Articles: traumatic-brain-injuries.
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It is estimated that up to 69 million people per year experience traumatic brain injury (TBI) with the highest prevalence found in low- and middle-income countries (LMICs). A paucity of data suggests that the mortality rate after severe TBI is twice as high in LMICs than in high-income countries. ⋯ TBI-related mortality in LMICs is 3-fold to 4-fold higher than that reported in high-income countries. Within LMICs, parameters associated with poorer outcomes after TBI include factors recognized as social determinants of health. Addressing social determinants of health in LMICs might expedite the quest to close the care delivery gap after TBI.
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Journal of neurotrauma · Oct 2023
Transcranial, noninvasive evaluation of the potential misery perfusion during hyperventilation therapy of traumatic brain injury patients.
Hyperventilation (HV) therapy uses vasoconstriction to reduce intracranial pressure (ICP) by reducing cerebral blood volume. However, as HV also lowers cerebral blood flow (CBF), it may provoke misery perfusion (MP), in which the decrease in CBF is coupled with increased oxygen extraction fraction (OEF). MP may rapidly lead to the exhaustion of brain energy metabolites, making the brain vulnerable to ischemia. ⋯ We have characterized each statistically significant event in detail and its possible relationship to clinical and radiological status (decompressive craniectomy and presence of a cerebral lesion), without detecting any statistically significant difference (p > 0.05). However, MP detection stresses the need for personalized, real-time assessment in future clinical trials with HV, in order to provide an optimal evaluation of the risk-benefit balance of HV. Our study provides pilot data demonstrating that bedside transcranial hybrid near-infrared spectroscopies could be utilized to assess potential MP.
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Journal of neurotrauma · Oct 2023
Mild Traumatic Brain Injury Affects Orexin/Hypocretin Physiology Differently in Male and Female Mice.
Traumatic brain injury (TBI) is known to affect the physiology of neural circuits in several brain regions, which can contribute to behavioral changes after injury. Disordered sleep is a behavior that is often seen after TBI, but there is little research into how injury affects the circuitry that contributes to disrupted sleep regulation. Orexin/hypocretin neurons (hereafter referred to as orexin neurons) located in the lateral hypothalamus normally stabilize wakefulness in healthy animals and have been suggested as a source of dysregulated sleep behavior. ⋯ Alterations in afferent excitatory activity occurred in different parameters in male and female animals. The increased afferent inhibitory activity after injury is more pronounced in recordings from female animals. Our results indicate that mTBI changes the physiology of orexin neuron circuitry and that these changes are not the same in male and female animals.
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Journal of neurotrauma · Oct 2023
Sample size, replicability, and pre-test likelihoods - essential, overlooked, and critical components of statistical inference - A Journal of Neurotrauma Guide to Statistical Methods and Study Design.
Perhaps one of the most overlooked components of statistical inference is the sample size. While in randomized controlled trials, power analysis is common and sample size justification is an integral component of the core statistical analysis plan, observational and laboratory research studies often rely on convenience samples and/or underpowered analyses. Insufficiently powered studies increase uncertainty associated with the results and limit interpretability. ⋯ Further, if the effect size is small, replication often requires sample sizes that are substantially larger than the original study. For most neurotrauma research, thousands of subjects are usually not required, but many studies do require substantially larger sample sizes than are typically presented in published research to increase replicability. In this methodological tutorial, choice of sample size, pre-test probability, and the concept of positive predictive value for scientific findings will be discussed, together with suggestions to improve replicability of neurotrauma research in the future.
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Wien. Klin. Wochenschr. · Oct 2023
Red blood cell distribution width and Charlson comorbidity index help to identify frail polytraumatized patients : Experiences from a level I trauma center.
Little is known about the potential impact of the red blood cell distribution width (RDW) and pre-existing comorbidities on the late-phase survival of polytraumatized patients. ⋯ Even younger elderly polytraumatized patients (> 55 years of age) showed significant higher RDW values and higher CCI scores. In addition to the presence of severe TBI and age > 55 years, RDW value > 13.75% on admission and CCI score > 2 might help to identify the "younger" frail polytraumatized patient at risk.