Journal of neurotrauma
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Journal of neurotrauma · Dec 2017
Preliminary validation of the WHODAS 2.0 for mild traumatic brain injury.
The purpose of this study is to examine the reliability, factor structure, and validity of the World Health Organization Disability Assessment Schedule (WHODAS 2.0 12 item version) in a sample of patients who were slow to recover from a mild traumatic brain injury (mTBI). Participants were 79 adults with mTBI recruited from one of four specialty outpatient clinics in Vancouver, Canada. The WHODAS 2.0 12 item version is a disease-nonspecific measure of disability representing six International Classification of Disability, Functioning, and Health activity and participation domains including cognition, mobility, self-care, interpersonal functioning, life activities, and participation. ⋯ Concurrent validity was also supported by lower WHODAS scores in participants who had returned to work versus those who had not. To our knowledge, this is the first study to evaluate the psychometric properties of the WHODAS 2.0 in a sample of people with mTBI. In summary, the WHODAS was sensitive to post-concussion syndrome after mTBI, as well as to health conditions that commonly co-occur with mTBI (e.g., mental health problems and chronic pain).
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Journal of neurotrauma · Dec 2017
ReviewPressure Autoregulation Measurement Techniques in Adult TBI, Part II: A Scoping Review of Continuous Methods.
A scoping review of the literature was performed systematically on commonly described continuous autoregulation measurement techniques in adult traumatic brain injury (TBI) to provide an overview of methodology and comprehensive reference library of the available literature for each technique. Five separate small systematic reviews were conducted for each of the continuous techniques: pressure reactivity index (PRx), laser Doppler flowmetry (LDF), near infrared spectroscopy (NIRS) techniques, brain tissue oxygen tension (PbtO2), and thermal diffusion (TD) techniques. Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to December 2016), and reference lists of relevant articles were searched. ⋯ The PRx has the largest literature base supporting the association with patient outcome. Various methods of continuous autoregulation assessment are described within the adult TBI literature. Many studies exist on these various indices, suggesting an association between their values and patient morbidity/death.
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Journal of neurotrauma · Dec 2017
ReviewPressure Autoregulation Measurement Techniques in Adult TBI, Part I: A Scoping Review of Intermittent/Semi-Intermittent Methods.
The purpose of this study was to perform a systematic, scoping review of commonly described intermittent/semi-intermittent autoregulation measurement techniques in adult traumatic brain injury (TBI). Nine separate systematic reviews were conducted for each intermittent technique: computed tomographic perfusion (CTP)/Xenon-CT (Xe-CT), positron emission tomography (PET), magnetic resonance imaging (MRI), arteriovenous difference in oxygen (AVDO2) technique, thigh cuff deflation technique (TCDT), transient hyperemic response test (THRT), orthostatic hypotension test (OHT), mean flow index (Mx), and transfer function autoregulation index (TF-ARI). MEDLINE®, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to December 2016), and reference lists of relevant articles were searched. ⋯ They have provided fundamental insight into human autoregulatory capacity, leading to the development of continuous and more commonly applied techniques in the intensive care unit (ICU). Numerous methods of intermittent/semi-intermittent pressure autoregulation assessment in adult TBI exist, including: CTP/Xe-CT, PET, AVDO2 technique, TCDT-based ARI, THRT, OHT, Mx, and TF-ARI. MRI-based techniques in adult TBI are yet to be described, with the main focus of MRI techniques on metabolic-based cerebrovascular reactivity (CVR) and not pressure-based autoregulation.
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Journal of neurotrauma · Dec 2017
Observational StudyD-dimer elevation as a blood biomarker for detection of structural disorder in mild traumatic brain injury.
CT scans are useful in patients with traumatic brain injury (TBI), but the potential risks associated with ionizing radiation are unknown. Further, CT scans are not commonly available in developing countries. In this study, coagulopathy and abnormal fibrinolysis were investigated as blood biomarkers for detection of structural disorder in mild traumatic brain injury (TBI). ⋯ In multivariate logistic regression analysis, D-dimer (3.6 vs. 0.8 μg/mL) was the only significant independent risk factor for structural disorder (p < 0.001). Platelet counts (23.9 vs. 23.5 × 104 /μL), PT-INR (1.05 vs. 1.07), APTT (29.3 vs. 31.7 sec), FDP (12 vs. 2.4 μg/mL), and fibrinogen levels (260.6 vs. 231.3 mg/dL) were not associated with structural disorder. These results show that D-dimer is associated with intracranial structural disorder in mild TBI.
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Journal of neurotrauma · Dec 2017
Traumatic Brain Injury in a Community-based Cohort of Homeless and Vulnerably-housed Individuals.
We characterized traumatic brain injury (TBI) and studied its associations with mental and physical health in a community cohort of homeless and vulnerably housed individuals. Detailed mental and physical health structured interviews, neuropsychological testing, and multimodal magnetic resonance imaging (MRI) were performed on 283 participants. Two TBI participant groups were defined for primary analyses: those with a self-reported history of TBI and those with MRI confirmation of TBI. ⋯ Neurocognitive test scores positively correlated with both FA and cortical gray matter volumes in participants with MRI evidence of trauma. Previous TBI is associated with poorer mental and physical health in homeless and vulnerably housed individuals and interacts with mood disorders to exacerbate poor mental health. Focal traumatic lesions evident on MRI are associated with diffusely lower gray matter volumes and white matter integrity, which predict cognitive functioning.