1
|
Yaseen A, Robertson C, Cruz Navarro J, Chen J, Heckler B, DeSantis SM, Temkin N, Barber J, Foreman B, Diaz-Arrastia R, Chesnut R, Manley GT, Wright DW, Vassar M, Ferguson AR, Markowitz AJ, Yamal JM. Integrating, Harmonizing, and Curating Studies With High-Frequency and Hourly Physiological Data: Proof of Concept from Seven Traumatic Brain Injury Data Sets. J Neurotrauma 2023; 40:2362-2375. [PMID: 37341031 DOI: 10.1089/neu.2023.0023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Research in severe traumatic brain injury (TBI) has historically been limited by studies with relatively small sample sizes that result in low power to detect small, yet clinically meaningful outcomes. Data sharing and integration from existing sources hold promise to yield larger more robust sample sizes that improve the potential signal and generalizability of important research questions. However, curation and harmonization of data of different types and of disparate provenance is challenging. We report our approach and experience integrating multiple TBI data sets containing collected physiological data, including both expected and unexpected challenges encountered in the integration process. Our harmonized data set included data on 1536 patients from the Citicoline Brain Injury Treatment Trial (COBRIT), Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial (EPO Severe TBI), BEST-TRIP, Progesterone for the Treatment of Traumatic Brain Injury III Clinical Trial (ProTECT III), Transforming Research and Clinical Knowledge in Traumatic brain Injury (TRACK-TBI), Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II (BOOST-2), and Ben Taub General Hospital (BTGH) Research Database studies. We conclude with process recommendations for data acquisition for future prospective studies to aid integration of these data with existing studies. These recommendations include using common data elements whenever possible, a standardized recording system for labeling and timing of high-frequency physiological data, and secondary use of studies in systems such as Federal Interagency Traumatic Brain Injury Research Informatics System (FITBIR), to engage investigators who collected the original data.
Collapse
Affiliation(s)
- Ashraf Yaseen
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Claudia Robertson
- Department of Neurosurgery, and University of Washington, Seattle, Washington, USA
| | - Jovany Cruz Navarro
- Department of Anesthesiology Baylor College of Medicine, University of Washington, Seattle, Washington, USA
| | - Jingxiao Chen
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Brian Heckler
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Stacia M DeSantis
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| | - Nancy Temkin
- Department of Department of Neurological Surgery and Biostatistics, University of Washington, Seattle, Washington, USA
| | - Jason Barber
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Randall Chesnut
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David W Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary Vassar
- Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adam R Ferguson
- Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amy J Markowitz
- Brain and Spinal Injury Center, University of California, San Francisco, San Francisco, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, USA
| |
Collapse
|
2
|
Bodien YG, Barber J, Taylor SR, Boase K, Corrigan JD, Dikmen S, Gardner RC, Kramer JH, Levin H, Machamer J, McAllister T, Nelson LD, Ngwenya LB, Sherer M, Stein MB, Vassar M, Whyte J, Yue JK, Markowitz A, McCrea MA, Manley GT, Temkin N, Giacino JT. Feasibility and Utility of a Flexible Outcome Assessment Battery for Longitudinal Traumatic Brain Injury Research: A TRACK-TBI Study. J Neurotrauma 2023; 40:337-348. [PMID: 36097759 PMCID: PMC9902043 DOI: 10.1089/neu.2022.0141] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The effects of traumatic brain injury (TBI) are difficult to measure in longitudinal cohort studies, because disparate pre-injury characteristics and injury mechanisms produce variable impairment profiles and recovery trajectories. In preparation for the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, which followed patients with injuries ranging from uncomplicated mild TBI to coma, we designed a multi-dimensional Flexible outcome Assessment Battery (FAB). The FAB relies on a decision-making algorithm that assigns participants to a Comprehensive (CAB) or Abbreviated Assessment Battery (AAB) and guides test selection across all phases of recovery. To assess feasibility of the FAB, we calculated the proportion of participants followed at 2 weeks (2w) and at 3, 6, and 12 months (3m, 6m, 12m) post-injury who completed the FAB and received valid scores. We evaluated utility of the FAB by examining differences in 6m and 12m Glasgow Outcome Scale-Extended (GOSE) scores between participant subgroups derived from the FAB-enabled versus traditional approach to outcome assessment applied at 2w. Among participants followed at 2w (n = 2094), 3m (n = 1871), 6m (n = 1736), and 12m (n = 1607) post-injury, 95-99% received valid completion scores on the FAB, in full or in part, either in person or by telephone. Level of function assessed by the FAB-enabled approach at 2w was associated with 6m and 12m GOSE scores (proportional odds p < 0.001). These findings suggest that the participant classification methodology afforded by the FAB may enable more effective data collection to improve detection of natural history changes and TBI treatment effects.
Collapse
Affiliation(s)
- Yelena G. Bodien
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Jason Barber
- University of Washington, Seattle, Washington, USA
| | - Sabrina R. Taylor
- University of California, San Francisco, San Francisco, California, USA
| | - Kim Boase
- University of Washington, Seattle, Washington, USA
| | | | | | - Raquel C. Gardner
- University of California, San Francisco, San Francisco, California, USA
| | - Joel H. Kramer
- University of California, San Francisco, San Francisco, California, USA
| | | | | | - Thomas McAllister
- University of Indiana School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Mark Sherer
- Baylor College of Medicine, Houston, Texas, USA
- TIRR Memorial Hermann, Houston, Texas, USA
| | - Murray B. Stein
- University of California San Diego, La Jolla, California, USA
| | - Mary Vassar
- University of California, San Francisco, San Francisco, California, USA
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA
| | - John K. Yue
- University of California, San Francisco, San Francisco, California, USA
| | - Amy Markowitz
- University of California, San Francisco, San Francisco, California, USA
| | | | | | - Nancy Temkin
- University of Washington, Seattle, Washington, USA
| | - Joseph T. Giacino
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| |
Collapse
|
3
|
Gardner RC, Puccio AM, Korley FK, Wang KKW, Diaz-Arrastia R, Okonkwo DO, Puffer RC, Yuh EL, Yue JK, Sun X, Taylor SR, Mukherjee P, Jain S, Manley GT, Ferguson AR, Gaudette E, Shankar GC, Keene D, Madden C, Martin A, McCrea M, Merchant R, Mukherjee P, Ngwenya LB, Robertson C, Temkin N, Vassar M, Yue JK, Zafonte R. Effects of age and time since injury on traumatic brain injury blood biomarkers: a TRACK-TBI study. Brain Commun 2022; 5:fcac316. [PMID: 36642999 PMCID: PMC9832515 DOI: 10.1093/braincomms/fcac316] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/07/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Older adults have the highest incidence of traumatic brain injury globally. Accurate blood-based biomarkers are needed to assist with diagnosis of patients across the spectrum of age and time post-injury. Several reports have suggested lower accuracy for blood-based biomarkers in older adults, and there is a paucity of data beyond day-1 post-injury. Our aims were to investigate age-related differences in diagnostic accuracy and 2-week evolution of four leading candidate blood-based traumatic brain injury biomarkers-plasma glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, S100 calcium binding protein B and neuron-specific enolase-among participants in the 18-site prospective cohort study Transforming Research And Clinical Knowledge in Traumatic Brain Injury. Day-1 biomarker data were available for 2602 participants including 2151 patients with traumatic brain injury, 242 orthopedic trauma controls and 209 healthy controls. Participants were stratified into 3 age categories (young: 17-39 years, middle-aged: 40-64 years, older: 65-90 years). We investigated age-stratified biomarker levels and biomarker discriminative abilities across three diagnostic groups: head CT-positive/negative; traumatic brain injury/orthopedic controls; and traumatic brain injury/healthy controls. The difference in day-1 glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1 and neuron-specific enolase levels across most diagnostic groups was significantly smaller for older versus younger adults, resulting in a narrower range within which a traumatic brain injury diagnosis may be discriminated in older adults. Despite this, day-1 glial fibrillary acidic protein had good to excellent performance across all age-categories for discriminating all three diagnostic groups (area under the curve 0.84-0.96; lower limit of 95% confidence intervals all >0.78). Day-1 S100 calcium-binding protein B and ubiquitin carboxy-terminal hydrolase L1 showed good discrimination of CT-positive versus negative only among adults under age 40 years within 6 hours of injury. Longitudinal blood-based biomarker data were available for 522 hospitalized patients with traumatic brain injury and 24 hospitalized orthopaedic controls. Glial fibrillary acidic protein levels maintained good to excellent discrimination across diagnostic groups until day 3 post-injury irrespective of age, until day 5 post-injury among middle-aged or younger patients and until week 2 post-injury among young patients only. In conclusion, the blood-based glial fibrillary acidic protein assay tested here has good to excellent performance across all age-categories for discriminating key traumatic brain injury diagnostic groups to at least 3 days post-injury in this trauma centre cohort. The addition of a blood-based diagnostic to the evaluation of traumatic brain injury, including geriatric traumatic brain injury, has potential to streamline diagnosis.
Collapse
Affiliation(s)
- Raquel C Gardner
- Correspondence to: Raquel C. Gardner, MD Sheba Medical Center, Derech Sheba 2 Ramat Gan, Israel 52621 E-mail:
| | - Ava M Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kevin K W Wang
- Departments of Emergency Medicine, Psychiatry, and Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA,Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd., 32608, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Ross C Puffer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA,Department of Neurological Surgery, Mayo Clinic, Rochester, MN 55901, USA
| | - Esther L Yuh
- Department of Radiology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Xiaoying Sun
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA 92161, USA
| | - Sabrina R Taylor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Pratik Mukherjee
- Department of Radiology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA 92161, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Ferrell MC, Khojasteh J, Vassar M. Public awareness of cardiopulmonary resuscitation and cardiac arrest in association with Christian Eriksen. Public Health 2022; 212:42-45. [PMID: 36208501 DOI: 10.1016/j.puhe.2022.08.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES During the Union of European Football Association EURO 2020 Football Championship, Danish football player Christian Eriksen experienced a cardiac arrest on the field of play. With prompt intervention and cardiopulmonary resuscitation (CPR), Erikson had a positive outcome and survived the arrest. Our goal is to determine the extent to which this event informed the general population about cardiac arrests and CPR. STUDY DESIGN This was a cross-sectional internet analysis. METHODS First, Google Trends was used to identify the search interest of topics "Cardiopulmonary resuscitation," "Myocardial infarction," and disease "Cardiac arrest" worldwide from May 29, 2021, to June 19, 2021. Second, we downloaded Twitter data via Sprout Social using the keywords "CPR" and "cardiac arrest," which are presented as the absolute number of tweets. An ARIMA model was used to forecast expected search volumes. RESULTS The following week, there was an increase of 91.72% (95% confidence interval [CI] 89.01-94.93) for "Cardiac arrest" above expected values, an 80.67% (95% CI 75.84-85.5) increase for "Cardiopulmonary resuscitation," and a 65.50% (95% CI 62.98-68.02) increase for "Myocardial infarction." Within Twitter, there was a peak increase in daily tweets using "CPR" by 184,706 (95% CI 181,933-187,479) beyond expected values and a peak increase in the daily tweets using "cardiac arrest" by 73,126 (95% CI 72,499-73,752). CONCLUSION Although all cardiac arrests are undesirable, public knowledge of the positive effects of CPR could contribute to a means of promoting and increasing the desire for CPR awareness as well as its application.
Collapse
Affiliation(s)
- M C Ferrell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
| | - J Khojasteh
- Research, Evaluation, Measurement and Statistics, Oklahoma State University-Tulsa, Tulsa, OK, USA
| | - M Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
5
|
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
|
6
|
McIntire R, Howard C, Stewart C, McIntosh H, Vassar M. The use of superlatives in news articles pertaining to asthma treatment. Pulmonology 2022; 28:228-230. [DOI: 10.1016/j.pulmoe.2021.12.005] [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] [Received: 12/18/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022] Open
|
7
|
Bodien Y, Barra A, Temkin N, Barber J, Foreman B, Vassar M, Robertson CS, Taylor SR, Markowitz AJ, Manley GT, Giacino J, Edlow BL. Diagnosing Level of Consciousness: The Limits of the Glasgow Coma Scale Total Score. J Neurotrauma 2021; 38:3295-3305. [PMID: 34605668 DOI: 10.1089/neu.2021.0199] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 10/20/2022] Open
Abstract
In nearly all clinical and research contexts, the initial severity of a traumatic brain injury (TBI) is measured using the Glasgow Coma Scale (GCS) total score. However, the GCS total score may not accurately reflect level of consciousness, a critical indicator of injury severity. We investigated the relationship between GCS total scores and level of consciousness in a consecutive sample of 2,455 adult subjects assessed with the GCS 69,487 times as part of the multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. We assigned each GCS subscale score combination a level of consciousness rating based upon published criteria for the following disorders of consciousness (DoC) diagnoses: coma, vegetative state/unresponsive wakefulness syndrome, minimally conscious state, and post-traumatic confusional state, and present our findings using summary statistics and four illustrative cases. Participants had the following characteristics: mean (standard deviation) age 41.9 (17.6) years, 69% male, initial GCS 3-8=13%; 9-12=5%; 13-15=82%. All GCS total scores between 4-14 were associated with more than one DoC diagnosis; the greatest variability was observed for scores of 7-11. Furthermore, a wide range of total scores were associated with identical DoC diagnoses. Importantly, a diagnosis of coma was only possible with GCS total scores of 3-6. The GCS total score does not accurately reflect level of consciousness based on published DoC diagnostic criteria. To improve the classification of patients with TBI and to inform the design of future clinical trials, clinicians and investigators should consider individual subscale behaviors and more comprehensive assessments when evaluating TBI severity.
Collapse
Affiliation(s)
- Yelena Bodien
- Massachusetts General Hospital, 2348, Neurology, Boston, Massachusetts, United States.,Spaulding Rehabilitation Hospital, 24498, Physical Medicine and Rehabilitation, Charlestown, Massachusetts, United States;
| | | | - Nancy Temkin
- University of Washington, 7284, Departments of Neurological Surgery and Biostatistics, Seattle, Washington, United States;
| | - Jason Barber
- University of Washington, 7284, Seattle, Washington, United States;
| | - Brandon Foreman
- University of Cincinnati, Neurology, Cincinnati, Ohio, United States;
| | - Mary Vassar
- University of California San Francisco, 8785, San Francisco, California, United States;
| | - Claudia S Robertson
- Baylor College of Medicine, Neurosurgery, One Baylor Plaza, Houston, Texas, United States, 77030;
| | - Sabrina R Taylor
- University of California San Francisco Department of Neurological Surgery, 189227, San Francisco, California, United States;
| | - Amy J Markowitz
- University of California, San Francisco, Brain and Spinal Injury Center (BASIC), 1001 Potrero Ave, Bldg 1 Rm 101, San Francisco, California, United States, 94110;
| | - Geoffrey T Manley
- University of California San Francisco, Neurosurgery, San Francisco, California, United States.,UCSF Weill Institute for Neurosciences, San Francisco, California, United States;
| | - Joseph Giacino
- Spaulding Rehabilitation Hospital, 24498, PM&R, 300 1st Ave, Charlestown, Massachusetts, United States, 02129-3109;
| | - Brian L Edlow
- Harvard Medical School, 1811, 175 Cambridge Street - Suite 300, Boston, Massachusetts, United States, 02115.,Massachusetts General Hospital, 2348, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States;
| |
Collapse
|
8
|
McCrea MA, Giacino JT, Barber J, Temkin NR, Nelson LD, Levin HS, Dikmen S, Stein M, Bodien YG, Boase K, Taylor SR, Vassar M, Mukherjee P, Robertson C, Diaz-Arrastia R, Okonkwo DO, Markowitz AJ, Manley GT, Adeoye O, Badjatia N, Bullock MR, Chesnut R, Corrigan JD, Crawford K, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson AR, Foreman B, Gardner R, Gaudette E, Goldman D, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Jain S, Keene CD, Korley FK, Kramer J, Kreitzer N, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, Merchant R, Ngwenya LB, Noel F, Nolan A, Palacios E, Perl D, Puccio A, Rabinowitz M, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Sherer M, Toga A, Valadka A, Wang K, Yue JK, Yuh E, Zafonte R. Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study. JAMA Neurol 2021; 78:982-992. [PMID: 34228047 DOI: 10.1001/jamaneurol.2021.2043] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Moderate to severe traumatic brain injury (msTBI) is a major cause of death and disability in the US and worldwide. Few studies have enabled prospective, longitudinal outcome data collection from the acute to chronic phases of recovery after msTBI. Objective To prospectively assess outcomes in major areas of life function at 2 weeks and 3, 6, and 12 months after msTBI. Design, Setting, and Participants This cohort study, as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, was conducted at 18 level 1 trauma centers in the US from February 2014 to August 2018 and prospectively assessed longitudinal outcomes, with follow-up to 12 months postinjury. Participants were patients with msTBI (Glasgow Coma Scale scores 3-12) extracted from a larger group of patients with mild, moderate, or severe TBI who were enrolled in TRACK-TBI. Data analysis took place from October 2019 to April 2021. Exposures Moderate or severe TBI. Main Outcomes and Measures The Glasgow Outcome Scale-Extended (GOSE) and Disability Rating Scale (DRS) were used to assess global functional status 2 weeks and 3, 6, and 12 months postinjury. Scores on the GOSE were dichotomized to determine favorable (scores 4-8) vs unfavorable (scores 1-3) outcomes. Neurocognitive testing and patient reported outcomes at 12 months postinjury were analyzed. Results A total of 484 eligible patients were included from the 2679 individuals in the TRACK-TBI study. Participants with severe TBI (n = 362; 283 men [78.2%]; median [interquartile range] age, 35.5 [25-53] years) and moderate TBI (n = 122; 98 men [80.3%]; median [interquartile range] age, 38 [25-53] years) were comparable on demographic and premorbid variables. At 2 weeks postinjury, 36 of 290 participants with severe TBI (12.4%) and 38 of 93 participants with moderate TBI (41%) had favorable outcomes (GOSE scores 4-8); 301 of 322 in the severe TBI group (93.5%) and 81 of 103 in the moderate TBI group (78.6%) had moderate disability or worse on the DRS (total score ≥4). By 12 months postinjury, 142 of 271 with severe TBI (52.4%) and 54 of 72 with moderate TBI (75%) achieved favorable outcomes. Nearly 1 in 5 participants with severe TBI (52 of 270 [19.3%]) and 1 in 3 with moderate TBI (23 of 71 [32%]) reported no disability (DRS score 0) at 12 months. Among participants in a vegetative state at 2 weeks, 62 of 79 (78%) regained consciousness and 14 of 56 with available data (25%) regained orientation by 12 months. Conclusions and Relevance In this study, patients with msTBI frequently demonstrated major functional gains, including recovery of independence, between 2 weeks and 12 months postinjury. Severe impairment in the short term did not portend poor outcomes in a substantial minority of patients with msTBI. When discussing prognosis during the first 2 weeks after injury, clinicians should be particularly cautious about making early, definitive prognostic statements suggesting poor outcomes and withdrawal of life-sustaining treatment in patients with msTBI.
Collapse
Affiliation(s)
- Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Harvey S Levin
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Sureyya Dikmen
- Department of Neurological Surgery, University of Washington, Seattle
| | - Murray Stein
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Kim Boase
- Department of Neurological Surgery, University of Washington, Seattle
| | - Sabrina R Taylor
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Mary Vassar
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Pratik Mukherjee
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Claudia Robertson
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | | | - David O Okonkwo
- Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amy J Markowitz
- Neurological Surgery, University of California, San Francisco, San Francisco
| | - Geoffrey T Manley
- Neurological Surgery, University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sonia Jain
- University of California, San Diego, La Jolla
| | | | | | - Joel Kramer
- University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | - Amber Nolan
- University of California, San Francisco, San Francisco
| | - Eva Palacios
- University of California, San Francisco, San Francisco
| | - Daniel Perl
- Uniformed Services University, Bethesda, Maryland
| | - Ava Puccio
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | - Arthur Toga
- University of Southern California, Los Angeles
| | | | | | - John K Yue
- University of California, San Francisco, San Francisco
| | - Esther Yuh
- University of California, San Francisco, San Francisco
| | | |
Collapse
|
9
|
Yuh EL, Jain S, Sun X, Pisica D, Harris MH, Taylor SR, Markowitz AJ, Mukherjee P, Verheyden J, Giacino JT, Levin HS, McCrea M, Stein MB, Temkin NR, Diaz-Arrastia R, Robertson CS, Lingsma HF, Okonkwo DO, Maas AIR, Manley GT, Adeoye O, Badjatia N, Boase K, Bodien Y, Corrigan JD, Crawford K, Dikmen S, Duhaime AC, Ellenbogen R, Feeser VR, Ferguson AR, Foreman B, Gardner R, Gaudette E, Gonzalez L, Gopinath S, Gullapalli R, Hemphill JC, Hotz G, Keene CD, Kramer J, Kreitzer N, Lindsell C, Machamer J, Madden C, Martin A, McAllister T, Merchant R, Nelson L, Ngwenya LB, Noel F, Nolan A, Palacios E, Perl D, Rabinowitz M, Rosand J, Sander A, Satris G, Schnyer D, Seabury S, Toga A, Valadka A, Vassar M, Zafonte R. Pathological Computed Tomography Features Associated With Adverse Outcomes After Mild Traumatic Brain Injury: A TRACK-TBI Study With External Validation in CENTER-TBI. JAMA Neurol 2021; 78:1137-1148. [PMID: 34279565 PMCID: PMC8290344 DOI: 10.1001/jamaneurol.2021.2120] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Question Are different patterns of intracranial injury on head computed tomography associated with prognosis after mild traumatic brain injury (mTBI)? Findings In this cohort study, subarachnoid hemorrhage, subdural hematoma, and contusion often co-occurred and were associated with both incomplete recovery and more severe impairment out to 12 months after injury, while intraventricular and/or petechial hemorrhage co-occurred and were associated with more severe impairment up to 12 months after injury; epidural hematoma was associated with incomplete recovery at some points but not with more severe impairment. Some intracranial hemorrhage patterns were more strongly associated with outcomes than previously validated demographic and clinical variables. Meaning In this study, different pathological features on head computed tomography carried different implications for mild traumatic brain injury prognosis to 1 year. Importance A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT features have been shown to be associated with outcomes. In mild TBI (mTBI; GCS scores 13-15), distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood. Objective To identify pathological CT features associated with adverse outcomes after mTBI. Design, Setting, and Participants The longitudinal, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled patients with TBI, including those 17 years and older with GCS scores of 13 to 15 who presented to emergency departments at 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018, and underwent head CT imaging within 24 hours of TBI. Evaluations of CT imaging used TBI Common Data Elements. Glasgow Outcome Scale–Extended (GOSE) scores were assessed at 2 weeks and 3, 6, and 12 months postinjury. External validation of results was performed via the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Data analyses were completed from February 2020 to February 2021. Exposures Acute nonpenetrating head trauma. Main Outcomes and Measures Frequency, co-occurrence, and clustering of CT features; incomplete recovery (GOSE scores <8 vs 8); and an unfavorable outcome (GOSE scores <5 vs ≥5) at 2 weeks and 3, 6, and 12 months. Results In 1935 patients with mTBI (mean [SD] age, 41.5 [17.6] years; 1286 men [66.5%]) in the TRACK-TBI cohort and 2594 patients with mTBI (mean [SD] age, 51.8 [20.3] years; 1658 men [63.9%]) in an external validation cohort, hierarchical cluster analysis identified 3 major clusters of CT features: contusion, subarachnoid hemorrhage, and/or subdural hematoma; intraventricular and/or petechial hemorrhage; and epidural hematoma. Contusion, subarachnoid hemorrhage, and/or subdural hematoma features were associated with incomplete recovery (odds ratios [ORs] for GOSE scores <8 at 1 year: TRACK-TBI, 1.80 [95% CI, 1.39-2.33]; CENTER-TBI, 2.73 [95% CI, 2.18-3.41]) and greater degrees of unfavorable outcomes (ORs for GOSE scores <5 at 1 year: TRACK-TBI, 3.23 [95% CI, 1.59-6.58]; CENTER-TBI, 1.68 [95% CI, 1.13-2.49]) out to 12 months after injury, but epidural hematoma was not. Intraventricular and/or petechial hemorrhage was associated with greater degrees of unfavorable outcomes up to 12 months after injury (eg, OR for GOSE scores <5 at 1 year in TRACK-TBI: 3.47 [95% CI, 1.66-7.26]). Some CT features were more strongly associated with outcomes than previously validated variables (eg, ORs for GOSE scores <5 at 1 year in TRACK-TBI: neuropsychiatric history, 1.43 [95% CI .98-2.10] vs contusion, subarachnoid hemorrhage, and/or subdural hematoma, 3.23 [95% CI 1.59-6.58]). Findings were externally validated in 2594 patients with mTBI enrolled in the CENTER-TBI study. Conclusions and Relevance In this study, pathological CT features carried different prognostic implications after mTBI to 1 year postinjury. Some patterns of injury were associated with worse outcomes than others. These results support that patients with mTBI and these CT features need TBI-specific education and systematic follow-up.
Collapse
Affiliation(s)
- Esther L Yuh
- Brain and Spinal Injury Center, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Xiaoying Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Dana Pisica
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mark H Harris
- Brain and Spinal Injury Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco, San Francisco
| | - Sabrina R Taylor
- Brain and Spinal Injury Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco, San Francisco
| | - Amy J Markowitz
- Brain and Spinal Injury Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco, San Francisco
| | - Pratik Mukherjee
- Brain and Spinal Injury Center, San Francisco, California.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
| | - Jan Verheyden
- Research and Development, Icometrix, Leuven, Belgium
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Harvey S Levin
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla.,Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle
| | | | | | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Geoffrey T Manley
- Brain and Spinal Injury Center, San Francisco, California.,Department of Neurological Surgery, University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Joel Kramer
- University of California, San Francisco, San Francisco
| | | | | | | | | | | | | | | | | | | | | | - Amber Nolan
- University of California, San Francisco, San Francisco
| | - Eva Palacios
- University of California, San Francisco, San Francisco
| | - Daniel Perl
- Uniformed Services University, Bethesda, Maryland
| | | | | | | | | | | | | | - Arthur Toga
- University of Southern California, Los Angeles
| | | | - Mary Vassar
- University of California, San Francisco, San Francisco
| | | |
Collapse
|
10
|
Wright B, Johnson B, Saidian A, Rais-Bahrami S, Vassar M, Gunn A. Abstract No. 110 Trans-arterial embolization of renal cell carcinoma: a systematic review and meta-analysis. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.116] [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: 11/28/2022] Open
|
11
|
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
|
12
|
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
|
13
|
Bodien Y, Sherer M, Taylor S, Dikmen S, Yue J, Stein M, Corrigan J, Levin H, Temkin N, Machamer J, Boase K, Vassar M, McCrea M, McAllister T, Whyte J, Barber J, Gardner R, Kramer J, Nelson L, Manley G, Giacino J. Feasibility and Utility of a Flexible Outcome Assessment Battery for Use in Longitudinal Traumatic Brain Injury Research. Arch Phys Med Rehabil 2020. [DOI: 10.1016/j.apmr.2020.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
14
|
Wayant C, Puljak L, Bibens M, Vassar M. Risk of Bias and Quality of Reporting in Colon and Rectal Cancer Systematic Reviews Cited by National Comprehensive Cancer Network Guidelines. J Gen Intern Med 2020; 35:2352-2356. [PMID: 31950401 PMCID: PMC7403354 DOI: 10.1007/s11606-020-05639-y] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/03/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Given the changing landscape of colorectal cancer, systematic reviews are likely to play a key role in advancing the understanding of prevention, diagnosis, and treatment. METHODS We conducted a cross-sectional investigation of the risk of bias and reporting quality of systematic reviews referenced by colon and rectal cancer National Comprehensive Cancer Network (NCCN) guidelines. We used two widely accepted tools: Risk of Bias in Systematic reviews (ROBIS) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Using ROBIS, only 3 (4.8%) systematic reviews were judged with low risk of bias, 35 (55.6%) systematic reviews were judged with unclear risk of bias, and 25 (39.7%) systematic reviews were judged with high risk of bias. Across all systematic reviews, the individual bias domains at the highest risk of bias were domains 1 (protocol and eligibility criteria) and 2 (methods to identify and select studies). Across all studies, the median adherence to PRISMA was 74.1% (IQR 69.2-80.0%), corresponding to approximately 20 of 27 items. CONCLUSIONS Systematic reviews cited in NCCN guidelines for colon and rectal cancer are frequently at unclear or high risk of bias and do not report key systematic review items that are important for the critical appraisal of results.
Collapse
Affiliation(s)
- C Wayant
- Department of Biomedical Sciences, Oklahoma State University Center for Health Sciences, 1111 West 17th Street, Tulsa, OK, 74104, USA.
| | - L Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, 10000, Zagreb, Croatia
| | - M Bibens
- Department of Psychiatry and Behavioral Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, 74104, USA
| | - M Vassar
- Department of Psychiatry and Behavioral Health, Oklahoma State University Center for Health Sciences, Tulsa, OK, 74104, USA
| |
Collapse
|
15
|
Smith CA, Nolan J, Tritz DJ, Heavener TE, Pelton J, Cook K, Vassar M. Evaluation of reproducible and transparent research practices in pulmonology. Pulmonology 2020; 27:134-143. [PMID: 32739326 DOI: 10.1016/j.pulmoe.2020.07.001] [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: 01/10/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Study reproducibility is valuable for validating or refuting results. Provision of reproducibility indicators, such as materials, protocols, and raw data in a study improve its potential for reproduction. Efforts to reproduce noteworthy studies in the biomedical sciences have resulted in an overwhelming majority of them being found to be unreplicable, causing concern for the integrity of research in other fields, including medical specialties. Here, we analyzed the reproducibility of studies in the field of pulmonology. METHODS 500 pulmonology articles were randomly selected from an initial PubMed search for data extraction. Two authors scoured these articles for reproducibility indicators including materials, protocols, raw data, analysis scripts, inclusion in systematic reviews, and citations by replication studies as well as other factors of research transparency including open accessibility, funding source and competing interest disclosures, and study preregistration. FINDINGS Few publications included statements regarding materials (10%), protocols (1%), data (15%), and analysis script (0%) availability. Less than 10% indicated preregistration. More than half of the publications analyzed failed to provide a funding statement. Conversely, 63% of the publications were open access and 73% included a conflict of interest statement. INTERPRETATION Overall, our study indicates pulmonology research is currently lacking in efforts to increase replicability. Future studies should focus on providing sufficient information regarding materials, protocols, raw data, and analysis scripts, among other indicators, for the sake of clinical decisions that depend on replicable or refutable results from the primary literature.
Collapse
Affiliation(s)
- C A Smith
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74107 USA.
| | - J Nolan
- Kansas City University of Medicine and Biosciences, 2901 St Johns Blvd, Joplin, MO 64804, USA
| | - D J Tritz
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74107 USA
| | - T E Heavener
- Department of Medicine, Citizens Memorial Hospital, 1500 N. Oakland Ave, Bolivar, MO 65613 USA
| | - J Pelton
- Department of Internal Medicine, Oklahoma State University Medical Center, 744 W. 9th St., Tulsa, OK 74127 USA
| | - K Cook
- Department of Internal Medicine, Oklahoma State University Medical Center, 744 W. 9th St., Tulsa, OK 74127 USA
| | - M Vassar
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, 1111 W. 17th St., Tulsa, OK 74107 USA
| |
Collapse
|
16
|
Bindernagel R, Cook C, Wayant C, Jellison S, Vassar M. Assessing the quality of intervention reporting in dermatology randomized controlled trials using the TIDieR checklist. Br J Dermatol 2020; 183:1114-1115. [PMID: 32628774 DOI: 10.1111/bjd.19382] [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] [Received: 08/26/2019] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/01/2022]
Affiliation(s)
- R Bindernagel
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - C Cook
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - C Wayant
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - S Jellison
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - M Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
17
|
Ottwell R, Rogers TC, Johnson AL, Jaiswal D, Beswick T, Vassar M. Superlative use in news articles pertaining to dermatologic therapies: a cross-sectional analysis. J Eur Acad Dermatol Venereol 2020; 34:e637-e640. [PMID: 32311180 DOI: 10.1111/jdv.16508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Ottwell
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - T C Rogers
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - A L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - D Jaiswal
- Oklahoma State University Medical Center, Tulsa, OK, USA
| | - T Beswick
- Center for Dermatology, Tulsa, OK, USA
| | - M Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
18
|
Ercole A, Brinck V, George P, Hicks R, Huijben J, Jarrett M, Vassar M, Wilson L. Guidelines for Data Acquisition, Quality and Curation for Observational Research Designs (DAQCORD). J Clin Transl Sci 2020; 4:354-359. [PMID: 33244417 PMCID: PMC7681114 DOI: 10.1017/cts.2020.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND High-quality data are critical to the entire scientific enterprise, yet the complexity and effort involved in data curation are vastly under-appreciated. This is especially true for large observational, clinical studies because of the amount of multimodal data that is captured and the opportunity for addressing numerous research questions through analysis, either alone or in combination with other data sets. However, a lack of details concerning data curation methods can result in unresolved questions about the robustness of the data, its utility for addressing specific research questions or hypotheses and how to interpret the results. We aimed to develop a framework for the design, documentation and reporting of data curation methods in order to advance the scientific rigour, reproducibility and analysis of the data. METHODS Forty-six experts participated in a modified Delphi process to reach consensus on indicators of data curation that could be used in the design and reporting of studies. RESULTS We identified 46 indicators that are applicable to the design, training/testing, run time and post-collection phases of studies. CONCLUSION The Data Acquisition, Quality and Curation for Observational Research Designs (DAQCORD) Guidelines are the first comprehensive set of data quality indicators for large observational studies. They were developed around the needs of neuroscience projects, but we believe they are relevant and generalisable, in whole or in part, to other fields of health research, and also to smaller observational studies and preclinical research. The DAQCORD Guidelines provide a framework for achieving high-quality data; a cornerstone of health research.
Collapse
Affiliation(s)
- Ari Ercole
- Department of Medicine, Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | | | - Pradeep George
- International Neuroinformatics Coordinating Facility, Karolinska Institutet, Stockholm, Sweden
| | | | - Jilske Huijben
- Department of Public Health, Center for Medical Decision Sciences, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mary Vassar
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | | |
Collapse
|
19
|
Wayant C, Margalski D, Vaughn K, Vassar M. Evaluation of spin in oncology clinical trials. Crit Rev Oncol Hematol 2019; 144:102821. [DOI: 10.1016/j.critrevonc.2019.102821] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/30/2022] Open
|
20
|
Austin J, Smith C, Natarajan K, Som M, Wayant C, Vassar M. Evaluation of spin within abstracts in obesity randomized clinical trials: A cross-sectional review. Clin Obes 2019; 9:e12292. [PMID: 30576083 DOI: 10.1111/cob.12292] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/30/2018] [Accepted: 11/23/2018] [Indexed: 01/25/2023]
Abstract
This is a cross-sectional analysis of spin in randomized controlled trial (RCT) abstracts published in top-ranked obesity and general medicine journals. The top seven obesity and four general medicine journals were searched from 1 January 2016 to 31 December 2017. To be included in this study, a trial must be an RCT with non-significant primary endpoint (P > 0.05), exclusively randomize subjects with overweight or obesity or have a primary endpoint of weight loss. These studies were analysed by two reviewers for spin in the abstract. The primary endpoint of our investigation was the frequency and type of spin. The secondary endpoint was to assess whether funding source was associated with the presence of spin. Our PubMed search yielded 1143 articles. Primary screening excluded 992 articles, and full-text evaluation excluded an additional 106. Overall, 45 articles were included. Spin was identified in 21 of the 45 (46.7%) abstracts analysed. Evidence of spin was found in 17 (37.8%) abstract result sections and 11 (24.4%) abstract conclusion sections. Of the 39 RCTs reporting a clinical trial registry, 6 (15.4%) had evidence of selective reporting bias. Our study found that obesity medicine RCTs from top-ranked journals with non-significant primary endpoints published in 2016 and 2017 frequently have spin in their abstracts. Abstracts with evidence of spin may influence a reader's perception of new drugs or procedures. These results warrant a careful review of future RCTs, but may not be generalizable to RCTs published in lower-ranked journals.
Collapse
Affiliation(s)
- J Austin
- Department of Psychiatry, Oklahoma State University-Center for Health Sciences, Tulsa, OK, USA
| | - C Smith
- Internal Medicine, Oklahoma State University, Stillwater, OK, USA
| | - K Natarajan
- Oklahoma State University Medical Center, Tulsa, OK, USA
| | - M Som
- Oklahoma State University Medical Center, Tulsa, OK, USA
| | - C Wayant
- Department of Psychiatry, Oklahoma State University-Center for Health Sciences, Tulsa, OK, USA
| | - M Vassar
- Department of Psychiatry, Oklahoma State University-Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
21
|
Wayant C, Vassar M. A comparison of matched interim analysis publications and final analysis publications in oncology clinical trials. Ann Oncol 2018; 29:2384-2390. [DOI: 10.1093/annonc/mdy447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
|
22
|
Affiliation(s)
- T. Combs
- Oklahoma State University Center for Health Sciences - College of Osteopathic Medicine; 1111 W 17th St Tulsa OK 74107-1898 U.S.A
| | - P. Atakpo
- Oklahoma State University Center for Health Sciences - College of Osteopathic Medicine; 1111 W 17th St Tulsa OK 74107-1898 U.S.A
| | - M. Vassar
- Oklahoma State University Center for Health Sciences; Department of Behavioral Sciences; Tulsa OK U.S.A
| |
Collapse
|
23
|
Cook C, Checketts J, Atakpo P, Nelson N, Vassar M. How well are reporting guidelines and trial registration used by dermatology journals to limit bias? A meta-epidemiological study. Br J Dermatol 2018; 178:1433-1434. [DOI: 10.1111/bjd.16135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Cook
- Oklahoma State University Center for Health Sciences; 1111 W. 17th St Tulsa OK 74017 U.S.A
| | - J.X. Checketts
- Oklahoma State University Center for Health Sciences; 1111 W. 17th St Tulsa OK 74017 U.S.A
| | - P. Atakpo
- Oklahoma State University Center for Health Sciences; 1111 W. 17th St Tulsa OK 74017 U.S.A
| | - N. Nelson
- Oklahoma State University Center for Health Sciences; 1111 W. 17th St Tulsa OK 74017 U.S.A
| | - M. Vassar
- Oklahoma State University Center for Health Sciences; 1111 W. 17th St Tulsa OK 74017 U.S.A
| |
Collapse
|
24
|
Ross A, Young J, Hedin R, Aran G, Demand A, Stafford A, Worley J, Moore M, Vassar M. A systematic review of outcomes in postoperative pain studies in paediatric and adolescent patients: towards development of a core outcome set. Anaesthesia 2018; 73:375-383. [DOI: 10.1111/anae.14211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 12/13/2022]
Affiliation(s)
- A. Ross
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - J. Young
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - R. Hedin
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - G. Aran
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - A. Demand
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | | | - J. Worley
- University of Oklahoma-Tulsa; Tulsa Oklahoma USA
| | - M. Moore
- Oklahoma State University Medical Centre; Tulsa Oklahoma USA
| | - M. Vassar
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| |
Collapse
|
25
|
Umberham B, Hedin R, Detweiler B, Kollmorgen L, Hicks C, Vassar M. Heterogeneity of studies in anesthesiology systematic reviews: a meta-epidemiological review and proposal for evidence mapping. Br J Anaesth 2017; 119:874-884. [DOI: 10.1093/bja/aex251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 01/25/2023] Open
|
26
|
Wright M, Vassar M, Gordon J, Frye L, Po W, Babb C. Evaluating Research Pipelines in Clinical Research for Minimally Invasive Gynecologic Surgery Guidelines. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.339] [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: 10/18/2022]
|
27
|
Rankin J, Ross A, Baker J, O'Brien M, Scheckel C, Vassar M. Selective outcome reporting in obesity clinical trials: a cross-sectional review. Clin Obes 2017; 7:245-254. [PMID: 28557240 DOI: 10.1111/cob.12199] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/03/2017] [Accepted: 04/20/2017] [Indexed: 11/29/2022]
Abstract
Selective outcome reporting is a form of bias resulting from discrepancies between outcomes presented in a trial's registration and the published report. We investigate this selective bias in obesity clinical trials. A PubMed search was conducted to identify randomized controlled trials (RCTs) published in four obesity journals from 2013 to 2015. Primary, secondary and tertiary outcomes were recorded for each trial and compared to pre-specified outcomes in each trial's registration. Of the 392 identified articles, 142 were included in the final analysis; 22 (15%) RCTs demonstrated major outcome discrepancies between registration and publication: No primary outcomes were demoted to a secondary or tertiary outcome; 14 (36.84%) primary outcomes were omitted; 14 (36.84%) primary outcomes were added: 5 (13.16%) secondary outcomes were upgraded to primary outcomes; and timing of assessment for a primary outcome changed 5 (13.16%) times. Out of the 63 prospectively registered studies, 53 had no discrepancies. A total of 76 of the studies (29.80%) were unregistered or did not have an associated registration number. Our results suggest that selective outcome reporting may be a concern in obesity clinical trials. As selective outcome reporting may distort clinical findings and limit outcomes in systematic reviews, we encourage trialists and journal editors to work towards solutions to mitigate this issue.
Collapse
Affiliation(s)
- J Rankin
- Oklahoma State University, Department of Psychiatry, Center for Health Sciences, Tulsa, OK, USA
| | - A Ross
- Oklahoma State University, Department of Psychiatry, Center for Health Sciences, Tulsa, OK, USA
| | - J Baker
- Oklahoma State University, Department of Psychiatry, Center for Health Sciences, Tulsa, OK, USA
| | - M O'Brien
- Oklahoma State University, Department of Psychiatry, Center for Health Sciences, Tulsa, OK, USA
| | - C Scheckel
- Oklahoma State University, Department of Psychiatry, Center for Health Sciences, Tulsa, OK, USA
| | - M Vassar
- Oklahoma State University, Department of Psychiatry, Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
28
|
Herrmann D, Sinnett P, Holmes J, Khan S, Koller C, Vassar M. Statistical controversies in clinical research: publication bias evaluations are not routinely conducted in clinical oncology systematic reviews. Ann Oncol 2017; 28:931-937. [DOI: 10.1093/annonc/mdw691] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
29
|
Wayant C, Smith C, Sims M, Vassar M. Hematology journals do not sufficiently adhere to reporting guidelines: a systematic review. J Thromb Haemost 2017; 15:608-617. [PMID: 28122156 DOI: 10.1111/jth.13637] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/09/2016] [Indexed: 01/15/2023]
Abstract
Essentials Reporting guidelines and trial/review registration aim to limit bias in research. We systematically reviewed hematology journals to examine the use of these policies. Forty-eight percent of journals made no use of these policies. Improving the use of reporting guidelines will improve research for all stakeholders. SUMMARY Background Reporting guidelines and trial/review registration policies have been instituted in order to minimize bias and improve research practices. Objective The objective of this study was to investigate the policies of hematology journals concerning reporting guideline adoption and trial/review registration. Methods We performed a web-based data abstraction from the Instructions for Authors of 67 hematology journals catalogued in the Expanded Science Citation Index of the 2014 Journal Citation Reports to identify whether each journal required, recommended or made no mention of the following reporting guidelines: EQUATOR, ICMJE, CONSORT, MOOSE, QUOROM, PRISMA, STARD, STROBE, ARRIVE and CARE. We also extracted whether journals required or recommended trial or systematic review registration. We e-mailed editors three times to determine which types of studies their journal accepts. Results Forty-eight per cent (32/67) of hematology journals do not adhere to any reporting guidelines. For responding journals, the QUOROM statement, MOOSE, CARE and PROSPERO were the least often mentioned, whereas the ICMJE guidelines, CONSORT statement and general trial registration were most often mentioned. Discussion Reporting guidelines are infrequently required or recommended by hematology journals. Furthermore, few require clinical trial or systematic review database registration. A higher rate of adherence to reporting guidelines can prevent bias from entering the literature. Participation from all stakeholders, including authors and journal editors, to improve reporting guideline and policy practices is required.
Collapse
Affiliation(s)
- C Wayant
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - C Smith
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - M Sims
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - M Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
30
|
Chong AB, Taylor M, Schubert G, Vassar M. Interventional Radiology Clinical Practice Guideline Recommendations for Neurovascular Disorders Are Not Based on High-Quality Systematic Reviews. AJNR Am J Neuroradiol 2017; 38:759-765. [PMID: 28154125 DOI: 10.3174/ajnr.a5079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/02/2016] [Accepted: 11/22/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND In recent years, clinical practice guidelines have been criticized for biased interpretations of research evidence, and interventional radiology is no exception. PURPOSE Our aim was to evaluate the methodologic quality and transparency of reporting in systematic reviews used as evidence in interventional radiology clinical practice guidelines for neurovascular disorders from the Society of Interventional Radiology. DATA SOURCES Our sources were 9 neurovascular disorder clinical practice guidelines from the Society of Interventional Radiology. STUDY SELECTION We selected 65 systematic reviews and meta-analyses. DATA ANALYSIS A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) tools were used to assess the methodologic quality and reporting transparency of systematic reviews. Radial plots were created on the basis of average scores for PRISMA and AMSTAR items. DATA SYNTHESIS On the basis of AMSTAR scores, 3 (4.62%) reviews were high-quality, 28 reviews (43.08%) were moderate-quality, and 34 reviews (52.31%) were low-quality, with an average quality score of 3.66 (34.32%; minimum, 0%; maximum, 81.82%). The average PRISMA score was 18.18 (69.41%). LIMITATIONS We were unable to obtain previous versions for 8 reviews, 7 of which were from the Cochrane Database of Systematic Reviews. CONCLUSIONS The methodologic quality of systematic reviews needs to be improved. Although reporting clarity was much better than the methodologic quality, it still has room for improvement. The methodologic quality and transparency of reporting did not vary much among clinical practice guidelines. This study can also be applied to other medical specialties to examine the quality of studies used as evidence in their own clinical practice guidelines.
Collapse
Affiliation(s)
- A B Chong
- From the Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - M Taylor
- From the Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - G Schubert
- From the Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma
| | - M Vassar
- From the Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma.
| |
Collapse
|
31
|
Nissen T, Wayant C, Wahlstrom A, Sinnett P, Fugate C, Herrington J, Vassar M. Methodological quality, completeness of reporting and use of systematic reviews as evidence in clinical practice guidelines for paediatric overweight and obesity. Clin Obes 2017; 7:34-45. [PMID: 28112500 DOI: 10.1111/cob.12174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/13/2016] [Accepted: 11/01/2016] [Indexed: 12/18/2022]
Abstract
Paediatric obesity rates remain high despite extensive efforts to prevent and treat obesity in children. We investigated the quality of the methodology and reporting within systematic reviews (SRs) underpinning paediatric content in US clinical practice guidelines (CPGs). In June 2016 we searched guideline clearinghouses and professional organization websites for guidelines published by national or professional organizations in the United States from January 2007 onwards. In our primary, a priori analysis, we used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) instruments to score SRs and meta-analyses that included paediatric populations and were cited by included CPGs. In a secondary, post hoc analysis, we determined the extent to which US CPGs use available, relevant SRs and meta-analyses compared with non-US CPGs. Eight US-based CPGs with 27 references to 22 unique SRs were found. AMSTAR and PRISMA scores were low overall, with only three SRs having 'high' methodological quality. Items dealing with bias assessments and search strategies had especially low scores. US CPGs were also older on average and cited fewer SRs than their international counterparts. Low quality scores and dated guidelines should be a cause for concern among practicing clinicians and a call to action for future guideline developers, publishers and research institutions.
Collapse
Affiliation(s)
- T Nissen
- Analytical and Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - C Wayant
- Analytical and Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - A Wahlstrom
- Department of Pediatrics, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - P Sinnett
- Analytical and Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - C Fugate
- Department of Pediatrics, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - J Herrington
- Department of Emergency Medicine, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - M Vassar
- Analytical and Institutional Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Patel PA, Mallow PJ, Vassar M, Rizzo JA, Pandya BJ, Kruzikas DT. Traumatic Brain Injury: Patient Characteristics, Hospital Costs and Trends Over Time. J Health Econ Outcomes Res 2014; 2:108-118. [PMID: 37663583 PMCID: PMC10471361 DOI: 10.36469/9893] [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] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background: Traumatic brain injury (TBI) is an increasingly diagnosed condition, but the trends in TBI visits and the cost of which have not been quantified from the hospital perspective. Objectives: To quantify the costs of TBI stratified by inpatient and outpatient visits and to examine trends in TBI incidence over time. Methods: This descriptive study utilized data for 2007-2012 from the Premier hospital database, which includes clinical and utilization information from hospitals across the United States. TBI was identified through International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Descriptive data were obtained to identify the TBI costs, visit costs, patient characteristics, and intertemporal trends in TBI rates. Results: TBI patients were treated on an outpatient basis 88% of the time. Nearly 45% (44.3%) of TBI patients requiring inpatient admissions were age 65 or over, and 20% of TBI patients treated as an outpatient were age 75 or over. Children aged 4 or younger accounted for nearly 14% of TBI cases treated on an outpatient basis. TBI patients treated in the inpatient setting incurred fairly long hospital visits (mean 4.8 days; median 3.0 days) and substantial hospital costs (mean $12,717; median $8,176). The rate of TBI visits have risen substantially over time, especially among children under age 18 years and patients in the Northeast US Census Region. Conclusion: TBI is a serious medical condition that appears to be on the rise. Large differences exist between the hospital costs associated with TBIs treated in the inpatient and outpatient settings. Further research to understand factors affecting the costs and clinical outcomes of TBI can help refine treatment strategies to enhance patient outcomes while providing cost effective care.
Collapse
Affiliation(s)
| | - Peter J Mallow
- CTI Clinical Trial and Consulting Services, Cincinnati, OH, USA
| | - Mary Vassar
- University of California Brain and Spinal Injury Center, San Francisco, CA, USA
| | | | | | | |
Collapse
|
34
|
Sciortino S, Vassar M, Radetsky M, Knudson MM. San Francisco pedestrian injury surveillance: mapping, under-reporting, and injury severity in police and hospital records. Accid Anal Prev 2005; 37:1102-13. [PMID: 16084782 DOI: 10.1016/j.aap.2005.06.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Revised: 06/01/2005] [Accepted: 06/09/2005] [Indexed: 05/03/2023]
Abstract
GOALS Police reports of severely injured pedestrians help identify hazardous traffic areas in San Francisco, but they under-report non-fatal collisions. We set out to: identify injured pedestrians who were missing from police collision reports, see what biases exist in injury reporting and assess the utility of broad categories of police severe injury (including fatal) for mapping and analysis. METHODS We linked data on injured pedestrians from police collision reports listed in the Statewide Integrated Traffic Reporting System (SWITRS, n = 1991) with records of pedestrians treated at San Francisco General Hospital (SFGH, n = 1323) for 2000 and 2001. Data were analyzed using bivariate statistics, logistic regression and mapping. RESULTS : We found that police collision reports underestimated the number of injured pedestrians by 21% (531/2442). Pedestrians treated at SFGH who were African-American were less likely then whites (odds ratio = 0.55, p-value < or= 0.01), and females were more likely than males (odds ratio = 1.5, p-value < or = 0.01) to have a police collision report. Over 70% of pedestrians deemed by the police to have a severe injury received treatment at SFGH, regardless of the collision's distance from SFGH. The sensitivity of a police-designated severe injury (including fatal) was 69% and the specificity was 89% when compared with a known SFGH assessment. But, sensitivity declined when we included pedestrians without a SFGH record. CONCLUSION Though collision reports have demonstrated limitations, broad categories of police severity may be sensitive enough to map locations where numerous severe injuries occur, for timely countermeasure selection.
Collapse
Affiliation(s)
- Stanley Sciortino
- Community Health Education Section, San Francisco Department of Public Health, CA 94102, USA.
| | | | | | | |
Collapse
|
35
|
Kizer KW, Moran ME, Vassar M. Apparent change in the male:female ratio of incidence of urolithiasis in California. Med J Aust 1994; 160:448. [PMID: 8007873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
36
|
Affiliation(s)
- Kenneth W Klzer
- Department of Community and International HealthSchool of MedicineTB‐168 University of California DavisCalifornia95616
| | - Michael E Moran
- Albany Medical College319 S ManningBoulevardSuite 106AlbanyNew York12208
| | - Mary Vassar
- Department of Community and International HealthSchool of MedicineTB‐168 University of California DavisCalifornia95616
| |
Collapse
|