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Yue JK, Lee YM, Sun X, van Essen TA, Elguindy MM, Belton PJ, Pisică D, Mikolic A, Deng H, Kanter JH, McCrea MA, Bodien YG, Satris GG, Wong JC, Ambati VS, Grandhi R, Puccio AM, Mukherjee P, Valadka AB, Tarapore PE, Huang MC, DiGiorgio AM, Markowitz AJ, Yuh EL, Okonkwo DO, Steyerberg EW, Lingsma HF, Menon DK, Maas AIR, Jain S, Manley GT. Performance of the IMPACT and CRASH prognostic models for traumatic brain injury in a contemporary multicenter cohort: a TRACK-TBI study. J Neurosurg 2024:1-13. [PMID: 38489823 PMCID: PMC11010725 DOI: 10.3171/2023.11.jns231425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/16/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVE The International Mission on Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) and Corticosteroid Randomization After Significant Head Injury (CRASH) prognostic models for mortality and outcome after traumatic brain injury (TBI) were developed using data from 1984 to 2004. This study examined IMPACT and CRASH model performances in a contemporary cohort of US patients. METHODS The prospective 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study (enrollment years 2014-2018) enrolled subjects aged ≥ 17 years who presented to level I trauma centers and received head CT within 24 hours of TBI. Data were extracted from the subjects who met the model criteria (for IMPACT, Glasgow Coma Scale [GCS] score 3-12 with 6-month Glasgow Outcome Scale-Extended [GOSE] data [n = 441]; for CRASH, GCS score 3-14 with 2-week mortality data and 6-month GOSE data [n = 831]). Analyses were conducted in the overall cohort and stratified on the basis of TBI severity (severe/moderate/mild TBI defined as GCS score 3-8/9-12/13-14), age (17-64 years or ≥ 65 years), and the 5 top enrolling sites. Unfavorable outcome was defined as GOSE score 1-4. Original IMPACT and CRASH model coefficients were applied, and model performances were assessed by calibration (intercept [< 0 indicated overprediction; > 0 indicated underprediction] and slope) and discrimination (c-statistic). RESULTS Overall, the IMPACT models overpredicted mortality (intercept -0.79 [95% CI -1.05 to -0.53], slope 1.37 [1.05-1.69]) and acceptably predicted unfavorable outcome (intercept 0.07 [-0.14 to 0.29], slope 1.19 [0.96-1.42]), with good discrimination (c-statistics 0.84 and 0.83, respectively). The CRASH models overpredicted mortality (intercept -1.06 [-1.36 to -0.75], slope 0.96 [0.79-1.14]) and unfavorable outcome (intercept -0.60 [-0.78 to -0.41], slope 1.20 [1.03-1.37]), with good discrimination (c-statistics 0.92 and 0.88, respectively). IMPACT overpredicted mortality and acceptably predicted unfavorable outcome in the severe and moderate TBI subgroups, with good discrimination (c-statistic ≥ 0.81). CRASH overpredicted mortality in the severe and moderate TBI subgroups and acceptably predicted mortality in the mild TBI subgroup, with good discrimination (c-statistic ≥ 0.86); unfavorable outcome was overpredicted in the severe and mild TBI subgroups with adequate discrimination (c-statistic ≥ 0.78), whereas calibration was nonlinear in the moderate TBI subgroup. In subjects ≥ 65 years of age, the models performed variably (IMPACT-mortality, intercept 0.28, slope 0.68, and c-statistic 0.68; CRASH-unfavorable outcome, intercept -0.97, slope 1.32, and c-statistic 0.88; nonlinear calibration for IMPACT-unfavorable outcome and CRASH-mortality). Model performance differences were observed across the top enrolling sites for mortality and unfavorable outcome. CONCLUSIONS The IMPACT and CRASH models adequately discriminated mortality and unfavorable outcome. Observed overestimations of mortality and unfavorable outcome underscore the need to update prognostic models to incorporate contemporary changes in TBI management and case-mix. Investigations to elucidate the relationships between increased survival, outcome, treatment intensity, and site-specific practices will be relevant to improve models in specific TBI subpopulations (e.g., older adults), which may benefit from the inclusion of blood-based biomarkers, neuroimaging features, and treatment data.
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Affiliation(s)
- John K Yue
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Young M Lee
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Xiaoying Sun
- 3Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, California
| | - Thomas A van Essen
- 4University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center, Leiden, The Hague, The Netherlands
| | - Mahmoud M Elguindy
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Patrick J Belton
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Dana Pisică
- 5Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ana Mikolic
- 5Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
- 6Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hansen Deng
- 7Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John H Kanter
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Michael A McCrea
- 8Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yelena G Bodien
- 9Department of Neurological Surgery, University of Utah Health Center, Salt Lake City, Utah
- 10Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Gabriela G Satris
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Justin C Wong
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Vardhaan S Ambati
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Ramesh Grandhi
- 11Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Ava M Puccio
- 7Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pratik Mukherjee
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- 12Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Alex B Valadka
- 13Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Phiroz E Tarapore
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Michael C Huang
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Anthony M DiGiorgio
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- 14Institute of Health Policy Studies, University of California, San Francisco, California
| | - Amy J Markowitz
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Esther L Yuh
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
- 12Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - David O Okonkwo
- 7Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ewout W Steyerberg
- 15Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Hester F Lingsma
- 5Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - David K Menon
- 16Division of Anesthesia, Department of Medicine, University of Cambridge, United Kingdom; and
| | - Andrew I R Maas
- 17Department of Neurological Surgery, Antwerp University Hospital and University of Antwerp, Belgium
| | - Sonia Jain
- 3Biostatistics Research Center, Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, California
| | - Geoffrey T Manley
- 1Department of Neurological Surgery, University of California, San Francisco, California
- 2Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California
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Roberts CJ, Barber J, Temkin NR, Dong A, Robertson CS, Valadka AB, Yue JK, Markowitz AJ, Manley GT, Nelson LD. Clinical Outcomes After Traumatic Brain Injury and Exposure to Extracranial Surgery: A TRACK-TBI Study. JAMA Surg 2024; 159:248-259. [PMID: 38091011 PMCID: PMC10719833 DOI: 10.1001/jamasurg.2023.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/04/2023] [Indexed: 12/17/2023]
Abstract
Importance Traumatic brain injury (TBI) is associated with persistent functional and cognitive deficits, which may be susceptible to secondary insults. The implications of exposure to surgery and anesthesia after TBI warrant investigation, given that surgery has been associated with neurocognitive disorders. Objective To examine whether exposure to extracranial (EC) surgery and anesthesia is related to worse functional and cognitive outcomes after TBI. Design, Setting, and Participants This study was a retrospective, secondary analysis of data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a prospective cohort study that assessed longitudinal outcomes of participants enrolled at 18 level I US trauma centers between February 1, 2014, and August 31, 2018. Participants were 17 years or older, presented within 24 hours of trauma, were admitted to an inpatient unit from the emergency department, had known Glasgow Coma Scale (GCS) and head computed tomography (CT) status, and did not undergo cranial surgery. This analysis was conducted between January 2, 2020, and August 8, 2023. Exposure Participants who underwent EC surgery during the index admission were compared with participants with no surgery in groups with a peripheral orthopedic injury or a TBI and were classified as having uncomplicated mild TBI (GCS score of 13-15 and negative CT results [CT- mTBI]), complicated mild TBI (GCS score of 13-15 and positive CT results [CT+ mTBI]), or moderate to severe TBI (GCS score of 3-12 [m/sTBI]). Main Outcomes and Measures The primary outcomes were functional limitations quantified by the Glasgow Outcome Scale-Extended for all injuries (GOSE-ALL) and brain injury (GOSE-TBI) and neurocognitive outcomes at 2 weeks and 6 months after injury. Results A total of 1835 participants (mean [SD] age, 42.2 [17.8] years; 1279 [70%] male; 299 Black, 1412 White, and 96 other) were analyzed, including 1349 nonsurgical participants and 486 participants undergoing EC surgery. The participants undergoing EC surgery across all TBI severities had significantly worse GOSE-ALL scores at 2 weeks and 6 months compared with their nonsurgical counterparts. At 6 months after injury, m/sTBI and CT+ mTBI participants who underwent EC surgery had significantly worse GOSE-TBI scores (B = -1.11 [95% CI, -1.53 to -0.68] in participants with m/sTBI and -0.39 [95% CI, -0.77 to -0.01] in participants with CT+ mTBI) and performed worse on the Trail Making Test Part B (B = 30.1 [95% CI, 11.9-48.2] in participants with m/sTBI and 26.3 [95% CI, 11.3-41.2] in participants with CT+ mTBI). Conclusions and Relevance This study found that exposure to EC surgery and anesthesia was associated with adverse functional outcomes and impaired executive function after TBI. This unfavorable association warrants further investigation of the potential mechanisms and clinical implications that could inform decisions regarding the timing of surgical interventions in patients after TBI.
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Affiliation(s)
- Christopher J. Roberts
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Athena Dong
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee
- Department of Anesthesiology, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin
| | | | - Alex B. Valadka
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - John K. Yue
- Department of Neurological Surgery, University of California, San Francisco
| | | | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco
- Brain and Spinal Injury Center, San Francisco, California
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
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Chilakapati S, Dragun AJ, Chiu RG, George KM, Valadka AB. Use of MRI in patients with severe diffuse traumatic brain injury: a matched National Trauma Data Bank analysis. J Trauma Acute Care Surg 2024:01586154-990000000-00608. [PMID: 38196125 DOI: 10.1097/ta.0000000000004255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE MRI is increasingly used to evaluate patients with diffuse traumatic brain injury (dTBI). However, the utility of early MRI is understudied. We hypothesize that early MRI patients will have increased length of stay but no changes in ICP management or disposition. METHODS The 2019 NTDB was queried for patients with dTBI and Glasgow Coma Scale score ≤ 8. Extra-axial and focal intra-axial hemorrhages were excluded. Clinical characteristics were controlled for. Patients with and without MRI were compared for ICP management, outcome, mortality, and disposition. A propensity score matching algorithm was used to create a 1:1 match cohort. RESULTS In 2568 patients, MRI was less common in severe dTBI patients with clear reasons for poor exam, including bilaterally unreactive pupils or midline shift. After matching, 501 patients who underwent MRI within one week were compared to 501 patients without MRI. MRI patients had longer ICU stays (11.6 ± 9.6 vs. 13.4 ± 9.5, p < 0.01 [-3.03, -0.66 95% CI]). There was no difference between groups in ICP monitor (23.6% vs. 27.3%, p = 0.17 [-0.09, 0.02 95% CI]) or ventriculostomy placement (13.6% vs. 13.2%, p = 0.85 [-0.04, 0.05 95% CI]) or in withdrawal of care (15.0% versus 18.6%, p = 0.12 [-0.08, 0.01 95% CI]). MRI patients were more likely to be discharged to inpatient rehabilitation (42.9% vs. 33.5%, p < 0.01 [0.03, 0.15 95% CI]) but not to home (9.4% versus 9.0 %, p = 0.83 [-0.03, 0.04 95% CI]). CONCLUSIONS The decision to pursue early brain MRI may be driven by lack of obvious reasons for a patient's poor neurologic status. MRI patients had longer ICU stays but no difference in rates of placement of ICP monitors or ventriculostomies or withdrawal of care. Further study is required to define the role of early MRI in dTBI patients. LEVEL OF EVIDENCE Prognostic/epidemiological, IV.
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Affiliation(s)
- Sai Chilakapati
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030
| | - Anthony J Dragun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Ryan G Chiu
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Keith M George
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Alex B Valadka
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390
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Chen JW, Valadka AB, Ross Bullock M, Carpenter KLH. Editorial: Cerebral microdialysis. Front Neurol 2023; 14:1266540. [PMID: 37609655 PMCID: PMC10441213 DOI: 10.3389/fneur.2023.1266540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/24/2023] Open
Affiliation(s)
- Jefferson W. Chen
- Department of Neurological Surgery, University of California, Irvine, Orange, CA, United States
| | - Alex B. Valadka
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - M. Ross Bullock
- Department of Neurological Surgery, University of Miami, Coral Gables, FL, United States
| | - Keri L. H. Carpenter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Biffl WL, Stein DM, Livingston DH, Winchell RJ, Diaz JJ, Albrecht R, Brasel KJ, Burlew CC, Costantini TW, Dicker RA, Inaba K, Kozar RA, Nance ML, Napolitano LM, Salim A, Santry HP, Valadka AB, Wolinsky P, Zarzaur B, Coimbra R. The Journal of Trauma and Acute Care Surgery Position on the Issue of Disclosure of Conflict of Interests by Authors of Scientific Manuscripts. J Trauma Acute Care Surg 2023:01586154-990000000-00381. [PMID: 37246300 DOI: 10.1097/ta.0000000000004024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Yue JK, Krishnan N, Kanter JH, Deng H, Okonkwo DO, Puccio AM, Madhok DY, Belton PJ, Lindquist BE, Satris GG, Lee YM, Umbach G, Duhaime AC, Mukherjee P, Yuh EL, Valadka AB, DiGiorgio AM, Tarapore PE, Huang MC, Manley GT, Investigators TTRACKTBI. Neuroworsening in the Emergency Department Is a Predictor of Traumatic Brain Injury Intervention and Outcome: A TRACK-TBI Pilot Study. J Clin Med 2023; 12:2024. [PMID: 36902811 PMCID: PMC10004432 DOI: 10.3390/jcm12052024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Neuroworsening may be a sign of progressive brain injury and is a factor for treatment of traumatic brain injury (TBI) in intensive care settings. The implications of neuroworsening for clinical management and long-term sequelae of TBI in the emergency department (ED) require characterization. METHODS Adult TBI subjects from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot Study with ED admission and disposition Glasgow Coma Scale (GCS) scores were extracted. All patients received head computed tomography (CT) scan <24 h post-injury. Neuroworsening was defined as a decline in motor GCS at ED disposition (vs. ED admission). Clinical and CT characteristics, neurosurgical intervention, in-hospital mortality, and 3- and 6-month Glasgow Outcome Scale-Extended (GOS-E) scores were compared by neuroworsening status. Multivariable regressions were performed for neurosurgical intervention and unfavorable outcome (GOS-E ≤ 3). Multivariable odds ratios (mOR) with [95% confidence intervals] were reported. RESULTS In 481 subjects, 91.1% had ED admission GCS 13-15 and 3.3% had neuroworsening. All neuroworsening subjects were admitted to intensive care unit (vs. non-neuroworsening: 26.2%) and were CT-positive for structural injury (vs. 45.4%). Neuroworsening was associated with subdural (75.0%/22.2%), subarachnoid (81.3%/31.2%), and intraventricular hemorrhage (18.8%/2.2%), contusion (68.8%/20.4%), midline shift (50.0%/2.6%), cisternal compression (56.3%/5.6%), and cerebral edema (68.8%/12.3%; all p < 0.001). Neuroworsening subjects had higher likelihoods of cranial surgery (56.3%/3.5%), intracranial pressure (ICP) monitoring (62.5%/2.6%), in-hospital mortality (37.5%/0.6%), and unfavorable 3- and 6-month outcome (58.3%/4.9%; 53.8%/6.2%; all p < 0.001). On multivariable analysis, neuroworsening predicted surgery (mOR = 4.65 [1.02-21.19]), ICP monitoring (mOR = 15.48 [2.92-81.85], and unfavorable 3- and 6-month outcome (mOR = 5.36 [1.13-25.36]; mOR = 5.68 [1.18-27.35]). CONCLUSIONS Neuroworsening in the ED is an early indicator of TBI severity, and a predictor of neurosurgical intervention and unfavorable outcome. Clinicians must be vigilant in detecting neuroworsening, as affected patients are at increased risk for poor outcomes and may benefit from immediate therapeutic interventions.
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Affiliation(s)
- John K. Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Nishanth Krishnan
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - John H. Kanter
- Section of Neurological Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Ava M. Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Debbie Y. Madhok
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94110, USA
| | - Patrick J. Belton
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Britta E. Lindquist
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA 94110, USA
| | - Gabriela G. Satris
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Young M. Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Gray Umbach
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Ann-Christine Duhaime
- Department of Neurological Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94110, USA
| | - Esther L. Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94110, USA
| | - Alex B. Valadka
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Anthony M. DiGiorgio
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94158, USA
| | - Phiroz E. Tarapore
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Michael C. Huang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94110, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
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Zebrowski CA, Schaettle PR, Alemagno SA, McCaw BR, Valadka AB, Sharfstein SS, Reid-Arndt SA, Gorman GH, Lazarus JA. From the Defense Health Board: Military Accessions and the Continuum of Mental Health Research. Mil Med 2022; 187:308-310. [PMID: 35779046 DOI: 10.1093/milmed/usac186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 11/14/2022] Open
Abstract
The Defense Health Board conducted a year-long examination of mental health accession screening and related issues. In its August 2020 report, Examination of Mental Health Accession Screening: Predictive Value of Current Measures and Processes, the Board recommends a paradigm shift in how mental health impacts on readiness are understood and addressed. This shift can only occur with the development and implementation of a research plan that follows cohorts of military personnel from recruitment through their military career. The following article describes this research plan as an excerpt of the larger report.
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Affiliation(s)
| | | | - Sonia A Alemagno
- College of Public Health, Kent State University, Kent, OH 44242, USA
| | - Brigid R McCaw
- Center to Advance Trauma-Informed Health Care, University of California, San Francisco, CA 94117, USA
| | - Alex B Valadka
- Department of Neurological Surgery, UT Southwestern Medical Center, Virginia Commonwealth University, Richmond, VA 23284, USA
| | | | | | - Gregory H Gorman
- Defense Health Board, DHB Support Division, Falls Church, VA 22042, USA
| | - Jeremy A Lazarus
- School of Medicine, University of Colorado, Aurora, CO 80045, USA
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Stein DM, Braverman MA, Phuong J, Shipper E, Price MA, Bixby PJ, Adelson PD, Ansel BM, Cifu DX, DeVine JG, Galvagno SM, Gelb DE, Harris O, Kang CS, Kitagawa RS, McQuillan KA, Patel MB, Robertson CS, Salim A, Shutter L, Valadka AB, Bulger EM. Developing a National Trauma Research Action Plan: Results from the Neurotrauma Research Panel Delphi Survey. J Trauma Acute Care Surg 2022; 92:906-915. [PMID: 35001020 DOI: 10.1097/ta.0000000000003527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2016, the National Academies of Science, Engineering and Medicine called for the development of a National Trauma Research Action Plan. The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. Given the public health burden of injuries to the central nervous system, neurotrauma was one of 11 panels formed to address this recommendation with a gap analysis and generation of high-priority research questions. METHODS We recruited interdisciplinary experts to identify gaps in the neurotrauma literature, generate research questions, and prioritize those questions using a consensus-driven Delphi survey approach. We conducted four Delphi rounds in which participants generated key research questions and then prioritized the importance of the questions on a 9-point Likert scale. Consensus was defined as 60% or greater of panelists agreeing on the priority category. We then coded research questions using an National Trauma Research Action Plan taxonomy of 118 research concepts, which were consistent across all 11 panels. RESULTS Twenty-eight neurotrauma experts generated 675 research questions. Of these, 364 (53.9%) reached consensus, and 56 were determined to be high priority (15.4%), 303 were deemed to be medium priority (83.2%), and 5 were low priority (1.4%). The research topics were stratified into three groups-severe traumatic brain injury (TBI), mild TBI (mTBI), and spinal cord injury. The number of high-priority questions for each subtopic was 46 for severe TBI (19.7%), 3 for mTBI (4.3%) and 7 for SCI (11.7%). CONCLUSION This Delphi gap analysis of neurotrauma research identified 56 high-priority research questions. There are clear areas of focus for severe TBI, mTBI, and spinal cord injury that will help guide investigators in future neurotrauma research. Funding agencies should consider these gaps when they prioritize future research. LEVEL OF EVIDENCE Diagnostic Test or Criteria, Level IV.
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Affiliation(s)
- Deborah M Stein
- From the Program in Trauma, University of Maryland School of Medicine (D.M.S.), Baltimore, Maryland; Department of Biomedical Informatics and Medical Education (J.P.), University of Washington, Seattle, Washington; Coalition for National Trauma Research (M.A.B., E.S., M.A.P., P.J.B.), San Antonio, Texas; Department of Neurosurgery, Mayo Clinic (P.D.A.), Barrow Neurological Institute at Phoenix Children's Hospital; Division of Neurosurgery, Department of Child Health (P.D.A.), University of Arizona, Phoenix, Arizona; Department of Neurological Surgery (B.M.A.), Indiana University School of Medicine, Indianapolis, Indiana; Department of Physical Medicine and Rehabilitation (D.X.C.), Virginia Commonwealth University School of Medicine, Richmond, Virginia; Department of Orthopaedics, Augusta University Health (J.G.D.), Augusta, Georgia; Department of Anesthesiology (S.M.G.), Department of Orthopaedics (D.E.G.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurosurgery (O.H.), Stanford University, Palo Alto, California; Department of Emergency Medicine (C.S.K.), Madigan Army Medicine Center, Tacoma, Washington; Department of Neurosurgery (R.S.K.), McGovern Medical School, Houston, Texas; R Adams Cowley Shock Trauma Center (K.A.M.), University of Maryland Medical Center, Baltimore, Maryland; Department of Surgery (M.B.P.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Neurosurgery (C.S.R.), Baylor College of Medicine, Houston, Texas; Department of Surgery (A.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Critical Care Medicine (L.S.), Neurology & Neurosurgery, University of Pittsburg, Pittsburgh, Pennsylvania; Department of Neurosurgery (A.B.V.), Virginia Commonwealth University School of Medicine, Richmond, Virginia; Department of Surgery (E.M.B.), Harborview Medical Center, University of Washington, Seattle, Washington
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9
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Yue JK, Phelps RRL, Hemmerle DP, Upadhyayula PS, Winkler EA, Deng H, Chang D, Vassar M, Taylor S, Schnyer D, Lingsma HF, Puccio A, Yuh E, Mukherjee P, Huang MC, Ngwenya LB, Valadka AB, Markowitz A, Okonkwo DO, Manley GT. 182 Predictors of Six-Month Inability to Return to Work in Previously Employed Subjects After Mild Traumatic Brain Injury: A TRACK-TBI Pilot Study. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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10
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Dincer A, Stanton AN, Parham KJ, Carr MT, Opalak CF, Valadka AB, Broaddus WC. The Richmond Acute Subdural Hematoma Score: A Validated Grading Scale to Predict Postoperative Mortality. Neurosurgery 2022; 90:278-286. [PMID: 35113829 DOI: 10.1227/neu.0000000000001786] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 09/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Traumatic acute subdural hematomas (aSDHs) are common, life-threatening injuries often requiring emergency surgery. OBJECTIVE To develop and validate the Richmond acute subdural hematoma (RASH) score to stratify patients by risk of mortality after aSDH evacuation. METHODS The 2016 National Trauma Data Bank (NTDB) was queried to identify adult patients with traumatic aSDHs who underwent craniectomy or craniotomy within 4 h of arrival to an emergency department. Multivariate logistic regression modeling identified risk factors independently associated with mortality. The RASH score was developed based on a factor's strength and level of association with mortality. The model was validated using the 2017 NTDB and the area under the receiver operating characteristic curve (AUC). RESULTS A total of 2516 cases met study criteria. The patients were 69.3% male with a mean age of 55.7 yr and overall mortality rate of 36.4%. Factors associated with mortality included age between 61 and 79 yr (odds ratio [OR] = 2.3, P < .001), age ≥80 yr (OR = 6.3, P < .001), loss of consciousness (OR = 2.3, P < .001), Glasgow Coma Scale score of ≤8 (OR = 2.6, P < .001), unilateral (OR = 2.8, P < .001) or bilateral (OR = 3.9, P < .001) unresponsive pupils, and midline shift >5 mm (OR = 1.7, P < .001). Using these risk factors, the RASH score predicted progressively increasing mortality ranging from 0% to 94% for scores of 0 to 8, respectively (AUC = 0.72). Application of the RASH score to 3091 cases from 2017 resulted in similar accuracy (AUC = 0.74). CONCLUSION The RASH score is a simple and validated grading scale that uses easily accessible preoperative factors to predict estimated mortality rates in patients with traumatic aSDHs who undergo surgical evacuation.
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Affiliation(s)
- Alper Dincer
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Amanda N Stanton
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kevin J Parham
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Matthew T Carr
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Charles F Opalak
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - William C Broaddus
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
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11
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Bean JR, Valadka AB, Knape FT. Professional conduct oversight in neurosurgery. J Neurosurg 2021; 135:1280-1283. [PMID: 34049272 DOI: 10.3171/2020.12.jns204230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Alex B Valadka
- 2Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia; and
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12
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Yue JK, Phelps RR, Hemmerle DD, Upadhyayula PS, Winkler EA, Deng H, Chang D, Vassar MJ, Taylor SR, Schnyer DM, Lingsma HF, Puccio AM, Yuh EL, Mukherjee P, Huang MC, Ngwenya LB, Valadka AB, Markowitz AJ, Okonkwo DO, Manley GT. Predictors of six-month inability to return to work in previously employed subjects after mild traumatic brain injury: A TRACK-TBI pilot study. J Concussion 2021; 5. [PMID: 34046212 PMCID: PMC8153496 DOI: 10.1177/20597002211007271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Return to work (RTW) is an important milestone of mild traumatic brain injury (mTBI) recovery. The objective of this study was to evaluate whether baseline clinical variables, three-month RTW, and three-month postconcussional symptoms (PCS) were associated with six-month RTW after mTBI. Methods: Adult subjects from the prospective multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with mTBI (Glasgow Coma Scale 13–15) who were employed at baseline, with completed three-and six-month RTW status, and three-month Acute Concussion Evaluation (ACE), were extracted. Univariate and multivariable analyses were performed for six-month RTW, with focus on baseline employment, three-month RTW, and three-month ACE domains (physical, cognitive, sleep, and/or emotional postconcussional symptoms (PCS)). Odds ratios (OR) and 95% confidence intervals [CI] were reported. Significance was assessed at p < 0.05. Results: In 152 patients aged 40.7 ± 15.0years, 72% were employed full-time at baseline. Three- and six-month RTW were 77.6% and 78.9%, respectively. At three months, 59.2%, 47.4%, 46.1% and 31.6% scored positive for ACE physical, cognitive, sleep, and emotional PCS domains, respectively. Three-month RTW predicted six-month RTW (OR = 19.80, 95% CI [7.61–51.52]). On univariate analysis, scoring positive in any three-month ACE domain predicted inability for six-month RTW (OR = 0.10–0.11). On multivariable analysis, emotional symptoms predicted inability to six-month RTW (OR = 0.19 [0.04–0.85]). Subjects who scored positive in all four ACE domains were more likely to be unable to RTW at six months (4 domains: 58.3%, vs. 0-to-3 domains: 9.5%; multivariable OR = 0.09 [0.02–0.33]). Conclusions: Three-month post-injury is an important time point at which RTW status and PCS should be assessed, as both are prognostic markers for six-month RTW. Clinicians should be particularly vigilant of patients who present with emotional symptoms, and patients with symptoms across multiple PCS categories, as these patients are at further risk of inability to RTW and may benefit from targeted evaluation and support.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Ryan Rl Phelps
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Debra D Hemmerle
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Diana Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Mary J Vassar
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Sabrina R Taylor
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - David M Schnyer
- Department of Psychology, University of Texas, Austin, TX, USA
| | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ava M Puccio
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Esther L Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Michael C Huang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Laura B Ngwenya
- Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Alex B Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Amy J Markowitz
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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13
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Davis GA, Makdissi M, Bloomfield P, Clifton P, Cowie C, Echemendia R, Falvey EC, Fuller GW, Green GA, Harcourt P, Hill J, Leahy K, Loosemore MP, McCrory P, McGoldrick A, Meeuwisse W, Moran K, Nagahiro S, Orchard JW, Pugh J, Raftery M, Sills AK, Solomon GS, Valadka AB. Concussion Guidelines in National and International Professional and Elite Sports. Neurosurgery 2021; 87:418-425. [PMID: 32232354 DOI: 10.1093/neuros/nyaa057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/11/2020] [Indexed: 11/13/2022] Open
Abstract
The Berlin statement on sport-related concussion was published in 2017 using evidence-based recommendations. We aimed to examine (1) the implementation of, distribution and education based on the Berlin recommendations, and the development of sport-specific protocols/guidelines among professional and elite sports, (2) the implementation of guidelines at the community level, (3) translation of guidelines into different languages, and (4) research activities. Senior medical advisers and chief medical officers from Australian Football League, All Japan Judo Federation, British Horseracing Authority, Cricket Australia, Fédération Equestre Internationale, Football Association, Gaelic Athletic Association, International Boxing Association, Irish Horseracing Regulatory Board, Major League Baseball, National Football League, National Hockey League, National Rugby League, and World Rugby completed a questionnaire. The results demonstrated that all 14 sporting organizations have published concussion protocols/guidelines based on the Berlin recommendations, including Recognize, Removal from play, Re-evaluation, Rest, Recovery, and Return to play. There is variable inclusion of Prolonged symptoms. Prevention and Risk reduction and Long-term effects are addressed in the guidelines, rules and regulations, and/or sport-specific research. There is variability in education programs, monitoring compliance with guidelines, and publication in other languages. All sporting bodies are actively involved in concussion research. We conclude that the Berlin recommendations have been included in concussion protocols/guidelines by all the sporting bodies, with consistency in the essential components of the recommendations, whilst also allowing for sport- and regional-specific variations. Education at the elite, community, and junior levels remains an ongoing challenge, and future iterations of guidelines may consider multiple language versions, and community- and junior-level guidelines.
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Affiliation(s)
- Gavin A Davis
- Australian Football League Concussion Working Group, Melbourne, Australia
| | | | | | | | - Charlotte Cowie
- The Football Association, St George's Park, Needwood, England
| | | | | | - Gordon Ward Fuller
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | | | | | - Jerry Hill
- British Horseracing Authority, London, United Kingdom
| | - Kevin Leahy
- Gaelic Athletic Association, Dublin, Ireland
| | - Mike P Loosemore
- Institute Sport Exercise & Health, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
| | | | | | | | - Kevin Moran
- Gaelic Athletic Association, Dublin, Ireland
| | | | - John W Orchard
- School of Public Health, University of Sydney, NSW, Australia
| | - Jennifer Pugh
- The Irish Horseracing Regulatory Body, The Curragh, Ireland
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14
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DeKosky ST, Kochanek PM, Valadka AB, Clark RS, Chou SHY, Au AK, Horvat C, Jha RM, Mannix R, Wisniewski SR, Wintermark M, Rowell SE, Welch RD, Lewis L, House S, Tanzi RE, Smith DR, Vittor AY, Denslow ND, Davis MD, Glushakova OY, Hayes RL. Blood Biomarkers for Detection of Brain Injury in COVID-19 Patients. J Neurotrauma 2021; 38:1-43. [PMID: 33115334 PMCID: PMC7757533 DOI: 10.1089/neu.2020.7332] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus attacks multiple organs of coronavirus disease 2019 (COVID-19) patients, including the brain. There are worldwide descriptions of neurological deficits in COVID-19 patients. Central nervous system (CNS) symptoms can be present early in the course of the disease. As many as 55% of hospitalized COVID-19 patients have been reported to have neurological disturbances three months after infection by SARS-CoV-2. The mutability of the SARS-COV-2 virus and its potential to directly affect the CNS highlight the urgency of developing technology to diagnose, manage, and treat brain injury in COVID-19 patients. The pathobiology of CNS infection by SARS-CoV-2 and the associated neurological sequelae of this infection remain poorly understood. In this review, we outline the rationale for the use of blood biomarkers (BBs) for diagnosis of brain injury in COVID-19 patients, the research needed to incorporate their use into clinical practice, and the improvements in patient management and outcomes that can result. BBs of brain injury could potentially provide tools for detection of brain injury in COVID-19 patients. Elevations of BBs have been reported in cerebrospinal fluid (CSF) and blood of COVID-19 patients. BB proteins have been analyzed in CSF to detect CNS involvement in patients with infectious diseases, including human immunodeficiency virus and tuberculous meningitis. BBs are approved by the U.S. Food and Drug Administration for diagnosis of mild versus moderate traumatic brain injury and have identified brain injury after stroke, cardiac arrest, hypoxia, and epilepsy. BBs, integrated with other diagnostic tools, could enhance understanding of viral mechanisms of brain injury, predict severity of neurological deficits, guide triage of patients and assignment to appropriate medical pathways, and assess efficacy of therapeutic interventions in COVID-19 patients.
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Affiliation(s)
- Steven T. DeKosky
- McKnight Brain Institute, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Patrick M. Kochanek
- Department of Critical Care Medicine, Department of Anesthesiology, Pediatrics, Bioengineering, and Clinical and Translational Science, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Robert S.B. Clark
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sherry H.-Y. Chou
- Department of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia K. Au
- University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher Horvat
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Division of Pediatric Critical Care, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ruchira M. Jha
- Departments of Critical Care Medicine, Neurology, Neurological Surgery, Clinical and Translational Science Institute, Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebekah Mannix
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Department of Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Max Wintermark
- Department of Neuroradiology, Stanford University, Stanford, California, USA
| | - Susan E. Rowell
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert D. Welch
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit Receiving Hospital/University Health Center, Detroit, Michigan, USA
| | - Lawrence Lewis
- Department of Emergency Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stacey House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rudolph E. Tanzi
- Genetics and Aging Research Unit, Massachusetts General Hospital, McCance Center for Brain Health, Massachusetts General Hospital, MassGeneral Institute for Neurodegenerative Diseases, Massachusetts General Hospital, Department of Neurology (Research), Massachusetts General Hospital, Department of Neurology, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Darci R. Smith
- Immunodiagnostics Department, Naval Medical Research Center, Biological Defense Research Directorate, Fort Detrick, Maryland, USA
| | - Amy Y. Vittor
- Division of Infectious Disease and Global Medicine, University of Florida, Emerging Pathogens Institute, Gainesville, Florida, USA
| | - Nancy D. Denslow
- Departments of Physiological Sciences and Biochemistry and Molecular Biology, University of Florida, Center for Environmental and Human Toxicology, Gainesville, Florida
| | - Michael D. Davis
- Department of Pediatrics, Wells Center for Pediatric Research/Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children at Indiana University, Indianapolis, Indiana, USA
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15
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Green GA, Porter KP, Conte S, Valadka AB, Soloff L, Curriero FC. Preventing Concussions From Foul Tips and Backswings in Professional Baseball: Catchers' Perceptions of and Experiences With Conventional and Hockey-Style Masks. Clin J Sport Med 2021; 31:e1-e7. [PMID: 30358617 DOI: 10.1097/jsm.0000000000000679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To understand catchers' preferences for mask type and perceptions regarding safety, comfort, and fit, and determine whether mask type is correlated with self-reported concussion and related symptoms after impacts from foul tips or backswings. DESIGN Cross-sectional study. SETTING Survey of active baseball catchers. PARTICIPANTS Professional baseball catchers. INTERVENTION From May 1, 2015, to June 30, 2015, an online survey was administered in English and Spanish to all Major and Minor League catchers (n = 836). MAIN OUTCOME MEASURES Survey items addressed the type of mask routinely and previously used (conventional or hockey style); brand and material (steel or titanium); perceptions regarding safety, comfort, and fit; and experiences with concussions. RESULTS The sample consisted of 596 catchers of which 26% reported being diagnosed with a concussion. Some concussions occurred from non-baseball activities, such as car accidents or off the field incidents. For those that occurred playing baseball, 35% resulted from a foul tip. Once catchers entered professional baseball, the use of a conventional mask rose significantly: 71% of catchers reported wearing conventional-style masks, and 30% hockey-style masks at the time the survey was conducted (P < 0.05). Both conventional and hockey-style mask wearers significantly selected hockey-style masks as providing better overall safety and protection than conventional masks (P < 0.05). CONCLUSIONS This research supports foul tips as an important cause of concussion in catchers and provides important information about preferences among catchers for masks that are not perceived as the safest and strongest. Future research should supplement these data by conducting laboratory testing to determine which masks are stronger and by collecting qualitative data to explore why some players are more likely to wear a mask type that they perceive as offering less safety or protection.
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Affiliation(s)
- Gary Alan Green
- UCLA Division of Sports Medicine, Pacific Palisades Medical Group, Pacific Palisades, California
| | - Keshia Pollack Porter
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stan Conte
- Baseball Medicine, Conte Injury Analytics, Santa Clara University
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Lonnie Soloff
- Medical Services, Cleveland Indians Baseball, Cleveland, Ohio; and
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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16
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Yue JK, Satris G, Dalle Ore CL, Huie JR, Deng H, Winkler EA, Lee YM, Vassar M, Taylor S, Schnyer DM, Lingsma HF, Puccio A, Yuh E, Mukherjee P, Valadka AB, Ferguson A, Okonkwo DO, Manley GT. Polytrauma is Associated with Worse 3- and 6-month Disability After Traumatic Brain Injury. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Yue JK, Yuh E, Stein M, Winkler E, Deng H, Dalle Ore CL, Vassar M, Taylor S, Schnyer D, Lingsma HF, Puccio A, Mukherjee P, Valadka AB, Okonkwo DO, Diaz-Arrastia R, Manley GT. Diffuse Axonal Injury and Cerebral Contusions on MRI Are Associated with Decreased Functional Outcome in CT-negative TBI. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Dincer A, Stanton AN, Parham K, Carr MT, Opalak CF, Valadka AB, Broaddus WC. The Acute Subdural Hematoma (ASH) Score. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Wang MC, Boop FA, Kondziolka D, Resnick DK, Kalkanis SN, Koehnen E, Selden NR, Heilman CB, Valadka AB, Cockroft KM, Wilson JA, Ellenbogen RG, Asher AL, Byrne RW, Camarata PJ, Huang J, Knightly JJ, Levy EI, Lonser RR, Connolly ES, Meyer FB, Liau LM. Continuous improvement in patient safety and quality in neurological surgery: the American Board of Neurological Surgery in the past, present, and future. J Neurosurg 2020:1-7. [PMID: 33065539 DOI: 10.3171/2020.6.jns202066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
The American Board of Neurological Surgery (ABNS) was incorporated in 1940 in recognition of the need for detailed training in and special qualifications for the practice of neurological surgery and for self-regulation of quality and safety in the field. The ABNS believes it is the duty of neurosurgeons to place a patient's welfare and rights above all other considerations and to provide care with compassion, respect for human dignity, honesty, and integrity. At its inception, the ABNS was the 13th member board of the American Board of Medical Specialties (ABMS), which itself was founded in 1933. Today, the ABNS is one of the 24 member boards of the ABMS.To better serve public health and safety in a rapidly changing healthcare environment, the ABNS continues to evolve in order to elevate standards for the practice of neurological surgery. In connection with its activities, including initial certification, recognition of focused practice, and continuous certification, the ABNS actively seeks and incorporates input from the public and the physicians it serves. The ABNS board certification processes are designed to evaluate both real-life subspecialty neurosurgical practice and overall neurosurgical knowledge, since most neurosurgeons provide call coverage for hospitals and thus must be competent to care for the full spectrum of neurosurgery.The purpose of this report is to describe the history, current state, and anticipated future direction of ABNS certification in the US.
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Affiliation(s)
- Marjorie C Wang
- 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Frederick A Boop
- 2Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- 3Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Daniel K Resnick
- 4Department of Neurosurgery, University of Wisconsin Medical School, Madison, Wisconsin
| | - Steven N Kalkanis
- 5Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | | | - Nathan R Selden
- 7Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Carl B Heilman
- 8Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
| | - Alex B Valadka
- 9Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Kevin M Cockroft
- 10Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - John A Wilson
- 11Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Richard G Ellenbogen
- 12Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Anthony L Asher
- 13Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Richard W Byrne
- 14Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Paul J Camarata
- 15Department of Neurosurgery, University of Kansas, Kansas City, Kansas
| | - Judy Huang
- 16Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Elad I Levy
- 18Department of Neurosurgery, University at Buffalo, New York
| | - Russell R Lonser
- 19Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - E Sander Connolly
- 20Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Fredric B Meyer
- 21Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
| | - Linda M Liau
- 22Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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20
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Yue JK, Satris GG, Dalle Ore CL, Huie JR, Deng H, Winkler EA, Lee YM, Vassar MJ, Taylor SR, Schnyer DM, Lingsma HF, Puccio AM, Yuh EL, Mukherjee P, Valadka AB, Ferguson AR, Markowitz AJ, Okonkwo DO, Manley GT. Polytrauma Is Associated with Increased Three- and Six-Month Disability after Traumatic Brain Injury: A TRACK-TBI Pilot Study. Neurotrauma Rep 2020; 1:32-41. [PMID: 34223528 PMCID: PMC8240880 DOI: 10.1089/neur.2020.0004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Polytrauma and traumatic brain injury (TBI) frequently co-occur and outcomes are routinely measured by the Glasgow Outcome Scale-Extended (GOSE). Polytrauma may confound GOSE measurement of TBI-specific outcomes. Adult patients with TBI from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study had presented to a Level 1 trauma center after injury, received head computed tomography (CT) within 24 h, and completed the GOSE at 3 months and 6 months post-injury. Polytrauma was defined as an Abbreviated Injury Score (AIS) ≥3 in any extracranial region. Univariate regressions were performed using known GOSE clinical cutoffs. Multi-variable regressions were performed for the 3- and 6-month GOSE, controlling for known demographic and injury predictors. Of 361 subjects (age 44.9 ± 18.9 years, 69.8% male), 69 (19.1%) suffered polytrauma. By Glasgow Coma Scale (GCS) assessment, 80.1% had mild, 5.8% moderate, and 14.1% severe TBI. On univariate logistic regression, polytrauma was associated with increased odds of moderate disability or worse (GOSE ≤6; 3 month odds ratio [OR] = 2.57 [95% confidence interval (CI): 1.50-4.41; 6 month OR = 1.70 [95% CI: 1.01-2.88]) and death/severe disability (GOSE ≤4; 3 month OR = 3.80 [95% CI: 2.03-7.11]; 6 month OR = 3.33 [95% CI: 1.71-6.46]). Compared with patients with isolated TBI, more polytrauma patients experienced a decline in GOSE from 3 to 6 months (37.7 vs. 24.7%), and fewer improved (11.6 vs. 22.6%). Polytrauma was associated with greater univariate ordinal odds for poorer GOSE (3 month OR = 2.79 [95% CI: 1.73-4.49]; 6 month OR = 1.73 [95% CI: 1.07-2.79]), which was conserved on multi-variable ordinal regression (3 month OR = 3.05 [95% CI: 1.76-5.26]; 6 month OR = 2.04 [95% CI: 1.18-3.42]). Patients with TBI with polytrauma are at greater risk for 3- and 6-month disability compared with those with isolated TBI. Methodological improvements in assessing TBI-specific disability, versus disability attributable to all systemic injuries, will generate better TBI outcomes assessment tools.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Gabriela G Satris
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Cecilia L Dalle Ore
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - J Russell Huie
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Young M Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Mary J Vassar
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Sabrina R Taylor
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - David M Schnyer
- Department of Psychology, University of Texas, Austin, Texas, USA
| | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ava M Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Esther L Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.,Department of Radiology, University of California San Francisco, San Francisco, California, USA
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.,Department of Radiology, University of California San Francisco, San Francisco, California, USA
| | - Alex B Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Amy J Markowitz
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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21
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Yue JK, Phelps RRL, Winkler EA, Deng H, Upadhyayula PS, Vassar MJ, Madhok DY, Schnyer DM, Puccio AM, Lingsma HF, Yuh EL, Mukherjee P, Valadka AB, Okonkwo DO, Manley GT. Substance use on admission toxicology screen is associated with peri-injury factors and six-month outcome after traumatic brain injury: A TRACK-TBI Pilot study. J Clin Neurosci 2020; 75:149-156. [PMID: 32173156 DOI: 10.1016/j.jocn.2020.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/10/2020] [Indexed: 01/07/2023]
Abstract
Substance use is commonly associated with traumatic brain injury (TBI). We investigate associations between active substance use, peri-injury factors, and outcome after TBI across three U.S. Level I trauma centers. TBI subjects from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) with Marshall computed tomography (CT) score 1-3, no neurosurgical procedure/operation, and admission urine toxicology screen (tox+/-) were extracted. Associations between tox+/-, comorbidities, hospital variables, and six-month functional (GOSE) and neuropsychiatric (PCL-C, BSI18, RPQ-13, SWLS) outcomes were analyzed. Multivariable regression was performed for associations significant on univariate analysis with odds ratios (mOR) presented. Significance assessed at p < 0.05. In 133 subjects, tox+/tox- were 29.1%/72.9%. Tox+ was younger (35.5/43.6-years, p = 0.018), trended toward male sex (80.6%/63.9%, p = 0.067), was associated with history of seizures (27.8%/10.3%, p = 0.012), self-reported substance use (44.4%/17.5%, p = 0.001), prior TBI (58.8%/34.1%, p = 0.009), GCS < 15 (69.4%/48.4%, p = 0.031) and blood alcohol level >0.08-mg/dl (55.6%/30.8%, p = 0.022). In CT-negative subjects, tox+ was associated with increased hospital admission (95.7%/66.7%, p = 0.034). At six-months, tox+ was associated with screening positive for post-traumatic stress disorder (PCL-C: 40.0%/15.9%; mOR = 8.24, p = 0.022) and psychiatric symptoms (BSI18: 40.0%/14.3%, mOR = 11.06, p = 0.023). Active substance use in TBI may confound GCS assessment, triage to higher level of care, and be associated with increased six-month neuropsychiatric symptoms. Substance use screening should be integrated into standard emergency/acute care TBI protocols to optimize management and resource utilization. Clinicians should be vigilant in providing education, counselling, and follow-up for TBI patients with substance use.
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Affiliation(s)
- John K Yue
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Ryan R L Phelps
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Ethan A Winkler
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pavan S Upadhyayula
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Mary J Vassar
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Debbie Y Madhok
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
| | - David M Schnyer
- Department of Psychology, University of Texas in Austin, Austin, TX, USA
| | - Ava M Puccio
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Esther L Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
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22
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Opalak CF, Vega RA, Koste JL, Graham RS, Valadka AB. One hundred years of neurosurgery at the Medical College of Virginia/Virginia Commonwealth University (1919-2019). J Neurosurg 2019; 133:1873-1879. [PMID: 31675697 DOI: 10.3171/2019.8.jns183464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 08/13/2019] [Indexed: 11/06/2022]
Abstract
The Department of Neurosurgery at the Medical College of Virginia/Virginia Commonwealth University (VCU) celebrates its 100th anniversary in 2019. It was founded by C. C. Coleman, who directed the US Army School of Brain Surgery during World War I and was one of the original members of the Society of Neurological Surgeons. Coleman began a residency program that was among the first four such programs in the United States and that produced such prominent graduates as Frank Mayfield, Gayle Crutchfield, and John Meredith. Neurosurgery at VCU later became a division under the medical school's surgery department. Division chairs included William Collins and Donald Becker. It was during the Becker years that VCU became a leading National Institutes of Health-funded neurotrauma research center. Harold Young oversaw the transition from division to department and expanded the practice base of the program. In 2015, Alex Valadka assumed leadership and established international collaborations for research and education. In its first 100 years, VCU Neurosurgery has distinguished itself as an innovator in clinical research and an incubator of compassionate and service-oriented physicians.
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Affiliation(s)
- Charles F Opalak
- 1Department of Neurosurgery, Virginia Commonwealth University School of Medicine, and
| | - Rafael A Vega
- 1Department of Neurosurgery, Virginia Commonwealth University School of Medicine, and
| | - Jodi L Koste
- 2Tompkins-McCaw Library, Virginia Commonwealth University, Richmond, Virginia
| | - R Scott Graham
- 1Department of Neurosurgery, Virginia Commonwealth University School of Medicine, and
| | - Alex B Valadka
- 1Department of Neurosurgery, Virginia Commonwealth University School of Medicine, and
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23
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Valadka AB, Maas AIR, Servadei F. Introduction. Traumatic brain injury. Neurosurg Focus 2019; 47:E1. [PMID: 31675704 DOI: 10.3171/2019.8.focus19688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alex B Valadka
- 1Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Andrew I R Maas
- 2Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Belgium; and
| | - Franco Servadei
- 3Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
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24
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Yue JK, Winkler EA, Deng H, Phelps RRL, Chandra A, Vassar MJ, Schnyer DM, Puccio A, Lingsma HF, Yuh E, Mukherjee P, Valadka AB, Okonkwo DO, Manley GT. Brain Derived Neurotrophic Factor (BDNF) Val66Met Single Nucleotide Polymorphism (rs6265) is Associated With Decreased Functional Outcome After Traumatic Brain Injury: A Multicenter Cohort Study. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Wickwire EM, Albrecht JS, Griffin NR, Schnyer DM, Yue JK, Markowitz AJ, Okonkwo DO, Valadka AB, Badjatia N, Manley GT. Sleep disturbances precede depressive symptomatology following traumatic brain injury. Curr Neurobiol 2019; 10:49-55. [PMID: 34040318 PMCID: PMC8148630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of the present study was to evaluate the impact of sleep disturbances on subsequent depressive symptomatology among a representative sample of patients following traumatic brain injury (TBI). Within a retrospective cohort design, our sample included 305 individuals from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot; NINDS-OD09-004) database. At 3-months post-TBI, symptoms of insomnia were reported by 34% of patients, and symptoms of hypersomnia were reported by 39% of patients. For the vast majority of individuals, sleep complaints were likely to persist through 6-month follow-up. Symptoms of hypersomnia but not insomnia at three months were associated with worsened depressive symptomatology at six months. These results highlight the importance of sleep disturbances in recovery from TBI and suggest targeted sleep treatments as a pathway to improve outcomes and quality of life following TBI.
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Affiliation(s)
- Emerson M. Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | | | | | - John K. Yue
- Department of Neurosurgery, University of California, San Francisco, School of Medicine
| | - Amy J. Markowitz
- Department of Neurosurgery, University of California, San Francisco, School of Medicine
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh School of Medicine
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine
| | - Neeraj Badjatia
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Geoffrey T. Manley
- Department of Neurosurgery, University of California, San Francisco, School of Medicine
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26
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Ranson J, Magnus BE, Temkin N, Dikmen S, Giacino JT, Okonkwo DO, Valadka AB, Manley GT, Nelson LD. Diagnosing the GOSE: Structural and Psychometric Properties Using Item Response Theory, a TRACK-TBI Pilot Study. J Neurotrauma 2019; 36:2493-2505. [PMID: 30907261 DOI: 10.1089/neu.2018.5998] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The Glasgow Outcome Scale-Extended (GOSE) was designed to assess global outcome after traumatic brain injury (TBI). Since its introduction, several empirically founded criticisms of the GOSE have been raised, including poor reliability; an insensitivity to small, but potentially meaningful, changes; a tendency to produce ceiling effects; inconsistent associations with neurocognitive, psychological, and quality-of-life measures; and an inability to assess the multi-dimensional nature of TBI outcome. The current project took a diagnostic approach to identifying the underlying causes of reported limitations by exploring the internal construct validity of the GOSE at 3 and 6 months post-injury using item response theory (IRT) techniques. Data were from the TRACK-TBI Pilot Study, a large (N = 586), prospective, multi-site project that included TBI cases of all injury severity levels. To assess the level of latent functional "impairment" captured by GOSE items independent of the assigned outcome category or GOSE total score, items were modified so that higher scores reflected greater impairment. Results showed that although the GOSE's items capture varying levels of impairment across a broad disability spectrum at 3 and 6 months, there was also evidence at each time point of item redundancy (multiple items capturing similar levels of impairment), item deficiency (lack of items capturing lower levels of impairment), and item inefficiency (items only capturing minimal impairment information). The findings illustrate the value of IRT to illuminate strengths and weaknesses of clinical outcome assessment measures and provide a framework for future measure refinement.
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Affiliation(s)
- Jana Ranson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brooke E Magnus
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - Nancy Temkin
- Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, Washington
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Joseph T Giacino
- Department of Rehabilitation Neuropsychology, Spaulding Rehabilitation Center, Charlestown, Massachusetts
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, and the Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, California
| | - Lindsay D Nelson
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
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27
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Yue JK, Levin HS, Suen CG, Morrissey MR, Runyon SJ, Winkler EA, Puffer RC, Deng H, Robinson CK, Rick JW, Phelps RRL, Sharma S, Taylor SR, Vassar MJ, Cnossen MC, Lingsma HF, Gardner RC, Temkin NR, Barber J, Dikmen SS, Yuh EL, Mukherjee P, Stein MB, Cage TA, Valadka AB, Okonkwo DO, Manley GT. Age and sex-mediated differences in six-month outcomes after mild traumatic brain injury in young adults: a TRACK-TBI study. Neurol Res 2019; 41:609-623. [PMID: 31007155 DOI: 10.1080/01616412.2019.1602312] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Risk factors for young adults with mTBI are not well understood. Improved understanding of age and sex as risk factors for impaired six-month outcomes in young adults is needed. Methods: Young adult mTBI subjects aged 18-39 years (18-29y; 30-39y) with six-month outcomes were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Multivariable regressions were performed for outcomes with age, sex, and the interaction factor age-group*sex as variables of interest, controlling for demographic and injury variables. Mean-differences (B) and 95% CIs are reported. Results: One hundred mTBI subjects (18-29y, 70%; 30-39y, 30%; male, 71%; female, 29%) met inclusion criteria. On multivariable analysis, age-group*sex was associated with six-month post-traumatic stress disorder (PTSD; PTSD Checklist-Civilian version); compared with female 30-39y, female 18-29y (B= -19.55 [-26.54, -4.45]), male 18-29y (B= -19.70 [-30.07, -9.33]), and male 30-39y (B= -15.49 [-26.54, -4.45]) were associated with decreased PTSD symptomatology. Female sex was associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended (GOSE): B= -0.6 [1.0, -0.1]). Comparatively, 30-39y scored higher on six-month nonverbal processing speed (Wechsler Adult Intelligence Scale-Processing Speed Index (WAIS-PSI); B= 11.88, 95% CI [1.66, 22.09]). Conclusions: Following mTBI, young adults aged 18-29y and 30-39y may have different risks for impairment. Sex may interact with age for PTSD symptomatology, with females 30-39y at highest risk. These results may be attributable to cortical maturation, biological response, social modifiers, and/or differential self-report. Confirmation in larger samples is needed; however, prevention and rehabilitation/counseling strategies after mTBI should likely be tailored for age and sex.
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Affiliation(s)
- John K Yue
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Harvey S Levin
- c Departments of Neurology and Neurosurgery , Baylor College of Medicine , Houston , TX , USA
| | - Catherine G Suen
- d Department of Neurology , University of Utah , Salt Lake City , UT , USA
| | - Molly Rose Morrissey
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sarah J Runyon
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ethan A Winkler
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ross C Puffer
- e Department of Neurological Surgery , Mayo Clinic , Rochester , MN , USA.,f Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Hansen Deng
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Caitlin K Robinson
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Jonathan W Rick
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ryan R L Phelps
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sourabh Sharma
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sabrina R Taylor
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Mary J Vassar
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Maryse C Cnossen
- g Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Hester F Lingsma
- g Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Raquel C Gardner
- h Department of Neurology , University of California San Francisco , San Francisco , CA , USA.,i Department of Neurology , Veterans Affairs Medical Center , San Francisco , CA , USA
| | - Nancy R Temkin
- j Departments of Neurological Surgery and Biostatistics , University of Washington , Seattle , WA , USA
| | - Jason Barber
- j Departments of Neurological Surgery and Biostatistics , University of Washington , Seattle , WA , USA
| | - Sureyya S Dikmen
- k Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Esther L Yuh
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,l Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - Pratik Mukherjee
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,l Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - Murray B Stein
- m Departments of Psychiatry and Family Medicine , University of California San Diego , San Diego , CA , USA
| | - Tene A Cage
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Alex B Valadka
- n Department of Neurological Surgery , Virginia Commonwealth University , Richmond , VA , USA
| | - David O Okonkwo
- f Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Geoffrey T Manley
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
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- o TRACK-TBI Investigators are listed below in alphabetical order by last name
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Yue JK, Cnossen MC, Winkler EA, Deng H, Phelps RRL, Coss NA, Sharma S, Robinson CK, Suen CG, Vassar MJ, Schnyer DM, Puccio AM, Gardner RC, Yuh EL, Mukherjee P, Valadka AB, Okonkwo DO, Lingsma HF, Manley GT. Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study. Front Neurol 2019; 10:343. [PMID: 31024436 PMCID: PMC6465546 DOI: 10.3389/fneur.2019.00343] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/20/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: Over 70% of traumatic brain injuries (TBI) are classified as mild (mTBI), which present heterogeneously. Associations between pre-injury comorbidities and outcomes are not well-understood, and understanding their status as risk factors may improve mTBI management and prognostication. Methods: mTBI subjects (GCS 13-15) from TRACK-TBI Pilot completing 3- and 6-month functional [Glasgow Outcome Scale-Extended (GOSE)] and post-concussive outcomes [Acute Concussion Evaluation (ACE) physical/cognitive/sleep/emotional subdomains] were extracted. Pre-injury comorbidities >10% incidence were included in regressions for functional disability (GOSE ≤ 6) and post-concussive symptoms by subdomain. Odds ratios (OR) and mean differences (B) were reported. Significance was assessed at p < 0.0083 (Bonferroni correction). Results: In 260 subjects sustaining blunt mTBI, mean age was 44.0-years and 70.4% were male. Baseline comorbidities >10% incidence included psychiatric-30.0%, cardiac (hypertension)-23.8%, cardiac (structural/valvular/ischemic)-20.4%, gastrointestinal-15.8%, pulmonary-15.0%, and headache/migraine-11.5%. At 3- and 6-months separately, 30.8% had GOSE ≤ 6. At 3-months, psychiatric (GOSE ≤ 6: OR = 2.75, 95% CI [1.44-5.27]; ACE-physical: B = 1.06 [0.38-1.73]; ACE-cognitive: B = 0.72 [0.26-1.17]; ACE-sleep: B = 0.46 [0.17-0.75]; ACE-emotional: B = 0.64 [0.25-1.03]), headache/migraine (GOSE ≤ 6: OR = 4.10 [1.67-10.07]; ACE-sleep: B = 0.57 [0.15-1.00]; ACE-emotional: B = 0.92 [0.35-1.49]), and gastrointestinal history (ACE-physical: B = 1.25 [0.41-2.10]) were multivariable predictors of worse outcomes. At 6-months, psychiatric (GOSE ≤ 6: OR = 2.57 [1.38-4.77]; ACE-physical: B = 1.38 [0.68-2.09]; ACE-cognitive: B = 0.74 [0.28-1.20]; ACE-sleep: B = 0.51 [0.20-0.83]; ACE-emotional: B = 0.93 [0.53-1.33]), and headache/migraine history (ACE-physical: B = 1.81 [0.79-2.84]) predicted worse outcomes. Conclusions: Pre-injury psychiatric and pre-injury headache/migraine symptoms are risk factors for worse functional and post-concussive outcomes at 3- and 6-months post-mTBI. mTBI patients presenting to acute care should be evaluated for psychiatric and headache/migraine history, with lower thresholds for providing TBI education/resources, surveillance, and follow-up/referrals. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01565551.
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Affiliation(s)
- John K. Yue
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Maryse C. Cnossen
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ethan A. Winkler
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Hansen Deng
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Ryan R. L. Phelps
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Nathan A. Coss
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Sourabh Sharma
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Caitlin K. Robinson
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Catherine G. Suen
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Mary J. Vassar
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - David M. Schnyer
- Department of Psychology, University of Texas in Austin, Austin, TX, United States
| | - Ava M. Puccio
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Raquel C. Gardner
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Esther L. Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Department of Radiology, University of California, San Francisco, San Francisco, CA, United States
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Department of Radiology, University of California, San Francisco, San Francisco, CA, United States
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, United States
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Hester F. Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Geoffrey T. Manley
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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29
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Glushakova OY, Glushakov AV, Yang L, Hayes RL, Valadka AB. Intracranial Pressure Monitoring in Experimental Traumatic Brain Injury: Implications for Clinical Management. J Neurotrauma 2019; 37:2401-2413. [PMID: 30595079 DOI: 10.1089/neu.2018.6145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is often associated with long-term disability and chronic neurological sequelae. One common contributor to unfavorable outcomes is secondary brain injury, which is potentially treatable and preventable through appropriate management of patients in the neurosurgical intensive care unit. Intracranial pressure (ICP) is currently the predominant neurological-specific physiological parameter used to direct the care of severe TBI (sTBI) patients. However, recent clinical evidence has called into question the association of ICP monitoring with improved clinical outcome. The detailed cellular and molecular derangements associated with intracranial hypertension (IC-HTN) and their relationship to injury phenotype and neurological outcomes are not completely understood. Various animal models of TBI have been developed, but the clinical applicability of ICP monitoring in the pre-clinical setting has not been well-characterized. Linking basic mechanistic studies in translational TBI models with investigation of ICP monitoring that more faithfully replicates the clinical setting will provide clinical investigators with a more informed understanding of the pathophysiology of IC-HTN, thus facilitating development of improved therapies for sTBI patients.
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Affiliation(s)
- Olena Y Glushakova
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Likun Yang
- Department of Neurosurgery, The 101st Hospital of Chinese People's Liberation Army, Xuxi, Jiangsu, China
| | - Ronald L Hayes
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.,Banyan Biomarkers, Inc., Alachua, Florida, USA
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
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30
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DeWitt DS, Hawkins BE, Dixon CE, Kochanek PM, Armstead W, Bass CR, Bramlett HM, Buki A, Dietrich WD, Ferguson AR, Hall ED, Hayes RL, Hinds SR, LaPlaca MC, Long JB, Meaney DF, Mondello S, Noble-Haeusslein LJ, Poloyac SM, Prough DS, Robertson CS, Saatman KE, Shultz SR, Shear DA, Smith DH, Valadka AB, VandeVord P, Zhang L. Pre-Clinical Testing of Therapies for Traumatic Brain Injury. J Neurotrauma 2018; 35:2737-2754. [PMID: 29756522 PMCID: PMC8349722 DOI: 10.1089/neu.2018.5778] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Despite the large number of promising neuroprotective agents identified in experimental traumatic brain injury (TBI) studies, none has yet shown meaningful improvements in long-term outcome in clinical trials. To develop recommendations and guidelines for pre-clinical testing of pharmacological or biological therapies for TBI, the Moody Project for Translational Traumatic Brain Injury Research hosted a symposium attended by investigators with extensive experience in pre-clinical TBI testing. The symposium participants discussed issues related to pre-clinical TBI testing including experimental models, therapy and outcome selection, study design, data analysis, and dissemination. Consensus recommendations included the creation of a manual of standard operating procedures with sufficiently detailed descriptions of modeling and outcome measurement procedures to permit replication. The importance of the selection of clinically relevant outcome variables, especially related to behavior testing, was noted. Considering the heterogeneous nature of human TBI, evidence of therapeutic efficacy in multiple, diverse (e.g., diffuse vs. focused) rodent models and a species with a gyrencephalic brain prior to clinical testing was encouraged. Basing drug doses, times, and routes of administration on pharmacokinetic and pharmacodynamic data in the test species was recommended. Symposium participants agreed that the publication of negative results would reduce costly and unnecessary duplication of unsuccessful experiments. Although some of the recommendations are more relevant to multi-center, multi-investigator collaborations, most are applicable to pre-clinical therapy testing in general. The goal of these consensus guidelines is to increase the likelihood that therapies that improve outcomes in pre-clinical studies will also improve outcomes in TBI patients.
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Affiliation(s)
- Douglas S. DeWitt
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - Bridget E. Hawkins
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | - C. Edward Dixon
- Department of Neurological Surgery, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Patrick M. Kochanek
- Department of Critical Care Medicine, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - William Armstead
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cameron R. Bass
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Helen M. Bramlett
- Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, Florida
| | - Andras Buki
- Department of Neurosurgery, Medical University of Pécs, Pécs, Hungary
| | - W. Dalton Dietrich
- The Miami Project to Cure Paralysis, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Adam R. Ferguson
- Weill Institute for Neurosciences, Brain and Spinal Injury Center (BASIC), Department of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, California
| | - Edward D. Hall
- Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky Medical Center, Lexington, Kentucky
| | - Ronald L. Hayes
- University of Florida, Virginia Commonwealth University, Banyan Biomarkers, Inc., Alachua, Florida
| | - Sidney R. Hinds
- United States Army Medical Research and Materiel Command, Fort Detrick, Maryland
| | | | - Joseph B. Long
- Blast-Induced Neurotrauma Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - David F. Meaney
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefania Mondello
- Department of Neurosciences, University of Messina, Via Consolare Valeria, Messina, Italy
| | - Linda J. Noble-Haeusslein
- Departments of Neurology and Psychology, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Samuel M. Poloyac
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Donald S. Prough
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas
| | | | - Kathryn E. Saatman
- Spinal Cord and Brain Injury Research Center (SCoBIRC), University of Kentucky, Lexington, Kentucky
| | - Sandy R. Shultz
- Department of Medicine, Melbourne Brain Center, The University of Melbourne, Parkville, Victoria, Australia
| | - Deborah A. Shear
- Brain Trauma Neuroprotection Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Douglas H. Smith
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Pamela VandeVord
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Liying Zhang
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
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31
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Valadka AB, Valadka JS, Valadka PR, Valadka PC. The 2018 AANS Presidential Address. The privilege of service. J Neurosurg 2018; 129:1377-1383. [PMID: 30544328 DOI: 10.3171/2018.7.jns182047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 11/06/2022]
Abstract
The theme of the 2018 American Association of Neurological Surgeons Annual Meeting was "The Privilege of Service." In the current climate of rapid change in healthcare delivery and increasing pressure on physicians, this theme was chosen to remind us of our true priorities and of the amazing opportunities that we have as neurosurgeons. In parallel to the classic triple-threat practitioner who excels in teaching, research, and clinical care, future neurosurgeons will need to acquire mastery in three areas of service, which have been summarized as the three A's: administration, advocacy, and altruism. The blessings that we enjoy afford us a platform from which we can take advantage of the many opportunities to experience the privilege of serving others.
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Affiliation(s)
- Alex B Valadka
- 1Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Jaclyn S Valadka
- 2Department of Psychological Sciences, University of Missouri, Columbia, Missouri
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Yue JK, Rick JW, Morrissey MR, Taylor SR, Deng H, Suen CG, Vassar MJ, Cnossen MC, Lingsma HF, Yuh EL, Mukherjee P, Gardner RC, Valadka AB, Okonkwo DO, Cage TA, Manley GT. Preinjury employment status as a risk factor for symptomatology and disability in mild traumatic brain injury: A TRACK-TBI analysis. NeuroRehabilitation 2018; 43:169-182. [PMID: 30040754 DOI: 10.3233/nre-172375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Preinjury employment status may contribute to disparity, injury risk, and recovery patterns following mild traumatic brain injury (MTBI). OBJECTIVE To characterize associations between preinjury unemployment, prior comorbidities, and outcomes following MTBI. METHODS MTBI patients from TRACK-TBI Pilot with complete six-month outcomes were extracted. Preinjury unemployment, comorbidities, injury factors, and intracranial pathology were considered. Multivariable regression was performed for employment and outcomes, correcting for demographic and injury factors. Mean-differences (B) and 95% CIs are reported. Statistical significance was assessed at p < 0.05. RESULTS 162 MTBI patients were aged 39.8±15.4-years and 24.6% -unemployed. Unemployed patients demonstrated increased psychiatric comorbidities (45.0% -vs.- 23.8%; p = 0.010), drug use (52.5% -vs.- 21.3%; p < 0.001), smoking (62.5% -vs.- 27.0%; p < 0.001), prior TBI (78.4% -vs.- 55.0%; p = 0.012), and lower education (15.0% -vs.- 45.1% college degree; p = 0.003). On multivariable analysis, unemployment associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended: B = - 0.50, 95% CI [- 0.88, - 0.11]), increased psychiatric disturbance (Brief Symptom Inventory-18: B = 6.22 [2.33, 10.10]), postconcussional symptoms (Rivermead Questionnaire: B = 4.91 [0.38, 9.44]), and post-traumatic stress disorder (PTSD Checklist-Civilian: B = 5.99 [0.76, 11.22]). No differences were observed for cognitive measures or satisfaction with life. CONCLUSIONS Unemployed patients are at risk for preinjury psychosocial comorbidities, poorer six-month functional recovery and increased psychiatric/postconcussional/PTSD symptoms. Resource allocation and return precautions should be implemented to mitigate and/or prevent the decline of at-risk patients.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Jonathan W Rick
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Molly Rose Morrissey
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Sabrina R Taylor
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Catherine G Suen
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Mary J Vassar
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Maryse C Cnossen
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Hester F Lingsma
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Esther L Yuh
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Raquel C Gardner
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alex B Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, PA, USA
| | - Tene A Cage
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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33
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Yue JK, Winkler EA, Puffer RC, Deng H, Phelps RRL, Wagle S, Morrissey MR, Rivera EJ, Runyon SJ, Vassar MJ, Taylor SR, Cnossen MC, Lingsma HF, Yuh EL, Mukherjee P, Schnyer DM, Puccio AM, Valadka AB, Okonkwo DO, Manley GT, The Track-Tbi Investigators. Temporal lobe contusions on computed tomography are associated with impaired 6-month functional recovery after mild traumatic brain injury: a TRACK-TBI study. Neurol Res 2018; 40:972-981. [PMID: 30175944 DOI: 10.1080/01616412.2018.1505416] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Mild traumatic brain injury (MTBI) can cause persistent functional deficits and healthcare burden. Understanding the association between intracranial contusions and outcome may aid in MTBI treatment and prognosis. METHODS MTBI patients with Glasgow Coma Scale 13-15 and 6-month outcomes [Glasgow Outcome Scale-Extended (GOSE)], without polytrauma from the prospective TRACK-TBI Pilot study were analyzed. Intracranial contusions on computed tomography (CT) were coded by location. Multivariable regression evaluated associations between intracranial injury type (temporal contusion [TC], frontal contusion, extraaxial [epidural/subdural/subarachnoid], other-intraaxial [intracerebral/intraventricular hemorrhage, axonal injury]) and GOSE. Odds ratios (OR) are reported. RESULTS Overall, 260 MTBI subjects were aged 44.4 ± 18.1-years; 67.7% were male. Ninety-seven subjects were CT-positive and 46 had contusions (41.3%-frontal, 30.4%-temporal, 21.7%-frontal + temporal, 2.2% each-parietal/occipital/brainstem); 95.7% had concurrent extraaxial hemorrhage. Mortality was 0% at discharge and 2.3% by 6-months. GOSE distribution was 2.3%-death, 1.5%-severe disability, 27.7%-moderate disability, 68.5%-good recovery. Forty-six percent of TC-positive subjects suffered moderate disability or worse (GOSE ≤6) and 41.7% were unable to return to baseline work capacity (RTBWC), compared to 29.1%/20.4% for CT-negative and 26.1%/20.9% for CT-positive subjects without TC. On multivariable regression, TC associated with OR = 3.33 (95% CI [1.16-9.60], p = 0.026) for GOSE ≤6, and OR = 4.48 ([1.49-13.51], p = 0.008) for inability to RTBWC. CONCLUSIONS Parenchymal contusions in MTBI are often accompanied by extraaxial hemorrhage. TCs may be associated with 6-month functional impairment. Their presence on imaging should alert the clinician to the need for heightened surveillance of sequelae complicating RTBWC, with low threshold for referral to services.
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Affiliation(s)
- John K Yue
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ethan A Winkler
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ross C Puffer
- c Department of Neurological Surgery , Mayo Clinic , Rochester , MN , USA.,d Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Hansen Deng
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ryan R L Phelps
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sagar Wagle
- e Department of Radiology , Mayo Clinic , Rochester , MN , USA
| | - Molly Rose Morrissey
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Ernesto J Rivera
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sarah J Runyon
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Mary J Vassar
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Sabrina R Taylor
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
| | - Maryse C Cnossen
- f Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Hester F Lingsma
- f Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Esther L Yuh
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,g Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - Pratik Mukherjee
- b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA.,g Department of Radiology , University of California San Francisco , San Francisco , CA , USA
| | - David M Schnyer
- h Department of Psychology , University of Texas at Austin , Austin , TX , USA
| | - Ava M Puccio
- d Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Alex B Valadka
- i Department of Neurological Surgery , Virginia Commonwealth University , Richmond , VA , USA
| | - David O Okonkwo
- d Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA
| | - Geoffrey T Manley
- a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA.,b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA
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Korley FK, Yue JK, Wilson DH, Hrusovsky K, Diaz-Arrastia R, Ferguson AR, Yuh EL, Mukherjee P, Wang KKW, Valadka AB, Puccio AM, Okonkwo DO, Manley GT. Performance Evaluation of a Multiplex Assay for Simultaneous Detection of Four Clinically Relevant Traumatic Brain Injury Biomarkers. J Neurotrauma 2018; 36:182-187. [PMID: 29690824 PMCID: PMC6306681 DOI: 10.1089/neu.2017.5623] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Traumatic brain injury (TBI) results in heterogeneous pathology affecting multiple cells and tissue types in the brain. It is likely that assessment of such complexity will require simultaneous measurement of multiple molecular biomarkers in a single sample of biological fluid. We measured glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase L1 (UCH-L1), neurofilament light chain (NF-L) and total tau in plasma samples obtained from 107 subjects enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) Study using the Quanterix Simoa 4-Plex assay. We also measured NF-L using the Simoa singleplex assay. We computed the correlation between the different biomarkers and calculated the discriminative value of each biomarker for distinguishing between subjects with abnormal versus normal head computed tomography (CT). We found a strong correlation between NF-L values derived from the multiplex and singleplex assays (correlation coefficient = 0.997). Among biomarker values derived from the multiplex assay, the strongest correlation was between the axonal and neuronal markers, NF-L and UCH-L1 (coefficient = 0.71). The weakest correlation was between the glial marker GFAP and the axonal marker tau (coefficient = 0.06). The areas under the curves for distinguishing between subjects with/without abnormal head CT for multiplex GFAP, UCH-L1, NF-L, and total tau were: 0.88 (95% confidence interval 0.81-0.95), 0.86 (0.79-0.93), 0.84 (0.77-0.92), and 0.77 0.67-0.86), respectively. We conclude that the multiplex assay provides simultaneous quantification of GFAP, UCH-L1, NF-L, and tau, and may be clinically useful in the diagnosis of TBI as well as identifying different types of cellular injury.
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Affiliation(s)
- Frederick K. Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - John K. Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | | | | | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Traumatic Brain Injury Clinical Research Center, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Esther L. Yuh
- Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Pratik Mukherjee
- Department of Radiology, University of California, San Francisco, San Francisco, California
| | - Kevin K. W. Wang
- Center for Neuroproteomics and Biomarkers Research, Department of Psychiatry, McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Alex B. Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Ava M. Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Si B, Dumkrieger G, Wu T, Zafonte R, Valadka AB, Okonkwo DO, Manley GT, Wang L, Dodick DW, Schwedt TJ, Li J. Sub-classifying patients with mild traumatic brain injury: A clustering approach based on baseline clinical characteristics and 90-day and 180-day outcomes. PLoS One 2018; 13:e0198741. [PMID: 29995912 PMCID: PMC6040703 DOI: 10.1371/journal.pone.0198741] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/24/2018] [Indexed: 12/04/2022] Open
Abstract
Background The current classification of traumatic brain injury (TBI) into “mild”, “moderate”, or “severe” does not adequately account for the patient heterogeneity that still exists within each of these categories. The objective of this study was to identify “sub-groups” of mild TBI (mTBI) patients based on data available at the time of the initial post-TBI patient evaluation and to determine if the sub-grouping correlates with patient outcomes at 90 and 180 days post-TBI. Methods Data from patients in the TRACK-TBI Pilot dataset who had a Glasgow Coma Scale (GCS) score of 13 to 15 at arrival to the Emergency Department and a closed head injury were included. Considering 53 clinical variables that are typically available during the initial evaluation of the patient with mild TBI, sparse heirarchial clustering with cluster quality assessment was used to identify the optimal number of patient sub-groups. Patient sub-groups were then compared for ten outcomes measured at 90 or 180 days post-TBI. Results Amongst the 485 patients with mTBI, optimal clustering was based on the inclusion of 12 clinical variables that divided the patients into 5 mild TBI sub-groups. Clinical variables driving the sub-clustering included: gender, employment status, marital status, TBI due to falling, brain CT scan result, systolic blood pressure, diastolic blood pressure, administration of IV fluids in the Emergency Department, alcohol use, tobacco use, history of neurologic disease, and history of psychiatric disease. These 5 mild TBI sub-groups differed in their 90 day and 180 day outcomes within several domains including global outcomes, persistence of TBI-related symptoms, and neuropsychological impairment. Conclusions Sub-groups of patients with mTBI can be identified according to clinical variables that are relatively easy to obtain at the time of initial patient evaluation. A patient’s sub-group assignment is associated with multidimensional patient outcomes at 90 and 180 days. These findings support the notion that there are clinically meaningful subgroups of patients amongst those currently classified as having mTBI.
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Affiliation(s)
- Bing Si
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
| | - Gina Dumkrieger
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
- Department of Neurology, Mayo Clinic, Phoenix, AZ, United States of America
| | - Teresa Wu
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, United States of America
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco, CA, United States of America
| | - Lujia Wang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
| | - David W. Dodick
- Department of Neurology, Mayo Clinic, Phoenix, AZ, United States of America
| | - Todd J. Schwedt
- Department of Neurology, Mayo Clinic, Phoenix, AZ, United States of America
- * E-mail: (JL); (TS)
| | - Jing Li
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, AZ, United States of America
- * E-mail: (JL); (TS)
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Gardner RC, Nelson LD, Yue JK, Valadka AB, McCrea MA, Giacino JT, Manley GT. F5‐06‐01: EARLY COGNITIVE DECLINE WITHIN ONE YEAR AFTER TRAUMATIC BRAIN INJURY: A TRACK‐TBI STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Raquel C. Gardner
- University of California San Francisco/San Francisco VA Medical CenterSan FranciscoCAUSA
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Gardner RC, Rubenstein R, Wang KKW, Korley FK, Yue JK, Yuh EL, Mukherje P, Valadka AB, Okonkwo DO, Diaz-Arrastia R, Manley GT. Age-Related Differences in Diagnostic Accuracy of Plasma Glial Fibrillary Acidic Protein and Tau for Identifying Acute Intracranial Trauma on Computed Tomography: A TRACK-TBI Study. J Neurotrauma 2018; 35:2341-2350. [PMID: 29717620 DOI: 10.1089/neu.2018.5694] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Plasma tau and glial fibrillary acidic protein (GFAP) are promising biomarkers for identifying traumatic brain injury (TBI) patients with intracranial trauma on computed tomography (CT). Accuracy in older adults with mild TBI (mTBI), the fastest growing TBI population, is unknown. Our aim was to assess for age-related differences in diagnostic accuracy of plasma tau and GFAP for identifying intracranial trauma on CT. Samples from 169 patients (age <40 years [n = 79], age 40-59 years [n = 60], age 60 years+ [n = 30]), a subset of patients from the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot study who presented with mTBI (Glasgow Coma Scale score of 13-15), received head CT, and consented to blood draw within 24 h of injury, were assayed for hyperphosphorylated-tau (P-tau), total-tau (T-tau; both via amplification-linked enhanced immunoassay using multi-arrayed fiberoptics), and GFAP (via sandwich enzyme-linked immunosorbent assay). P-tau, T-tau, P-tau:T-tau ratio, and GFAP concentration were significantly associated with CT findings. Overall, discriminative ability declined with increasing age for all assays, but this decline was only statistically significant for GFAP (area under the receiver operating characteristic curve [AUC]: old 0.73 [reference group; ref] vs. young 0.93 [p = 0.037] or middle-aged 0.92 [p = 0.0497]). P-tau concentration consistently showed the highest diagnostic accuracy across all age-groups (AUC: old 0.84 [ref] vs. young 0.95 [p = 0.274] or middle-aged 0.93 [p = 0.367]). Comparison of models including P-tau alone versus P-tau plus GFAP revealed significant added value of GFAP. In conclusion, the GFAP assay was less accurate for identifying intracranial trauma on CT among older versus younger mTBI patients. Mechanisms of this age-related difference, including role of assay methodology, specific TBI neuroanatomy, pre-existing conditions, and anti-thrombotic use, warrant further study.
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Affiliation(s)
- Raquel C Gardner
- 1 Department of Neurology, Memory and Aging Center, and Weill Institute for Neurosciences, University of California San Francisco , San Francisco, California.,2 Department of Neurology and Center for Population Brain Health, San Francisco Veterans Affairs Medical Center , San Francisco, California
| | - Richard Rubenstein
- 3 Departments of Neurology and Physiology/Pharmacology, Laboratory of Neurodegenerative Diseases and CNS Biomarker Discovery, State University of New York Downstate Medical Center , Brooklyn, New York
| | - Kevin K W Wang
- 4 Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry, Neuroscience and Chemistry, University of Florida , Gainesville, Florida.,5 Brain Rehabilitation Research Center , Malcom Randall VA Medical Center, Gainesville, Florida
| | - Frederick K Korley
- 6 Department of Emergency Medicine, University of Michigan , Ann Arbor, Michigan
| | - John K Yue
- 7 Department of Neurological Surgery, University of California San Francisco , San Francisco, California.,8 Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Esther L Yuh
- 8 Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital, San Francisco, California.,9 Department of Radiology, University of California San Francisco , San Francisco, California
| | - Pratik Mukherje
- 8 Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital, San Francisco, California.,9 Department of Radiology, University of California San Francisco , San Francisco, California
| | - Alex B Valadka
- 10 Department of Neurological Surgery, Virginia Commonwealth University , Richmond, Virginia
| | - David O Okonkwo
- 11 Department of Neurological Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Ramon Diaz-Arrastia
- 12 Department of Neurology, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania
| | - Geoffrey T Manley
- 7 Department of Neurological Surgery, University of California San Francisco , San Francisco, California.,8 Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital, San Francisco, California
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Ngwenya LB, Gardner RC, Yue JK, Burke JF, Ferguson AR, Huang MC, Winkler EA, Pirracchio R, Satris GG, Yuh EL, Mukherjee P, Valadka AB, Okonkwo DO, Manley GT. Concordance of common data elements for assessment of subjective cognitive complaints after mild-traumatic brain injury: a TRACK-TBI Pilot Study. Brain Inj 2018; 32:1071-1078. [DOI: 10.1080/02699052.2018.1481527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Laura B. Ngwenya
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Raquel C. Gardner
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, San Francisco Veterans Administration Medical Center, San Francisco, CA, USA
| | - John K. Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - John F. Burke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Michael C. Huang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Ethan A. Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - Gabriela G. Satris
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Esther L. Yuh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Alex B. Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
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Glushakova OY, Glushakov AO, Borlongan CV, Valadka AB, Hayes RL, Glushakov AV. Role of Caspase-3-Mediated Apoptosis in Chronic Caspase-3-Cleaved Tau Accumulation and Blood–Brain Barrier Damage in the Corpus Callosum after Traumatic Brain Injury in Rats. J Neurotrauma 2018. [DOI: 10.1089/neu.2017.4999] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Olena Y. Glushakova
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Andriy O. Glushakov
- Department of Neurosurgery, University of South Florida College of Medicine, Tampa, Florida
| | - Cesar V. Borlongan
- Department of Neurosurgery, University of South Florida College of Medicine, Tampa, Florida
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
| | - Ronald L. Hayes
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia
- Banyan Biomarkers, Inc., Alachua, Florida
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Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, Bragge P, Brazinova A, Büki A, Chesnut RM, Citerio G, Coburn M, Cooper DJ, Crowder AT, Czeiter E, Czosnyka M, Diaz-Arrastia R, Dreier JP, Duhaime AC, Ercole A, van Essen TA, Feigin VL, Gao G, Giacino J, Gonzalez-Lara LE, Gruen RL, Gupta D, Hartings JA, Hill S, Jiang JY, Ketharanathan N, Kompanje EJO, Lanyon L, Laureys S, Lecky F, Levin H, Lingsma HF, Maegele M, Majdan M, Manley G, Marsteller J, Mascia L, McFadyen C, Mondello S, Newcombe V, Palotie A, Parizel PM, Peul W, Piercy J, Polinder S, Puybasset L, Rasmussen TE, Rossaint R, Smielewski P, Söderberg J, Stanworth SJ, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Synnot A, Te Ao B, Tenovuo O, Theadom A, Tibboel D, Videtta W, Wang KKW, Williams WH, Wilson L, Yaffe K, Adams H, Agnoletti V, Allanson J, Amrein K, Andaluz N, Anke A, Antoni A, van As AB, Audibert G, Azaševac A, Azouvi P, Azzolini ML, Baciu C, Badenes R, Barlow KM, Bartels R, Bauerfeind U, Beauchamp M, Beer D, Beer R, Belda FJ, Bellander BM, Bellier R, Benali H, Benard T, Beqiri V, Beretta L, Bernard F, Bertolini G, Bilotta F, Blaabjerg M, den Boogert H, Boutis K, Bouzat P, Brooks B, Brorsson C, Bullinger M, Burns E, Calappi E, Cameron P, Carise E, Castaño-León AM, Causin F, Chevallard G, Chieregato A, Christie B, Cnossen M, Coles J, Collett J, Della Corte F, Craig W, Csato G, Csomos A, Curry N, Dahyot-Fizelier C, Dawes H, DeMatteo C, Depreitere B, Dewey D, van Dijck J, Đilvesi Đ, Dippel D, Dizdarevic K, Donoghue E, Duek O, Dulière GL, Dzeko A, Eapen G, Emery CA, English S, Esser P, Ezer E, Fabricius M, Feng J, Fergusson D, Figaji A, Fleming J, Foks K, Francony G, Freedman S, Freo U, Frisvold SK, Gagnon I, Galanaud D, Gantner D, Giraud B, Glocker B, Golubovic J, Gómez López PA, Gordon WA, Gradisek P, Gravel J, Griesdale D, Grossi F, Haagsma JA, Håberg AK, Haitsma I, Van Hecke W, Helbok R, Helseth E, van Heugten C, Hoedemaekers C, Höfer S, Horton L, Hui J, Huijben JA, Hutchinson PJ, Jacobs B, van der Jagt M, Jankowski S, Janssens K, Jelaca B, Jones KM, Kamnitsas K, Kaps R, Karan M, Katila A, Kaukonen KM, De Keyser V, Kivisaari R, Kolias AG, Kolumbán B, Kolundžija K, Kondziella D, Koskinen LO, Kovács N, Kramer A, Kutsogiannis D, Kyprianou T, Lagares A, Lamontagne F, Latini R, Lauzier F, Lazar I, Ledig C, Lefering R, Legrand V, Levi L, Lightfoot R, Lozano A, MacDonald S, Major S, Manara A, Manhes P, Maréchal H, Martino C, Masala A, Masson S, Mattern J, McFadyen B, McMahon C, Meade M, Melegh B, Menovsky T, Moore L, Morgado Correia M, Morganti-Kossmann MC, Muehlan H, Mukherjee P, Murray L, van der Naalt J, Negru A, Nelson D, Nieboer D, Noirhomme Q, Nyirádi J, Oddo M, Okonkwo DO, Oldenbeuving AW, Ortolano F, Osmond M, Payen JF, Perlbarg V, Persona P, Pichon N, Piippo-Karjalainen A, Pili-Floury S, Pirinen M, Ple H, Poca MA, Posti J, Van Praag D, Ptito A, Radoi A, Ragauskas A, Raj R, Real RGL, Reed N, Rhodes J, Robertson C, Rocka S, Røe C, Røise O, Roks G, Rosand J, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossi S, Rueckert D, de Ruiter GCW, Sacchi M, Sahakian BJ, Sahuquillo J, Sakowitz O, Salvato G, Sánchez-Porras R, Sándor J, Sangha G, Schäfer N, Schmidt S, Schneider KJ, Schnyer D, Schöhl H, Schoonman GG, Schou RF, Sir Ö, Skandsen T, Smeets D, Sorinola A, Stamatakis E, Stevanovic A, Stevens RD, Sundström N, Taccone FS, Takala R, Tanskanen P, Taylor MS, Telgmann R, Temkin N, Teodorani G, Thomas M, Tolias CM, Trapani T, Turgeon A, Vajkoczy P, Valadka AB, Valeinis E, Vallance S, Vámos Z, Vargiolu A, Vega E, Verheyden J, Vik A, Vilcinis R, Vleggeert-Lankamp C, Vogt L, Volovici V, Voormolen DC, Vulekovic P, Vande Vyvere T, Van Waesberghe J, Wessels L, Wildschut E, Williams G, Winkler MKL, Wolf S, Wood G, Xirouchaki N, Younsi A, Zaaroor M, Zelinkova V, Zemek R, Zumbo F. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017; 16:987-1048. [DOI: 10.1016/s1474-4422(17)30371-x] [Citation(s) in RCA: 822] [Impact Index Per Article: 117.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/06/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
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Yue JK, Winkler EA, Sharma S, Vassar MJ, Ratcliff JJ, Korley FK, Seabury SA, Ferguson AR, Lingsma HF, Deng H, Meeuws S, Adeoye OM, Rick JW, Robinson CK, Duarte SM, Yuh EL, Mukherjee P, Dikmen SS, McAllister TW, Diaz-Arrastia R, Valadka AB, Gordon WA, Okonkwo DO, Manley GT. Temporal profile of care following mild traumatic brain injury: predictors of hospital admission, follow-up referral and six-month outcome. Brain Inj 2017; 31:1820-1829. [DOI: 10.1080/02699052.2017.1351000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- John K. Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Ethan A. Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Sourabh Sharma
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Mary J. Vassar
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Jonathan J. Ratcliff
- Departments of Emergency Medicine and Neurology, Emory University, Atlanta, GA, USA
| | - Frederick K. Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Seth A. Seabury
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Adam R. Ferguson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Hester F. Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Sacha Meeuws
- Department of Neurological Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Opeolu M. Adeoye
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jonathan W. Rick
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Caitlin K. Robinson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Siena M. Duarte
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Esther L. Yuh
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
- Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Sureyya S. Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | | - Ramon Diaz-Arrastia
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA
| | | | - Wayne A. Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T. Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
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Rubenstein R, Chang B, Yue JK, Chiu A, Winkler EA, Puccio AM, Diaz-Arrastia R, Yuh EL, Mukherjee P, Valadka AB, Gordon WA, Okonkwo DO, Davies P, Agarwal S, Lin F, Sarkis G, Yadikar H, Yang Z, Manley GT, Wang KKW, Cooper SR, Dams-O'Connor K, Borrasso AJ, Inoue T, Maas AIR, Menon DK, Schnyer DM, Vassar MJ. Comparing Plasma Phospho Tau, Total Tau, and Phospho Tau-Total Tau Ratio as Acute and Chronic Traumatic Brain Injury Biomarkers. JAMA Neurol 2017; 74:1063-1072. [PMID: 28738126 DOI: 10.1001/jamaneurol.2017.0655] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Annually in the United States, at least 3.5 million people seek medical attention for traumatic brain injury (TBI). The development of therapies for TBI is limited by the absence of diagnostic and prognostic biomarkers. Microtubule-associated protein tau is an axonal phosphoprotein. To date, the presence of the hypophosphorylated tau protein (P-tau) in plasma from patients with acute TBI and chronic TBI has not been investigated. Objective To examine the associations between plasma P-tau and total-tau (T-tau) levels and injury presence, severity, type of pathoanatomic lesion (neuroimaging), and patient outcomes in acute and chronic TBI. Design, Setting, and Participants In the TRACK-TBI Pilot study, plasma was collected at a single time point from 196 patients with acute TBI admitted to 3 level I trauma centers (<24 hours after injury) and 21 patients with TBI admitted to inpatient rehabilitation units (mean [SD], 176.4 [44.5] days after injury). Control samples were purchased from a commercial vendor. The TRACK-TBI Pilot study was conducted from April 1, 2010, to June 30, 2012. Data analysis for the current investigation was performed from August 1, 2015, to March 13, 2017. Main Outcomes and Measures Plasma samples were assayed for P-tau (using an antibody that specifically recognizes phosphothreonine-231) and T-tau using ultra-high sensitivity laser-based immunoassay multi-arrayed fiberoptics conjugated with rolling circle amplification. Results In the 217 patients with TBI, 161 (74.2%) were men; mean (SD) age was 42.5 (18.1) years. The P-tau and T-tau levels and P-tau-T-tau ratio in patients with acute TBI were higher than those in healthy controls. Receiver operating characteristic analysis for the 3 tau indices demonstrated accuracy with area under the curve (AUC) of 1.000, 0.916, and 1.000, respectively, for discriminating mild TBI (Glasgow Coma Scale [GCS] score, 13-15, n = 162) from healthy controls. The P-tau level and P-tau-T-tau ratio were higher in individuals with more severe TBI (GCS, ≤12 vs 13-15). The P-tau level and P-tau-T-tau ratio outperformed the T-tau level in distinguishing cranial computed tomography-positive from -negative cases (AUC = 0.921, 0.923, and 0.646, respectively). Acute P-tau levels and P-tau-T-tau ratio weakly distinguished patients with TBI who had good outcomes (Glasgow Outcome Scale-Extended GOS-E, 7-8) (AUC = 0.663 and 0.658, respectively) and identified those with poor outcomes (GOS-E, ≤4 vs >4) (AUC = 0.771 and 0.777, respectively). Plasma samples from patients with chronic TBI also showed elevated P-tau levels and a P-tau-T-tau ratio significantly higher than that of healthy controls, with both P-tau indices strongly discriminating patients with chronic TBI from healthy controls (AUC = 1.000 and 0.963, respectively). Conclusions and Relevance Plasma P-tau levels and P-tau-T-tau ratio outperformed T-tau level as diagnostic and prognostic biomarkers for acute TBI. Compared with T-tau levels alone, P-tau levels and P-tau-T-tau ratios show more robust and sustained elevations among patients with chronic TBI.
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Affiliation(s)
- Richard Rubenstein
- Laboratory of Neurodegenerative Diseases and CNS Biomarker Discovery, Departments of Neurology and Physiology/Pharmacology, State University of New York Downstate Medical Center, Brooklyn
| | - Binggong Chang
- Laboratory of Neurodegenerative Diseases and CNS Biomarker Discovery, Departments of Neurology and Physiology/Pharmacology, State University of New York Downstate Medical Center, Brooklyn
| | - John K Yue
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - Allen Chiu
- Laboratory of Neurodegenerative Diseases and CNS Biomarker Discovery, Departments of Neurology and Physiology/Pharmacology, State University of New York Downstate Medical Center, Brooklyn
| | - Ethan A Winkler
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco
| | - Ava M Puccio
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Esther L Yuh
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Department of Radiology, University of California, San Francisco
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Department of Radiology, University of California, San Francisco
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond
| | - Wayne A Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David O Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Peter Davies
- Litwin-Zucker Center for Research in Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, New York
| | - Sanjeev Agarwal
- Department of Orthopedic Surgery and Rehabilitation Medicine, State University of New York Downstate Medical Center, Brooklyn
| | - Fan Lin
- Program for Neurotrauma, Neuroproteomics, and Biomarker Research, Department of Emergency Medicine, Psychiatry and Chemistry, University of Florida, Gainesville
| | - George Sarkis
- Program for Neurotrauma, Neuroproteomics, and Biomarker Research, Department of Emergency Medicine, Psychiatry and Chemistry, University of Florida, Gainesville.,Department of Chemistry, Faculty of Science, Alexandria University, Ibrahimia, Alexandria, Egypt
| | - Hamad Yadikar
- Program for Neurotrauma, Neuroproteomics, and Biomarker Research, Department of Emergency Medicine, Psychiatry and Chemistry, University of Florida, Gainesville.,Department of Biochemistry, Kuwait University, Khadiya, Kuwait
| | - Zhihui Yang
- Program for Neurotrauma, Neuroproteomics, and Biomarker Research, Department of Emergency Medicine, Psychiatry and Chemistry, University of Florida, Gainesville
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco
| | - Kevin K W Wang
- Program for Neurotrauma, Neuroproteomics, and Biomarker Research, Department of Emergency Medicine, Psychiatry and Chemistry, University of Florida, Gainesville
| | | | - Shelly R Cooper
- Department of Psychology, Washington University, St Louis, Missouri
| | - Kristen Dams-O'Connor
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Allison J Borrasso
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tomoo Inoue
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
| | - David K Menon
- Departments of Anesthesia and Neurocritical Care, University of Cambridge, Cambridge, England
| | | | - Mary J Vassar
- Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco
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Yue JK, Robinson CK, Burke JF, Winkler EA, Deng H, Cnossen MC, Lingsma HF, Ferguson AR, McAllister TW, Rosand J, Burchard EG, Sorani MD, Sharma S, Nielson JL, Satris GG, Talbott JF, Tarapore PE, Korley FK, Wang KK, Yuh EL, Mukherjee P, Diaz‐Arrastia R, Valadka AB, Okonkwo DO, Manley GT. Apolipoprotein E epsilon 4 (APOE-ε 4) genotype is associated with decreased 6-month verbal memory performance after mild traumatic brain injury. Brain Behav 2017; 7:e00791. [PMID: 28948085 PMCID: PMC5607554 DOI: 10.1002/brb3.791] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The apolipoprotein E (APOE) ε4 allele associates with memory impairment in neurodegenerative diseases. Its association with memory after mild traumatic brain injury (mTBI) is unclear. METHODS mTBI patients (Glasgow Coma Scale score 13-15, no neurosurgical intervention, extracranial Abbreviated Injury Scale score ≤1) aged ≥18 years with APOE genotyping results were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Cohorts determined by APOE-ε4(+/-) were assessed for associations with 6-month verbal memory, measured by California Verbal Learning Test, Second Edition (CVLT-II) subscales: Immediate Recall Trials 1-5 (IRT), Short-Delay Free Recall (SDFR), Short-Delay Cued Recall (SDCR), Long-Delay Free Recall (LDFR), and Long-Delay Cued Recall (LDCR). Multivariable regression controlled for demographic factors, seizure history, loss of consciousness, posttraumatic amnesia, and acute intracranial pathology on computed tomography (CT). RESULTS In 114 mTBI patients (APOE-ε4(-)=79; APOE-ε4(+)=35), ApoE-ε4(+) was associated with long-delay verbal memory deficits (LDFR: B = -1.17 points, 95% CI [-2.33, -0.01], p = .049; LDCR: B = -1.58 [-2.63, -0.52], p = .004), and a marginal decrease on SDCR (B = -1.02 [-2.05, 0.00], p = .050). CT pathology was the strongest predictor of decreased verbal memory (IRT: B = -8.49, SDFR: B = -2.50, SDCR: B = -1.85, LDFR: B = -2.61, LDCR: B = -2.60; p < .001). Seizure history was associated with decreased short-term memory (SDFR: B = -1.32, p = .037; SDCR: B = -1.44, p = .038). CONCLUSION The APOE-ε4 allele may confer an increased risk of impairment of 6-month verbal memory for patients suffering mTBI, with implications for heightened surveillance and targeted therapies. Acute intracranial pathology remains the driver of decreased verbal memory performance at 6 months after mTBI.
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Affiliation(s)
- John K. Yue
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Caitlin K. Robinson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - John F. Burke
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Ethan A. Winkler
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Hansen Deng
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Maryse C. Cnossen
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | - Hester F. Lingsma
- Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
| | - Adam R. Ferguson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | | | - Jonathan Rosand
- Program in Medical and Population GeneticsThe Broad Institute at MIT and HarvardCambridgeMAUSA
- Department of NeurologyHarvard Medical SchoolBostonMAUSA
| | - Esteban G. Burchard
- Department of Bioengineering and Therapeutic SciencesUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Marco D. Sorani
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Sourabh Sharma
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Stritch School of Medicine at Loyola UniversityMaywoodILUSA
| | - Jessica L. Nielson
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Gabriela G. Satris
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Jason F. Talbott
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Phiroz E. Tarapore
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
| | - Frederick K. Korley
- Department of Emergency MedicineUniversity of Michigan at Ann ArborAnn ArborMIUSA
| | - Kevin K.W. Wang
- Departments of Psychiatry and NeuroscienceUniversity of FloridaGainesvilleFLUSA
| | - Esther L. Yuh
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Pratik Mukherjee
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Department of RadiologyUniversity of California, San FranciscoSan FranciscoCAUSA
| | | | - Alex B. Valadka
- Department of Neurological SurgeryVirginia Commonwealth UniversityRichmondVAUSA
| | - David O. Okonkwo
- Department of Neurological SurgeryUniversity of Pittsburgh Medical CenterPittsburghPAUSA
| | - Geoffrey T. Manley
- Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoCAUSA
- Brain and Spinal Injury CenterSan Francisco General HospitalSan FranciscoCAUSA
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Yue JK, Ngwenya LB, Upadhyayula PS, Deng H, Winkler EA, Burke JF, Lee YM, Robinson CK, Ferguson AR, Lingsma HF, Cnossen MC, Pirracchio R, Korley FK, Vassar MJ, Yuh EL, Mukherjee P, Gordon WA, Valadka AB, Okonkwo DO, Manley GT. Emergency department blood alcohol level associates with injury factors and six-month outcome after uncomplicated mild traumatic brain injury. J Clin Neurosci 2017; 45:293-298. [PMID: 28789959 DOI: 10.1016/j.jocn.2017.07.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
The relationship between blood alcohol level (BAL) and mild traumatic brain injury (mTBI) remains in need of improved characterization. Adult patients suffering mTBI without intracranial pathology on computed tomography (CT) from the prospective Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with emergency department (ED) Glasgow Coma Scale (GCS) 13-15 and recorded blood alcohol level (BAL) were extracted. BAL≥80-mg/dl was set as proxy for excessive use. Multivariable regression was performed for patients with six-month Glasgow Outcome Scale-Extended (GOSE; functional recovery) and Wechsler Adult Intelligence Scale Processing Speed Index Composite Score (WAIS-PSI; nonverbal processing speed), using BAL≥80-mg/dl and <80-mg/dl cohorts, adjusting for demographic/injury factors. Overall, 107 patients were aged 42.7±16.8-years, 67.3%-male, and 80.4%-Caucasian; 65.4% had BAL=0-mg/dl, 4.6% BAL<80-mg/dl, and 30.0% BAL≥80-mg/dl (range 100-440-mg/dl). BAL differed across loss of consciousness (LOC; none: median 0-mg/dl [interquartile range (IQR) 0-0], <30-min: 0-mg/dl [0-43], ≥30-min: 224-mg/dl [50-269], unknown: 108-mg/dl [0-232]; p=0.002). GCS<15 associated with higher BAL (19-mg/dl [0-204] vs. 0-mg/dl [0-20]; p=0.013). On univariate analysis, BAL≥80-mg/dl associated with less-than-full functional recovery (GOSE≤7; 38.1% vs. 11.5%; p=0.025) and lower WAIS-PSI (92.4±12.7, 30th-percentile vs. 105.1±11.7, 63rd-percentile; p<0.001). On multivariable regression BAL≥80-mg/dl demonstrated an odds ratio of 8.05 (95% CI [1.35-47.92]; p=0.022) for GOSE≤7 and an adjusted mean decrease of 8.88-points (95% CI [0.67-17.09]; p=0.035) on WAIS-PSI. Day-of-injury BAL>80-mg/dl after uncomplicated mTBI was associated with decreased GCS score and prolongation of reported LOC. BAL may be a biomarker for impaired return to baseline function and decreased nonverbal processing speed at six-months postinjury. Future confirmatory studies are needed.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Laura B Ngwenya
- Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Young M Lee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Caitlin K Robinson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maryse C Cnossen
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Division of Biostatistics, University of California, Berkeley, Berkeley, CA, USA
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mary J Vassar
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA
| | - Esther L Yuh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Pratik Mukherjee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology, University of California, San Francisco, San Francisco, CA, USA
| | - Wayne A Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex B Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA; Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, CA, USA.
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Cnossen MC, Winkler EA, Yue JK, Okonkwo DO, Valadka AB, Steyerberg EW, Lingsma HF, Manley GT. Development of a Prediction Model for Post-Concussive Symptoms following Mild Traumatic Brain Injury: A TRACK-TBI Pilot Study. J Neurotrauma 2017; 34:2396-2409. [PMID: 28343409 DOI: 10.1089/neu.2016.4819] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Post-concussive symptoms occur frequently after mild traumatic brain injury (mTBI) and may be categorized as cognitive, somatic, or emotional. We aimed to: 1) assess whether patient demographics and clinical variables predict development of each of these three symptom categories, and 2) develop a prediction model for 6-month post-concussive symptoms. Patients with mTBI (Glasgow Coma Scale score 13-15) from the prospective multi-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study (2010-2012) who completed the Rivermead Post Concussion Symptoms Questionnaire (RPQ) at 6 months post-injury were included. Linear regression was utilized to determine the predictive value of candidate predictors for cognitive, somatic, and emotional subscales individually, as well as the overall RPQ. The final prediction model was developed using least absolute shrinkage and selection operator shrinkage and bootstrap validation. We included 277 mTBI patients (70% male; median age 42 years). No major differences in the predictive value of our set of predictors existed for the cognitive, somatic, and emotional subscales, and therefore one prediction model for the RPQ total scale was developed. Years of education, pre-injury psychiatric disorders, and prior TBI were the strongest predictors of 6-month post-concussive symptoms. The total set of predictors explained 21% of the variance, which decreased to 14% after bootstrap validation. Demographic and clinical variables at baseline are predictive of 6-month post-concussive symptoms following mTBI; however, these variables explain less than one-fifth of the total variance in outcome. Model refinement with larger datasets, more granular variables, and objective biomarkers are needed before implementation in clinical practice.
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Affiliation(s)
- Maryse C Cnossen
- Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alex B Valadka
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Ewout W Steyerberg
- Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hester F Lingsma
- Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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47
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Glushakova OY, Glushakov AA, Wijesinghe DS, Valadka AB, Hayes RL, Glushakov AV. Prospective clinical biomarkers of caspase-mediated apoptosis associated with neuronal and neurovascular damage following stroke and other severe brain injuries: Implications for chronic neurodegeneration. Brain Circ 2017; 3:87-108. [PMID: 30276309 PMCID: PMC6126261 DOI: 10.4103/bc.bc_27_16] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 04/10/2017] [Accepted: 04/17/2017] [Indexed: 12/11/2022] Open
Abstract
Acute brain injuries, including ischemic and hemorrhagic stroke, as well as traumatic brain injury (TBI), are major worldwide health concerns with very limited options for effective diagnosis and treatment. Stroke and TBI pose an increased risk for the development of chronic neurodegenerative diseases, notably chronic traumatic encephalopathy, Alzheimer's disease, and Parkinson's disease. The existence of premorbid neurodegenerative diseases can exacerbate the severity and prognosis of acute brain injuries. Apoptosis involving caspase-3 is one of the most common mechanisms involved in the etiopathology of both acute and chronic neurological and neurodegenerative diseases, suggesting a relationship between these disorders. Over the past two decades, several clinical biomarkers of apoptosis have been identified in cerebrospinal fluid and peripheral blood following ischemic stroke, intracerebral and subarachnoid hemorrhage, and TBI. These biomarkers include selected caspases, notably caspase-3 and its specific cleavage products such as caspase-cleaved cytokeratin-18, caspase-cleaved tau, and a caspase-specific 120 kDa αII-spectrin breakdown product. The levels of these biomarkers might be a valuable tool for the identification of pathological pathways such as apoptosis and inflammation involved in injury progression, assessment of injury severity, and prediction of clinical outcomes. This review focuses on clinical studies involving biomarkers of caspase-3-mediated pathways, following stroke and TBI. The review further examines their prospective diagnostic utility, as well as clinical utility for improved personalized treatment of stroke and TBI patients and the development of prophylactic treatment chronic neurodegenerative disease.
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Affiliation(s)
- Olena Y Glushakova
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Andriy A Glushakov
- Department of Neurosurgery, University of South Florida College of Medicine, Tampa, FL, USA
| | - Dayanjan S Wijesinghe
- Department of Pharmacotherapy and Outcomes Sciences, Laboratory of Pharmacometabolomics and Companion Diagnostics, Virginia Commonwealth University, Richmond, VA, USA
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Ronald L Hayes
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, USA
- Banyan Biomarkers, Inc., Alachua, 32615, USA
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48
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Nielson JL, Cooper SR, Yue JK, Sorani MD, Inoue T, Yuh EL, Mukherjee P, Petrossian TC, Paquette J, Lum PY, Carlsson GE, Vassar MJ, Lingsma HF, Gordon WA, Valadka AB, Okonkwo DO, Manley GT, Ferguson AR. Uncovering precision phenotype-biomarker associations in traumatic brain injury using topological data analysis. PLoS One 2017; 12:e0169490. [PMID: 28257413 PMCID: PMC5336356 DOI: 10.1371/journal.pone.0169490] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a complex disorder that is traditionally stratified based on clinical signs and symptoms. Recent imaging and molecular biomarker innovations provide unprecedented opportunities for improved TBI precision medicine, incorporating patho-anatomical and molecular mechanisms. Complete integration of these diverse data for TBI diagnosis and patient stratification remains an unmet challenge. Methods and findings The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot multicenter study enrolled 586 acute TBI patients and collected diverse common data elements (TBI-CDEs) across the study population, including imaging, genetics, and clinical outcomes. We then applied topology-based data-driven discovery to identify natural subgroups of patients, based on the TBI-CDEs collected. Our hypothesis was two-fold: 1) A machine learning tool known as topological data analysis (TDA) would reveal data-driven patterns in patient outcomes to identify candidate biomarkers of recovery, and 2) TDA-identified biomarkers would significantly predict patient outcome recovery after TBI using more traditional methods of univariate statistical tests. TDA algorithms organized and mapped the data of TBI patients in multidimensional space, identifying a subset of mild TBI patients with a specific multivariate phenotype associated with unfavorable outcome at 3 and 6 months after injury. Further analyses revealed that this patient subset had high rates of post-traumatic stress disorder (PTSD), and enrichment in several distinct genetic polymorphisms associated with cellular responses to stress and DNA damage (PARP1), and in striatal dopamine processing (ANKK1, COMT, DRD2). Conclusions TDA identified a unique diagnostic subgroup of patients with unfavorable outcome after mild TBI that were significantly predicted by the presence of specific genetic polymorphisms. Machine learning methods such as TDA may provide a robust method for patient stratification and treatment planning targeting identified biomarkers in future clinical trials in TBI patients. Trial Registration ClinicalTrials.gov Identifier NCT01565551
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MESH Headings
- Adult
- Biomarkers
- Brain Injuries, Traumatic/diagnosis
- Brain Injuries, Traumatic/diagnostic imaging
- Brain Injuries, Traumatic/genetics
- Brain Injuries, Traumatic/physiopathology
- Catechol O-Methyltransferase/genetics
- Female
- Humans
- Machine Learning
- Male
- Middle Aged
- Poly (ADP-Ribose) Polymerase-1/genetics
- Polymorphism, Single Nucleotide
- Protein Serine-Threonine Kinases/genetics
- Receptors, Dopamine D2/genetics
- Stress Disorders, Post-Traumatic/diagnosis
- Stress Disorders, Post-Traumatic/diagnostic imaging
- Stress Disorders, Post-Traumatic/genetics
- Stress Disorders, Post-Traumatic/physiopathology
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Affiliation(s)
- Jessica L. Nielson
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | - Shelly R. Cooper
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States of America
| | - John K. Yue
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | - Marco D. Sorani
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | - Tomoo Inoue
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | - Esther L. Yuh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States of America
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States of America
| | | | | | - Pek Y. Lum
- Ayasdi, Inc, Palo Alto, CA, United States of America
| | | | - Mary J. Vassar
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | | | - Wayne A. Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine, Mount Sinai, New York, NY, United States of America
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, United States of America
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Geoffrey T. Manley
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
- * E-mail: (ARF); (GTM)
| | - Adam R. Ferguson
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
- Department of Veterans Affairs, San Francisco VA Medical Center, San Francisco, CA, United States of America
- * E-mail: (ARF); (GTM)
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Abstract
Traumatic brain injury (TBI) continues to be a major public health problem. Proposed treatments have not withstood testing in clinical trials because of failure to account for different types of TBI and other weaknesses in trial design. Management goals continue to be prevention and prompt treatment of secondary insults (hypotension, hypoxia, and other physiologic derangements). This goal is best accomplished by careful attention to airway, breathing, circulation, and basic principles of intensive care unit management. Attempts to intervene prophylactically to prevent intracranial hypertension or other complications have not been beneficial and may even have deleterious effects.
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Affiliation(s)
- Wittstatt Alexandra Whitaker-Lea
- Department of Neurosurgery, Virginia Commonwealth University, 417 North 11th Street, 6th Floor, PO Box 980631, Richmond, VA 23298-0631, USA
| | - Alex B Valadka
- Department of Neurosurgery, Virginia Commonwealth University, 417 North 11th Street, 6th Floor, PO Box 980631, Richmond, VA 23298-0631, USA.
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50
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Palacios EM, Yuh EL, Chang YS, Yue JK, Schnyer DM, Okonkwo DO, Valadka AB, Gordon WA, Maas AIR, Vassar M, Manley GT, Mukherjee P. Resting-State Functional Connectivity Alterations Associated with Six-Month Outcomes in Mild Traumatic Brain Injury. J Neurotrauma 2017; 34:1546-1557. [PMID: 28085565 DOI: 10.1089/neu.2016.4752] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Brain lesions are subtle or absent in most patients with mild traumatic brain injury (mTBI) and the standard clinical criteria are not reliable for predicting long-term outcome. This study investigates resting-state functional MRI (rsfMRI) to assess semiacute alterations in brain connectivity and its relationship with outcome measures assessed 6 months after injury. Seventy-five mTBI patients were recruited as part of the prospective multicenter Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) pilot study and compared with matched 47 healthy subjects. Patients were classified following radiological criteria: CT/MRI positive, evidence of lesions; CT/MRI negative, without evidence of brain lesions. rsfMRI data were acquired and then processed using probabilistic independent component analysis. We compared the functional connectivity of the resting-state networks (RSNs) between patients and controls, as well as group differences in the interactions between RSNs, and related both to cognitive and behavioral performance at 6 months post-injury. Alterations were found in the spatial maps of the RSNs between mTBI patients and healthy controls in networks involved in behavioral and cognition processes. These alterations were predictive of mTBI patients' outcomes at 6 months post-injury. Moreover, different patterns of reduced network interactions were found between the CT/MRI positive and CT/MRI negative patients and the control group. These rsfMRI results demonstrate that even mTBI patients not showing brain lesions on conventional CT/MRI scans can have alterations of functional connectivity at the semiacute stage that help explain their outcomes. These results suggest rsfMRI as a sensitive biomarker both for early diagnosis and for prediction of the cognitive and behavioral performance of these patients.
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Affiliation(s)
- Eva M Palacios
- 1 Department of Radiology and Biomedical Imaging, University of California , San Francisco, California
| | - Esther L Yuh
- 1 Department of Radiology and Biomedical Imaging, University of California , San Francisco, California.,2 Brain and Spinal Cord Injury Center, San Francisco General Hospital and Trauma Center , San Francisco, California
| | - Yi-Shin Chang
- 1 Department of Radiology and Biomedical Imaging, University of California , San Francisco, California
| | - John K Yue
- 2 Brain and Spinal Cord Injury Center, San Francisco General Hospital and Trauma Center , San Francisco, California.,3 Department of Neurological Surgery and Brain and Spinal Injury Center, University of California , San Francisco, California
| | - David M Schnyer
- 4 Department of Psychology, University of Texas , Austin, Texas
| | - David O Okonkwo
- 5 Department of Neurological Surgery and Neurotrauma Clinical Trials Center, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Alex B Valadka
- 6 Department of Neurosurgery, Virginia Commonwealth University , Richmond, Virginia
| | - Wayne A Gordon
- 7 Department of Rehabilitation Medicine, Ichan School of Medicine at Mount Sinai , New York, New York
| | - Andrew I R Maas
- 8 Department of Neurosurgery, Antwerp University Hospital , Edegem, Belgium
| | - Mary Vassar
- 2 Brain and Spinal Cord Injury Center, San Francisco General Hospital and Trauma Center , San Francisco, California.,3 Department of Neurological Surgery and Brain and Spinal Injury Center, University of California , San Francisco, California
| | - Geoffrey T Manley
- 2 Brain and Spinal Cord Injury Center, San Francisco General Hospital and Trauma Center , San Francisco, California.,3 Department of Neurological Surgery and Brain and Spinal Injury Center, University of California , San Francisco, California
| | - Pratik Mukherjee
- 1 Department of Radiology and Biomedical Imaging, University of California , San Francisco, California.,2 Brain and Spinal Cord Injury Center, San Francisco General Hospital and Trauma Center , San Francisco, California
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