In summary, CCR5 is a translational target for neural repair in stroke and TBI and the first reported gene associated with enhanced recovery in human stroke.
Helmet use in preventing acute concussive symptoms in recreational vehicle related head trauma
Marco Daverio, Franz E Babl, Ruth Barker, Dario Gregori, Liviana Da Dalt & Silvia Bressan
Pages 335-341, Brain Injury. Published online: 22 Jan 2018
https://doi.org/10.1080/02699052.2018.1426107
ABSTRACT
Objectives: Helmets use has proved effective in reducing head trauma (HT) severity in children riding non-motorised recreational vehicles. Scant data are available on their role in reducing concussive symptoms in children with HT while riding non-motorised recreational vehicles such as bicycles, push scooters and skateboards (BSS). We aimed to investigate whether helmet use is associated with a reduction in acute concussive symptoms in children with BSS-related-HT.
Methods: Prospective study of children <18 years who presented with a BSS related-HT between April 2011 and January 2014 at a tertiary Paediatric Emergency Department (ED).
Results: We included 190 patients. Median age 9.4 years (IQR 4.8–13.8). 66% were riding a bicycle, 23% a push scooter, and 11% a skateboard. 62% were wearing a helmet and 62% had at least one concussive symptom. Multivariate logistic regression analysis adjusting for age, gender, and type of vehicle showed that patients without a helmet presented more likely with headache (adjusted odds-ratio (aOR) 2.54, 95% CI 1.27–5.06), vomiting (aOR 2.16, 95% CI 1.00–4.66), abnormal behaviour (aOR 2.34, 95% CI 1.08–5.06), or the presence of at least one concussive symptom (aOR 2.39, 95% CI 1.20–4.80).
Conclusions: In children presenting to the ED following a wheeled BSS-related HT helmet use was associated with less acute concussive symptoms.
ABBREVIATIONS: aOR, adjusted odds ratio; APHIRST, Australasian Paediatric Head Injury Rules Study; BSS, bicycles, push scooters and skateboards; CI, confidence interval; CT, computed tomography; ED, emergency department; HT, head trauma; IQR, interquartile range; OR, odds ratio; RCH, Royal Children’s Hospital; RV, recreational vehicle.
Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury A TRACK-TBI Study.
Stein, Sonia Jain, Giacino et al. JAMA Psychiatry. 2019; 76(3):249-258.
https://doi.org/10.1001/jamapsychiatry.2018.4288
Published online: January 30, 2019
Importance Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector.
Objective To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI).
Design, Setting, and Participants Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study.
Main Outcomes and Measures Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury.
Results Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk.
Conclusions and Relevance After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention.
Lagerstedt L, Egea-Guerrero JJ, Bustamante A, Rodríguez-Rodríguez A, El Rahal A, Quintana-Diaz M, et al. (2018) Combining H-FABP and GFAP increases the capacity to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury. PLoS ONE 13(7): e0200394.
https://doi.org/10.1371/journal.pone.0200394
Abstract:
Mild traumatic brain injury (mTBI) patients may have trauma-induced brain lesions detectable using CT scans. However, most patients will be CT-negative. There is thus a need for an additional tool to detect patients at risk. Single blood biomarkers, such as S100B and GFAP, have been widely studied in mTBI patients, but to date, none seems to perform well enough. In many different diseases, combining several biomarkers into panels has become increasingly interesting for diagnoses and to enhance classification performance.
The present study evaluated 13 proteins individually—H-FABP, MMP-1, MMP-3, MMP-9, VCAM, ICAM, SAA, CRP, GSTP, NKDA, PRDX1, DJ-1 and IL-10—for their capacity to differentiate between patients with and without a brain lesion according to CT results. The best performing proteins were then compared and combined with the S100B and GFAP proteins into a CT-scan triage panel. Patients diagnosed with mTBI, with a Glasgow Coma Scale score of 15 and one additional clinical symptom were enrolled at three different European sites. A blood sample was collected at hospital admission, and a CT scan was performed. Patients were divided into two two-centre cohorts and further dichotomised into CT-positive and CT-negative groups for statistical analysis. Single markers and panels were evaluated using Cohort 1.
Four proteins—H-FABP, IL-10, S100B and GFAP—showed significantly higher levels in CT-positive patients. The best-performing biomarker was H-FABP, with a specificity of 32% (95% CI 23–40) and sensitivity reaching 100%. The best-performing two-marker panel for Cohort 1, subsequently validated in Cohort 2, was a combination of H-FABP and GFAP, enhancing specificity to 46% (95% CI 36–55). When adding IL-10 to this panel, specificity reached 52% (95% CI 43–61) with 100% sensitivity.
These results showed that proteins combined into panels could be used to efficiently classify CT-positive and CT-negative mTBI patients.
Traumatic Brain Injury and the Risk for Subsequent Crime Perpetration
Bonow, Robert H; Wang, Jin, et al. The Journal of Head Trauma Rehabilitation: January/February 2019 – Volume 34 – Issue 1 – p E61–E69
http://doi.org/10.1097/HTR.0000000000000413
Abstract
Objective:
To examine whether patients with traumatic brain injury (TBI) are at higher risk for subsequent crime perpetration compared with injured patients without TBI and those hospitalized for reasons other than injury.
Setting and Participants:
Patients hospitalized in Washington State from 2006-2007.
Design:
A retrospective cohort study using linked statewide datasets.
Main measures:
Primary outcomes were arrest for any violent or nonviolent crime within 5 years of discharge. Adjusted subhazard ratios were calculated using regression models incorporating death as a competing risk.
Results:
Compared with uninjured patients (n = 158 247), the adjusted rate of arrest for any crime was greater among injured patients with TBI (n = 6894; subdistribution hazard ratios [sHR], 1.57; 95% confidence interval [CI], 1.49-1.62) and without TBI (n = 40 035; sHR, 1.55; 95% CI, 1.49-1.62). When patients with TBI were directly compared with injured patients without TBI, no effect of TBI on subsequent arrests was found (sHR, 1.02; 95% CI, 0.94-1.11). TBI did not increase the likelihood of either violent or nonviolent crime when these outcomes were examined separately.
Conclusions:
TBI survivors do not appear to be at increased risk for criminality compared with injured individuals without TBI. However, injured persons with or without TBI may be at elevated risk of crime perpetration compared with those who are uninjured.
Time for change in acquired brain injury
David K Menon, Chris Bryant, MP. The Lancet, Neurology, CORRESPONDENCE| VOLUME 18, ISSUE 1, P28, JANUARY 01, 2019
https://doi.org/10.1016/S1474-4422(18)30463-0
The term acquired brain injury includes several conditions that affect clinical outcome and quality of life in survivors. The most common causes include traumatic brain injury, stroke, and hypoxic-ischaemic encephalopathy after cardiac arrest. Acquired brain injury is a rapidly growing public health problem, resulting in nearly 1000 hospital admissions each day in the UK, with about a 10% increase in incidence over the past decade. Although improvements in emergency care (eg, through major trauma centres, stroke units, and bystander cardiopulmonary resuscitation) have resulted in improvements in survival, neurorehabilitation provision for survivors is inadequate, and their reintegration into society is limited by a poor understanding of the consequences of acquired brain injury among non-specialists and the public.
In this context, Time for change,1 the report produced by the UK All-Party Parliamentary Group on Acquired Brain Injury (APPG-ABI), argues for a better link between acute and post-acute care and makes a series of recommendations about other policy areas that need to be addressed. The APPG-ABI consists of UK Members of Parliament who have come together, with organisational support from the UK Acquired Brain Injury Foundation, to gather input from patients, patient support organisations, and health professionals.
Acquired brain injury leaves survivors with a considerable burden of physical, cognitive, and psychosocial sequelae, and can also increase the risk of late neurodegenerative disease. Early neurorehabilitation is cost-effective and can minimise residual disability. However, neurorehabilitation resources across the UK are patchy and inadequate, implementation of past recommendations is poor, and the use of rehabilitation prescriptions is inconsistent. The report recommended a national review of neurorehabilitation provision and better recording of numbers of patients presenting at emergency departments with acquired brain injury.
Many survivors of acquired brain injury are children and young people. However, many education professionals do not have awareness and understanding of acquired brain injury, which hampers educational progress and neglects an important opportunity for rehabilitation in the school environment. The report recommends inclusion of acquired brain injury in the Special Educational Needs and Disability Code of Practice, and that education professionals should have a minimum level of awareness and understanding about acquired brain injury, with additional training for named lead professionals.
Children and young people with traumatic brain injury are more likely to develop behavioural problems that are linked to an increased propensity to criminal offending. Individuals in custody report a higher incidence of brain injury than the general population, but acquired brain injury is rarely considered in the justice system during police or court interviews, sentencing, or while assessing rehabilitative needs. Identifying and managing the consequences of acquired brain injury at an early stage could have substantial individual, societal, and financial benefits. The report indicated that these gains could be realised by better awareness of acquired brain injury among the professionals in the criminal justice system, assessment of individuals for brain injury when they enter the system, and ensuring that all stakeholders working in this context check that the rehabilitative needs of such individuals were appropriately addressed.
Sport-related concussion is probably the most common cause of traumatic brain injury, and the small proportion of patients who have persistent post-concussional symptoms beyond 2 weeks is still a large number of patients. Repeated concussion might also predispose patients to late neurodegenerative disease. The report highlights the need for clear guidelines to establish the management, recovery, and safe return to play after a sport-related concussion.
Furthermore, the report noted that many acquired brain injury survivors lose employment and income at a time when they are especially vulnerable. These difficulties are accentuated by the complexity of processes involved in accessing welfare benefits, which are challenging to acquired brain injury survivors, many of whom have cognitive problems. These problems can be compounded by poorly informed assessors with poor knowledge of acquired brain injury. The report recommended increasing assessment intervals and improving training of assessors.
This report was published almost exactly a year since The Lancet Neurology Commission on traumatic brain injury2 was launched, with the aims of influencing research funders and policy makers. The first of these aims has been substantially realised through interactions with the International Initiative for Traumatic Brain Injury Research. The engagement of policy makers and patient organisations has resulted in outputs more slowly, but the report from the APPG-ABI is a very welcome step in the right direction.
The association between post-concussion symptoms and health-related quality of life in patients with mild traumatic brain injury
Daphne C.Voormolena, Suzanne Polindera, Nicole von Steinbuechel, Pieter E.Vosc, Maryse C.Cnossena, Juanita A.Haagsmaad. Injury. Available online 7 December 2018
https://doi.org/10.1016/j.injury.2018.12.002
A subset of mild traumatic brain injury (mTBI) patients experience post-concussion symptoms. When a cluster of post-concussion symptoms persists for over three months, it is referred to as post-concussion syndrome (PCS). Little is known about the association between PCS and Health-Related Quality of Life (HRQoL) after mTBI. The aims of this study were to assess the implications of PCS on HRQoL six months after mTBI and the relationship between PCS and HRQoL domains. A prospective observational cohort study was conducted among a sample of mTBI patients. Follow-up postal questionnaires at six months after emergency department (ED) admission included socio-demographic information, the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), and HRQoL measured with the 36-item Short-Form Health Survey (SF-36) and the Perceived Quality of Life Scale (PQoL). In total, 731 mTBI patients were included, of whom 38.7% were classified as suffering from PCS. Patients with PCS had significantly lower scores on all SF-36 domains, lower physical and mental component summary scores and lower mean PQoL scores compared to patients without PCS. All items of the RPQ were negatively correlated to all SF-36 domains and PQoL subscale scores, indicating that reporting problems on any of the RPQ symptoms was associated with a decrease on different aspects of an individuals’ HRQoL. To conclude, PCS is common following mTBI and patients with PCS have a considerably lower HRQoL. A better understanding of the relationship between PCS and HRQoL and possible mediating factors in this relationship could improve intervention strategies, the recovery process for mTBI patients and benchmarking.
Traumatic Brain Injury in Early Childhood and Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Nationwide Longitudinal Study.
Chang HK, Hsu JW, Wu JC, Huang KL, Chang HC, Bai YM, Chen T, Chen M. J Clin Psychiatry. 2018 Oct 16;79(6).
https://doi.org/10.4088/JCP.17m11857
OBJECTIVE:
Early childhood (< 3 years of age) is a critical period for neurodevelopment. This study investigated the correlation between early childhood traumatic brain injury (TBI) and subsequent risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental delay (DD) by analyzing a national-scale cohort.
METHODS:
Data from the National Health Insurance Research Database, which comprises health care information from > 99% of the Taiwanese population, were analyzed. Children with TBI in their early childhood were enrolled from 1998-2008, and the incidence of subsequent ADHD, ASD, or DD (according to ICD-9 criteria) was assessed and compared with controls without TBI. Patients’ age, number of TBI events, and TBI severity were investigated for the risk of ADHD, ASD, or DD.
RESULTS:
A total of 7,801 and 31,204 children were enrolled in the TBI and control cohorts, respectively. The TBI cohort exhibited a higher incidence of subsequent ADHD, ASD, or DD than the controls (all P < .001). Diagnoses of ADHD, ASD, or DD in the TBI cohort were made at a younger age compared with the controls. Cox regression demonstrated the highest hazard ratios (HRs) of ADHD, ASD, or DD with repeated TBI events, severe TBI, and TBI events before 1 year of age, with the exception that the HR of ASD did not significantly increase after repeated TBI (P = .335). In addition, cumulative HRs (> 10 years) of ADHD, ASD, or DD were increased after TBI (all P < .001).
CONCLUSIONS:
Data from this study suggest that the incidence of ADHD, ASD, and DD significantly increased after TBI events in early childhood (< 3 years of age). The risk factors include severe TBI, repeated TBI events, and TBI at a younger age. The long-term follow-up demonstrated an increased cumulative risk of ADHD, ASD, and DD after TBI.
The Brain Injury Rehabilitation Workbook edited by Rachel Winson, Barbara A. Wilson, and Andrew Bateman.
Packed with practical tools and examples, this state-of-the-art workbook provides a holistic framework for supporting clients with acquired brain injury. Clinicians are guided to set and meet collaborative treatment goals based on a shared understanding of the strengths and needs of clients and their family members. Effective strategies are described for building skills and teaching compensatory strategies in such areas as attention, memory, executive functions, mood, and communication. Particular attention is given to facilitating the challenging process of identity change following a life-altering injury. In a large-size format for easy photocopying, the volume features 93 reproducible client handouts. Purchasers get access to a Web page where they can download and print the reproducible materials.
Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury, Journal of Neurotrauma, September 2018, F. Hammond; J. Giacino; R. Nakase-Richardson; J. A. Haley; X. Tang.
Few studies have assessed the long-term functional outcomes of patients with a disorder of consciousness due to traumatic brain injury (TBI).
This study examined functional status during the first ten years after TBI among a cohort with disorders of consciousness (i.e., coma, vegetative state, minimally conscious state).
The study sample included 110 individuals with TBI who were unable to follow commands prior to inpatient rehabilitation and for whom follow-up data were available at 1, 2, 5, and 10 years post-injury.
The sample was subdivided into those who demonstrated command-following early (before 28 days post-injury) versus late (>28 days post-injury or never).
Measureable functional recovery occurred throughout the 10-year period, with more than 2/3 of the sample achieving independence in mobility and self-care, and about 1/4 achieving independent cognitive function by 10 years.
Following commands prior to 28 days was associated with greater functional independence at all outcome time points.
More than half the sample achieved near-maximal recovery by 1-year post-injury, while the later command-following subgroups recovered over longer periods of time. Significant late functional decline was not observed in this cohort.
The proportion of participants achieving functional independence increased between 5 and 10 years post-injury.
These findings suggest that individuals with disorders of consciousness may benefit from ongoing functional monitoring and updated care plans for at least the first decade after TBI.
0207 164 6821
Harlow, Blackheath, Wimbledon, Haywards Heath, Hemel Hempstead, Mildenhall and surroundings area.
Company Name: Npsych Limited. Company Number: 07119496, Place of Registration: England and Wales. Registered Office: 7 Ducketts Mead, Roydon, Essex, CM19 5EG
Copyright All Rights Reserved © 2024 │ Privacy Policy │ Disclaimer │ NPsych Limited │ Designed by The Look Blog Agency
