Traumatic Brain Injury

Cognitive function and other risk factors for mild traumatic brain injury in young men: nationwide cohort study

Authors: Nordström A, Edin BB, Lindström S, Nordström P.

OBJECTIVE: To investigate cognitive function and other risk factors for mild traumatic brain injury in young men.
DESIGN: Nationwide prospective cohort study.
SETTING: Sweden.
PARTICIPANTS: 305 885 men conscripted for military service from 1989 to 1994.
MAIN OUTCOME MEASURE: mild traumatic brain injuries in relation to cognitive function and other potential risk factors assessed at conscription and follow-up.

Wide variation and systematic bias in expert clinicians' perceptions of prognosis following brain injury

Authors: Moore NA, Brennan PM, Baillie JK.

Background. The heterogeneous nature of traumatic brain injury (TBI) makes outcome prediction difficult. Although a considerable evidence base exists in the form of well-validated predictive models, these models are not widely used. We hypothesised that this prognostic gap, between the availability and use of prognostic data, leads to inaccurate perceptions of patient outcome. We investigated whether outcome predictions in TBI made by expert clinicians were consistent and accurate when compared to a well-validated prognostic model (IMPACT). Methods. Neurosurgeons and neurointensivists were asked to predict probability of death at 6 months for 12 case vignettes describing patients with isolated TBI. Predictions were compared to IMPACT prognosis for each vignette. To interrogate potential sources of bias in clinical predictions, respondents were given one of two sets of vignettes (A or B) identical apart from one critical factor known to make a large difference to outcome. Results. 27 of 33 questionnaires were returned. Clinicians were consistently more pessimistic about outcomes than the IMPACT model, predicting a significantly greater probability of death (mean difference + 16.3%, 95% CI 13.3-19.4, p < 0.001). There was wide variation between clinicians predicting outcomes for any given vignette (mean range 68.3%), and within the predictions made by each individual: 30% of clinicians were both the most pessimistic respondent, and the most optimistic, for at least one vignette. Clinicians modified their predictions appropriately for most of the factors altered between corresponding vignettes. However when the reported blood glucose was changed, clinicians' predictions deviated widely from IMPACT predictions, indicating that clinicians systematically overlooked the prognostic relevance of this information. Conclusion. Clinical experts' predictions of outcome in TBI are widely variable and systematically pessimistic compared to IMPACT. Clinicians overlook important factors in formulating these predictions. Use of well-validated outcome models may add value and consistency to prognostication.

Impulsive and episodic disorders of aggressive behaviour following traumatic brain injury

Authors: Wood RL, Thomas RH.

Background: Aggressive behaviour is a frequent legacy of traumatic brain injury (TBI) and a major obstacle to psychosocial recovery. Aggression can take many forms and there is currently no uniform method of assessment that distinguishes aggressive sub-types in a way that can assist decisions for treatment. Review: This paper attempts to provide a framework that will help distinguish two primary sub-types of aggression following TBI, impulsive and episodic aggression, based on their most prominent clinical characteristics. It is hoped that, by providing a description of the phenomenology associated with each form of aggression, together with an explanation of the probable neuropathology underpinning each sub-type, the clinical classification of these two forms of aggression will improve, leading to a commensurate improvement in the choice of treatment interventions, resulting in better psychosocial outcomes.

Hypothermia Decreases Cerebrospinal Fluid Asymmetric Dimethylarginine Levels in Traumatic Brain Injury Children

Authors: Thampatty BP, Klamerus MM, Oberly PJ, Feldman KL, Bell MJ, Tyler-Kabara EC, Adelson PD, Clark RS, Kochanek PM, Poloyac SM.

OBJECTIVES:: Pathological increases in asymmetric dimethylarginine, an endogenous nitric oxide synthase inhibitor, have been implicated in endothelial dysfunction and vascular diseases. Reduced nitric oxide early after traumatic brain injury may contribute to hypoperfusion. Currently, methods to quantify asymmetric dimethylarginine in the cerebrospinal fluid have not been fully explored. We aimed to develop and validate a method to determine asymmetric dimethylarginine in the cerebrospinal fluid of a pediatric traumatic brain injury population and to use this method to assess the effects of 1) traumatic brain injury and 2) therapeutic hypothermia on this mediator. 

Perception of illness in patients with traumatic brain injury

Authors: Var FA, Rajeswaran J.

BACKGROUND: Perception of illness plays an important role in recovery process. It affects our coping behaviors, adherence to treatment and preventive measures taken for healthy recovery.
AIMS: The aim of the study is to examine perception of illness in patients with traumatic brain injury (TBI).
MATERIALS AND METHODS: This was a cross sectional study design done on sample of 31 patients with mild to moderate TBI. Depression anxiety stress scales-21 (DASS-21), Brief illness perception questionnaire (IPQ) and Rivermead Post Concussion Symptoms Questionnaire (RPQ) was used.
STATISTICAL ANALYSIS: Descriptive and correlational statistics was used.
RESULTS: The results indicated that overall higher percentage falls within low and medium range of IPQ. However higher percentage falls within higher range, on coherence and emotional response subscales of IPQ. Consequence, timeline, personal control, treatment control, concern, emotional control, and total of the subscales of IPQ were positively correlated with RPQ3 and RPQ13 at 0.01 and 0.05 level of significance. A significant correlation was found between demographic variables and subscales of IPQ at 0.01 and 0.05 level of significance.
CONCLUSION: The study shows one to one relationship between symptoms experienced by patients, how they perceive their illness and socio demographic variables.

Risk for Addiction-Related Disorders Following Mild Traumatic Brain Injury in a Large Cohort of Active-Duty U.S. Airmen

Authors: Miller SC, Baktash SH, Webb TS, Whitehead CR, Maynard C, Wells TS, Otte CN, Gore RK.

OBJECTIVE Military personnel are at increased risk for traumatic brain injury (TBI) from combat and noncombat exposures. The sequelae of moderate to severe TBI are well described, but little is known regarding long-term performance decrements associated with mild TBI. Furthermore, while alcohol and drug use are well known to increase risk for TBI, little is known regarding the reverse pattern. The authors sought to assess possible associations between mild TBI and addiction-related disorders in active-duty U.S. military personnel. METHOD A historical prospective study was conducted using electronically recorded demographic, medical, and military data for more than a half million active-duty U.S. Air Force service members. Cases were identified by ICD-9-CM codes considered by an expert panel to be indicative of mild TBI. Outcomes included ICD-9-CM diagnoses of selected addiction-related disorders. Cox proportional hazards modeling was used to calculate hazard ratios while controlling for varying lengths of follow-up and potential confounding variables. RESULTS Airmen with mild TBI were at increased risk for certain addiction-related disorders compared with a similarly injured non-mild TBI comparison group. Hazards for alcohol dependence, nicotine dependence, and nondependent abuse of drugs or alcohol were significantly elevated, with a consistent decrease over time. CONCLUSIONS A novel finding of this study was the initial increased risk for addiction-related disorders that decreased with time, thus eroding war fighter performance in a military population. Moreover, these results suggest that mild TBI is distinguished from moderate to severe TBI in terms of timing of the risk, indicating that there is a need for screening and prevention of addiction-related disorders in mild TBI. Screening may be warranted in military troops as well as civilians at both short- and long-term milestones following mild TBI.


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