Journal of neurotrauma
-
Journal of neurotrauma · Jun 2014
Restraints and peripheral nerve injuries in adult victims of motor vehicle crashes.
The pattern of injuries in restrained victims of motor vehicle crashes (MVCs) remains an issue of debate. We investigated the association of peripheral nerve injuries with the use of protective devices (seat belt and air bag) during MVCs. We performed a retrospective cohort study of 384,539 adult MVC victims who were registered in the National Trauma Data Bank (NTDB) between 2009 and 2011. ⋯ The location of the patient in the vehicle did not seem to affect the risk of peripheral nerve injury, with drivers demonstrating no association with nerve injuries (OR, 0.94; 95% CI, 0.87-1.02) in comparison with non-drivers. On the contrary, alcohol consumption was associated with increased incidence of peripheral nerve injuries (OR, 1.10; 95% CI, 1.01-1.20). In summary, restraint use was associated with decreased risk of peripheral nerve injury in MVC victims, after controlling for confounders.
-
Journal of neurotrauma · Jun 2014
Randomized Controlled Trial Multicenter StudyAddressing the challenges of obtaining functional outcomes in traumatic brain injury research: missing data patterns, timing of follow-up, and three prognostic models.
Traumatic brain injury (TBI) is common and debilitating. Randomized trials of interventions for TBI ideally assess effectiveness by using long-term functional neurological outcomes, but such outcomes are difficult to obtain and costly. If there is little change between functional status at hospital discharge versus 6 months, then shorter-term outcomes may be adequate for use in future clinical trials. ⋯ Of 1066 (83%) patients whose GOSE was obtained both at hospital discharge and at 6-months, 71% of patients had the same dichotomized functional status (severe disability/death vs. moderate/no disability) after 6 months as at discharge, 28% had an improved functional status, and 1% had worsened. Performance was excellent (C-statistic between 0.88 and 0.91) for all three prognostic models and calibration adequate for two models (p values, 0.22 and 0.85). Our results suggest that multiple imputation of the standard 6-month GOSE may be reasonable in TBI research when the primary outcome cannot be obtained through other means.
-
Journal of neurotrauma · Jun 2014
Longitudinal and Prognostic Evaluation of Mild Traumatic Brain Injury: a 1H-MRS Study.
In the majority of patients with mild traumatic brain injury (mTBI), brain tissue impairment is undetectable by computed tomography and/or structural magnetic resonance imaging. Even in confirmed cases of head injury, conventional neuroimaging methods lack sensitivity in predicting neuropsychological outcomes of patients. The objectives of this study were to (1) cross-sectionally determine deviations in the neurometabolic profile of patients with mTBI from healthy controls at different stages of mTBI using tightly controlled examination windows, and (2) determine associations between acute neurometabolic markers of mTBI and chronic neurocognitive performance. ⋯ Measurements in the thalamus and centrum semiovale (CSV) emerged as the most indicative of injury and were used to predict neurocognitive outcome. The major findings of this study are (1) decreases in Cho/Cre (choline-to-creatine ratio) measured in the thalamus (p=0.042) and CSV (p=0.017) at the late subacute stage of mTBI; (2) positive associations of early subacute Cre measurements in the CSV with chronic ANAM scores measuring performance in delayed (r=0.497, p=0.019) and immediate (r=0.391, p=0.072) code substitution. These findings show that metabolic measurements in the thalamus and CSV can potentially serve as diagnostic and prognostic markers of mTBI.
-
Journal of neurotrauma · Jun 2014
Serial Plasma DNA Levels as Predictors of Outcome in Acute Traumatic Brain Injury.
Increased plasma deoxyribonucleic acid (DNA) levels may be associated with disease severity after acute traumatic brain injury (TBI). This study posits that increased plasma DNA levels in acute TBI are predictive of outcome. Both serial plasma nuclear DNA (nDNA) and mitochondrial DNA (mtDNA) levels were examined in 88 consecutive patients with acute TBI and 66 control subjects. ⋯ Its levels on presentation were independently associated with outcome and higher levels (cutoff value >72.95 ng/mL) were associated with poorer outcomes. These findings suggest plasma nDNA levels reflect the severity of cerebral damage and can be considered a neuropathologic marker of patients with acute TBI. Further studies with bigger patient populations are warranted for better unbiased comparison.