Journal of neurotrauma
-
Journal of neurotrauma · Jul 2017
Directions for use of intracranial pressure monitoring in treatment of severe traumatic brain injury using data from the Japan Neurotrauma Data Bank.
Neuromonitoring can be used to observe intracranial pathological conditions in neurointensive care; however, use of intracranial pressure (ICP) monitoring is low in Japan. In this study, we retrospectively investigated the effects of ICP monitoring in the treatment of severe traumatic brain injury (TBI), using data from the Japan Neurotrauma Data Bank (JNTDB). The study was conducted in 1091 subjects enrolled in the JNTDB (Project 2009) from July 2009 to June 2011. ⋯ In multivariate analysis, age, GCS, pupillary abnormalities, perimesencephalic cistern disappearance or compression, and ICP were associated with a favorable outcome, but the therapeutic method did not affect outcome. We conclude that ICP monitoring and management of ICP are both important for management and care of severe TBI. However, current therapies do not control ICP sufficiently, and more effective therapies are needed.
-
Journal of neurotrauma · Jul 2017
Subconcussive impact -dependent increase in plasma S100β levels in collegiate football players.
The current study investigates whether repetitive subconcussive impacts cause changes in plasma S100β levels, and also tests the associations between S100β changes and frequency/magnitude of impacts sustained. This prospective study of 22 Division-I collegiate football players included baseline and pre-season practices (one helmet-only and four full-gear). Blood samples were obtained and assessed for S100β levels at baseline and pre- to post-practices; symptom scores were assessed at each time-point. ⋯ Players in the higher impact group showed consistently greater increases in plasma S100β levels, but not symptom scores, at each post-practice than the lower impact group. Collectively, these data suggest that although players continued to play without noticeable change in symptoms, a brain-enriched serological factor suggests an acute burden from head impacts. Assessing the effects of repetitive subconcussive head impacts on acute changes in S100β levels may be a clinically useful blood biomarker in tracking real-time acute brain damage in collegiate football players.
-
Journal of neurotrauma · Jul 2017
ReviewThe effect of concussion or mild traumatic brain injury on academic outcomes: A systematic review.
Concussion often results in symptoms, including difficulty concentrating, focusing, and remembering, that are typically managed with cognitive and physical rest. Often, the school environment is not conducive to cognitive rest and may lead to worsening or prolonged symptoms that can contribute to impaired academic performance. The objective of the review was to identify and summarize literature concerning the effects of concussion or mild traumatic brain injury (mTBI) on academic outcomes. ⋯ Four examined school absenteeism and found that students who developed post-concussion syndrome missed significantly more school days and took longer to return to school than students with extremity injuries. Although mTBI or concussion is associated with missed school, the results demonstrate minimal impact on school grades and national examination scores at a group level. Further research is needed to identify risk factors for impaired school functioning following mTBI and concussion in individual patients.
-
Journal of neurotrauma · Jul 2017
Inter-Subject Variability of Axonal Injury in Diffuse Traumatic Brain Injury.
Traumatic brain injury (TBI) is a leading cause of cognitive morbidity worldwide for which reliable biomarkers are needed. Diffusion tensor imaging (DTI) is a promising biomarker of traumatic axonal injury (TAI); however, existing studies have been limited by a primary reliance on group-level analytic methods not well suited to account for inter-subject variability. In this study, 42 adults with TBI of at least moderate severity were examined 3 months following injury and compared with 35 healthy controls. ⋯ In moderate-to-severe TBI, there is substantial inter-subject variation in TAI, with extent strongly correlated to post-traumatic deficits in processing speed. Significant group-level effects do not necessarily represent consistent effects at the individual level. Better accounting for inter-subject variability in neurobiological manifestations of TBI may substantially improve the ability to detect and classify patterns of injury.
-
Journal of neurotrauma · Jul 2017
Tripartite Stratification of the Glasgow Coma Scale in Children with Severe Traumatic Brain Injury and Mortality: An Analysis from a Multicenter, Comparative Effectiveness Study.
The Glasgow Coma Scale (GCS) score has not been validated in children younger than 5 years and the clinical circumstances at the time of assignment can limit its applicability. This study describes the distribution of GCS scores in the population, the relationship between injury characteristics with the GCS score, and the association between the tripartite stratification of the GCS on mortality in children with severe traumatic brain injury (TBI). The first 200 children from a multi-center comparative effectiveness study in severe TBI (inclusion criteria: age 0-18 years, GCS ≤8 at the time of intracranial pressure [ICP] monitoring) were analyzed. ⋯ In children younger than 5 years of age, a similar relationship between GCS and mortality was observed. Overall, GCS score at the time of ICP monitor placement is strongly associated with mortality across the pediatric age range. Development of models with GCS and other factors may allow identification of subtypes of children after severe TBI for future studies.