Articles: traumatic-brain-injuries.
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Journal of neurosurgery · Dec 2024
Effects of optimal versus suboptimal median household income on the surgically treated traumatic brain injury population at a level I trauma center in the Boston metropolitan area: a propensity score-matched analysis.
The median household income is a useful metric for healthcare disparity assessment. New England holds the highly diverse, densely populated Boston metropolitan area, which is known for having one of the highest living wages in the US. To the authors' knowledge, there is no published data on the effects of optimal versus suboptimal median household income on the surgical treatment of patients with traumatic brain injury (TBI). The authors sought to evaluate the disparities of an optimal versus suboptimal median household income-stratified population of patients with TBI who underwent surgical treatment at a single level I trauma center with a high safety-net burden in a major US metropolitan area. ⋯ Although the suboptimal income group is significantly more ethnically diverse, median household income does not seem to affect TBI outcomes and discharge disposition. Patients in the optimal income group more frequently presented as transfers from other facilities, potentially indicating fair high-level care at a specialized trauma center with a high safety-net burden adapted to a diverse patient population.
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Traumatic brain injury (TBI) prediction models have gained significant attention in recent years because of their potential to aid in clinical decision making. Existing models, such as Corticosteroid Randomization after Significant Head Injury and International Mission for Prognosis and Analysis of Clinical Trials, are currently losing external validity and performance, probably because of their diverse inclusion criteria and changes in treatment modalities over the years. There is a lack of models that predict outcomes strictly pertaining to primary decompression after TBI. In this study, we aimed to develop an easy-to-use prediction model for predicting the risk of poor functional outcomes at 3 months after hospital discharge in adult patients who had undergone primary decompressive craniectomy for isolated moderate-to-severe TBI. ⋯ Our study provides a ready-to-use prognostic nomogram derived from prospective data that can predict the risk of having a GOSE of 1-4 at three months following primary decompressive craniectomy with high sensitivity, PPV, and low LR-.
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Timely palliative care (PC) consultations offer demonstrable benefits for patients with traumatic brain injury (TBI), yet their implementation remains inconsistent. This study employs machine learning methods to identify distinct patient phenotypes and elucidate the primary drivers of PC consultation timing variability in TBI management, aiming to uncover disparities and inform more equitable care strategies. ⋯ This study unveils crucial disparities in PC consultation timing for patients with TBI, primarily driven by demographic factors rather than clinical presentation or injury characteristics. The identification of distinct patient phenotypes and quantification of factors influencing PC consultation timing provide a foundation for developing for standardized protocols and decision support tools to ensure timely and equitable palliative care access for patients with TBI.
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J Clin Monit Comput · Dec 2024
Relationship between the amplitudes of cerebral blood flow velocity and intracranial pressure using linear and non-linear approach.
Intracranial pressure (ICP), cerebral blood flow and volume are affected by craniospinal elasticity and cerebrospinal fluid dynamics, interacting in complex, nonlinear ways. Traumatic brain injury (TBI) may significantly alter this relationship. This retrospective study investigated the relationship between the vascular and parenchymal intracranial compartments by analysing two amplitudes: cerebral blood flow velocity (AmpCBFV) and ICP (AMP) during hypocapnia manoeuvre in TBI patients. ⋯ The relative frequency of symmetrical word types (JSAsym) describing the AmpCBFV-AMP interaction decreased during hypocapnia (0.35 ± 0.30) compared to baseline (0.44 ± 0.030; p = 0.004). Our results indicate that while the grouped-averaged AmpCBFV and AMP were not significantly correlated, either at baseline or during hypocapnia, significant changes were observed when using RAMP and JSA indices. Further validation of these new parameters, which reflect the association between the vascular and parenchymal intracranial compartments, is needed in a larger cohort.
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Pediatric emergency care · Dec 2024
Pediatric Emergency Medicine Physicians' Perspectives of Concussion in Young Children.
Traumatic brain injury (TBI) during early childhood (before 6 years) is prevalent, accounting for rising rates of emergency department visits. These injuries may lead to postconcussive symptoms, which may be subtle and difficult to diagnose in young children. Inadequate discharge counseling may lead to prolonged duration of symptoms and possible developmental delays. We aimed to explore pediatric emergency medicine (PEM) physicians' perspectives on "concussion" terminology, diagnosis, and management, specifically in a young child with mild TBI. ⋯ Variability exists among PEM physicians in diagnosis and management of concussions in young children. Discomfort with lack of reliability of symptoms and underappreciation of typical early childhood characteristics may account for findings. Educational initiatives, age-appropriate clinical tools and treatment-guided outcomes research are needed to guide PEM physicians in the care of young children with head injuries.