Journal of neurotrauma
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Journal of neurotrauma · Dec 2020
Observational StudyPoint-of-Care Platform Blood Biomarker Testing of GFAP versus S100B for Prediction of Traumatic Brain Injuries: a TRACK-TBI study.
Glial fibrillary acidic protein (GFAP) is cleared by the Food and Drug Administration (FDA) to determine need for head computed tomography (CT) within 12 h after mild traumatic brain injury (TBI) (Glasgow Coma Score [GCS] 13-15); S100 calcium-binding protein B (S100B) serves this function in Europe. This phase 1 biomarker cohort analysis of the multi-center, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study compares GFAP's diagnostic performance, measured on a rapid point-of-care platform, against protein S100B to predict intracranial abnormalities on CT within 24 h post-injury across the spectrum of TBI (GCS 3-15). Head CT scan performed in TBI subjects and blood was collected for all consenting subjects presenting to 18 United States level 1 trauma centers. ⋯ Receiver operating characteristic curves were generated for prediction of intracranial injury on admission CT scan; area under the curve (AUC) for GFAP was significantly higher than for S100B in the same cohort (GFAP AUC - 0.85, 95% confidence interval [CI] 0.83-0.87; S100B AUC - 0.67, 95% CI 0.64-0.70; p 0.001). GFAP, measured on a point-of-care platform prototype assay, has high discriminative ability to predict intracranial abnormalities on CT scan in patients with TBI across the full injury spectrum of GCS 3-15 through 24 h post-injury. GFAP substantially outperforms S100B.
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Journal of neurotrauma · Dec 2020
Treatment of Depression Following Traumatic Brain Injury Reduces Risk of Neuropsychiatric Outcomes.
The objectives of this study were to identify characteristics associated with receipt of antidepressants for treatment of incident depression diagnosed following traumatic brain injury (TBI) and to assess the impact of receipt of treatment for depression on risk of other neuropsychiatric outcomes associated with TBI. We conducted a retrospective cohort study of individuals with TBI who were subsequently diagnosed with incident depression between 2008 and 2014 using data from the OptumLabs® Data Warehouse. We identified factors associated with receipt of antidepressants and compared risk of new diagnosis of alcohol dependence disorder, anxiety, insomnia, and substance dependence disorder between those who received antidepressants and those who did not over a maximum 2-year follow-up, controlling for duration of use and clinical and demographic characteristics. ⋯ Moderate-severe TBI (odds ratio [OR] 1.44; 95% confidence interval [CI]: 1.39, 1.50), female sex (OR 1.21; 95% CI: 1.19, 1.24), diagnosis of Alzheimer's disease (OR 1.39; 95% CI: 1.35, 1.44), and anxiety (OR 1.35; 95% CI: 1.31, 1.38) were associated with receipt of antidepressants. Longer duration of antidepressant use was associated with decreased risk of newly diagnosed anxiety (hazard ratio [HR] 0.92; 95% CI: 0.89, 0.96), insomnia (HR 0.94; 95% CI: 0.91, 0.98), and substance dependence disorder (HR 0.92; 95% CI: 0.88, 0.97). These results provide evidence of a beneficial effect of antidepressant use on incidence of outcomes associated with poorer recovery from TBI.
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Journal of neurotrauma · Dec 2020
Concussion recovery evaluation using the inertial sensor instrumented Y Balance Test.
The current sports concussion assessment paradigm lacks reliability, has learning effects, and is not sufficiently challenging for athletes. As a result, subtle deficits in sensorimotor function may be unidentified, increasing the risk of future injury. This study examined if the inertial-sensor instrumented Y Balance test could capture concussion-induced alterations in dynamic movement control. ⋯ There was a statistically significant linear association between Jerk Mag RMS 24 to 48 h post-injury and the natural log of RTP duration (R2 = 0.27 to 0.33). These results indicate that concussed athletes possessed alterations in dynamic movement control 24 to 48 h post-concussion, which typically returns to pre-injury levels by the point of RTP. Further, evaluation of dynamic movement control 24 to 48 h post-injury may aid in the evaluation of recovery prognosis.
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Journal of neurotrauma · Dec 2020
The Utility Of The Modified Frailty Index In Outcome Prediction For Elderly Patients With Acute Traumatic Subdural Haematoma.
This study aimed to evaluate the utility of the 11-variable modified Frailty Index (mFI) in prognosticating elderly patients with traumatic acute subdural hematomas (aSDHs). A state-service level 1 trauma center registry was interrogated to investigate consecutive patients ≥65 years of age presenting with traumatic aSDH, with or without major extracranial injury, between January 2013 and December 2017. mFI on admission, demographics, and admission details, including Glasgow Coma Scale (GCS) and pupillary status and radiological findings, were retrospectively retrieved from institutional records. Clinical outcome data were retrieved from medical records and the Victorian State Trauma Registry (VSTR). ⋯ Multi-variate analysis showed that greater mFI score of ≥3/11 variables (≥0.27) suggested a significantly higher risk of 30-day mortality (p = 0.009) and unfavorable outcome (p < 0.001). We conclude that increasing frailty, as measured by the mFI, was associated with significantly higher risk of 30-day mortality and 6-month unfavorable outcome in elderly patients presenting with aSDH to a level 1 neurotrauma center. Assessment of mFI in elderly patients with aSDH may be a useful determinant of outcome for this rapidly growing population.
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Journal of neurotrauma · Dec 2020
Functional and structural neuroimaging correlates of repetitive low-level blast exposure in career breachers.
Combat military and civilian law enforcement personnel may be exposed to repetitive low-intensity blast events during training and operations. Persons who use explosives to gain entry (i.e., breach) into buildings are known as "breachers" or dynamic entry personnel. Breachers operate under the guidance of established safety protocols, but despite these precautions, breachers who are exposed to low-level blast throughout their careers frequently report performance deficits and symptoms to healthcare providers. ⋯ To better understand the relationship between repetitive low-level blast exposure and behavioral and imaging differences in humans, we analyzed the data using similarity-driven multi-view linear reconstruction (SiMLR). SiMLR is specifically designed for multiple modality statistical integration using dimensionality-reduction techniques for studies with high-dimensional, yet sparse, data (i.e., low number of subjects and many data per subject). We identify significant group effects in these data spanning brain structure, function, and blood biomarkers.