Lawsuit and Traumatic Brain Injury: The Relationship Between Long-Lasting Sequelae and Financial Compensation in Litigants. Results From the PariS-TBI Study

Medical-Legal Issues in Traumatic Brain Injury

Traumatic Brain Injury (TBI) cases often involve both medical and legal issues, litigation and prolonged recovery timelines. As TBI cases are often complex, and can have a significant impact on the lives of the patients and their families/caregivers, having a comprehensive understanding of the causes, diagnoses, treatments and long term outcomes will be valuable in understanding the medical and legal aspects of this type of injury. Patients, families, and health care professionals will all benefit from a deeper understanding of the medical and legal aspects of TBI, which should help improve rehabilitation and recovery outcomes.

The Glasgow Coma Scale: A disconnect between medical documentation and traumatic brain injury litigation in the United States

Traumatic brain injuries are consistently difficult to objectively measure. This creates significant challenges for medical and legal practitioners who each apply the Glasgow Coma Scale-based traumatic brain injury severity classifications of "mild", "moderate" and "severe". It can be difficult to medically define an often-subjective traumatic brain injury, where the law requires objective evidence of injuries. This descriptive review aims to elucidate the intended purpose of the Glasgow Coma Scale in traumatic brain injury assessment by doctors and attorneys. We highlight two different Glasgow Coma Scale uses, demonstrating a disconnect between the clinical traumatic brain injury adjectival classifications used in medicine and law. The Glasgow Coma Scale-based adjectival traumatic brain injury classifications create a diagnostic label which can affect a patient long after their initial medical assessment, representing a de facto diagnosis to the legal profession which may affect a patient's potential legal financial recovery.

Stachydrine, a potential drug for the treatment of cardiovascular system and central nervous system diseases

Cardiovascular disease (CVD) is the leading cause of death globally and poses at significant challenge in terms of effective medical treatment. Leonurus japonicus Houtt, a traditional Chinese herb, is widely used in China for the treatment of obstetrical and gynecological disorders, including menstrual disorders, dysmenorrhea, amenorrhea, blood stasis, postpartum bleeding, and blood-related diseases such as CVD. Stachydrine, the main alkaloid component of Leonurus, has been shown to exhibit a wide range of biological activities including anti-inflammatory, antioxidant, anti-coagulant, anti-apoptotic, vasodilator, angiogenic promoter. Additionally, it has been demonstrated to have unique advantages in the prevention and treatment of CVD through regulation of various disease-related signaling pathways and molecular targets. In this comprehensive review, we examine the latest pharmacological effects and molecular mechanisms of Stachydrine in treating cardiovascular and cerebrovascular diseases. Our aim is to solid scientific basis for the development of new CVD drug formulations.

Relationship Between Neighborhood Disadvantage and Mild Traumatic Brain Injury Symptoms

OBJECTIVE

To test the hypotheses that (1) higher neighborhood disadvantage is associated with greater injury-related symptom severity in civilians with mild traumatic brain injury (mTBI) and (2) neighborhood disadvantage remains predictive after controlling for other established predictors.

SETTING

Level 1 trauma center and affiliated academic medical center.

PARTICIPANTS

N = 171 individuals with mTBI.

DESIGN

Prospective cohort study.

MAIN MEASURES

Rivermead Post Concussion Symptoms Questionnaire (RPQ) total score assessed less than 24 hours and at 2 weeks, 3 months, and 6 months postinjury. Linear mixed-effects models were used to assess the relationship between predictor variables and mTBI-related symptom burden (RPQ score). Neighborhood disadvantage was quantified by the Area Deprivation Index (ADI), a composite of 17 markers of socioeconomic position (SEP) scored at the census block group level.

RESULTS

Individuals in the upper ADI quartile of the national distribution displayed higher RPQ symptoms than those in the lower 3 quartiles ( P < .001), with a nonsignificant ADI × visit interaction ( P = .903). In a multivariable model, the effect of ADI remained significant ( P = .034) after adjusting for demographics, individual SEP, and injury factors. Other unique predictors in the multivariable model were gender (gender × visit P = .035), health insurance type ( P = .017), and injury-related litigation ( P = .012).

CONCLUSION

Neighborhood disadvantage as quantified by the ADI is robustly associated with greater mTBI-related symptom burden throughout the first 6 months postinjury. That the effect of ADI remained after controlling for demographics, individual SEP, and injury characteristics implies that neighborhood disadvantage is an important, understudied factor contributing to clinical recovery from mTBI.

Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections

OBJECTIVE

Aortic aneurysms and dissections are prevalent causes of morbidity and mortality. The management of aortic pathologies may be called into question in malpractice suits. Malpractice claims were analyzed to understand common reasons for litigation, medical specialties involved, patient injuries, and outcomes.

METHODS

Litigation cases in the Westlaw database from September 1st, 1987 to October 23 rd, 2019 were analyzed. Search terms included "aortic aneurysm" and "aortic dissection." Data on plaintiff, defendant, litigation claims, patient injuries, misdiagnoses, and case outcomes were collected and compared for aortic aneurysms, aortic dissections, and overall cases.

RESULTS

A total of 346 cases were identified, 196 involving aortic aneurysms and 150 aortic dissections. Physician defendants were emergency medicine (29%), cardiology (20%), internal medicine (14%), radiology (11%), cardiothoracic (10%) and vascular surgery (10%). Litigation claims included "failure to diagnose and treat" (61%), "delayed diagnosis and treatment" (21%), "post-operative complications after open repair" (10%) and "negligent post-operative care" (10%). Patients with aneurysms presented with abdominal (63%) and back pain (37%), while dissections presented with chest pain (78%), abdominal pain (15%), and shortness of breath (14%). Misdiagnoses included gastrointestinal (12%), other cardiovascular (9%), and musculoskeletal conditions (9%), but many were not specified (58%). Overall, 83% of cases were wrongful death suits. Injuries included loss of consortium (23%), emotional distress (19%), and bleeding (17%). In 53% of the cases, the jury ruled in favor of the defendant. 25% of cases ruled for the plaintiff. 22% of cases resulted in a settlement. The mean rewarded for each case was $1,644,590.66 (SD: $5,939,134.58; Range: $17,500-$68,035,462).

CONCLUSION

For aortic pathologies, post-operative complications were not prominent among the reasons why suits were brought forth. This suggests improvements in education across all involved medical specialties may allow for improved diagnostic accuracy and efficient treatment, which could then translate to a decrease in associated litigation cases.

Potential for recovery between 4 and 8 years after a severe traumatic brain injury. Data from the PariS-TBI longitudinal study

BACKGROUND

Severe traumatic brain injury (TBI) is a leading cause of complex and persistent disability. Yet, long-term change in global functioning and determinants of this change remain unclear.

OBJECTIVES

This study aimed to assess change in global functioning in the long-term after severe TBI and factors associated with the change.

METHODS

This was a prospective observational study of an inception cohort of adults with severe TBI in the Paris area (PariS-TBI). Outcome was assessed at 1, 4 and 8 years post-injury. For the included participants (n=257), change in global outcome between 4 and 8 years was evaluated with the Glasgow Outcome Scale Extended (GOSE) score, and its association with pre-injury, injury-related and post-injury variables was tested with univariate and multivariable analyses.

RESULTS

More than half of the 73 participants evaluated at both 4 and 8 years showed global improvement (of at least one point) in GOSE score and an improvement in mood, executive function, and subjective complaints. On univariate analysis, none of the pre-injury, injury or post-injury variables were associated with GOSE score change between 4 and 8 years, except for GOSE score at 4 years (rho=-0.24, P=0.04). On multivariable analysis, probability of increased GOSE score was associated with more years of education (odds ratio 1.18 [95% confidence interval 1.02-1.37], P=0.03). The change in GOSE score was significantly correlated with change in Hospital Anxiety Depression Scale score between 4 and 8 years (rho=-0.42, P<0.001).

CONCLUSIONS

Most participants with severe TBI in the present sample showed a late improvement (4 to 8 years post-injury) in global functioning. Of the socio-demographic and injury-related factors, only more years of education was associated with improvement in global functioning. Decreased anxiety and depression symptoms were associated with improved global functioning. Targeting interventions to enhance resilience may be the most effective in the long-term after severe TBI.

Average symptom severity and related predictors of prolonged recovery in pediatric patients with concussion

The purpose of this study is to compare the predictive utility of total number of individual symptoms endorsed, total symptom severity, and average symptom severity on prolonged recovery among children/adolescents with a concussion. Patients (n = 115) completed the Post-Concussion Symptom Scale (PCSS) at their initial clinical visit (7.9 ± 6.6 days) days post-injury. PCSS outcomes were total symptom severity (i.e., total PCSS score), number of symptoms endorsed (i.e., number out of 22-items on the PCSS with a symptom score >0) and average symptom severity (i.e., mean of scores for each of the 22-items on the PCSS, not just endorsed symptoms). Logistic regression was performed with all symptom measures and recovery time >30 days as the binary outcome. Logistic regression indicated that average symptom severity (OR = 1.9; p = 0.01) and later time to first clinical visit (OR = 5.0; p < 0.001) were the only significant predictors of recovery time. Average symptom severity at initial clinic visit and earlier clinical visit may be a better predictor of recovery time than total number of symptoms endorsed or total symptom severity among children and adolescents.