Brain injury最新文献

Aim: Ischemic stroke remains a leading global cause of morbidity and mortality, emphasizing the need for timely treatment strategies. This study aimed to develop a machine learning model to predict clinical outcomes in ischemic stroke patients undergoing Alteplase therapy.

Methods: Data from 457 ischemic stroke patients were analyzed, including 50 demographic, clinical, laboratory, and imaging variables. Five machine learning algorithms - k-nearest neighbors (KNN), support vector machines (SVM), Naïve Bayes (NB), decision trees (DT), and random forest (RF) - were applied for constructing models. Additional feature importance analysis were p to identify high-impact predictors.

Results: The Random Forest model showed the highest predictive reliability, outperforming other algorithms in sensitivity (0.97 ± 0.02) and F-measure (0.96 ± 0.02). feature importance analysis identified NIH1C (LOC commands (eye and hand movements)), NIH1B (LOC questions (birthday and age recall)), and NIH_noValue (the absence of any stroke characteristics) as the most influential predictors. Using only the top-ranked features identified from the feature importance analysis, the model maintained comparable performance, suggesting a streamlined yet effective predictive approach.

Conclusion: Our findings highlight the potential of machine learning in optimizing ischemic stroke treatment outcomes. Random Forest, in particular, proved effective as a decision-support tool, offering clinicians valuable insights for more tailored treatment approaches.

Background: Methamphetamine (Meth) use is rising in the US. Most research focuses on severe TBI, neglecting milder cases. We evaluated Meth's impact on patient outcomes and hospital resource use across all TBI severities.

Methods: This study included National Trauma Data Bank (NTDB) patients from 2017-2019, aged 18-54, with near-isolated TBI, a drug screen, and negative blood alcohol. Meth+ patients were compared to Meth- patients on demographics, injury severity, and outcomes using χ² and Wilcoxon rank-sum tests.

Results: Of 29,416 patients with TBI patients, 337 (1%) were Meth+. Meth+ patients had significantly higher ICU admissions (61% vs. 50%, p < 0.001), mechanical ventilation (32% vs. 22%, p < 0.001), and tracheostomy (7% vs. 4%, p < 0.008). Meth+ had longer hospital stays (median 4 vs. 3 days, p < 0.001) and higher cerebral monitor use (8% vs. 5%, p < 0.05). Mortality rates were similar (5% vs. 5%, p = 0.46). Meth+ patients had more preexisting mental health/personality (20% vs. 12%, p < 0.001) and substance use disorders (44% vs. 6%, p < 0.001).

Conclusions: Meth use in patients with near-isolated TBI patients is linked to greater injury severity, increased resource use, and longer hospital stays but does not significantly impact mortality. Targeted interventions are needed to manage clinical challenges and optimize resource utilization.

Background: Work-related traumatic brain injury (wrTBI) is considered a critical injury that can be prevented. Few studies have integrated clinical data and workers' injury narratives to inform sex-specific wrTBI prevention.

Objective: To examine sex differences in pre-injury factors and provide recommendations for primary prevention of wrTBI.

Methods: Concurrent mixed methods study. The Person-Environment-Occupation (PEO) model served as a theoretical framework for qualitative and quantitative data analyses.

Results: The sample consisted of 93 workers (51% female, 67% aged over 40) with wrTBI sustained as a result of being struck by/against an object (SBA, 46%), falls (30%), motor vehicle accident (13%), and assault (11%). Qualitative analysis of injury events revealed distinct patterns between male and female workers in the nature and physical/social load of occupational activities performed at the time of injury. Quantitative analysis enriched interpretation of observed sex differences across PEO factors. New insights emerged by stratifying SBA injury cases, revealing sex differences in Environment- and Occupation-related factors unique to workers struck by an object.

Implications: Sex- and cause-specific analysis of injury events is essential for surveillance and prevention of wrTBI. Addressing fitness for duty, supervisor-worker relationships, and industry-specific hazards in prevention strategies is essential to ensure workplace safety.

Background: Adjusting to life changes posed by an acquired brain injury (ABI) can be challenging for both individuals with ABI and their families. The current study explores the experience of adjustment, incorporating similarities and differences in this process as reported by the family members and individuals with ABI.

Method: Thirty-nine participants, recruited from a regional brain injury charity group, took part in semi-structured interviews (20/39 individuals with ABI, 19/39 relatives). Transcripts were analyzed using thematic analysis.

Findings: Three main categories of adjustment were developed: adjusted to life after ABI, partially adjusted to life after ABI and not adjusted to life after ABI. However, it is the complexity of experiences within these main categories which uncovers the diversity in individual experience. Of specific interest are adjustment as best case and resigned adjustment responses which indicate a level of burden for the person experiencing these feelings of adjustment.

Conclusions: The categories of grateful acceptance and resigned acceptance were specific to relatives and show the need to look beyond the individual with ABI to identify where support may be required for a family as a whole. On the basis of these findings, we offer an inclusive, family-oriented conceptualization of adjustment to brain-injury.

Objectives: This manuscript describes traumatic brain injury (TBI)-related mortality in the United States during 2021, by geography, sociodemographic characteristics, mechanism of injury, and injury intent.

Method: Multivariable modeling of TBI mortality was performed to assess the simultaneous effect of multiple factors (geographic region, sex, race and ethnicity, and age) included in the model. Authors analyzed multiple-cause-of-death data from the National Vital Statistics System and included records when an International Classification of Diseases, Tenth Revision (ICD-10) underlying cause of death injury code, and a TBI-related ICD-10 diagnosis code were both listed.

Results: During 2021, there were 69,473 TBI-related deaths. Rates were highest among older adults, males, and non-Hispanic American Indian/Alaska Native persons. A large proportion of all TBI-related deaths were attributed to unintentional falls and suicides. Model-based rates of TBI mortality revealed a divergent pattern with increasing rates by age group, while rate ratios simultaneously declined with age among specific racial/ethnic groups when compared with non-Hispanic White persons.

Conclusion: Findings indicate unintentional falls and suicides remain a common cause of fatal TBI and specific groups are disproportionally affected by such injuries. Health care providers can play a role by assessing patients at increased risk for TBI and providing referrals for care and culturally tailored interventions when warranted.

Background: The importance of corticospinal tract (CST) integrity in upper limb recovery poststroke is well established, but its association with standing balance and walking remains unclear. This meta-analysis aimed to establish the relationship between CST and non-CST motor tract integrity, and clinical scores of standing balance and walking poststroke.

Methods: In July 2024, five databases were searched for studies, focusing on diffusion MRI metrics and clinical scores of standing balance and/or walking independence poststroke. Meta-analyses were conducted to pool correlation coefficients (r) and group differences (d) based on CST integrity.

Results: Twenty-two studies were included. Cross-sectional analysis showed no correlation (r < .25) between CST metrics and the functional ambulation category (FAC) in the sub-acute phase. Weak prognostic associations were found for CST-FA and CST-FN with FAC. Significant FAC score differences were found between preserved- and disrupted CST groups in the sub-acute (d = .79) and chronic (d = 1.07) phase and for prognostic analysis (d = 1.40). Non-CST metrics showed no cross-sectional associations and mixed prognostic associations.

Conclusions: CST integrity was not significantly associated with standing balance or walking independence in the sub-acute phase. Early CST integrity showed weak prognostic value for walking at 6 months. Multimodal longitudinal research is needed to improve lower limb recovery prognostics.

Objective: Comatose survivors of cardiac arrest (CA) pose a complex challenge for physicians reliant on imperfect studies to determine the extent of neurologic injury. Clinically available imaging is frequently relied upon despite limited sensitivity. We conducted a prospective pilot study comparing diffusion kurtosis imaging (DKI)-MRI and somatosensory evoked potentials (SSEPs) in comatose survivors of CA to investigate the benefit of utilizing higher diffusion b-values to enhance prediction of arousal recovery.

Methods: Survivors of CA admitted from June 2015 through November 2019 with DKI-MRI and SSEPs were evaluated. Advanced diffusion metrics differentiating present or absent SSEPs were analyzed using whole-brain voxelwise nonparametric permutation inference with threshold-free cluster enhancement.

Results: Twenty survivors of CA were included, mean age 52, 45% female and out-of-hospital arrests accounting for 75% of cases. Baseline characteristics and examination findings were not statistically different between groups at admission or 48 h after achieving normothermia. A decrease in mean diffusivity (MD) and increase in mean kurtosis (MK) was demonstrated in subjects without arousal recovery potential, most prominently in the posterior mesial temporal, parietal and occipital lobes.

Conclusion: DKI-MRI may improve early arousal recovery prediction during the immediate phase of post-CA care, especially where SSEPs are unavailable or unreliable.

Objective: To study the functional outcomes of traumatic brain injury (TBI) patients who have undergone surgical intervention in the hyperacute phase (<24 h).

Data sources: Cochrane Library, PubMed, Embase, Medline and Web of Science databases.

Review methods: A meta-analysis of 7 trials involving 237 patients was performed. Patients were categorized into two groups based on time to surgery: within 6 h and within 24 h. Patients were also categorized into developed and developing regions. Effect estimates were calculated using a fixed-effects model and heterogeneity was assessed with Cochrane I² statistic.

Results: Our findings revealed that those who underwent neurosurgery in the hyperacute phase of TBI were at risk of adverse outcomes. The odds ratio (OR) was 1.50 (95% CI 1.03-2.19). Subgroup analysis demonstrated that TBI patients who underwent surgery within 6 h were at a greater risk of adverse effects (OR, 1.72; 95% CI, 1.08-2.74). Moreover, a greater risk was observed in developing regions (OR, 2.33; 95% CI, 0.97-5.58).

Conclusion: Earlier neurosurgical intervention in the acute phase of TBI might result in higher incidence of adverse events. Surgery would be postponed for TBI patients whose initial GCS score is greater than 8 during the hyperacute period.

Objective: Paradoxical herniation (PH) is a rare but potentially life-threatening complication after decompressive craniectomy. The core treatment strategy for PH focuses on increasing intracranial pressure. Here, we present the treatment course of intractable PH in a 59-year-old patient with a traumatic acute subdural hematoma.

Methods: The patient underwent two operations to evacuate intracranial hematomas followed by decompressive craniectomy within 48 h. Intractable PH was induced by persistent cerebrospinal fluid leakage due to multiple lumbar punctures. The condition was managed with conventional interventions, such as a supine position, intravenous fluid infusion, and multiple intrathecal saline injections, which have been proven to be inefficient. Owing to his unconsciousness and concurrent severe pneumonia, the patient underwent invasive mechanical ventilation with increased positive end-expiratory pressure (PEEP) to optimize oxygen delivery. PEEP was set at 10 cmH₂O with the intention of facilitating alveolar recruitment.

Results: Increased PEEP unexpectedly played a role in elevating intracranial pressure and, as a result, led to the complete resolution of PH. The patient gradually recovered and resumed his daily activities.

Conclusions: Applying invasive mechanical ventilation with increased PEEP for treating intractable PH can yield a favorable outcome. It represents a novel approach to dealing with such a rare complication.