Journal of neurotrauma
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Journal of neurotrauma · Jan 2019
Adult Firearm-Related Traumatic Brain Injury in United States Trauma Centers.
Civilian firearm injury is an important public health concern in the United States. Gunshot wounds to the head (GSWH) remain in need of update and systematic characterization. We identify predictors of prolonged hospital length of stay (HLOS), intensive care unit length of stay (ICU LOS), medical complications, mortality, and discharge disposition from a population-based sample using the National Sample Program (NSP) of the National Trauma Data Bank (NTDB), years 2003-2012. ⋯ Our results support hypotension, injury severity, injury intent, firearm type, and U. S. geographical location as important prognostic variables in firearm-related TBI. Improved understanding of civilian GSWH is critical to promoting increased awareness of firearm injuries as a public health concern and reducing its debilitating injury burden to patients, families, and healthcare systems.
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Journal of neurotrauma · Jan 2019
Neurostimulant prescribing patterns in children admitted to the ICU after traumatic brain injury.
Neurostimulant medications are commonly prescribed following traumatic brain injury (TBI) in adults; little is known about their use in children with TBI. Our objective was to analyze neurostimulant prescribing practices from 2005 to 2015 in children admitted to the intensive care unit (ICU) with TBI. We hypothesized that neurostimulant prescriptions have increased over time and are associated with older age and injury severity. ⋯ In a multi-variable analysis, variables most strongly associated with receipt of a neurostimulant were age 14-18 years (odds ratio 5.8, 95% confidence interval [4.3,7.8]), motor vehicle collision (3.1, [2.4,4.2]), intracranial pressure (ICP) monitor (3.8, [3.1,4.5]), and mechanical ventilation (3.4, [2.7,4.3]). Use of neurostimulants following pediatric TBI is uncommon, has increased over time, and is associated with indicators of higher severity of illness. Knowledge of prescribing practices may assist in optimizing the design of efficacy and outcome studies that will inform clinical guidelines.
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Journal of neurotrauma · Jan 2019
Interactive Effect of Traumatic Brain Injury and Psychiatric Symptoms on Cognition among Late Middle-Aged Men: Findings from the Vietnam Era Twin Study of Aging.
Traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and depressive symptoms each increase the risk for cognitive impairment in older adults. We investigated whether TBI has long-term associations with cognition in late middle-aged men, and examined the role of current PTSD/depressive symptoms. Participants were 953 men (ages 56-66) from the Vietnam Era Twin Study of Aging (VETSA), who were classified by presence or absence of (1) history of TBI and (2) current elevated psychiatric symptoms (defined as PTSD or depressive symptoms above cutoffs). ⋯ Cognition was largely unaffected in men with either risk factor in isolation. Among late middle-aged men, the combination of even mild and very remote TBI with current elevated psychiatric symptoms is associated with deficits in executive function and related abilities. Future longitudinal studies should investigate how TBI and psychiatric factors interact to impact brain aging.
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Journal of neurotrauma · Jan 2019
Relative Deficiency of Plasma ADAMTS13 Activity and Elevation of Human Neutrophil Peptides in Patients with Traumatic Brain Injury.
Traumatic microvascular injury (tMVI) is a universal endophenotype of traumatic brain injury (TBI) that is responsible for significant neurological morbidity and mortality. The mechanism underlying tMVI is not fully understood. The present study aims to determine plasma levels of von Willebrand factor (VWF), a disintegrin and metalloprotease with thrombospondin type 1 repeats (ADAMTS) 13 activity, and human neutrophil peptides (HNP) 1-3 and to correlate these biomarkers with functional outcomes after moderate-severe TBI. ⋯ This resulted in a dramatic reduction in the ratio of ADAMTS13 activity to VWFAg or ADAMTS13 to VWFAc in all 5 post-TBI days. Cluster analysis demonstrated that high median plasma levels of VWFAg and HNP1-3 were observed in the cluster with a high mortality rate. These results demonstrate that a relative deficiency of plasma ADAMTS13 activity, resulting from activation of neutrophils and endothelium, may contribute to the formation of microvascular thrombosis and mortality after moderate-severe TBI.
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Journal of neurotrauma · Jan 2019
In-Season Variations in Head Impact Exposure among Youth Football Players.
Head impact exposure (HIE) is often summarized by the total exposure measured during the season and does not indicate how the exposure was accumulated, or how it varied during the season. Therefore, the objective of this study was to compare HIE during pre-season, the first and second halves of the regular season, and playoffs in a sample of youth football players (n = 119, aged 9-13 years). Athletes were divided into one of four exposure groups based on quartiles computed from the distribution of risk-weighted cumulative exposure (RWECP). ⋯ Time of season had a significant relationship with mean 95th percentile linear and rotational acceleration in games (both, p = 0.01) but not with practice accelerations or impacts per session. The in-practice mean levels of 95th percentile linear and rotational acceleration remained fairly constant across the four time frames, but in games these changed over time depending on exposure group (interactions, p ≤ 0.05). The results of this study improve our understanding of in-season variations in HIE in youth football and may inform important opportunities for future interventions.