Brain injury最新文献

Background: Helmet use is widely accepted to reduce head injury severity by absorbing impact forces, but the specific effect on the presence of radiologically detected intracranial injuries remains unclear.

Objective: To examine the relationship between helmet use and Rotterdam CT score components, craniocervical fractures, and short-term mortality in cyclists and motorcyclists with severe TBI.

Method: This is a secondary analysis of data from the BRAIN-PROTECT dataset, a prospective observational study of 2,589 subjects with severe traumatic brain injury in the Netherlands. Logistic regression analysis was used, with helmet use as the independent variable, and Rotterdam score components, craniocervical fractures, and 30-day mortality as outcome measures.

Results: Among 499 severe TBI patients analyzed (median age 43 years), helmet use significantly reduced epidural mass (OR 0.25, 95% CI 0.10-0.60, p = 0.008) and skull fractures (OR 0.37, 95% CI 0.25-0.56, p = 0.004). However, helmeted patients had higher odds of cervical fractures (OR 2.94, 95% CI 1.74-4.98, p = 0.004), which persisted after adjusting for age and motor GCS component.

Conclusion: Among patients with severe TBI, those wearing helmets showed epidural mass lesions and skull fractures less frequently, but more often had cervical fractures than those not wearing helmets.

Background: This study investigated whether exposure to adverse childhood experiences (ACEs) were correlated with the duration or severity of post-concussion symptoms.

Methods: Participants referred to The Hull-Ellis Concussion and Research Clinic within 1 week of injury were followed for up to 16 weeks. Recovery from concussion was determined by a physician assessment of physical, cognitive, and sensory functioning. Symptom endorsement was quantified using the Sports Concussion Assessment Tool 3 (SCAT3) and ACEs with the ACE Questionnaire.

Results: Data from 256 participants were analyzed. There was no significant relationship between ACE scores and time to recovery (ρ = 0.18, p = 0.81). However, secondary analyses found significant associations at week 1 between ACEs and SCAT symptoms and severity (ρ = 0.18, p = 0.004; ρ = 0.19, p = 0.002).

Conclusions: Exposure to ACEs may sensitize individuals to concussion symptom endorsement in the acute stages but do not appear to prolong recovery from concussion. These findings support that clinicians should be aware of the impact of childhood traumas on an individual's health and assist in tailoring and providing individualized treatment plans, education and resources post-concussion.

Objectives: 1) Describe clinically significant symptoms over 4 years following hospitalization after mild traumatic brain injury (mTBI); 2) examine quality of life (QoL), social participation, and healthcare service use in relation to symptom burden.

Methods: Longitudinal cohort study in which 142 adults (ages 18-65) hospitalized following mTBI were assessed 4, 8, 12, 24, 36, and 48 months post-injury. Questionnaires and interviews evaluated fatigue, insomnia, cognitive complaints, anxiety, depression, headaches, dizziness, QoL, social participation, and healthcare service use for mTBI symptoms. The number of clinically significant symptoms (based on validated cutoff scores) was totaled for each participant; QoL, social participation, and healthcare services were examined in relation to the number of symptoms.

Results: At each timepoint, ≥45% of the participants experienced 3+ symptoms and ≥15% experienced 5+. The mean number of symptoms was similar over time (2.48-2.79; p = 0.32). The presence of 3+ symptoms was associated with poor QoL and social participation, including lower rates of return-to-work. Healthcare service use was not universal, even among individuals with 5+ symptoms.

Conclusions: Clinicians should be alert to the long-term presence of multiple symptoms following hospitalization after mTBI, as these affect a significant proportion of individuals and are associated with poorer outcomes.

Introduction: To determine differences in mechanism of injury and initial symptomatology of pediatric concussions across different age ranges.

Materials and methods: Information was collected on concussion patients presenting to orthopedic clinics in a tertiary children's hospital system including mechanism of injury, symptoms, and demographic information. Patients were grouped by age: 0-7, 8-12 and 13+ years and compared using Kruskal-Wallis for continuous variables and Fisher's exact test for categorical variables.

Results: Three hundred and thirty-three patients (381 concussions) were included in the study. The proportion of males decreased in older age groups (p = 0.007). When comparing age groups, more patients were injured through non-sports mechanisms at younger ages (p < 0.001). For symptoms reported at time of initial presentation, older age groups reported more headache, neck pain, sensitivity to sound, feeling slowed down, difficulty remembering, fogginess, and low energy (p < 0.05).

Conclusions: The results build on previous studies showing that younger pediatric patients sustain concussions mostly from non-sports mechanisms and endorse fewer symptoms which could be due to lower severity of injury and/or primarily relying on parent reporting of observable concussion symptoms. Pediatric concussion mechanism and presentation differ across ages, emphasizing the importance of age-appropriate symptom checklists and assessing for non-observable symptoms to ensure accurate diagnosis and management in pediatric populations.

Background: This study investigated the presence and level of alexithymia and examined the relationship between alexithymia and affect recognition abilities after acquired brain injury (ABI), accounting separately for etiology due to stroke or traumatic brain injury (TBI).

Methods: Ninety-nine neurologically healthy adults (NHA) and 119 adults with moderate-to-severe ABI (63 TBI, 56 stroke) participated. Main measures included the Toronto Alexithymia Scale-20 (TAS-20) and Multicultural Facial Emotion Perception Test (MFEPT).

Results: ABI groups endorsed greater alexithymia than NHA, but TBI and stroke subgroups did not significantly differ. Hierarchical multiple regression indicated that TAS-20 subscales difficulty identifying feelings (DIF) and externally oriented thinking (EOT), but not Difficulty Describing Feelings (DDF), added unique value to predicting objective affect recognition (MFEPT) after accounting for age, education, sex, face recognition ability, and general cognitive function. Moreover, the relationship between alexithymia and affect recognition was moderated by group: DIF and DDF were inversely related to MFEPT only for adults with ABI. EOT was inversely related to affect recognition for all three groups.

Conclusions: Adults with ABI experience alexithymia more frequently and intensely than neurologically healthy adults, and this impairment may partly underlie struggles with affective processing frequently observed in these individuals on experimental tasks and in real-world interactions.

Background: Geriatric patients are disproportionately affected by neurocritical conditions including traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH), yet remain underrepresented in clinical research and guidelines.

Objective: To assess the current state of geriatric-specific research and guideline development in neurocritical care (NCC), and to identify gaps in evidence and recommendations.

Methods: We conducted a structured literature review of original research articles published between 2018 and 2023 that focused on geriatric SAH, ICH, and TBI. Search strategies included key terms applied to Medline with specific inclusion/exclusion criteria. Additionally, we reviewed existing guidelines from major stakeholders including the Neurocritical Care Society and American Geriatrics Society for geriatric relevance.

Results: Of 70 featured NCC articles, 38 addressed SAH, ICH, or TBI. After filtering, 59 geriatric SAH, 218 geriatric TBI, and 63 geriatric ICH studies were identified. Results highlight a growing but insufficient body of geriatric neurotrauma research. Key gaps include the lack of validated risk stratification tools for older patients and a paucity of guideline recommendations specific to geriatric populations.

Conclusions: Despite increased incidence and complexity of neurotrauma in the elderly, current research and guidelines inadequately address geriatric needs. There is a pressing need for multidisciplinary guideline development, frailty-informed protocols, and targeted clinical research.

Purpose: Mild traumatic brain injury (mTBI) is a common injury in youth, and it has been shown to be related to a host of externalizing and internalizing symptoms. The long-term impact of mTBI may be greater for youth from marginalized backgrounds. Additionally, mental health symptoms present prior to the injury may also affect responses to mTBI in youth.

Methods: The current study utilized cross-sectional and longitudinal data from the Project on Human Development in Chicago Neighborhoods (n = 1,785) to assess the potential interactive effects of mTBI, Caregiver education (i.e. a SES proxy), and preexisting psychopathology on post-injury externalizing and internalizing psychopathology.

Results and significance: The three factors interacted to predict post-injury externalizing but not internalizing psychopathology. Youth with lower preexisting mental health symptoms who experienced a mTBI were at greater risk for psychopathology than those with higher pre-injury mental health symptoms and non-injured youth. Lower caregiver education was found to be a risk factor for greater increases in externalizing psychopathology following mTBI in youth. As such, stakeholders should be made aware of the possibilities raised by these findings and seek methods for reducing this disparity in outcomes for marginalized youth.

Objectives: To measure epidemiological data on concussions and examine the association between knowledge and attitudes about concussions and inappropriate post-injury behavior.

Design: Descriptive, cross-sectional study.

Setting: Online survey.

Participants: A total of 365 competitive cyclists in Japan.

Main outcome measures: Survey items included participant information, the experience of concussion-like symptoms, concussion knowledge index (CKI) score, concussion attitude index (CAI) score, and inappropriate behavior post-concussion injury.

Results: The prevalence of concussion-like symptoms among all competitive cyclists was 45.8%. CKI and CAI scores for all participants were 21.7 ± 3.4 and 10.5 ± 3.4, respectively. No significant differences were identified in CKI and CAI scores based on concussion-like symptom experience. After adjusting for covariates, we found that the risk of 'returning to training without rest after injury' decreased by 20% for each 1-point increase in CKI score. In contrast, the risk of 'returning to training with symptoms remaining' decreased by 13% for each 1-point increase in CAI.

Conclusions: An association was found between concussion knowledge and return to competition without a period of rest post-injury, as well as between attitude toward concussion and return to competition with symptoms. Therefore, these findings can contribute to concussion education among cyclists.

Background: The American Board of Medical Specialties recognized brain injury medicine (BIM) as a subspecialty certification for physicians from diverse training backgrounds. Increasing the number of physicians pursuing BIM fellowship training remains imperative given the increasing prevalence of patients with traumatic brain injuries.

Methods: This was a retrospective cohort study of BIM fellowship applicants from 2017 to 2024. The annual volume of available training positions, applications, match rates, and unfilled training positions were calculated.

Results: The annual volume of BIM training programs (16 to 26, 63% increase), training positions (17 to 31, 82% increase), and applicants (16 to 26, 63% increase) increased over the study period (p < 0.001). The annual applicant-to-training position ratio ranged between 0.7-1.2 with no significant change over the study period (p = 0.598). In total, there were 198 available training positions and 39 went unfilled (20%). The rate of unfilled training positions (12% to 16%, p = 0.601) and annual match rates (94%-100%, p = 0.958) did not change. Most applicants matched at their first-choice (45%) or second-choice (16%) fellowship programs.

Conclusions: There were 198 BIM fellowship positions available over the study period and 39 went unfilled (20%). Coordinated efforts may stimulate earlier physician interest in BIM training to meet future demands.

Introduction: Approximately thirty percent of patients with mild traumatic brain injury (mTBI) suffer from persistent symptoms that can impact their day-to-day activities. The primary aim of this study was to examine the relationship between waiting time for rehabilitation services and persistent post-mTBI symptoms. The secondary objective was to explore the relationship between sociodemographic characteristics and persistent symptoms.

Materials and methods: An observational cohort study was conducted at a specialized interdisciplinary rehabilitation program for mTBI in Québec, Canada. Waiting time was the predictor variable and symptom outcomes were measured at two points in time.

Results: Twenty-six participants completedquestionnaires at both baseline and follow-up. Approximately 70% of participants received their first appointment within six months of the injury, while the others waited more than eight months. Longer waiting times were associated with higher scores of persistent post-concussion symptoms on the Rivermead Post-Concussion Symptoms Questionnaire (p = 0.008), higher scores on the Beck Anxiety Inventory (p = 0.005), and lower scores on the Community Integration Questionnaire (p = 0.006) at baseline, as well as higher scores on the Beck Anxiety Inventory (p = 0.046) at follow-up.

Conclusion: This study reveals the negative effects of delayed access to specialized rehabilitation services for patients with mTBI and calls for necessary policy changes.