Brain injury最新文献

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.

Introduction: Concussions pose a serious threat to adolescents, with potential long-term effects. This systematic review considers whether cardiac autonomic nervous system dysfunction occurs post-concussion in adolescents.

Methods: Eight databases were searched on 30/5/24 using terms related to adolescents, concussion, and the cardiac autonomic nervous system. Included were full-text English articles comparing heart rate, blood pressure, or heart rate variability among adolescents with concussion history and controls. JBI critical appraisal tools assessed methodological quality. Meta-analysis was not performed due to inter-study methodological variations.

Results: Ten studies met the inclusion criteria. Two studies included participants with longer-term concussion histories. Eight studies involved exertion. Mixed results were found for all metrics. A greater percentage of results was significant during exertion; the lowest percentage was for resting heart rate variability (15%), whilst the highest was for heart rate under exertion (46.15%). Critical appraisal highlights methodological flaws. Studies often inappropriately manage confounding factors, and some selected controls inappropriately, such as using individuals with a history of concussion as controls.

Discussion: Evidence suggests possible cardiac autonomic dysfunction post-concussion, more apparent under exertion. Methodological limitations prevent definitive conclusions. Future research should better manage confounding factors to determine whether cardiac autonomic assessment can assist concussion diagnosis and management.

Objective: To identify characteristics predictive of ambulation at discharge from inpatient rehabilitation in individuals with a Disorder of Consciousness (DoC) following traumatic brain injury (TBI).

Design: Prospective cohort pilot study.

Setting: Inpatient Rehabilitation Facility (IRF).

Participants: 15 adults (≥18 years) with a DoC after TBI, admitted to IRF within 6 months of injury.

Main outcome measure(s): 'Ambulate 50 feet' task from Inpatient Rehabilitation Facility - Patient Assessment Instrument.

Results: At discharge, 6 participants (40%) were classified as ambulators and 9 (60%) as wheelchair users. The 'ambulators' group had significantly fewer days between injury and admission to IRF (p < 0.001), higher JFK Coma Recovery Scale-Revised (CRS-R) scores at initial evaluation in IRF (p < 0.001), fewer days in IRF (p < 0.001), and faster rates of progress on the CRS-R in first 10 days at IRF (p = 0.047) compared to the 'wheelchair users' group.Both the rate of progress on the CRS-R in the first 10 days of IRF stay (p = 0.023) and days between injury and admission to IRF (p = 0.023) were significant predictors of ambulation at discharge.

Conclusion(s): This study identifies the rate of progress on the CRS-R in the first 10 days of IRF stay as a potential prognostic indicator for ambulation in individuals with DoC after TBI. Additional research with larger samples is warranted.

Purpose: There are unique characteristics of vulnerability among adult patients who experience a concussion and have persistent symptoms suggesting the need to tailor recruitment and retention strategies for this population. We aimed to obtain perspectives from post-concussion patients regarding factors they value to encourage recruitment and support retention, thereby assisting research teams conducting studies on concussion.

Methods: The authors used purposive, nonrandom sampling to identify potential research participants for this exploratory qualitative sub-study. Interview questions were designed using Appreciative Inquiry to gain patient-centered approaches to support recruitment and retention. Transcripts from telephone interviews were analyzed using reflexive thematic analysis.

Results: We identified two main themes: 1) positive change and 2) participant-centered study design. Each main theme had three sub-themes to support recruitment and/or retention. Positive changes included a) meaningful study impact, b) personal contribution counts, and c) gain information, and reassurance. Participant-centered study design included a) convenience, b) accommodation, and c) feeling valued.

Conclusions: Focused efforts in planning to recruit and retain vulnerable populations for research are paramount. Based on our exploratory findings from a limited sample, we offer patient-reported insights to reflect upon the ongoing learning process to optimize recruitment and retention in the field of concussion research.

Purpose: This study examined how demographic factors, health status, and caregiving preparedness influence the quality of life (QoL) of primary caregivers of stroke patients in Taiwan.

Methods: A cross-sectional survey was conducted with 145 caregivers at a central Taiwan hospital. Data were collected using the Caregiving Preparedness Scale (PCS), an 8-item tool assessing readiness in general care, emergency management, and resource access (5-point Likert scale), and the WHOQOL-BREF Taiwan version, a 28-item measure of physical, psychological, social, and environmental QoL.

Results: The average QoL score was 56.5 out of 80, assessed using WHOQOL-BREF. Stepwise regression analysis identified key predictors of QoL, with variance explained by CESD scores (34.9%), caregiving preparedness (19.3%), caregiver age (8.3%), marital status (0.9%), caregiving time (0.8%), employment status (0.7%), patient age (1.2%), and IADL score (2.6%). The reported percentages reflect each factor's contribution to QoL variance.

Conclusions: Support should be prioritized for caregivers with high depression scores, low caregiving preparedness, and socioeconomic vulnerabilities such as unemployment or low household income, to enhance their quality of life. The reported percentages reflect the variance in QoL explained by each predictor in the regression analysis.

Purpose: Our study aimed to investigate the association between initial serum magnesium levels and long-term functional outcomes in patients with TBI, accounting for variations across different age groups.

Methods: This retrospective study included adult patients with TBI and intracranial injury treated at a level-1 trauma hospital. The primary exposure was on serum magnesium levels within 6 hour of emergency department admission. Study outcomes included 6-month mortality and disability, assessed using the Glasgow Outcome Scale (scores 1-3). Multilevel multivariable logistic regression analysis was conducted to determine the relationship between serum magnesium levels and study outcomes, with stratified analysis employed to investigate potential variations based on age groups.

Results: Low magnesium levels were significantly associated with an increased risk of 6-month disability (Odds ratio (OR) 1.80, 95% confidence interval (CI): 1.14-2.68) and 6-month mortality (OR: 1.82, 95% CI: 1.03-2.99). This association remained significant exclusively among younger patients, with ORs of 2.70 (95% CI: 1.21-5.14) for 6-month disability and 2.33 (95%, CI: 1.11-4.49) for 6-month mortality when stratified by age.

Conclusion: Low serum magnesium levels are associated with poorer long-term outcomes in patients with TBI, and this effect is especially pronounced in younger adults (18-64 years). Specifically, younger patients exhibiting hypomagnesemia demonstrated a higher incidence of 6-month disability and mortality. These findings suggest a need to identify the causative links and explore whether correcting serum magnesium levels will improve TBI prognosis across different age groups.

Objective: Acute sleep disturbances after sport-related concussions (SRC) may affect recovery. This study assessed how sleep symptoms impact time to return-to-learn (RTL), symptom resolution (SR), and return-to-play (RTP).

Methods: A retrospective cohort study was conducted at a regional sports concussion center (11/2017-04/2022) with adolescents presenting within 3 days of SRC. Participants were dichotomized based on the presence or absence of 'trouble falling asleep' per the Post-Concussion Symptom Scale (PCSS). Mann-Whitney U tests compared outcomes, and multivariable regressions adjusted for PCSS, sex, age, and migraine or psychological history.

Results: Among 116 athletes, 29 (25%) reported sleep initiation symptoms. Median RTL was 4 days (IQR = 3-10) in those with sleep symptoms versus 3 days (IQR = 2-4, p = 0.005) without. Median SR and RTP times were longer for the sleep initiation symptoms group: 15 days (IQR = 7-27) vs. 8 days (IQR = 3-20, p = 0.024) for SR, and 16 days (IQR = 11-29) vs. 13 days (IQR = 6-21, p = 0.048) for RTP. Sleep initiation symptoms were not independent predictors of recovery, but migraine history predicted longer RTL, and prior concussions predicted longer RTP.

Conclusions: Although not independent predictors, acute sleep initiation symptoms were linked to delayed recovery. Strategies to optimize sleep acutely post-concussion may help facilitate timely recovery and improve outcomes.

Introduction: There is limited evidence regarding the association between traumatic brain injury (TBI) and the emergence of new-onset psychiatric disorders in adolescents. This prospective study analysed psychiatric disorders, quality of life, and emotional and behavioral difficulties in adolescents with TBI and orthopedic trauma at a 6-month follow-up.

Methods: Adolescents with TBI and a control orthopedic trauma group (without a history of psychiatric disorders) were evaluated using both the Strengths and Difficulties Questionnaire and the Paediatric Quality of Life Inventory.

Results: Forty-one adolescents with TBI and 45 with orthopedic injuries were assessed. TBI patients had significantly lower quality of life and higher levels of emotional difficulties. The prevalence of psychiatric disorders was higher in the TBI group (41.5% vs 15.6%). TBI group had higher rates of post-traumatic stress disorder and depression after 6 months. Hospitalization length and GCS scores were correlated with quality of life outcomes. Regression analysis revealed the presence of psychiatric disorders at 6 months was a significant predictor of reduced quality of life.

Conclusion: This study highlights a significant association between TBI and poorer quality of life and mental health outcomes in adolescents. Adolescents with TBI had higher rates of psychiatric disorder, more pronounced emotional difficulties, and a lower quality of life.