Journal of neurotrauma
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Journal of neurotrauma · Oct 2009
The economic impact of S-100B as a pre-head CT screening test on emergency department management of adult patients with mild traumatic brain injury.
Recent research suggests that serum S-100B may serve as a good pre-head computed tomography (CT) screening test because of its high sensitivity for abnormal head CT scans. The potential economic impact of using S-100B in the emergency department setting for management of adult patients with isolated mild traumatic brain injury (mTBI) has not been evaluated despite its clinical implementation in Europe. Using evidence from the literature, we constructed a decision tree to compare the average cost per patient of using S-100B as a pre-head CT screening test to the current practice of ordering CT scans based on patients' presenting symptoms without the aid of S-100B. ⋯ Generally speaking, if blood test results require less time than imaging, and if head CT scan rates for patients with isolated mTBI are relatively high, using S-100B will lower costs. Recommendations for using S-100B as a screening tool should account for setting-specific characteristics and their consequent economic impacts. Despite its high sensitivity and excellent negative predictive value, serum S-100B has low specificity and low positive predictive value, limiting its ability to reduce numbers of CT scans and hospital costs.
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Journal of neurotrauma · Oct 2009
Implications of reduced callosal area for social skills after severe traumatic brain injury in children.
The corpus callosum has been shown to be particularly vulnerable to the effects of traumatic brain injury (TBI) in childhood, and severe injury frequently results in a smaller corpus callosum post-injury. However, the long-term effects of TBI on the integrity of the callosum, as well as the potential functional significance of callosal injury are poorly understood. Some studies suggest the corpus callosum may be involved in social skills, which are often reduced following TBI. ⋯ In addition, callosal size correlated significantly with social skills, suggesting that callosal atrophy may be related to poorer social skills after TBI. These findings highlight the persistence of callosal abnormalities, which may be a result of interrupted neural development after childhood TBI. The results further underscore the potential importance of the corpus callosum for social competence after TBI.
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Journal of neurotrauma · Oct 2009
Hemostatic abnormalities in patients with closed head injuries and their role in predicting early mortality.
Abnormalities of blood coagulation are frequently found in patients following traumatic brain injury. Exposure to thromboplastin, which is abundant in brain, plays an important role in initiating coagulopathy. ⋯ Similarly, increased PT, FDP, and D-dimer values correlated with higher mortality in both groups, but platelet counts and a-PPTK values correlated with mortality only in the severe head injury group. From this study we conclude that hemostatic abnormalities are independent predictors of early mortality in moderate-to-severe head injury patients.
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Journal of neurotrauma · Oct 2009
Molecular, anatomical, physiological, and behavioral studies of rats treated with buprenorphine after spinal cord injury.
Acute pain is a common symptom experienced after spinal cord injury (SCI). The presence of this pain calls for treatment with analgesics, such as buprenorphine. However, there are concerns that the drug may exert other effects besides alleviation of pain. ⋯ Microarray analysis demonstrated no significant difference in gene expression between rats treated with buprenorphine and the control group at 2 and 4 days post-injury (DPI). Experiments performed to determine the effect of buprenorphine at the electrophysiological (tcMMEP), behavioral (BBB, grid walking and beam crossing), and histological (luxol staining) levels revealed no significant difference at 7 and 14 DPI in the return of nerve conduction, functional recovery, or white matter sparing between control and experimental groups (p > 0.05, n = 6). These results show that buprenorphine (0.05 mg/kg) can be used as part of the postoperative care to reduce pain after SCI without affecting behavioral, physiological, or anatomical parameters.
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Journal of neurotrauma · Oct 2009
Randomized Controlled TrialThe impact of age on mortality, impairment, and disability among adults with acute traumatic spinal cord injury.
Given the potential effects of age on mortality, impairment, and disability among individuals with traumatic spinal cord injury [(SCI), we examined these issues using a large, prospectively accrued clinical database. This study includes all patients who were enrolled in the Third National Spinal Cord Injury Study (NASCIS 3). Motor, sensory, and pain outcomes were assessed using NASCIS scores. ⋯ Our results suggest that older individuals have a substantially increased mortality rate during the first year following traumatic SCI in comparison with younger patients. Among survivors, the potential of older patients with SCI to neurologically improve within the first year post-injury does not appear to translate into similar functional recovery compared to that seen in younger individuals. Given this fact, rehabilitation protocols that are more focused on functional recovery may reduce disability among older people with acute traumatic SCI.