Journal of Head Trauma Rehabilitation最新文献

The following abstracts were presented at the 5 th Annual Meeting of the Canadian Concussion Network/Réseau Canadien des Commotions (CCN-RCC) in Victoria, British Columbia on June 9-10, 2025. Established in 2020, the CCN-RCC has a vision to establish and guide a coordinated national research and knowledge translation agenda in Canada. This agenda aims to reduce the risk of concussions and their consequences across four broad domains: prevention, detection/diagnosis, prognosis/modifiers, and treatment.

Objective: To characterize variation in the treatment of patients with mild traumatic brain injury (mTBI) who were reasonable candidates for hospitalization, we investigated patient-level associations with inpatient admission and hospital-level associations with length of stay (LOS). We further investigated whether patients treated at high-LOS hospitals were more likely to experience home discharge.

Setting: Patients were retrospectively identified from the ACS TQIP dataset.

Participants: A total of 122 406 patients with mTBI were included.

Design: We performed hierarchical logistic regression to investigate associations of patient-level variables with inpatient admission. Among hospitalized patients, a hierarchical linear regression was constructed for associations with LOS, including hospitals as a random effects term. Based on random effects coefficients, hospitals were classified as high-LOS outliers or non-outliers.

Main measures: Univariable comparisons on facility characteristics were performed. Patients were propensity score matched across hospital outlier status, and a multivariable logistic regression for associations with discharge to home was performed.

Results: The median age was 63 years (interquartile range [IQR], 42-77 years), and 111 306 (91%) patients experienced inpatient admission. Uninsured status was associated with lower odds of inpatient admission (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.65-0.76; P < .001). After excluding very low-volume hospitals, 80 258 admitted patients were treated across 469 hospitals, and 98 were designated as high-LOS outliers. These were more likely to be Level 1 trauma centers (76% vs. 26%; P < .001). After matching, patients treated at high-LOS outlier hospitals were less likely to experience home discharge (OR, 0.89; 95% CI, 0.85-0.93; P < .001). This effect was amplified for patients identifying as non-White, non-Black, non-Hispanic other races ( P = .003).

Conclusions: Inpatient admission after mTBI varies by insurance status, with uninsured patients less likely to be admitted. There is significant interhospital variation in LOS, with Level 1 trauma centers more likely to be high-LOS outliers. Despite their longer LOS, patients treated at outlier hospitals experienced lower odds of home discharge.

Objective: To explore and visually display differences in the distribution of the Glasgow Outcome Scale - Extended (GOS-E) over time after traumatic brain injury (TBI), focusing on variations in outcome distributions based on GOS-E at Year 1 postinjury and age at injury.

Setting: Community.

Participants: 14 010 individuals who received inpatient rehabilitation in the TBI Model Systems.

Design: Cross-sectional analysis of a prospectively collected longitudinal database.

Main measures: GOS-E scores at 1, 2, 5, 10, 15, and 20 years postinjury, and age at injury.

Results: The proportions of cases in each GOS-E category are displayed using 100% stacked bar graphs for each follow-up period. These graphs reveal that GOS-E at Year 1 and age at injury clearly influence outcomes over time. Trends include decreasing good recovery and increasing severe disability as Year 1 GOS-E worsens, along with rising mortality rates as age at injury increases.

Conclusion: The study introduces a novel approach for visually representing patterns of change in GOS-E outcomes, emphasizing differences across strata defined by GOS-E at Year 1 and age at injury. The figures provide a valuable tool for communicating potential outcomes, particularly when GOS-E at Year 1 and age are known. Evaluating the visual interpretability of these graphs among persons with brain injury, family members, healthcare providers, and other stakeholders will help determine their broader usability and value.

Objective: Those who served on active duty after September 11, 2001 (Post-9/11) are screened for deployment-related mild traumatic brain injury (mTBI) when initiating Veterans Health Administration (VHA) clinical services. Positive screeners are offered a referral to a Comprehensive TBI Evaluation (CTBIE) by a TBI specialist to further determine deployment-related mTBI history and access interdisciplinary care if indicated. This study examined whether Post-9/11 veterans who screened positive and also participated in a prospective longitudinal study (PLS) differed in characteristics and outcomes depending on their clinical VHA CTBIE completion status and mTBI positive (+) or negative (-) determinations (CTBIE = mTBI+, CTBIE = mTBI-, No CTBIE).

Setting: Veterans Health Administration (VHA) clinical and research settings.

Participants: 658 Post-9/11 veterans.

Design: Secondary analysis of the PLS using a retrospective cohort design.

Main measures: Primary outcomes were associations of VHA CTBIE completion/determination with competitive employment and service-connected disability ratings obtained at time of PLS completion. Secondary outcomes included a range of PLS demographic, military, potential concussive event, health, functional, and quality-of-life measures.

Results: Based on their PLS research data, relative to the No CTBIE group, the CTBIE = mTBI+ group had lower adjusted odds ratios (aOR) of competitive employment (aOR = .51, 95% confidence interval [CI] = 0.31-0.83, P = .008) and higher odds of having a ≥50% service-connected disability rating (aOR = 2.02, 95% CI = 0.31-0.83, P = .01). The CTBIE = mTBI+ group also reported higher neurobehavioral and posttraumatic stress disorder symptom severity, and poorer outcomes on quality-of-life measures than the No CTBIE group. Generally, few differences were detected between the CTBIE = mTBI- and either of the CTBIE = mTBI+ and No CTBIE groups.

Conclusions: This study leveraged the unique ability to combine VHA clinical and comprehensive research data to examine outcomes not routinely collected as part of standard VHA clinical care. These research data can inform VHA TBI leadership about long-term health and functional status of veterans who screen positive for TBI.

Objective: No previously published repeatability and reliability data for The Sports Concussion Assessment Tool-6 (SCAT6) exists. We aimed to evaluate inter/intra-tester reliability of the off-field SCAT6 in a non-concussed adult population.

Design: Inter-rater and Intra-rater reliability study design.

Setting: Single university site.

Participants: Twenty active adults (mean age: 27.55 ± 5.59 years) with no recent history of concussion (Concussive injury within past year).

Interventions: Participants completed 3 SCAT6 tests on the same day, with 3 testers (Inter-rater testing). The same participants returned at 2 further time points to complete the remaining 2 SCAT6 tests with 1 tester (Intra-rater testing). Participants complete a total of 5 SCAT6 assessments in total across testers and time. Rater Background: Those completing the SCAT6 testing, our study rater team, comprised of 1 senior physiotherapist and PhD candidate, and 2 MSc Physiotherapy students. All raters were from Scotland, and had significant training in completing SCAT6 assessments.

Main outcome measures: Off-field SCAT6 Domain scores.

Analysis: ICCs were used to establish inter and intra-rater reliability for continuous, ration and ordinal data components of the SCAT6. For nominal data sets, Fleiss's kappa was calculated. Kendall's W was used for non-parametric data. Percentage error scores were calculated for SCAT6 domains.

Results: Inter-tester: Symptom number, severity, and dual-task scoring demonstrated excellent reliability (ICC = 0.981; 0.984; 0.913, respectively). Total concentration score was found to have good reliability (0.827). Dual-task errors (0.398), Total mBESS (0.199), and Month recall all returned poor scores (k = 0.191). Intra-tester: Dual tasking was the only domain to report excellent reliability (ICC = 0.943). Symptom number (0.868), severity (0.831), total concentration (0.787), total mBESS (0.813), and time tandem gait (0.834) yielded good reliability scores. Dual-task error testing returned poor reliability scores (Kendall's W = 0.001). All remaining domains yielded moderate reliability. Percentage error rates ranges from 3% to 100%, demonstrating the variability between scores yielded for non-concussed individuals completing the same SCAT6 domain tests.

Conclusion: SCAT6 ICC results reported good-excellent reliability for 4 and 6 domains, out of 13 domains, for inter-tester and intra-tester reliability, respectively. Notably, the domains which relied on tester error scoring yielded poor reliability results. Percentage error highlighted the failure of the SCAT6 to provide consistent domain score results in this population.

Objective: Frailty is increasingly recognized as an important prognostic factor in trauma patients. Its role in predicting short-term mortality after traumatic brain injury (TBI), however, remains uncertain. A systematic review and meta-analysis were conducted to evaluate the association between baseline frailty and short-term mortality (within 12 months) in TBI patients.

Methods: Cohort studies were identified through PubMed, Embase, and Web of Science up to March 2025. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Results: Fifteen datasets from 14 cohort studies, comprising 1 567 950 patients, were included. Frailty was significantly associated with increased short-term mortality (OR, 1.58; 95% CI, 1.30-1.93; P < .001; I2 = 93%). Sensitivity analyses showed consistent findings (OR range: 1.48-1.66). Subgroup analyses revealed stronger associations in prospective versus retrospective studies (OR, 3.27 vs 1.41; P < .001), and in studies involving general TBI populations compared to those focusing on subdural hematoma or intracranial hemorrhage (OR, 2.03 vs 1.19; P < .001). The association remained consistent across age groups and sex distribution. Although numerically stronger in studies using non-modified frailty index (OR 2.00 vs 1.31), the difference was not statistically significant (P = .05). The association was most pronounced at 6-month follow-up compared to 1 month or during hospitalization and was attenuated in studies using multivariate rather than univariate analyses (P < .001).

Conclusions: Frailty may be independently associated with short-term mortality in patients with TBI. Incorporating frailty assessment may enhance risk stratification and support clinical decision-making.

Background: Given the heterogeneity of concussion symptoms and the variety of associated multidisciplinary treatment needs, classifying concussion symptoms into domains (eg, cognitive, physical, affective, and sleep/arousal) can allow a more comprehensive approach to management. However, little is known about whether and how concussion symptom domains respond to interventions. This study aimed to (1) characterize symptom domains represented in a sample of young adults with recent concussion and co-occurring anxiety, and (2) examine changes in concussion symptom domains after 2 interventions.

Methods: We randomized 50 young adults (aged 18-35 years) with recent concussion (3-10 weeks prior) and anxiety (≥5 on the Generalized Anxiety Disorder-7 questionnaire) to a mind-body intervention (Toolkit for Optimal Recovery-Concussion [TOR-C]), and a comparison intervention (Health Enhancement after Concussion [HE-C]). Participants completed the Post Concussion Symptom Scale at 3 time points: baseline, post-intervention, and 3-month post-intervention follow-up. We used mixed-model Analysis of Variance (ANOVA)s to test changes in symptom domain scores across the 3 time points after each intervention.

Results: At baseline, participants exhibited roughly similar ratio scores across domains (range = 0.20-0.25). All 4 domains improved for both groups across the 3 time points. Effect sizes for improvements following TOR-C were large for all domains from baseline to post-intervention (Cohen's d = -0.88 to -1.05) and from baseline to follow-up (d = -0.92 to -1.15). Effect sizes for the HE-C control were medium-sized for all domains from baseline to post-intervention (d = -0.54 to-0.71) and baseline to follow-up for the physical (d = -0.71) and sleep domains (d = -0.70), and large for the cognitive (d = -0.94) and affective domains (d = -0.89).

Conclusions: This study is the first to examine changes in concussion symptom domains following interventions. Symptom domains were largely equally prevalent and may be interconnected. TOR-C, a mind-body intervention which addresses anxiety, may help support concussion recovery across symptom domains.

Objective: To describe clinical uses of the class of alpha-2 receptor agonist medications in the treatment of traumatic brain injury sequelae. Clinicians treating patients with traumatic brain injuries (TBI) will often see patients who have been prescribed alpha-2 agonists or may consider initiating use.

Design: Narrative review.

Conclusion: This class of medication has a number of different indications (and side effects), and drugs within this class also have some unique properties that can be important factors in clinical decision-making. Although this class of medications has been available for many years, there is still much emerging information that is pertinent for the treatment of patients with TBI.

Objective: Psychological distress in mild traumatic brain injury (mTBI) can exacerbate post-concussion symptoms (PCS) and prolong recovery. However, little is known about the symptom-to-symptom relationships between psychological distress and PCS. Understanding the connection between these constructs can inform patient education and identify areas for treatment. This study used network analysis to explore item-level relationships between PCS and psychological distress in individuals with mTBI.

Setting: Participants were recruited from outpatient mTBI clinics throughout New Zealand.

Participants and setting: A total of 436 adults diagnosed with mTBI.

Design: A Cross-sectional network analysis design using the using the EBICglasso method. Bridge expected influence (BEI) was calculated to quantify the extent to which each node connects PCS and psychological distress within the network.

Measures: PCS were assessed using the Rivermead Post Concussion Questionnaire and psychological distress using the Depression, Anxiety, Stress Scale 21 (DASS-21).

Results: Two significant bridging connections were identified. The first connection had the highest BEI and was between the symptom of sleep disturbance and the hyperarousal (difficulties winding down and relaxing) component of psychological distress. The second connection was between the symptoms of concentration difficulties and lack of initiation within psychological distress.

Conclusion: This study highlights which specific symptoms between PCS and psychological distress may be important in connecting these 2 constructs. These findings provide novel insights into what symptoms may be worth prioritising when treating individuals experiencing psychological distress whilst recovering from mTBI.

Objective: Military service over the last several decades has been associated with an increased risk of injuries, including traumatic brain injury (TBI). Veterans with a history of TBI often experience poor health outcomes and have higher rates of premature mortality. In this study, we examined whether accelerated biological aging could help explain negative health outcomes following TBI.

Setting, participants, and design: We evaluated the association between TBI and rate of epigenetic aging (assessed using DunedinPACE) using data from post-9/11 veterans (N = 1152) enrolled in the VA Mid-Atlantic (VISN 6) MIRECC Post-Deployment Mental Health cohort study.

Main measures: TBI was assessed using self-report during a clinical interview categorized into three TBI groups (none, 1, 2 +), epigenetic aging was assessed using DunedinPACE derived from DNA methylation data.

Results: Veterans who reported more lifetime TBI (β = 0.07, 95% CI [0.01, 0.14], P = .029) or deployment-related TBI (β = 0.09, 95% CI [0.01, 0.18], P = .046) had faster epigenetic aging. TBI during and after military service was more strongly associated with accelerated aging than TBI prior to military service, and deployment-related TBI was more strongly associated with accelerated aging for women veterans. Overall, associations were small to moderate in size.

Conclusion: These findings show TBI could increase risk for accelerated aging and underscores its potential utility in identifying veterans who may face aging-related health issues. Early identification of TBI-related accelerated aging could inform interventions that mitigate long-term health risks as post-9/11 veterans transition into middle and older age.