vary considerably, not just among different disorders, but within a given disorder. Consequently the patterns of disease incidence, its prevalence, and its consequences are complex and may vary not just because of the condition itself, but also because, for example, case ascertainment may vary from study to study. The cumulative annual incidence of disabling neurological disorders is likely to exceed 1000 per 100000, or 1% of the population. The incidence is characterized by significant variation, which is mediated by genetic, geographical, demographic, and environmental factors. While useful comparisons can be made through standardization techniques, planning for local services should be based upon local epidemiology, whenever available.
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Harrison JE, Berry JG, Jamieson LM. Head and traumatic brain injuries among Australian youth and young adults, July 2000–June 2006. Brain Inj 2012; 26:996-1004. [DOI: 10.3109/02699052.2012.660515] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Francis R, Rowan EN, Gregson BA, Mendelow AD. Traumatic Intracerebral Hemorrhage—To Operate or Not? World Neurosurg 2011; 76:484-5. [DOI: 10.1016/j.wneu.2011.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Tsang KKT, Whitfield PC. Traumatic brain injury: review of current management strategies. Br J Oral Maxillofac Surg 2011; 50:298-308. [PMID: 21530028 DOI: 10.1016/j.bjoms.2011.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 03/17/2011] [Indexed: 11/26/2022]
Abstract
Head injury is a common condition with a high morbidity and mortality. Serious intracranial haematomas require early recognition and evacuation to maximise chances of independent outcomes. Recent organisational changes have promoted the development of trauma units and major trauma centres where patients can go through triage and be managed in an appropriate environment, and the development of management pathways in intensive treatment units has resulted in improvements in the outcome of traumatic brain injuries. Evidence for the treatment of cerebral perfusion pressure, and management of hyperventilation, osmotherapy, tracheostomy, and leakage of cerebrospinal fluid (CSF) has accumulated during the last decade and is important in the management of patients in all clinical settings. Since head injury is commonly associated with maxillofacial injuries, this review will be relevant to all who deal with this aspect of trauma.
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Affiliation(s)
- Kevin King-Tin Tsang
- Derriford Hospital, Department of Neurosurgery, Derriford Road, Plymouth PL6 8DH, United Kingdom.
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27
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Kelly F, Nikopoulos CK. Facilitating independence in personal activities of daily living after a severe traumatic brain injury. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.9.78037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims This study examined the effectiveness of two components of a treatment programme typically used by occupational therapists (OTs) in personal activities of daily living (PADL) rehabilitation. Methods A multiple baseline probe design across PADL tasks was used, one which is particularly suited to the examination of the effects of complex interventions on skill performance. The subjects were two male adults with severe brain injuries and cognitive impairments who were in the acute stages of recovery. The OT treatment program consisted of a combination of errorless learning and strategy training approaches. The impact of the program was measured by the number of steps completed independently in each of these tasks, the level and type of assistance required, and by administering the UK Functional Independence Measure and the Assessment of Motor and Process Skills. Findings Errorless learning and strategy training, as used within an OT programme, was demonstrated to be effective in reducing the amount of assistance both participants required to complete the targeted PADL tasks. Further, there was evidence of generalization of training effects among trained and untrained activities. Conclusions Selecting and combining treatment techniques based on detailed assessment of functional performance is an area of high clinical importance but with limited research; the current study stands as an attempt towards that direction.
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Affiliation(s)
- Fiona Kelly
- Neurosciences Clinical Lead Rehabilitation, Royal Free Hospital, Pond Street, London; and
| | - Christos K Nikopoulos
- Occupational Therapy, School of Health Sciences and Social Care, Mary Seacole Building, Brunel University, Uxbridge, UK
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Seeley HM, Kirker S, Harkin C, Dias C, Richards H, Pickard JD, Hutchinson PJ. Head injury rehabilitation: the role of a neurotrauma clinic. Br J Neurosurg 2009; 23:530-7. [DOI: 10.1080/02688690903078874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Moppett IK. Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth 2007; 99:18-31. [PMID: 17545555 DOI: 10.1093/bja/aem128] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This review examines the evidence base for the early management of head-injured patients. Traumatic brain injury (TBI) is common, carries a high morbidity and mortality, and has no specific treatment. The pathology of head injury is increasingly well understood. Mechanical forces result in shearing and compression of neuronal and vascular tissue at the time of impact. A series of pathological events may then ensue leading to further brain injury. This secondary injury may be amenable to intervention and is worsened by secondary physiological insults. Various risk factors for poor outcome after TBI have been identified. Most of these are fixed at the time of injury such as age, gender, mechanism of injury, and presenting signs (Glasgow Coma Scale and pupillary signs), but some such as hypotension and hypoxia are potential areas for medical intervention. There is very little evidence positively in favour of any treatments or packages of early care; however, prompt, specialist neurocritical care is associated with improved outcome. Various drugs that target specific pathways in the pathophysiology of brain injury have been the subject of animal and human research, but, to date, none has been proved to be successful in improving outcome.
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Affiliation(s)
- I K Moppett
- Division of Anaesthesia and Intensive Care, University of Nottingham and Queen's Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK.
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Yates PJ, Williams WH, Harris A, Round A, Jenkins R. An epidemiological study of head injuries in a UK population attending an emergency department. J Neurol Neurosurg Psychiatry 2006; 77:699-701. [PMID: 16464899 PMCID: PMC2117473 DOI: 10.1136/jnnp.2005.081901] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We aimed to identify the attendance rate for all head injuries, and for moderate to severe head injury (MSHI), in an emergency department (ED), and related risk factors for MSHI, including age, sex, area of residence, and socioeconomic status (SES). This was a retrospective descriptive epidemiological study of an ED database of head injury attendances over 6 years, carried out in an ED that serves both urban and mixed rural and urban areas, with a wide socioeconomic range, and a total population of 344,600. The main outcome measure was rates of attendance for head injury. Head injury presentations accounted for 3.4% of all attendances per year. An overall rate of 453 per 100,000 was found for all head injuries, of which 40 per 100,000 were moderate to severe (10.9%). Urban residents had significantly greater risk of presenting with MSHI compared with residents of mixed/rural areas. Males were more at risk than females, and children and adolescents had higher risk of MSHI. A high attendance rate of MSHI was found in the <5 year old age group in urban areas for both sexes. A gradient, with higher attendance in groups with lower SES, was observed for children in urban areas, while the gradient was reversed in mixed/rural areas. Head injuries are a relatively common cause of attendance at ED. There is significant variation in attendance with MSHI with regard to sex, age, socioeconomic factors, and type of area of residence. The planning and delivery of preventative and management services may be improved by such analyses.
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Affiliation(s)
- P J Yates
- Mardon Neuro-Rehabiliation Centre, Royal Devon & Exeter Hospital NHS Foundation Trust, and School of Psychology, Centre for Clinical Neuropsychological Research, University of Exeter, Exeter EX4 4QG, UK
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Eyres S, Carey A, Gilworth G, Neumann V, Tennant A. Construct validity and reliability of the Rivermead Post-Concussion Symptoms Questionnaire. Clin Rehabil 2006; 19:878-87. [PMID: 16323387 DOI: 10.1191/0269215505cr905oa] [Citation(s) in RCA: 179] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To provide further evidence of reliability and internal and external construct validity of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), which measures severity of postconcussion symptoms following head injury. DESIGN AND SETTING A cross-sectional study of consecutive patients presenting with a head injury in two urban teaching hospitals and a community trust. PATIENTS Three hundred and sixty-nine patients returned a questionnaire from 1689 consecutive adult patients (18 years and above) referred to radiology for a skull X-ray following a head injury, and those who were currently under the care of a community-based multidisciplinary head injury team. METHOD Internal construct validity tested by fit to the Rasch Measurement model; external construct validity tested by correlations with Rivermead Head Injury Follow-up Questionnaire (RHFUQ); test-retest reliability tested by correlations at two-week intervals. OUTCOME MEASURES Rivermead Post-Concussion Symptoms Questionnaire and Rivermead Head Injury Follow-up Questionnaire. MAIN RESULTS RPQ scores ranged from 0 to 64 (17.3% floor, 0.3% ceiling). Overall fit to the Rasch model was poor (item fit mean -0.416, SD = 1.989, chi-squared= 172.486, p<0.01) suggesting a lack of unidimensionality. The items headaches, dizziness and forgetful displayed misfitting residuals and the first two items also displayed significant item trait fit statistics (p < 0.0006). After removing the items headaches, dizziness and subsequently nausea the RPQ demonstrated good fit at overall and individual item levels, both for the remaining 13 items (RPQ-13) and the three items (RPQ-3) which now formed a subsidiary scale. All items functioned consistently across age and gender. The RPQ-13 and RPQ-3 scales showed test-retest reliability coefficients of 0.89 and 0.72 (both p-values < 0.01) and positive correlations with RHFUQ scores (0.83 for RPQ-13, 0.62 for RPQ-3, both p-values < 0.01). CONCLUSIONS As currently used, the RPQ does not meet modern psychometric standards. Its 16 items do not tap into the same underlying construct and should not be summated in a single score. When the RPQ is split into two separate scales, the RPQ-13 and the RPQ-3, each set of items forms a unidimensional construct for people with head injury at three months post injury. These scales show good test-retest reliability and adequate external construct validity.
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Affiliation(s)
- Sophie Eyres
- Academic Unit of Musculoskeletal and Rehabilitation Medicine, The University of Leeds, 36 Clarendon Road, Leeds LS2 9NZ, UK
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