Journal of neurotrauma
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Journal of neurotrauma · Apr 2019
Meta Analysis Comparative StudyComparing Region of Interest vs. Voxel-Wise Diffusion Tensor Imaging Analytic Methods in Mild and Moderate Traumatic Brain Injury: A Systematic Review and Meta-Analysis.
Diffusion tensor imaging is a magnetic resonance imaging technique that is uniquely capable of detecting microstructural tissue damage in mild and moderate traumatic brain injuries (TBIs). To date, it remains unknown if two common analytic techniques, region of interest (ROI) versus voxel-wise (VW) analyses, detect injury in similar locations. The purpose of this systematic review and meta-analysis was to directly compare the regions of abnormality elucidated by each method. ⋯ Moreover, we have shown that the magnitude of damage in the corpus callosum revealed by ROI analysis (z = -3.15) is greater than that demonstrated by VW analysis (z = -1.41). Overall, this study indicates that both ROI and VW analytic methods are sensitive to low FA in the corpus callosum; however, the ROI method has more power to detect the full extent of tissue abnormality in the corpus callosum. More research utilizing standardized methods and reporting is essential to fully characterize the extent to which ROI and VW analyses can concordantly detect other locations of pathology in mild and moderate TBI patients.
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Journal of neurotrauma · Apr 2019
Voluntary Head Rotational Velocity and Implications for Brain Injury Risk Metrics.
We investigated whether humans could sustain high head rotational velocities without brain injury. Rotational velocity has long been implicated for predicting concussion risk, and has recently been used to develop the rotational velocity-based Brain Injury Criterion (BrIC). To assess the efficacy of rotational velocity and BrIC for predicting concussion risk, we instrumented 9 male subjects with sensor-laden mouthguards and measured six-degree-of-freedom head accelerations for 27 rapid voluntary head rotations. ⋯ Baseline and post-experiment neurological testing revealed no significant deficits. We find that the head can tolerate high-velocity, low-acceleration rotational inputs too slow to produce substantial brain deformation. These findings suggest that the time regime over which angular velocities occur must be carefully considered for concussion prediction.
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Journal of neurotrauma · Apr 2019
Meta AnalysisExamination of Injury, Host, and Social-Environmental Moderators of Online Family Problem Solving Treatment Efficacy for Pediatric Traumatic Brain Injury Using an Individual Participant Data Meta-Analytic Approach.
A series of five randomized controlled clinical trials (RCTs) conducted between 2002 and 2015 support the potential efficacy of online family problem-solving treatment (OFPST) in improving both child and parent/family outcomes after pediatric traumatic brain injury (TBI). However, small sample sizes and heterogeneity across individual studies have precluded examination of potentially important moderators. We jointly analyzed individual participant data (IPD) from these five RCTs, involving 359 children and adolescents between the ages of 5 and 18 years, to confirm the role of previously identified moderators (child's age and pre-treatment symptom levels, parental education) and to examine other potential moderators (race, sex, IQ), using IPD meta-analysis. ⋯ Child IQ moderated the effect of OFPST on social competence, with significantly better competence for children with lower IQ who received OFPST. Lower levels of parental depression followed OFPST among subgroups with lower IQ, boys, and higher parental depression scores at baseline. Our findings indicate that the optimal application of OFPST is likely to involve older children, those with lower IQ scores, or those from families with lower socioeconomic status (SES).
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Journal of neurotrauma · Apr 2019
Meta AnalysisVentricular Drainage Catheters versus Intracranial Parenchymal Catheters for Intracranial Pressure Monitoring-Based Management of Traumatic Brain Injury: A Systematic Review and Meta-Analysis.
Intracranial pressure (ICP) monitoring is one of the mainstays in the treatment of severe traumatic brain injury (TBI), but different approaches to monitoring exist. The aim of this systematic review and meta-analysis is to compare the effectiveness and complication rate of ventricular drainage (VD) versus intracranial parenchymal (IP) catheters to monitor and treat raised ICP in patients with TBI. Pubmed, Embase, Web of Science, Google Scholar, and the Cochrane Database were searched for articles comparing ICP monitoring-based management with VDs and monitoring with IP monitors through March 2018. ⋯ VDs caused more complications, particularly more infections, but there was no difference in mortality or functional outcome between the two monitoring modalities. However, the studies had a high risk of bias. A need exists for high quality comparisons of VDs versus IP monitor-based management strategies on patient outcomes.
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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.