Journal of neurotrauma
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Journal of neurotrauma · Apr 2019
ReviewExperimental Designs for Repeated Mild Traumatic Brain Injury: Challenges and Considerations.
Mild traumatic brain injury (mild TBI) is a growing public concern, as evidence mounts that even brain injuries classified as "mild" can result in persistent neurological dysfunction. Multiple brain injuries heighten the likelihood of worsened or more prolonged symptomatology and may trigger long-term neurodegeneration. Animal models provide a logical platform to identify key parameters, such as loading forces, duration between injuries, and number of injuries, which contribute to additive or synergistic damage after repeated mild TBI. ⋯ The complexity of designing studies of repeated TBI is discussed, including challenges of incorporating appropriate control groups, informative experimental design, and relevant outcome measures. We then feature studies that provide a well-controlled, within-study design varying either the number of injuries or the interinjury interval. Harnessing the power of experimental models of TBI to elucidate which injury parameters are critical contributors to acute and chronic damage after repeated injury can further efforts at prevention and provide improved models for testing mechanisms and therapeutic interventions.
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Journal of neurotrauma · Apr 2019
Discordance between Documented Criteria and Documented Diagnosis of Traumatic Brain Injury in the Emergency Department.
Accurate diagnosis of traumatic brain injury (TBI) is critical to ensure that patients receive appropriate follow-up care, avoid risk of subsequent injury, and are aware of possible long-term consequences. However, diagnosis of TBI, particularly in the emergency department (ED), can be difficult because the symptoms of TBI are vague and nonspecific, and patients with suspected TBI may present with additional injuries that require immediate medical attention. We performed a retrospective chart review to evaluate accuracy of TBI diagnosis in the ED. ⋯ After controlling for demographic and clinical factors, patients presenting at a level I trauma center, with cause of injury other than fall, without CT findings of TBI, and without loss of consciousness were more likely to lack documented diagnosis despite meeting diagnostic criteria for TBI. A greater proportion of patients without documented ED diagnosis of TBI were discharged home compared to those with a documented diagnosis of TBI (58% vs. 40%; p < 0.001). Together, these data suggest that many patients who have sustained a TBI are discharged home from the ED without a documented diagnosis of TBI, and that improved awareness and implementation of diagnostic criteria for TBI is important in the ED and for in- and outpatient providers.
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Journal of neurotrauma · Apr 2019
Observational StudyElevations in MicroRNA Biomarkers in Serum Are Associated with Measures of Concussion, Neurocognitive Function and Subconcussive Trauma over a single NCAA Division I Season in Collegiate Football Players.
This prospective controlled observational cohort study assessed the performance of a novel panel of serum microRNA (miRNA) biomarkers on indicators of concussion, subconcussive impacts, and neurocognitive function in collegiate football players over the playing season. Male collegiate student football athletes participating in a Division I Football Bowl Subdivision of the National Collegiate Athletic Association (NCAA) were enrolled. There were a total of 53 participants included in the study, 30 non-athlete control subjects and 23 male collegiate student football athletes. ⋯ Those correlating with poor reaction times were miR-20a (0.043), miR-505* (p = 0.049), miR-30d (p = 0.031), miR-92 (p = 0.015), and miR-151-5p (p = 0.044). Select miRNAs were associated with baseline concussion assessments at the beginning of the season and with neurocognitive changes from pre to post-season in collegiate football players. Should these findings be replicated in a larger cohort of athletes, these markers could potentially serve as measures of neurocognitive status in athletes at risk for concussion and subconcussive injuries.
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Journal of neurotrauma · Apr 2019
ReviewSports-Related Repetitive Traumatic Brain Injury: A Novel Cause of Pituitary Dysfunction.
Traumatic brain injury (TBI) is one of the major causes of disability and death, particularly in the young population. Recent clinical studies have demonstrated that TBI-induced pituitary dysfunction occurs more frequently than previously estimated, and this may contribute to delayed diagnosis and treatment of hormonal abnormalities. ⋯ Current studies suggest that athletes who had retired, especially from combative sports, should be screened for hypopituitarism. In this review, we aim to increase the awareness of medical communities, athletes, coaches, and athletic trainers about this issue by sharing the current studies regarding the pituitary dysfunction attributed to repetitive TBI associated with sports.