Articles: traumatic-brain-injuries.
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The prognostication of long-term functional outcomes remains challenging in patients with traumatic brain injury (TBI). Our aim was to demonstrate that intensive care unit (ICU) variables are not efficient to predict 6-month functional outcome in survivors with moderate to severe TBI (msTBI) but are mostly associated with mortality, which leads to a mortality bias for models predicting a composite outcome of mortality and severe disability. ⋯ We demonstrated using machine learning-based predictive models that classically used ICU variables are strongly associated with mortality but not with 6-month outcome in survivors with msTBI, leading to a mortality bias when predicting a composite outcome of mortality and severe disability.
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Interventions to reduce intracranial pressure (ICP) in patients with traumatic brain injury (TBI) are multimodal but variable, including sedation-dosing strategies. This article quantifies the different sedation intensities administered in patients with moderate to severe TBI (msTBI) using the therapy intensity level (TIL) across different intensive care units (ICUs), including the use of additional ICP-lowering therapies. ⋯ Intensity of sedation and other therapies for elevated ICP for patients with msTBI demonstrate large practice-pattern variation across level 1 trauma centers within the TRACK-TBI cohort study, independent of patient severity. Optimizing sedation strategies using patient-specific physiologic and pathoanatomic information may optimize patient outcomes.
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Due to the lengthy and challenging nature of traumatic brain injury (TBI) rehabilitation, patients and carers increasingly rely on YouTube for information. However, no previous research has assessed the quality and reliability of these TBI rehabilitation videos on this platform. This study aims to assess the quality and reliability of YouTube videos on TBI rehabilitation. ⋯ The study revealed that videos uploaded by healthcare professionals have higher quality. For obtaining reliable information on TBI rehabilitation, it is also advisable to prioritize videos with longer durations and earlier upload dates. Given the significant role of social media platforms in educational outreach for rehabilitation, it is crucial to enhance the quality of these videos through appropriate measures.
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Review
Decompressive Craniectomy with or Without Dural Closure: Systematic Review and Meta-analysis.
Decompressive craniectomy is used to alleviate intracranial pressure in cases of traumatic brain injury and stroke by removing part of the skull to allow brain expansion. Traditionally, this procedure is followed by a watertight dural suture, although evidence supporting this method is not strong. This meta-analysis examines the feasibility of the open-dura (OD) approach versus the traditional closed-dura (CD) technique with watertight suturing. ⋯ Assessment of operation duration, however, demonstrated a significant difference between techniques, with a mean reduction of 52.50 min favoring the OD approach (mean difference - 52.50 [95% CI - 92.13 to - 12.87]; I2 = 96%). This study supports the viability of decompressive craniectomy without the conventional time-spending watertight duraplasty closure, exhibiting no differences in the rate of infections or CSF leaks. Furthermore, this approach has been associated with improved rates of complications and faster surgery, which are important aspects of this technique, particularly in its potential to reduce both costs and procedure length.
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Eur J Trauma Emerg Surg · Aug 2024
Diagnostic and prognostic utility of plasma thrombospondin-1 levels in traumatic brain injury.
Thrombospondin-1 (TSP-1), a powerful antiangiogenic agent, is increasingly expressed in mice brain tissues after traumatic brain injury (TBI). However, in the peripheral blood of TBI patients, TSP-1 concentrations have not been identified. This study aimed to determine if TSP-1 measured in the plasma of patients relates to TBI diagnosis and injury severity. ⋯ The results of this study indicate that plasma TSP-1 should be further investigated as a diagnostic and prognostic marker for patients with TBI.