Articles: traumatic-brain-injuries.
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The efficacy of copeptin in patients with severe head injuries remains unclear. ⋯ Serum copeptin levels rise after graded TBI and can distinguish between patients with and without intracranial or extracranial lesions evident on CCT. Copeptin levels also aid in identifying moderate or severe TBI and in predicting 28-day mortality.
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Journal of neurotrauma · Oct 2024
Predictive Blood Biomarkers of Targeted Intervention for Chronic Mental Health Symptoms following Traumatic Brain Injury.
The purpose of this study was to assess the performance of predictive blood biomarkers for responsiveness to targeted treatments for chronic psychological issues years after traumatic brain injury (TBI). Targeted Evaluation Action and Monitoring of TBI was a prospective 6-month interventional trial of participants with chronic TBI sequelae (n = 95). Plasma biomarkers were analyzed pre-intervention: glial fibrillary acidic protein (GFAP), tau, hyperphosphorylated tau Thr231 (p-Tau), von Willebrand factor (vWF), brain lipid-binding protein (BLBP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), vascular endothelial growth factor-a (VEGFa), and claudin-5 (CLDN5). ⋯ The model to differentiate participants who improved for PCL5 (R2=0.68; p < 0.001; AUC = 0.93) included vWF (p = 0.02), VEGFa (p = 0.008), and BLBP (p = 0.006). The model to differentiate participants who improved for BSI-18 (R2=0.25; p = 0.04; AUC = 0.75) included UCH-L1 (p = 0.03), GFAP (p = 0.06), and vWF (p = 0.03). Combinations of pre-intervention blood biomarkers were able to differentiate responders from nonresponders in both post-traumatic stress and overall psychological health domains.
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In the management of traumatic brain injury (TBI), intracranial pressure monitoring (ICPm) is crucial for the timely management of severe cases that show rapid neurological deterioration. External ventricular drains (EVDs) and intraparenchymal pressure monitors (IPMs) are the primary methods used in this setting; however, the debate over their comparative efficacy persists, primarily because of reliance on observational study data. This underscores the need for a meta-analysis to guide clinical decision-making. ⋯ However, IPM may offer significant advantages in reducing the duration of ICPm and intensive care unit length of stay. EVD may be preferable for certain mid-term to long-term monitoring. The predominance of observational studies in the current literature highlights the need for further clinical trials to compare these interventions.
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Journal of neurosurgery · Oct 2024
Evaluation of the Glasgow Coma Scale-Pupils score for predicting inpatient mortality among patients with traumatic subdural hematoma at United States trauma centers.
The Glasgow Coma Scale-Pupils (GCS-P) score has been suggested to better predict patient outcomes compared with GCS alone, while avoiding the need for more complex clinical models. This study aimed to compare the prognostic ability of GCS-P versus GCS in a national cohort of traumatic subdural hematoma (SDH) patients. ⋯ The GCS-P score provides better short-term prognostication compared with the GCS score alone among traumatic SDH patients with penetrating TBI. The GCS-P score overestimates inpatient mortality risk among penetrating TBI patients with higher rates of observed mortality. For penetrating TBI patients, which comprised 2.4% of our SDH cohort, a low GCS-P score should not justify clinical nihilism or forgoing aggressive treatment.
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Journal of neurosurgery · Oct 2024
Multicenter Study Comparative Study Observational StudyEarly versus delayed cranioplasty after decompressive craniectomy in traumatic brain injury: a multicenter observational study within CENTER-TBI and Net-QuRe.
The aim of this study was to compare the outcomes of early (≤ 90 days) and delayed (> 90 days) cranioplasty following decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). ⋯ Functional outcome and quality of life were similar between early and delayed cranioplasty in patients who had undergone DC for TBI. Neurosurgeons may consider performing cranioplasty during the index admission (early) to simplify the patient's chain of care and prevent readmission for cranioplasty but should be vigilant for an increased possibility of hydrocephalus. Clinical trial registration nos.: CENTER-TBI, NCT02210221 (clinicaltrials.gov); Net-QuRe, NTR6003 (trialsearch.who.int) and NL5761 (onderzoekmetmensen.nl).