Brain injury : [BI]
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Brain injury : [BI] · Jan 2019
Loss of consciousness and altered mental state predicting depressive and post-concussive symptoms after mild traumatic brain injury.
Objective: Limited studies exist on the association between loss of consciousness (LOC) and altered mental state (AMS) and development of depressive and post-concussive symptoms within six months after mild traumatic brain injury (mTBI). We tested the hypothesis that presence of both LOC and AMS predict the highest risk of symptoms within the first six months post-mTBI compared to either variable alone, and that LOC alone is more strongly associated with these symptoms. Research design: We analyzed data from 407 subjects with mTBI from the Head injury S erum M arkers for A ssessing R esponse to T rauma (HeadSMART) cohort, a prospective cohort of patients post-TBI presenting to two urban emergency departments. ⋯ LOC was associated only with post-concussive symptoms at one month (OR = 1.55;p = .048). Among those without LOC, AMS was associated with depressive symptoms at one month (OR = 2.24; p = .028). Conclusions: AMS predicts post-mTBI depressive symptoms both in the acute and chronic mTBI phases whereas LOC is a more sensitive predictor of post-concussive symptoms in the acute mTBI period.
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Background: It is essential to identify factors that predict helmet use, so as to mitigate the injury and mortality from bicycle accidents. Objective: To examine the relationship between helmet use and the bicycle-related trauma injury outcomes among bicyclists with head/neck injury in the US. Methods: Data from the 2002-2012 National Trauma Data Bank were used, including all trauma bicycle riders involved in bicycle-related accidents whose primary reason for the hospital or Intensive Care Unit stay was head or neck injury. ⋯ Males had a severe injury, longer HLOS, ICULOS, and higher mortality than female. Blacks and Hispanics had longer HLOS and ICULOS and higher total mortality than Whites, but had a similar chance for in-hospital mortality. Conclusions: More effort is needed to enhance helmet use among at-risk bicycle riders, which may reduce injury severity, HLOS, ICULOS, and mortality.
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Brain injury : [BI] · Jan 2019
Observational StudyA new global health outcome score after trauma (GHOST) for disability, cognitive impairment, and health-related quality of life: data from a prospective cross-sectional observational study.
Background:Trauma patients experience morbidity related to disability and cognitive impairment that negatively impact their health-related quality of life (HRQoL). We assessed the impact of trauma on disability, cognitive impairment and HRQoL after intensive care in patients with and without traumatic brain injury (TBI) and created a predictive score to identify patients with worse outcome. Methods:We identified 262 patients with severe trauma (ISS>15) admitted to the emergency room of a level 1 trauma center. ⋯ Conclusions:No significant differences were seen on disability, cognitive impairment and decreased HRQoL in patients with or without TBI. Our GHOST score showed that female gender, older age, and longer ICU stay were significantly associated with the worst outcome. Abbreviations: AIS: Abbreviated Injury Scale; EQ-5D: EuroQol 5-dimensions; EQ-5D-3L: EuroQol 5-dimensions 3-levels; GCS: Glasgow Coma Scale; GOSE: Glasgow Outcome Scale Extended; HRQoL: Health-Related Quality of Life; ICU: Intensive Care Unit; ISS: Injury Severity Score; MMS: Mini Mental State; NICE: National Institute for Health and Care Excellence; RTS: Revised Trauma Score; TBI: Traumatic brain injury; TRISS: Trauma Injury Severity Score; VAS: Visual Analogue Scale.
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Brain injury : [BI] · Jan 2019
Severe acquired brain injury aetiologies, early clinical factors, and rehabilitation outcomes: a retrospective study on pediatric patients in rehabilitation.
Objective: Studies on pediatric severe acquired brain injury (sABI) outcomes focused mostly on single etiologies, not clarifying the independent role of clinical factors, and scantly explored inter-dependence between variables. We assessed associations of clinical factors at admission with essential outcomes, controlling for inter-dependence and sABI etiology. Methods: We reviewed the clinical records of 280 patients with traumatic and 292 with non-traumatic sABI, discharged from intensive care to pediatric neurological rehabilitation. ⋯ Factor analysis of inter-dependence between GCS, time before rehabilitation, dysautonomia, device use, produced the indicators "injury severity" and "neurological dysfunction", independent from sABI etiology, age, sex, and admittance GOS. Multivariate analyzes showed that: coma duration, GOS outcome, and length of stay, which may depend on rehabilitation courses, were directly associated with injury severity, neurological dysfunction, and patients' age; death and persistent vegetative states were also associated with etiology. Conclusion: Future studies should analyze larger cohorts and investigate mechanisms linking specific etiologies and patients' age with outcomes.
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Brain injury : [BI] · Jan 2019
Computer Tomography (CT) for head injury: adherence to the National Institute for Health and Care Excellence (NICE) criteria.
Objective Head injury is a common presentation to the emergency department yet adherence to guidelines for management is suboptimal. Our study assesses adherence to National Institute for Health and Care Excellence (NICE) computed tomography (CT) head guidelines at a teaching hospital in the United Kingdom. It critically evaluates the efficacy of interventions. ⋯ The mean time to report all scans decreased from 89 to 57 minutes. The survey results were encouraging. Conclusion Adherence to NICE guidelines for head injury is inadequate but can be improved by interventions.