Articles: traumatic-brain-injuries.
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Scand J Trauma Resus · Jun 2023
Care pathways and factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe traumatic brain injury: a population-based study from the Norwegian trauma registry.
Systems ensuring continuity of care through the treatment chain improve outcomes for traumatic brain injury (TBI) patients. Non-neurosurgical acute care trauma hospitals are central in providing care continuity in current trauma systems, however, their role in TBI management is understudied. This study aimed to investigate characteristics and care pathways and identify factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe TBI primarily admitted to acute care trauma hospitals. ⋯ Acute care trauma hospitals managed a substantial burden of isolated moderate-to-severe TBI patients primarily and definitively, highlighting the importance of high-quality neurotrauma care in non-neurosurgical hospitals. The transfer probability declined with increasing age and comorbidity, suggesting that older patients were carefully selected for transfer to specialized care.
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Diffuse axonal injury (DAI) is a devastating traumatic neurologic injury with variable prognosis. Although outcomes such as mortality have been described, the time course of neurologic progression is poorly understood. We investigated the association between DAI neuroanatomic injury pattern and neurologic recovery timing. ⋯ Patients with grade 1 DAI demonstrated the fastest short-term neurologic recovery, although final discharge neurologic examination was comparable across DAI grades. DAI classification can provide useful short-term prognostic information regarding in-hospital neurologic improvement.
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Neuroinflammation after traumatic brain injury (TBI) is related to chronic neurodegenerative diseases and is one of the causes of acute secondary injury after TBI. Therefore, it is particularly important to clarify the role of cellular mechanisms in the neuroinflammatory response after TBI. The objective of this article is to understand the involvement of cells during the TBI inflammatory response (for instance, astrocytes, microglia, and oligodendrocytes) and shed light on the recent progress in the stimulation and interaction of granulocytes and lymphocytes, to provide a novel approach for clinical research. ⋯ However, not all of the mechanisms of cell-to-cell interactions have been well studied. After TBI, clinical treatment cannot simply suppress the inflammatory response, and the inflammatory phenotype of patients' needs to be defined according to their specific conditions after injury. Clinical trials of personalized inflammation regulation therapy for specific patients should be carried out in order to improve the prognosis of patients.
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Opioid use disorder is a worldwide economic and health concern. Opioid use seems to be increased in those who sustained traumatic brain injury (TBI). The aim of the current systematic review is to examine the prevalence of opioid use disorders among individuals with TBI. ⋯ Opioid use disorder is an imminent danger worldwide. Firm regulation for an opioid prescription for patients with TBI during hospitalization or in rehabilitation centers tackles co-existing behavioral problems, frequent follow-up, and the use of nonopioid medications as possible to control chronic pain in this vulnerable subgroup. Future prospective studies to measure the effect of different intervention methods to mitigate the increased risk of opioid use post-TBI are needed.
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The fluid percussion injury (FPI) model is a surgical method for mimicking traumatic brain injury (TBI) models as it automatically and accurately measures peak impact pressure. Nevertheless, its elevated costs have led numerous researchers to develop more inexpensive alternative methods. Therefore, we used a copy of the classic FPI device to develop a novel method to evaluate the pressure pulse and determine injury severity with even more precision during the surgical procedure to induce an injury. ⋯ The method developed to evaluate pressure pulse in an FPI model proved capable of precisely determining different degrees of injury.