Articles: traumatic-brain-injuries.
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The most extensively validated prognostic models for traumatic brain injury (TBI) are the Corticoid Randomization after Significant Head Injury (CRASH) and International Mission on Prognosis and Analysis of Clinical Trials (IMPACT). Model characteristics outside of area under the curve (AUC) are rarely reported. ⋯ Our results were consistent with previous literature regarding discriminative validity (AUC = 0.77-0.81). However, accuracy and false positive rates of both the CRASH and IMPACT models were poor.
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Patients with severe traumatic brain injury (TBI) are commonly intubated during prehospital treatment despite a lack of evidence that this is beneficial. Accumulating evidence even suggests that prehospital intubation may be hazardous, in particular when performed by inexperienced EMS clinicians. To expand the limited knowledge base, we studied the relationship between prehospital intubation and hospital mortality in patients with severe TBI in a large Dutch trauma database. We specifically hypothesized that the relationship differs depending on whether a physician-based emergency medical service (EMS) was involved in the treatment, as opposed to intubation by paramedics. ⋯ The data do not support the common practice of prehospital intubation. The effect of prehospital intubation on mortality might depend on EMS clinician experience, and it seems prudent to involve prehospital personnel well proficient in prehospital intubation whenever intubation is potentially required. The decision to perform prehospital intubation should not merely be based on the largely unsupported dogma that it is generally needed in severe TBI, but should rather individually weigh potential benefits and harms.
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Patients with head trauma who take antiplatelet or anticoagulant (APAC) agents have a higher rate of mortality. However, the association between these agents and mortality among blunt torso trauma patients without severe traumatic brain injury remains unclear. ⋯ The use of APAC agents before the injury was not associated with higher in-hospital mortality among blunt torso trauma patients without severe traumatic brain injury.
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Journal of neurotrauma · Jan 2023
A Study of 309 Patients and at One Year Follow-up for Depression Following Traumatic Brain Injury.
Traumatic brain injury (TBI) is one the major causes of death and morbidity in developing countries, where depression is a common psychiatric condition among individuals with TBI. The objectives were to investigate the occurrence and severity of depression one-year post-TBI; the association between radiological findings and depression; and the risk factors. We report a cross-sectional study among adult patients who were hospitalized because of TBI in the past one year. ⋯ The risk factors for depression at one-year post-TBI are moderate-severe TBI (odds ratio [OR]: 3.75, 95% confidence interval [CI] 2.03-6.90, p < 0.00), being unmarried (OR: 2.67, 95% CI 1.51-4.72, p = 0.001), female gender (OR: 2.62, 95% CI 1.25-5.46, p = 0.011), alcohol consumption (OR: 2.38, 95% CI 1.12-5.06, p = 0.024) and frontal lobe injury (OR: 1.96, 95% CI 1.05-3.68, p = 0.035). Increasing severity of TBI is associated with worsening levels of depression. Patients with frontal lobe injury have the highest risk of depression, while diffuse injury is associated with occurrence of moderate and moderately severe depression.
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Journal of neurotrauma · Jan 2023
Traumatic Brain Injury and Risk of Long-Term Nursing Home Entry among Older Adults: An Analysis of Medicare Administrative Claims Data.
Traumatic brain injury (TBI) is a leading cause of injury-related disability among older adults, and there is increasing interest in post-discharge management as this population grows. We evaluated the association between TBI and long-term nursing home (NH) entry among a nationally representative sample of older adults. We identified 207,355 adults aged ≥65 years who received a diagnosis of either a TBI, non-TBI trauma, or were uninjured between January 2008 and June 2015 from a 5% sample of Medicare beneficiaries. ⋯ After excluding beneficiaries living in a NH at index, there were 60,600 TBI, 63,762 non-TBI trauma, and 69,893 uninjured beneficiaries in the sample. In weighted models, beneficiaries with TBI entered NHs at higher rates relative to the non-TBI trauma (HR 1.15; 95% CI 1.10, 1.20) and uninjured (HR 1.67; 95% CI 1.60, 1.74) groups. Future research should focus on interventions to retain older adult TBI survivors within the community.