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Management of Pediatric Mild Traumatic Brain Injury Patients: S100b, Glial Fibrillary Acidic Protein, and Heart Fatty-Acid-Binding Protein Promising Biomarkers. 小儿轻度脑外伤患者的管理:S100b、胶质纤维酸性蛋白和心脏脂肪酸结合蛋白有望成为生物标志物。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-31 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2024.0027
Anne-Cécile Chiollaz, Virginie Pouillard, Fabian Spigariol, Fabrizio Romano, Michelle Seiler, Céline Ritter Schenk, Christian Korff, Céline Habre, Fabienne Maréchal, Verena Wyss, Lyssia Gruaz, Marcel Lamana-Vallverdu, Elvira Chocano, Lluis Sempere Bordes, Carlos Luaces-Cubells, María Méndez-Hernández, José Antonio Alonso Cadenas, María José Carpio Linde, Paula de la Torre Sanchez

Children are highly vulnerable to mild traumatic brain injury (mTBI). Blood biomarkers can help in their management. This study evaluated the performances of biomarkers, in discriminating between children with mTBI who had intracranial injuries (ICIs) on computed tomography (CT+) and (1) patients without ICI (CT-) or (2) both CT- and in-hospital-observation without CT patients. The aim was to rule out the need of unnecessary CT scans and decrease the length of stay in observation in the emergency department (ED). Newborns to teenagers (≤16 years old) with mTBI (Glasgow Coma Scale > 13) were included. S100b, glial fibrillary acidic protein (GFAP), and heart fatty-acid-binding protein (HFABP) performances to identify patients without ICI were evaluated through receiver operating characteristic curves, where sensitivity was set at 100%. A total of 222 mTBI children sampled within 6 h since their trauma were reported. Nineteen percent (n = 43/222) underwent CT scan examination, whereas the others (n = 179/222) were kept in observation at the ED. Sixteen percent (n = 7/43) of the children who underwent a CT scan had ICI, corresponding to 3% of all mTBI-included patients. When sensibility (SE) was set at 100% to exclude all patients with ICI, GFAP yielded 39% specificity (SP), HFABP 37%, and S100b 34% to rule out the need of CT scans. These biomarkers were even more performant: 52% SP for GFAP, 41% for HFABP, and 39% for S100b, when discriminating CT+ versus both in-hospital-observation and CT- patients. These markers can significantly help in the management of patients in the ED, avoiding unnecessary CT scans, and reducing length of stay for children and their families.

儿童极易受到轻微创伤性脑损伤(mTBI)的影响。血液生物标志物有助于对他们进行管理。本研究评估了生物标志物在区分计算机断层扫描(CT+)显示有颅内损伤(ICIs)的轻度脑损伤儿童和(1)无颅内损伤(ICIs)的患者(CT-)或(2)CT-和院内观察无CT患者的性能。目的是排除不必要的 CT 扫描,缩短急诊科(ED)的观察时间。研究对象包括患有 mTBI(格拉斯哥昏迷量表>13)的新生儿至青少年(≤16 岁)。通过接收器操作特征曲线评估了S100b、神经胶质纤维酸性蛋白(GFAP)和心脏脂肪酸结合蛋白(HFABP)在识别无ICI患者方面的性能,灵敏度设定为100%。共报告了 222 名在创伤后 6 小时内采样的 mTBI 儿童。19%的儿童(n = 43/222)接受了 CT 扫描检查,而其他儿童(n = 179/222)则在急诊室接受观察。在接受 CT 扫描的儿童中,16%(n = 7/43)患有 ICI,占所有 mTBI 患者的 3%。如果将排除所有 ICI 患者的敏感性(SE)设为 100%,则排除 CT 扫描需要的特异性(SP)为 GFAP 39%、HFABP 37%、S100b 34%。这些生物标记物的表现甚至更好:在区分 CT+患者与院内观察和 CT- 患者时,GFAP 的特异性为 52%,HFABP 为 41%,S100b 为 39%。这些标记物对急诊室患者的管理大有帮助,可避免不必要的 CT 扫描,缩短儿童及其家人的住院时间。
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引用次数: 0
The Cumulative Incidence of Post-Traumatic Epilepsy After Mild Traumatic Brain Injury: A Systematic Review and Individual Participant Data Meta-Analysis Protocol. 轻度脑外伤后创伤后癫痫的累积发病率:系统综述与个体参与者数据元分析协议》。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-31 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0117
Joshua Z Goldenberg, Richard Davis Batson, Mary Jo Pugh, Heather Zwickey, Jennifer Beardsley, Maurice P Zeegers, Michael Freeman

A precise understanding of the latency to post-traumatic epilepsy (PTE) following a traumatic brain injury (TBI) is necessary for optimal patient care. This precision is currently lacking despite a surprising number of available data sources that could address this pressing need. Following guidance from the Cochrane Collaboration and Joanna Briggs Institute, we conduct a systematic review to address the research questions: What is the cumulative incidence of PTE following mild TBI (mTBI; concussion), and what is the distribution of the latency to onset? We designed a comprehensive search of medical databases and gray literature sources. Citations will be screened on both abstract and full-text levels, independently and in duplicate. Studies will be evaluated for risk of bias independently and in duplicate using published instruments specific to incidence/prevalence studies. Data will be abstracted independently and in duplicate using piloted extraction forms. Disagreements will be resolved by consensus or third-party adjudication. Evidence synthesis will involve pairwise and individual participant data meta-analysis with heterogeneity explored via a set of predetermined subgroups. The robustness of the findings will be subjected to sensitivity analyses based on the risk of bias, outlier studies, and mTBI definitional criteria. The overall certainty in the estimates will be reported using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). This protocol presents an innovative and impactful approach to build on the growing body of knowledge surrounding post-mTBI PTE. Through a precise understanding of the latency period, this study can contribute to early detection, tailored interventions, and improved outcomes, leading to a substantial impact on patient care and quality of life.

准确了解创伤性脑损伤 (TBI) 后发生创伤后癫痫 (PTE) 的潜伏期对于优化患者护理非常必要。尽管有数量惊人的可用数据源可以满足这一迫切需求,但目前还缺乏这种精确性。根据 Cochrane 协作组织和乔安娜-布里格斯研究所的指导,我们开展了一项系统性综述,以解决以下研究问题:轻度 TBI(mTBI;脑震荡)后 PTE 的累积发病率是多少?我们对医学数据库和灰色文献资料进行了全面检索。我们将在摘要和全文两个层面对引文进行独立、重复的筛选。将使用已发布的发病率/流行率研究专用工具对研究进行独立评估,评估结果一式两份。将使用试行的数据提取表对数据进行一式两份的独立摘要。出现分歧时,将通过共识或第三方裁定来解决。证据综合将包括配对分析和单个参与者数据荟萃分析,并通过一组预先确定的分组探讨异质性。将根据偏倚风险、离群研究和 mTBI 定义标准对研究结果的稳健性进行敏感性分析。将使用 GRADE(建议、评估、发展和评价分级)报告估算结果的总体确定性。本方案提出了一种创新而有影响力的方法,以不断增长的有关创伤后脑损伤后 PTE 的知识为基础。通过对潜伏期的精确了解,这项研究可有助于早期检测、有针对性的干预和改善预后,从而对患者护理和生活质量产生重大影响。
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引用次数: 0
Association of Auditory Interference and Ocular-Motor Response with Subconcussive Head Impacts in Adolescent Football Players. 青少年足球运动员的听觉干扰和眼球运动反应与头部次撞击的关系
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-31 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0125
Zachary S Bellini, Grace O Recht, Taylor R Zuidema, Kyle A Kercher, Sage H Sweeney, Jesse A Steinfeldt, Keisuke Kawata

The aim of this study was to examine whether neuro-ophthalmological function, as assessed by the King-Devick test (KDT), alters during a high school football season and to explore the role of auditory interference on the sensitivity of KDT. During the 2021 and 2022 high school football seasons, football players' neuro-ophthalmological function was assessed at five time points (preseason, three in-season, postseason), whereas control athletes were assessed at preseason and postseason. Two-hundred ten football players and 80 control athletes participated in the study. The year 1 cohort (n = 94 football, n = 10 control) was tested with a conventional KDT, whereas the year 2 cohort (n = 116 football, n = 70 control) was tested with KDT while listening to loud traffic sounds to induce auditory interference. There were improvements in KDT during a season among football players, regardless of conventional KDT (preseason 53.4 ± 9.3 vs. postseason 46.4 ± 8.5 sec; β = -1.7, SE = 0.12, p < 0.01) or KDT with auditory interference (preseason 52.3 ± 11.5 vs. postseason 45.1 ± 9.5 sec; β = -1.7, SE = 0.11, p < 0.001). The degree of improvement was similar between the tests, with no significant group-by-time interaction (β = -0.08, SE = 0.17, p = 0.65). The control athletes also improved KDT performance at a similar degree as the football cohorts in both KDT conditions. Our data suggest that KDT performance improves during a season, regardless of auditory interference or head impact exposure. KDT performance was not impacted by a noisy environment, supporting its sideline utility for screening more severe forms of injury.

本研究旨在探讨在高中橄榄球赛季中,通过 King-Devick 测试(KDT)评估的神经眼科功能是否会发生变化,并探索听觉干扰对 KDT 灵敏度的影响。在 2021 年和 2022 年高中橄榄球赛季期间,在五个时间点(季前赛、季中赛、季后赛)对橄榄球运动员的神经眼科功能进行了评估,而在季前赛和季后赛对对照组运动员进行了评估。共有 210 名足球运动员和 80 名对照组运动员参加了这项研究。第一年的队列(94 名足球运动员,10 名对照组运动员)使用传统的 KDT 进行测试,而第二年的队列(116 名足球运动员,70 名对照组运动员)则使用 KDT 进行测试,同时聆听响亮的交通声音以诱发听觉干扰。在一个赛季中,不论是传统的 KDT(季前赛 53.4 ± 9.3 vs. 季后赛 46.4 ± 8.5 秒;β = -1.7, SE = 0.12, p < 0.01)还是听觉干扰下的 KDT(季前赛 52.3 ± 11.5 vs. 季后赛 45.1 ± 9.5 秒;β = -1.7, SE = 0.11, p < 0.001),足球运动员的 KDT 都有所提高。不同测试之间的改善程度相似,没有明显的组间时间交互作用(β = -0.08,SE = 0.17,p = 0.65)。对照组运动员在两种 KDT 条件下的 KDT 成绩提高程度也与足球组相似。我们的数据表明,无论听觉干扰或头部撞击情况如何,KDT 成绩在一个赛季中都会提高。KDT 性能不受嘈杂环境的影响,这支持了其在筛查更严重形式损伤时的边线效用。
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引用次数: 0
"Roberto Rodríguez" General Teaching Hospital of Moron, Ciego De Avila, Cuba, Neurosurgery and Pediatric Intensive Care Services Pediatric Neuromonitoring in Severe Head Trauma. 古巴谢戈德阿维拉莫龙 "罗伯托-罗德里格斯 "教学总医院,神经外科和儿科重症监护服务严重头部创伤的儿科神经监测。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-29 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2024.0031
Daysi Abreu Pérez, Angel J Lacerda Gallardo, Jose Antonio Gálvez

Among all types of trauma in children, traumatic brain injury has the greatest potential for the development of devastating consequences, with nearly three million affected each year in the world. A controlled, nonrandomized experimental study was carried out in pediatric patients with severe traumatic brain injury, whose objective was to evaluate the use of continuous multimodal neuromonitoring (MMN) of intracranial parameters as a guide in the treatment of children of different age-groups. The patients were divided into two groups according to the treatment received; clinical and imaging monitoring was performed in both. Group I included those whose treatment was guided by MMN of intracranial parameters such as intracranial pressure, cerebral perfusion pressure, and intracranial compliance, and group II included those who had only clinical and imaging monitoring. Eighty patients were studied, 41 in group I and 39 in group II. There were no significant differences between the groups with respect to the sociodemographic variables and the results; as a consequence, both forms of treatment were outlined, for patients with MMN and for those who only have clinical and imaging monitoring. It is concluded that both treatment schemes can be used depending on technological availability, although the scheme with MMN is optimal.

在所有类型的儿童创伤中,脑外伤最有可能造成破坏性后果,全世界每年有近 300 万人受到脑外伤的影响。我们在严重脑外伤的儿童患者中开展了一项非随机对照实验研究,目的是评估颅内参数连续多模态神经监测(MMN)作为不同年龄组儿童治疗指南的使用情况。根据所接受的治疗将患者分为两组,两组均进行临床和影像学监测。第一组包括以颅内压、脑灌注压和颅内顺应性等颅内参数 MMN 指导治疗的患者,第二组包括仅接受临床和影像学监测的患者。共研究了 80 名患者,其中 I 组 41 人,II 组 39 人。在社会人口学变量和结果方面,各组之间没有明显差异;因此,对 MMN 患者和仅接受临床和影像学监测的患者,两种治疗方式均适用。结论是,两种治疗方案都可以使用,具体取决于技术的可用性,但 MMN 方案是最佳方案。
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引用次数: 0
Associations Between Intracranial Pressure Extremes and Continuous Metrics of Cerebrovascular Pressure Reactivity in Acute Traumatic Neural Injury: A Scoping Review. 急性创伤性神经损伤中颅内压极值与脑血管压力反应性连续指标之间的关系:范围综述》。
IF 1.8 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-29 eCollection Date: 2024-01-01 DOI: 10.1089/neur.2023.0115
Kevin Y Stein, Fiorella Amenta, Logan Froese, Alwyn Gomez, Amanjyot Singh Sainbhi, Nuray Vakitbilir, Younis Ibrahim, Abrar Islam, Tobias Bergmann, Izabella Marquez, Frederick A Zeiler

Cerebrovascular pressure reactivity plays a key role in maintaining constant cerebral blood flow. Unfortunately, this mechanism is often impaired in acute traumatic neural injury states, exposing the already injured brain to further pressure-passive insults. While there has been much work on the association between impaired cerebrovascular reactivity following moderate/severe traumatic brain injury (TBI) and worse long-term outcomes, there is yet to be a comprehensive review on the association between cerebrovascular pressure reactivity and intracranial pressure (ICP) extremes. Therefore, we conducted a systematic review of the literature for all studies presenting a quantifiable statistical association between a continuous measure of cerebrovascular pressure reactivity and ICP in a human TBI cohort. The methodology described in the Cochrane Handbook for Systematic Reviews was used. BIOSIS, Cochrane Library, EMBASE, Global Health, MEDLINE, and SCOPUS were all searched from their inceptions to March of 2023 for relevant articles. Full-length original works with a sample size of ≥10 patients with moderate/severe TBI were included in this review. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 16 articles were included in this review. Studies varied in population characteristics and statistical tests used. Five studies looked at transcranial Doppler-based indices and 13 looked at ICP-based indices. All but two studies were able to present a statistically significant association between cerebrovascular pressure reactivity and ICP. Based on the findings of this review, impaired reactivity seems to be associated with elevated ICP and reduced ICP waveform complexity. This relationship may allow for the calculation of patient-specific ICP thresholds, past which cerebrovascular reactivity becomes persistently deranged. However, further work is required to better understand this relationship and improve algorithmic derivation of such individualized ICP thresholds.

脑血管压力反应在维持恒定脑血流方面发挥着关键作用。不幸的是,这种机制在急性创伤性神经损伤状态下往往会受到损害,使已经受伤的大脑进一步受到压力被动性损伤。关于中度/重度创伤性脑损伤(TBI)后脑血管反应性受损与更差的长期预后之间的关系已有很多研究,但关于脑血管压力反应性与颅内压(ICP)极值之间的关系还没有全面的综述。因此,我们对所有在人类 TBI 队列中连续测量脑血管压力反应性与 ICP 之间存在可量化统计关联的研究文献进行了系统性回顾。采用了《Cochrane 系统综述手册》中描述的方法。在 BIOSIS、Cochrane 图书馆、EMBASE、Global Health、MEDLINE 和 SCOPUS 中检索了自其成立至 2023 年 3 月的所有相关文章。样本量≥10 例中度/重度创伤性脑损伤患者的长篇原创文章被纳入本综述。数据按照《系统综述和元分析首选报告项目》进行报告。本综述共纳入 16 篇文章。研究的人群特征和使用的统计检验方法各不相同。5 项研究关注基于经颅多普勒的指数,13 项研究关注基于 ICP 的指数。除两项研究外,其他所有研究均显示脑血管压力反应性与 ICP 之间存在统计学意义上的显著关联。根据本综述的研究结果,反应性受损似乎与 ICP 升高和 ICP 波形复杂性降低有关。根据这种关系,可以计算出患者特定的 ICP 阈值,超过该阈值,脑血管反应性就会持续失常。然而,要更好地理解这种关系并改进这种个体化 ICP 阈值的算法推导,还需要进一步的工作。
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引用次数: 0
Granulocyte-Colony Stimulating Factor Improves Neurological and Functional Outcomes in Patients With Traumatic Incomplete Spinal Cord Injuries: A Systematic Review With Meta-Analyses 粒细胞集落刺激因子可改善外伤性不完全性脊髓损伤患者的神经和功能预后:带 Meta 分析的系统综述
Pub Date : 2024-05-01 DOI: 10.1089/neur.2023.0099
Luke J. Weisbrod, Thomas T. Nilles-Melchert, Judith R. Bergjord, Daniel L. Surdell
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引用次数: 0
Ventilatory Support, Extubation, and Cerebral Perfusion Changes in Pre-Term Neonates: A Near Infrared Spectroscopy Study 早产新生儿的通气支持、拔管和脑灌注变化:近红外光谱研究
Pub Date : 2024-04-01 DOI: 10.1089/neur.2023.0092
Paolo Massirio, Valentina Cardiello, Chiara Andreato, Samuele Caruggi, Marcella Battaglini, Andrea Calandrino, G. Polleri, F. Mongelli, M. Malova, D. Minghetti, A. Parodi, M. Calevo, D. Tortora, Andrea Rossi, Luca Ramenghi
Early extubation is considered to be beneficial for pre-term neonates. On the other hand, premature extubation can cause lung derecruitment, compromised gas exchange, and need for reintubation, which may be associated with severe brain injury caused by sudden cerebral blood flow changes. We used near infrared spectroscopy (NIRS) to investigate changes in cerebral oxygenation (rScO2) and fractional tissue oxygen extraction (+) after extubation in pre-term infants. This is a single-center retrospective study of NIRS data at extubation time of all consecutive pre-term neonates born at our institution over a 1-year period. Comparison between subgroups was performed. Nineteen patients were included; average gestational age (GA) was 29.4 weeks. No significant change was noted in rScO2 and cFTOE after extubation in the whole population. GA and germinal matrix hemorrhage (GMH)-intraventricular hemorrhage (IVH) showed a significant change in rScO2 and cFTOE after extubation. A significant increase in cFTOE was noted in patients with previous GMH-IVH (+0.040; p = 0.05). To conclude, extubation per se was not associated with significant change in cerebral oxygenation and perfusion. Patients with a diagnosed GMH-IVH showed an increase in cFTOE, suggesting perturbation in cerebral perfusion suggesting further understanding during this challenging phenomenon. Larger studies are required to corroborate our findings.
过早拔管被认为对早产新生儿有益。另一方面,过早拔管可能会导致肺不张、气体交换受损和需要再次插管,这可能与脑血流骤变导致的严重脑损伤有关。我们使用近红外光谱(NIRS)研究了早产儿拔管后脑氧饱和度(rScO2)和组织氧萃取分数(+)的变化。这是一项单中心回顾性研究,研究对象是我院一年内出生的所有连续早产新生儿拔管时的近红外光谱数据。对不同亚组进行了比较。共纳入 19 名患者;平均胎龄 (GA) 为 29.4 周。所有患者拔管后的 rScO2 和 cFTOE 均无明显变化。GA和胚芽基质出血(GMH)-脑室内出血(IVH)患者拔管后 rScO2 和 cFTOE 有明显变化。曾发生过 GMH-IVH 的患者 cFTOE 明显增加(+0.040;p = 0.05)。总之,拔管本身与脑氧合和灌注的显著变化无关。确诊为 GMH-IVH 的患者显示出 cFTOE 的增加,表明脑灌注发生了扰动,建议进一步了解这一具有挑战性的现象。我们需要更大规模的研究来证实我们的发现。
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引用次数: 0
Comparative Analysis of Clinical Severity and Outcomes in Penetrating Versus Blunt Traumatic Brain Injury Propensity Matched Cohorts 穿透性脑损伤与钝性脑损伤倾向匹配队列临床严重程度和预后的比较分析
Pub Date : 2024-04-01 DOI: 10.1089/neur.2024.0009
Ali Mansour, Plamena Powla, Ronald Alvarado-Dyer, Farima Fakhri, Paramita Das, Peleg Horowitz, Fernando D. Goldenberg, Christos Lazaridis
Traumatic brain injury (TBI) is a global health challenge; however, penetrating brain injury (PBI) remains under-represented in evidence-based knowledge and research efforts. This study utilized data from the Trauma Quality Improvement Program (TQIP) of the National Trauma Data Bank (NTDB) to investigate outcomes of PBI as compared with clinical-severity-matched non-penetrating or blunt TBI. A total of 1765 patients with PBI were 1:1 propensity score-matched for clinical severity with blunt TBI patients. The intent of PBI was self-inflicted in 34.1% of the cases, and the mechanism was firearm-inflicted in 89.1%. Mortality was found to be significantly more common in PBI than in the severity- matched TBI cohort (33.9% vs. 14.3 %, p < 0.001) as was unfavorable outcome. Mortality was mediated by withdrawal of life-sustaining therapies (WOLST) 30% of the time, and WOLST occurred earlier (median 3 days vs. 6 days, p < 0.001) in PBI. Increased rate of mortality was observed with a Glasgow Coma Scale (GCS) of <11 in PBI as compared with <7 in blunt TBI. In conclusion, PBI patients exhibited higher mortality rates and unfavorable outcomes; one third of excess mortality was mediated by WOLST. The study also brings into question the applicability of the conventional TBI classification, based on GCS, in PBI. We emphasize the need to address the observed disparities and better understand the distinctive characteristics and mechanisms underlying PBI outcomes to improve patient care and reduce mortality.
创伤性脑损伤(TBI)是一项全球性的健康挑战;然而,穿透性脑损伤(PBI)在循证知识和研究工作中的代表性仍然不足。本研究利用美国国家创伤数据库(NTDB)创伤质量改进计划(TQIP)的数据,对穿透性脑损伤与临床严重程度相匹配的非穿透性或钝性脑损伤的治疗效果进行了比较研究。共有 1765 名 PBI 患者与钝性 TBI 患者按临床严重程度进行了 1:1 的倾向性评分匹配。34.1%的创伤性脑损伤是自己造成的,89.1%的创伤性脑损伤是火器造成的。与严重程度相匹配的创伤性脑损伤患者队列相比,PBI 患者的死亡率明显更高(33.9% 对 14.3%,P < 0.001),而不良预后也更常见。30%的死亡率是由撤消维持生命疗法(WOLST)引起的,PBI患者撤消维持生命疗法的时间更早(中位数为3天 vs. 6天,p < 0.001)。格拉斯哥昏迷量表(GCS)小于11的PBI患者死亡率高于小于7的钝性创伤性脑损伤患者。总之,PBI 患者的死亡率更高,预后更差;三分之一的超额死亡率是由 WOLST 导致的。该研究还对基于 GCS 的传统 TBI 分类是否适用于 PBI 提出了质疑。我们强调有必要解决观察到的差异,并更好地了解 PBI 结果的独特特征和机制,以改善患者护理并降低死亡率。
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引用次数: 0
Spine Injuries Sustained After Falls While Crossing the U.S.-Mexico Border 穿越美墨边境时摔倒导致脊椎受伤
Pub Date : 2024-04-01 DOI: 10.1089/neur.2024.0035
Hannah R. Riva, Michael M. Polmear, Cyrena Petersen, June Y. Guillet, Taylor M. Yong, Adam H. Adler, R. Rajani, Vishwajeet Singh, David Chin Sing Wang
This study is to report the demographics, incidence, and patterns of spinal injuries associated with border crossings resulting from a fall from a significant height. A retrospective cohort study was performed at a Level I trauma center from January 2016 to December 2021 to identify all patients who fell from a significant height while traversing the U.S.-Mexico border and were subsequently admitted. A total of 448 patients were identified. Of the 448 patients, 117 (26.2%) had spine injuries and 39 (33.3%) underwent operative fixation. Females had a significantly higher incidence of spine injuries (60% vs. 40%; p < 0.00330). Patients with a spine fracture fell from a higher median fall height (6.1 vs. 4.6 m; p < 0.001), which resulted in longer median length of stay (LOS; 12 vs. 7 days; p < 0.001), greater median Injury Severity Score (ISS; 20 vs. 9; p < 0.001), and greater relative risk (RR) of ISS >15 (RR = 3.2; p < 0.001). Patients with operative spine injuries had significantly longer median intensive care unit (ICU) LOS than patients with non-operative spine injuries (4 vs. 2 days; p < 0.001). Patients with spinal cord injuries and ISS >15 sustained falls from a higher distance (median 6.1 vs. 5.5 m) and had a longer length of ICU stay (median 3 vs. 0 days). All patients with operative spine injuries had an ISS >15 relative to 50% of patients with non-operative spine injuries (median ISS 20 vs. 15; p < 0.001). Patients with spine trauma requiring surgery had a higher incidence of head (RR = 3.5; p 0.0353) and chest injuries (RR = 6.0; p = 0.0238), but a lower incidence of lower extremity injuries (RR = 0.5; p < 0.001). Thoracolumbar injuries occurred in 68.4% of all patients with spine injuries. Patients with operative spine injuries had a higher incidence of burst fracture (RR = 15.5; p < 0.001) and flexion-distraction injury (RR = 25.7; p = 0.0257). All patients with non-operative spine injuries had American Spinal Injury Association (ASIA) D or E presentations, and patients with operative spine injuries had a higher incidence of spinal cord injury: ASIA D or lower at time of presentation (RR = 6.3; p < 0.001). Falls from walls in border crossings result in significant injuries to the head, spine, long bones, and body, resulting in polytrauma casualties. Falls from higher height were associated with a higher frequency and severity of spinal injuries, greater ISS, and longer ICU length of stay. Operative spine injuries, compared with non-operative spine injuries, had longer ICU length of stay, greater ISS, and different fracture morphology. Spine surgeons and neurocritical care teams should be prepared to care for injuries associated with falls from height in this unique population.
本研究旨在报告与过境时从高处坠落导致的脊柱损伤有关的人口统计学、发病率和模式。2016 年 1 月至 2021 年 12 月期间,一家一级创伤中心开展了一项回顾性队列研究,以确定所有在穿越美墨边境时从高处跌落并随后入院的患者。共确认了 448 名患者。在 448 名患者中,117 人(26.2%)脊柱受伤,39 人(33.3%)接受了手术固定。女性脊柱损伤的发生率明显更高(60% vs. 40%; p 15 (RR = 3.2; p 15 从更高的距离(中位数为 6.1 米 vs. 5.5 米)持续跌倒),在重症监护室的住院时间也更长(中位数为 3 天 vs. 0 天)。所有脊柱手术损伤患者的ISS值均大于15,而50%的脊柱非手术损伤患者的ISS值大于15(ISS值中位数为20对15;P<0.001)。需要进行手术的脊柱创伤患者头部(RR = 3.5;P 0.0353)和胸部(RR = 6.0;P = 0.0238)受伤的发生率较高,但下肢受伤的发生率较低(RR = 0.5;P < 0.001)。在所有脊柱受伤的患者中,有68.4%的患者发生了胸腰椎损伤。手术脊柱损伤患者的爆裂性骨折(RR = 15.5;P < 0.001)和屈伸损伤(RR = 25.7;P = 0.0257)发生率较高。所有非手术脊柱损伤患者均为美国脊柱损伤协会(ASIA)D级或E级,而手术脊柱损伤患者脊髓损伤的发生率较高:手术脊柱损伤患者的脊髓损伤发生率较高:发病时为美国脊柱损伤协会(ASIA)D级或更低(RR = 6.3;P < 0.001)。在边境口岸从墙上跌落会对头部、脊柱、长骨和身体造成严重伤害,导致多发性创伤伤亡。从更高处坠落与脊柱损伤的频率和严重程度更高、ISS更高以及重症监护室住院时间更长有关。与非手术脊柱损伤相比,手术脊柱损伤的重症监护室住院时间更长,ISS值更高,骨折形态也不同。脊柱外科医生和神经重症监护团队应做好准备,应对这一特殊人群的高处坠落相关损伤。
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引用次数: 0
Medical Conditions in Former Professional American-Style Football Players Are Associated With Self-Reported Clinical Features of Traumatic Encephalopathy Syndrome 前美式橄榄球职业球员的医疗状况与自述的创伤性脑病综合征临床特征有关
Pub Date : 2024-04-01 DOI: 10.1089/neur.2024.0008
R. Grashow, Shawn R Eagle, Douglas P Terry, Heather DiGregorio, Aaron L. Baggish, Marc G. Weisskopf, A. Kontos, David O. Okonkwo, Ross Zafonte
Consensus criteria for traumatic encephalopathy syndrome (TES) specify that at least one core clinical feature of cognitive impairment (CI; e.g., difficulties with memory, executive function) or neurobehavioral dysregulation (ND; e.g., explosiveness, rage, and mood lability) be present and not fully accounted for by other health disorders. Associations between self-reported symptoms that mirror the core clinical features of TES—and how they may be related to concomitant medical conditions—remain unclear. The purpose of this study was to evaluate the association of medical conditions and football exposures with TES clinical features (CI+/–, ND+/–) in 1741 former professional American-style football (ASF) players (age, 57.7 ± 13.9 years; professional seasons, 6.6 ± 3.9 years). Demographics (age, race/ethnicity, current body mass index, age of first football exposure, use of performance-enhancing drugs, position played, and past concussion symptoms), self-reported medical conditions (anxiety, depression, attention-deficit hyperactivity disorder [ADHD], sleep apnea, headache, stroke, hypertension, heart disease, high cholesterol, erectile dysfunction, and low testosterone) were collected. Of 1741 participants, 7.4% were CI+ and/or ND+ (n = 129). Participants who were CI+ or ND+ were more likely to report one or more coexisting medical conditions than participants who did not report CI or ND (odds ratio [OR] = 2.04; 95% confidence interval: 1.25–3.47; p = 0.003). Separate general linear models for each medical condition that adjusted for demographics and football-related factors identified significant associations between ADHD, diabetes, erectile dysfunction, headaches, sleep apnea, anxiety, and low testosterone and CI+ and/or ND+ (ORs = 1.8–6.0). Chi-square automatic interaction detection (CHAID) multi-variable decision tree models that incorporated medical conditions and football exposures accurately differentiated former players meeting either CI or ND clinical criteria from those meeting none (accuracy = 91.2–96.6%). CHAID identified combinations of depression, headache, sleep apnea, ADHD, and upper quartiles of concussion symptom history as most predictive of CI+ and/or ND+ status. CI+ and/or ND+ players were more likely to report medical conditions known to cause cognitive symptoms. Concussion exposure and medical conditions significantly increased the likelihood that a former ASF player would demonstrate cognitive or neurobehavioral dysfunction. Clinicians engaged with this population should consider whether treatable coexisting condition(s) could account for some portion of the clinical picture associated with TES presentation.
创伤性脑病综合征(TES)的共识标准规定,至少有一种认知障碍(CI;如记忆困难、执行功能障碍)或神经行为失调(ND;如爆发力、愤怒和情绪不稳)的核心临床特征存在,且其他健康疾病无法完全解释。目前尚不清楚反映 TES 核心临床特征的自我报告症状之间的关联,以及这些症状与伴随的医疗状况之间的关系。本研究旨在评估 1741 名前美式橄榄球(ASF)职业球员(年龄为 57.7 ± 13.9 岁;职业赛季为 6.6 ± 3.9 年)的医疗状况和足球暴露与 TES 临床特征(CI+/-、ND+/-)之间的关联。研究人员收集了人口统计学数据(年龄、种族/民族、当前体重指数、首次接触橄榄球的年龄、使用提高运动能力药物的情况、所踢位置和既往脑震荡症状)和自我报告的医疗状况(焦虑、抑郁、注意力缺陷多动障碍 [ADHD]、睡眠呼吸暂停、头痛、中风、高血压、心脏病、高胆固醇、勃起功能障碍和睾酮低)。在 1741 名参与者中,7.4% 为 CI+ 和/或 ND+(n = 129)。与未报告 CI 或 ND 的参与者相比,CI+ 或 ND+ 的参与者更有可能报告一种或多种并存病症(几率比 [OR] = 2.04;95% 置信区间:1.25-3.47;P = 0.003)。对人口统计学和足球相关因素进行调整后,针对每种病症分别建立一般线性模型,发现多动症、糖尿病、勃起功能障碍、头痛、睡眠呼吸暂停、焦虑和低睾酮与 CI+ 和/或 ND+ 之间存在显著关联(ORs = 1.8-6.0)。智方自动交互检测(CHAID)多变量决策树模型结合了医疗条件和足球暴露,能准确区分符合 CI 或 ND 临床标准的退役球员和不符合这些标准的退役球员(准确率 = 91.2-96.6%)。CHAID确定了抑郁症、头痛、睡眠呼吸暂停、多动症和脑震荡症状史的上四分位数组合最能预测CI+和/或ND+状态。CI+和/或ND+球员更有可能报告已知会导致认知症状的病症。脑震荡暴露和医疗条件大大增加了前 ASF 球员出现认知或神经行为功能障碍的可能性。从事该人群研究的临床医生应考虑可治疗的并存病症是否会导致与 TES 相关的部分临床表现。
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引用次数: 0
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Neurotrauma reports
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