Articles: traumatic-brain-injuries.
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The polytrauma clinical triad (PCT), encompassing traumatic brain injury, PTSD, and chronic pain, has been identified as a significant concern in the Military Health System (MHS). Conditions in this triad mutually reinforce one another and can pose a significant challenge to treatment for patients and providers. Polytrauma clinical triad has previously been studied in deployed veterans but remains understudied in the active duty military population. Therefore, this novel study seeks to determine the prevalence of PCT among active duty service members and to identify the subpopulations most at risk for PCT. ⋯ This study is the first to identify the risk of PCT in the active duty military population. Awareness of the risk and subsequent prompt identification of the triad will enable treatment through an integrated, team approach, which should alleviate potential patient suffering and improve the efficiency of care and readiness of service members.
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Traumatic brain injury (TBI) brings severe mortality and morbidity risk to patients. Predicting the outcome of these patients is necessary for physicians to make suitable treatments to improve prognosis. The aim of this study is to develop a mortality prediction approach using XGBoost (extreme gradient boosting) in moderate-to-severe TBI. ⋯ Predicting mortality of patients with moderate-to-severe TBI using the XGBoost algorism is more effective and precise than logistic regression. The XGBoost prediction approach is beneficial for physicians to evaluate patients with TBI at high risk of poor outcome.
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The Glasgow Coma Scale (GCS) is intended to be an objective, reliable measure of a patient's mental status. It is included as a metric for trauma registries, having implications for performance metrics and research. Our study compared the GCS recorded in the trauma registry (GCS-1) with that recorded in the neurosurgery consultation (GCS-2). ⋯ The immediate GCS score recorded on patient arrival after trauma differs significantly from the GCS score recorded at later times. This finding significantly altered the probability of survival as calculated by the TRISS methodology. This situation could have profound effects on risk-adjusted benchmarking, assessments of quality of care, and injury severity stratification for research. More studies into the optimal timing of GCS score recording or changes in GCS score and their impact on survival are warranted.
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Observational Study
Urban-rural inequalities in care and outcomes of severe traumatic brain injury: A nationwide inpatient database analysis in Japan.
This study aimed to investigate urban-rural inequalities in care and outcomes of severe traumatic brain injury (TBI). ⋯ There are significant urban-rural inequalities in TBI in Japan, and the gap in in-hospital mortality has not improved over the last 10 years. Improving TBI care in rural communities may be a target for reducing disparities in health care.