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TBI and risk of death in military veterans over 14 years: Injury severity, timing, and cause of death. J Psychiatr Res 2022; 156:200-205. [PMID: 36257114 DOI: 10.1016/j.jpsychires.2022.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/26/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
Abstract
The objective of this study was to determine the association of traumatic brain injury (TBI) with mortality in military veterans and whether this association differs as a function of TBI severity, timing, and cause of death. This national cohort study used U.S. Department of Veterans Affairs' (VA) data of patients 18 years and older with TBI diagnoses (N = 213,290) and 1:1 propensity-matched comparison random sample of patients without TBI (N = 213,290). The main outcome measure was mortality within 6 months of TBI diagnosis and longer-term (after 6 months). Cox proportional hazards models were used to examine risk of all-cause mortality according to TBI severity and Fine-Gray proportional hazards regression to examine time to cause-specific mortality, accounting for competing risk of other deaths. For patients with moderate-to-severe TBI (compared with no TBI), hazard ratios (HRs) for mortality were highest within first 6 months of injury (fully-adjusted HR: 2.42, 95% CI: 2.32-2.53); for mild TBIs, HRs for mortality were lower and relatively constant over time (fully-adjusted HR within first 6 months: 1.33, 95% CI: 1.26-1.39). Veterans with mild and moderate-to-severe TBI had higher risk of future death over short term for 9 out 10 of the U.S. leading causes of death, with only unintentional injury, stroke, and suicide showing differences by TBI severity. Associations attenuated significantly from within to after 6 months TBI diagnosis. These findings indicate that adults with TBI are at increased risk of majority of leading causes of death, with differential risk by TBI severity and timing of death.
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Anestis DM, Monioudis PM, Foroglou NG, Tsonidis CA, Tsitsopoulos PP. Clinimetric study and review of the Reaction Level Scale. Acta Neurol Scand 2022; 145:706-720. [PMID: 35243607 DOI: 10.1111/ane.13604] [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: 12/07/2021] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although the Reaction Level Scale (RLS) is still used for the assessment of the level of consciousness in distinct centers, its clinical characteristics and significance have been incompletely researched. In the current study, the clinimetric properties, the prognostic value, and the impact of the raters' background on the application of the RLS, in comparison with the Glasgow Coma Scale (GCS), are investigated. MATERIALS AND METHODS A systematic review on the available clinical evidence for the RLS was first carried out. Next, the RLS was translated into Greek, and patients with neurosurgical pathologies in need of consciousness monitoring were independently assessed with both RLS and GCS, by four raters (two consultants, one resident, and one nurse) within one hour. Interrater reliability, construct validity, and predictive value (mortality and poor outcome, at discharge and at 6 months) were evaluated. RESULTS Literature review retrieved 9 clinimetric studies related to the RLS, most of low quality, indicating that the scale has not been thoroughly studied. Both versions of the RLS (original and modified) showed high interrater reliability (κw >0.80 for all pairs of raters), construct validity (Spearman's p > .90 for all raters), and prognostic value (areas under the curve >0.85 for all raters and outcomes). However, except for broader patients' coverage, it failed to show any advantage over the GCS. CONCLUSIONS The RLS has not succeeded in showing any advantage over the GCS in terms of reliability and validity. Available evidence cannot justify its use in clinical practice as a substitute to the widely applied GCS.
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Affiliation(s)
- Dimitrios M. Anestis
- Department of Neurosurgery Hippokration General Hospital Aristotle University School of Medicine Thessaloniki Greece
| | - Panagiotis M. Monioudis
- Department of Neurosurgery Hippokration General Hospital Aristotle University School of Medicine Thessaloniki Greece
| | - Nikolaos G. Foroglou
- Department of Neurosurgery AHEPA University Hospital Aristotle University School of Medicine Thessaloniki Greece
| | - Christos A. Tsonidis
- Department of Neurosurgery Hippokration General Hospital Aristotle University School of Medicine Thessaloniki Greece
| | - Parmenion P. Tsitsopoulos
- Department of Neurosurgery Hippokration General Hospital Aristotle University School of Medicine Thessaloniki Greece
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Mostert CQB, Singh RD, Gerritsen M, Kompanje EJO, Ribbers GM, Peul WC, van Dijck JTJM. Long-term outcome after severe traumatic brain injury: a systematic literature review. Acta Neurochir (Wien) 2022; 164:599-613. [PMID: 35098352 DOI: 10.1007/s00701-021-05086-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Expectation of long-term outcome is an important factor in treatment decision-making after severe traumatic brain injury (sTBI). Conclusive long-term outcome data substantiating these decisions is nowadays lacking. This systematic review aimed to provide an overview of the scientific literature on long-term outcome after sTBI. METHODS A systematic search was conducted using PubMed from 2008 to 2020. Studies were included when reporting long-term outcome ≥ 2 years after sTBI (GCS 3-8 or AIS head score ≥ 4), using standardized outcome measures. Study quality and risk of bias were assessed using the QUIPS tool. RESULTS Twenty observational studies were included. Studies showed substantial variation in study objectives and study methodology. GOS-E (n = 12) and GOS (n = 8) were the most frequently used outcome measures. Mortality was reported in 46% of patients (range 18-75%). Unfavourable outcome rates ranged from 29 to 100% and full recovery was seen in 21-27% of patients. Most surviving patients reported SF-36 scores lower than the general population. CONCLUSION Literature on long-term outcome after sTBI was limited and heterogeneous. Mortality and unfavourable outcome rates were high and persisting sequelae on multiple domains common. Nonetheless, a considerable proportion of survivors achieved favourable outcome. Future studies should incorporate standardized multidimensional and temporal long-term outcome measures to strengthen the evidence-base for acute and subacute decision-making. HIGHLIGHTS 1. Expectation of long-term outcome is an important factor in treatment decision-making for patients with severe traumatic brain injury (sTBI). 2. Favourable outcome and full recovery after sTBI are possible, but mortality and unfavourable outcome rates are high. 3. sTBI survivors are likely to suffer from a wide range of long-term consequences, underscoring the need for long-term and multi-modality outcome assessment in future studies. 4. The quality of the scientific literature on long-term outcome after sTBI can and should be improved to advance treatment decision-making.
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Affiliation(s)
- Cassidy Q B Mostert
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands.
| | - Ranjit D Singh
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Maxime Gerritsen
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Erwin J O Kompanje
- Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
| | - Jeroen T J M van Dijck
- University Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Leiden The Hague, Albinusdreef 2, J-11-R-83, 2333 ZA, Leiden, The Netherlands
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Life Expectancy of 1-Year Survivors of Traumatic Brain Injury, 1988-2019: Updated Results From the TBI Model Systems. Arch Phys Med Rehabil 2021; 103:176-179. [PMID: 34462114 DOI: 10.1016/j.apmr.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/28/2021] [Accepted: 05/18/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To update the life expectancy estimates according to age, sex, mobility, and feeding skills reported in the 2015 study of Brooks et al. To examine trends in survival over the past decade. DESIGN Observational cohort study. SETTING Poisson regression and life table analysis applied to long-term follow-up data on United States (US) Traumatic Brain Injury (TBI) Model Systems patients recorded in the national database. Functional mobility and feeding skills were assessed with FIM. PARTICIPANTS A total of 14,803 persons with TBI during the years 1988-2019 who underwent inpatient rehabilitation and provided at least 1 long-term assessment of functional skills 1 year or more postinjury (N=14,803). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Survival, mortality rates, and life expectancy. RESULTS Life expectancy was lower than that of the age- and sex-matched general population. Older age and severity of functional impairments were risk factors for mortality (both P<.0001 in regression models). Among ambulatory individuals, mortality was 51% (95% confidence interval, 35%-69%) higher in men than women. Life expectancy of 20-year-old women who walked well (FIM ambulation score 7) was 55 (SE=0.8) additional years to age 75, representing a reduction of 6.9 years from the normal general population figure. For 20-year-old men who walked well, the life expectancy was 49 (SE=0.5) additional years, representing a reduction of 8.1 years from normal. Life expectancies for men and women who did not walk and were fed by others were much lower. There was no significant change in mortality rates during the study period (hazard ratio, 1.008; P=.07). CONCLUSIONS There has been no significant change in the long-term survival of persons with TBI in the US since the late 1980s. The life expectancies reported here are similar to those reported in the 2015 study of Brooks et al, although they are more precise because of the larger sample size and longer follow-up.
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Esterov D, Bellamkonda E, Mandrekar J, Ransom JE, Brown AW. Cause of Death after Traumatic Brain Injury: A Population-Based Health Record Review Analysis Referenced for Nonhead Trauma. Neuroepidemiology 2021; 55:180-187. [PMID: 33839727 DOI: 10.1159/000514807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/24/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a leading cause of disability and is associated with decreased survival. Although it is generally accepted that TBI increases risk of death in acute and postacute periods after injury, causes of premature death after TBI in the long term are less clear. METHODS A cohort sample of Olmsted County, Minnesota, residents with confirmed TBI from January 1987 through December 1999 was identified. Each case was assigned an age- and sex-matched non-TBI referent case, called regular referent. Confirmed TBI cases with simultaneous nonhead injuries were identified, labeled special cases. These were assigned 2 age- and sex-matched special referents with nonhead injuries of similar severity. Underlying causes of death in each case were categorized using death certificates, International Classification of Diseases, Ninth Revision, International Statistical Classification of Diseases, Tenth Revision, and manual health record review. Comparisons were made over the study period and among 6-month survivors. RESULTS Case-regular referent pairs (n = 1,257) were identified over the study period, and 221 were special cases. In total, 237 deaths occurred among these pairs. A statistically significant difference was observed between total number of deaths among all cases (n = 139, 11%) and regular referents (n = 98, 8%) (p = 0.006) over the entire period. This outcome was not true for special cases (32/221, 14%) and special referents (61/441, 14%) (p = 0.81). A greater proportion of deaths by external cause than all other causes was observed in all cases (52/139, 37%) versus regular referents (3/98, 3%) and in special cases (13/32, 41%) versus special referents (5/61, 8%) (p < 0.001 for both). Among all case-referent pairs surviving 6 months, no difference was found between total number of deaths (p = 0.82). The underlying cause of death between these 2 groups was significantly different for external causes only (p < 0.01). For special cases surviving 6 months versus special referents, no difference was observed in total number of deaths (p = 0.24) or underlying causes of death (p = 1.00) between groups. DISCUSSION/CONCLUSION This population-based case-matched referent study showed that increased risk of death after TBI existed only during the first 6 months after injury, and the difference was due to external causes.
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Affiliation(s)
- Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Rochester, Minnesota, USA
| | - Erica Bellamkonda
- Department of Physical Medicine and Rehabilitation, Rochester, Minnesota, USA
| | - Jay Mandrekar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeanine E Ransom
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen W Brown
- Department of Physical Medicine and Rehabilitation, Rochester, Minnesota, USA
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Physical, Cognitive, and Psychosocial Characteristics Associated With Mortality in Chronic TBI Survivors: A National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2018; 33:237-245. [DOI: 10.1097/htr.0000000000000365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Singh R, Mason S, Lecky F, Dawson J. Prevalence of depression after TBI in a prospective cohort: The SHEFBIT study. Brain Inj 2017; 32:84-90. [DOI: 10.1080/02699052.2017.1376756] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rajiv Singh
- Osborn Neurorehabilitation Unit, Department of Rehabilitation Medicine, Sheffield Teaching Hospitals, Sheffield, UK
- Emergency Medicine Research in Sheffield (EMRiS), Health Services Research, School of Health and Related Research (ScHARR) University of Sheffield, UK
| | - Suzanne Mason
- Emergency Medicine Research in Sheffield (EMRiS), Health Services Research, School of Health and Related Research (ScHARR) University of Sheffield, UK
| | - Fiona Lecky
- Emergency Medicine Research in Sheffield (EMRiS), Health Services Research, School of Health and Related Research (ScHARR) University of Sheffield, UK
| | - Jeremy Dawson
- Institute of Work Psychology, Sheffield University Management School, Sheffield, UK
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Andersson E, Rackauskaite D, Svanborg E, Csajbók L, Öst M, Nellgård B. A prospective outcome study observing patients with severe traumatic brain injury over 10-15 years. Acta Anaesthesiol Scand 2017; 61:502-512. [PMID: 28374472 DOI: 10.1111/aas.12880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/16/2017] [Accepted: 02/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Severe traumatic brain injury (sTBI) can be divided into primary and secondary injuries. Intensive care protocols focus on preventing secondary injuries. This prospective cohort study was initiated to investigate outcome, including mortality, in patients treated according to the Lund Concept after a sTBI covering 10-15 years post-trauma. METHODS Patients were included during 2000-2004 when admitted to the neurointensive care unit, Sahlgrenska University Hospital. Inclusion criteria were: Glasgow coma scale score of ≤8, need for artificial ventilation and intracranial monitoring. Glasgow Outcome Scale (GOS) was used to evaluate outcome both at 1-year and 10-15 years post-trauma. RESULTS Ninety-five patients, (27 female and 68 male), were initially included. Both improvement and deterioration were noted between 1- and 10-15 years post-injury. Mortality rate (34/95) was higher in the studied population vs. a matched Swedish population, (Standard mortality rate (SMR) 9.5; P < 0.0001). When dividing the cohort into Good (GOS 4-5) and Poor (GOS 2-3) outcome at 1-year, only patients with Poor outcome had a higher mortality rate than the matched population (SMR 7.3; P < 0.0001). Further, good outcome (high GOS) at 1-year was associated with high GOS 10-15 years post-trauma (P < 0.0001). Finally, a majority of patients demonstrated symptoms of mental fatigue. CONCLUSION This indicates that patients with severe traumatic brain injury with Good outcome at 1-year have similar survival probability as a matched Swedish population and that high Glasgow outcome scale at 1-year is related to good long-term outcome. Our results further emphasise the advantage of the Lund concept.
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Affiliation(s)
- E. Andersson
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - D. Rackauskaite
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Svanborg
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - L. Csajbók
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - M. Öst
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - B. Nellgård
- Department of Anaesthesiology and Intensive Care Medicine; Sahlgrenska University Hospital and Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Sone JY, Kondziolka D, Huang JH, Samadani U. Helmet efficacy against concussion and traumatic brain injury: a review. J Neurosurg 2017; 126:768-781. [DOI: 10.3171/2016.2.jns151972] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Helmets are one of the earliest and most enduring methods of personal protection in human civilization. Although primarily developed for combat purposes in ancient times, modern helmets have become highly diversified to sports, recreation, and transportation. History and the scientific literature exhibit that helmets continue to be the primary and most effective prevention method against traumatic brain injury (TBI), which presents high mortality and morbidity rates in the US. The neurosurgical and neurotrauma literature on helmets and TBI indicate that helmets provide effectual protection against moderate to severe head trauma resulting in severe disability or death. However, there is a dearth of scientific data on helmet efficacy against concussion in both civilian and military aspects. The objective of this literature review was to explore the historical evolution of helmets, consider the effectiveness of helmets in protecting against severe intracranial injuries, and examine recent evidence on helmet efficacy against concussion. It was also the goal of this report to emphasize the need for more research on helmet efficacy with improved experimental design and quantitative standardization of assessments for concussion and TBI, and to promote expanded involvement of neurosurgery in studying the quantitative diagnostics of concussion and TBI. Recent evidence summarized by this literature review suggests that helmeted patients do not have better relative clinical outcome and protection against concussion than unhelmeted patients.
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Affiliation(s)
- Je Yeong Sone
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Douglas Kondziolka
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Jason H. Huang
- 2Department of Neurosurgery, Baylor Scott & White Central Division, Temple, Texas; and
| | - Uzma Samadani
- 3Department of Neurosurgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota
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Graff HJ, Christensen U, Poulsen I, Egerod I. Patient perspectives on navigating the field of traumatic brain injury rehabilitation: a qualitative thematic analysis. Disabil Rehabil 2017; 40:926-934. [DOI: 10.1080/09638288.2017.1280542] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Heidi J. Graff
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Trauma Center and Acute Admission, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Christensen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Rigshospitalet, Clinic of Neurorehabilitation, TBI Unit, University of Copenhagen, Hvidovre, Denmark
| | - Ingrid Egerod
- Trauma Center and Acute Admission, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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