Journal of neurotrauma
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Journal of neurotrauma · May 2010
Multicenter StudyA method for reducing misclassification in the extended Glasgow Outcome Score.
The eight-point extended Glasgow Outcome Scale (GOSE) is commonly used as the primary outcome measure in traumatic brain injury (TBI) clinical trials. The outcome is conventionally collected through a structured interview with the patient alone or together with a caretaker. Despite the fact that using the structured interview questionnaires helps reach agreement in GOSE assessment between raters, significant variation remains among different raters. ⋯ The group using the alternative rating system coupled with central monitoring yielded the highest inter-rater agreement among the three groups in rating GOS (97%; weighted kappa = 0.95; 95% CI 0.89, 1.00), and GOSE (97%; weighted kappa = 0.97; 95% CI 0.91, 1.00). The alternate system is an improved GOSE rating method that reduces inter-rater variations and provides for the first time, source documentation and structured narratives that allow a thorough central review of information. The data suggest that a collective effort can be made to minimize inter-rater variation.
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Journal of neurotrauma · May 2010
Attitude and opinion of neurosurgeons concerning protective bicycle-helmet use.
Wearing protective helmets decreases the risk of incurring traumatic brain injury (TBI) in bicycle accidents. In 2007, the German Neurosurgical Society advocated compulsory use of bicycle helmets. Although neurosurgeons are the specialists who primarily treat patients with TBI in Europe, the distribution of helmet users among neurosurgeons (NS), as well as factors that influence the decision to wear helmets and whether professional knowledge or experience in TBI influences the use or attitude concerning bicycle helmets, remains unclear. ⋯ With respect to compulsory helmet use, NS are also split in half. Experience with TBI and trauma education has effects. However, education alone does not suffice in promoting the use of bicycle helmets.
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Journal of neurotrauma · May 2010
Diffuse brain injury elevates tonic glutamate levels and potassium-evoked glutamate release in discrete brain regions at two days post-injury: an enzyme-based microelectrode array study.
Traumatic brain injury (TBI) survivors often suffer from a wide range of post-traumatic deficits, including impairments in behavioral, cognitive, and motor function. Regulation of glutamate signaling is vital for proper neuronal excitation in the central nervous system. Without proper regulation, increases in extracellular glutamate can contribute to the pathophysiology and neurological dysfunction seen in TBI. ⋯ The amplitudes of KCl-evoked glutamate release were increased significantly only in the striatum after moderate injury, with a 249% increase seen in the dorsal striatum. Thus, with the MEAs, we measured discrete regional changes in both tonic and KCl-evoked glutamate signaling, which were dependent on injury severity. Future studies may reveal the specific mechanisms responsible for glutamate dysregulation in the post-traumatic period, and may provide novel therapeutic means to improve outcomes after TBI.
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Journal of neurotrauma · May 2010
What contributes to quality of life in adult survivors of childhood traumatic brain injury?
Adult outcome from childhood brain injury is largely unknown, and health professionals have minimal evidence available to inform families about their child's long-term prognosis. This study aimed to investigate long-term outcomes in this group, focusing on quality of life (QOL) and the injury, developmental, and environmental factors that influence this domain, using a retrospective and cross-sectional design. The sample was ascertained via medical record audit at the Royal Children's Hospital, Melbourne, Australia, and included 130 adult survivors of child traumatic brain injury (TBI) (84 men). ⋯ While most adult survivors of childhood TBI rated their QOL as intact, 17% of the sample reported poor QOL. Poor QOL was more likely with low levels of perceived independence, severe TBI, younger age at injury, failure to complete high school, and psychological problems. In conclusion, QOL in adult survivors of childhood TBI is better than expected and closely associated with both injury and noninjury factors, most consistently with the individual's perception of their level of independence.
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Journal of neurotrauma · May 2010
Sensory stimulation prior to spinal cord injury induces post-injury dysesthesia in mice.
Chronic pain and dysesthesias are debilitating conditions that can arise following spinal cord injury (SCI). Research studies frequently employ rodent models of SCI to better understand the underlying mechanisms and develop better treatments for these phenomena. While evoked withdrawal tests can assess hypersensitivity in these SCI models, there is little consensus over how to evaluate spontaneous sensory abnormalities that are seen in clinical SCI subjects. ⋯ Mice subjected to either stimulus paradigm showed increased OG compared with unstimulated or uninjured mice. Histological analysis showed no difference in spinal cord lesion size due to sensory stimulation, or between mice that overgroomed or did not overgroom. The relationship between prior stimulation and contusion injury in mice that display OG indicates a critical interaction that may underlie one facet of spontaneous neuropathic symptoms after SCI.