Diagnostic significance of ubiquitin C-terminal hydrolase L1 in patients with mine-blast traumatic brain injury

Objective Traumatic brain injury (TBI) proves to be an obstacle for Bangladeshi patients due to the lack of facilities and specialist doctors in regional sections of the country. This study aimed to record different attributes of Bangladeshi TBI patients over a year i.e., their injury characteristics, treatments received and understand their impacts on the severity of TBI. Method This cross-sectional study was carried out among 280 TBI patients treated in a tertiary care hospital in Dhaka. The physicians determined TBI's severity and prognosis as per the Glasgow Coma Scale (GCS) and Glasgow Outcome Score (GOS) respectively. Results Most TBI patients were male (76.1%) and aged between 18 and 50 years (52.2%), as in previous studies in South Asian countries. However, the prevalence of TBI due to road traffic accidents (RTAs) was much higher (67.9%) than in the earlier studies in South Asia. Additionally, more patients suffered from severe TBI (29.3%) and moderate TBI (35.7%), and a higher percentage of patients went through surgery (56.8%) compared to previous studies. A significant association of demographic (residence) and clinical characteristics (consciousness after injury, CT scan findings and treatment type) with the severity of TBI was found in bivariate analysis. It also revealed the significant dependence of clinical characteristics (TBI etiology, post-injury consciousness, treatment type and TBI severity) on TBI prognosis. Multivariate analysis showed that patients who were unconscious after TBI and with evident brain injury observed in CT scans have a substantially higher risk of having moderate or severe TBI than mild TBI. Moreover, patients with TBI due to RTAs or falls, evident brain injury in CT scans, post-surgical seizure, and moderate or severe TBI have a significantly higher risk of getting a more unfavorable TBI prognosis than moderate disability. Conclusions In this study, RTAs were found to be the major cause of TBI. Additionally, some variables were identified as possible determinants of TBI severity and prognosis among Bangladeshi patients. The correlation of these variables with TBI should be further studied with the hopes that steps will be taken to reduce TBI incidents and improve its management to reduce the overall burden.

Posttraumatic brain injury patients with depressive symptoms were compared with nondepressed mild and moderate traumatic brain injury (TBI) patients based on their scores on the Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ). A factor analysis demonstrated that the items of the RPCSQ loaded into three factors: mood and cognition, general somatic, and visual somatic symptom groups. Factor scores based on this model were calculated for each group and it was found that depressed subjects reported a greater severity of all three symptom groups compared to nondepressed patients. These results suggest that depression post-TBI may influence patient perception of postconcussion symptoms.

Pediatric traumatic brain injury (TBI) contributes to impairments in behavior and academic performance. However, the long-term effects of early childhood TBI on functioning across settings remain poorly understood. To examine the long-term functional outcomes of early childhood TBI relative to early childhood orthopedic injuries (OIs). We also examine the moderating role of the social environment as defined by parent report and observational measures of family functioning, parenting practices, and home environment. A prospective, longitudinal, observational cohort study conducted at each child's home, school, and hospital, including 3 children's hospitals and 1 general hospital in the Midwest. Patients were enrolled in the initial study between January 2003 and October 2006. Follow-ups were completed between January 2010 and April 2015. Fifty-eight children who sustained a TBI (67% of original enrolled cohort) and 72 children who sustained an OI (61% of the original enrolled cohort) were prospectively followed up from shortly after injury (between the ages of 3 and 7 years at enrollment) to an average of 6.7 years after injury, with assessments occurring at multiple points. Long-term functional outcomes in everyday settings, as assessed through the Child and Adolescent Functional Assessment Scale (CAFAS). Of the 130 children included, the median age for those with OIs was 11.72 years and 11.97, 12.21, and 11.72 years for those with complicated mild, moderate, and severe TBIs, respectively. Children with moderate and severe TBI were rated as having more functional impairments in multiple domains than those with OIs (P < .05). Children with complicated mild TBI had greater impairments in school (odds ratio = 2.93; 95% CI = 1.10-7.82) and with thinking (odds ratio = 15.72; 95% CI = 3.31-74.73) than those with OIs. Functional impairments in children with TBI were more pronounced among children from families with higher levels of permissive (mean CAFAS of 49.71, 35.74, 58.14, and 16.16 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 33.55; P < .001] and complicated mild TBI and OI [difference = 41.98; P < .001]) or authoritarian (mean CAFAS of 56.45, 41.80, 54.90, and 17.12 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 39.33; P < .001], moderate TBI and OI [difference = 24.68; P = .003], and complicated mild TBI and OI [difference = 37.78; P < .001]) parenting or with fewer home resources (mean CAFAS of 69.57, 47.45, 49.00, and 23.81 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 45.77; P < .001], moderate TBI and OI [difference = 23.64; P < .001], and complicated mild TBI and OI [difference = 25.20; P < .001]). Even children with relatively mild early TBI experience long-term functional impairments, particularly in the context of less favorable home environments. These findings suggest that improving parenting skills and the quality of the home environment may promote functional recovery following early TBI.

Health care utilization and cost in the dual diagnosis of combined traumatic spinal cord injury and traumatic brain injury compared to traumatic brain injury alone: An analysis using MarketScan.

Guidelines recommend seizure prophylaxis for early posttraumatic seizures (PTS) after severe traumatic brain injury (TBI). Use of antiseizure medications for early seizure prophylaxis after mild or moderate TBI remains controversial. To determine the association between seizure prophylaxis and risk reduction for early PTS in mild and moderate TBI. PubMed, Google Scholar, and Web of Science (January 1, 1991, to April 18, 2023) were systematically searched. Observational studies of adult patients presenting to trauma centers in high-income countries with mild (Glasgow Coma Scale [GCS], 13-15) and moderate (GCS, 9-12) TBI comparing rates of early PTS among patients with seizure prophylaxis with those without seizure prophylaxis. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) reporting guidelines were used. Two authors independently reviewed all titles and abstracts, and 3 authors reviewed final studies for inclusion. A meta-analysis was performed using a random-effects model with absolute risk reduction. The main outcome was absolute risk reduction of early PTS, defined as seizures within 7 days of initial injury, in patients with mild or moderate TBI receiving seizure prophylaxis in the first week after injury. A secondary analysis was performed in patients with only mild TBI. A total of 64 full articles were reviewed after screening; 8 studies (including 5637 patients) were included for the mild and moderate TBI analysis, and 5 studies (including 3803 patients) were included for the mild TBI analysis. The absolute risk reduction of seizure prophylaxis for early PTS in mild to moderate TBI (GCS, 9-15) was 0.6% (95% CI, 0.1%-1.2%; P = .02). The absolute risk reduction for mild TBI alone was similar 0.6% (95% CI, 0.01%-1.2%; P = .04). The number needed to treat to prevent 1 seizure was 167 patients. Seizure prophylaxis after mild and moderate TBI was associated with a small but statistically significant reduced risk of early posttraumatic seizures after mild and moderate TBI. The small absolute risk reduction and low prevalence of early seizures should be weighed against potential acute risks of antiseizure medications as well as the risk of inappropriate continuation beyond 7 days.

Worldwide, 54-60 million individuals sustain traumatic brain injury (TBI) each year. This meta-analysis aimed to quantify intelligence impairments after TBI and to determine the value of age and injury severity in the prognosis of TBI. An electronic database search identified 81 relevant peer-reviewed articles encompassing 3890 patients. Full-scale IQ (FSIQ), performance IQ (PIQ) and verbal IQ (VIQ) impairments were quantified (Cohen's d) for patients with mild, moderate and severe TBI in the subacute phase of recovery and the chronic phase. Meta-regressions explored prognostic values of age and injury severity measures for intelligence impairments. The results showed that, in the subacute phase, FSIQ impairments were absent for patients with mild TBI, medium-sized for patients with moderate TBI (d = -0.61, P < 0.001) and large for patients with severe TBI (d = -1.09, P < 0.001). In the chronic phase, FSIQ impairments were small for patients with mild or moderate TBI (d = -0.37 and -0.19, P ≤ 0.008) and large for patients with severe TBI (d = -0.80, P < 0.001). Adults with mild TBI had larger PIQ and VIQ impairments in the chronic phase than children (both Q ≥ 5.21, P ≤ 0.02), whilst children with severe TBI had larger FSIQ and VIQ impairments than adults (both Q ≥ 4.40, P ≤ 0.04). Glasgow Coma Scale score, duration of loss of consciousness and post-traumatic amnesia duration moderately to strongly predicted FSIQ, PIQ and VIQ impairments (0.41 ≤ r ≤ 0.82, P ≤ 0.02), but no differences in predictive value were observed. In conclusion, TBI causes persisting intelligence impairments, where children may have better recovery from mild TBI and poorer recovery from severe TBI than adults. Injury severity measures predict intelligence impairments and do not outperform one another.

Exploring Serum Biomarkers for Mild Traumatic Brain Injury

Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI). To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity. Multisite US prospective cohort study. Eighteen level I trauma centers and 51 non-trauma center hospitals. A total of 3047 (weighted n = 10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years. Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury. At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD. More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.

ObjectivesWe analysed magnetic resonance imaging (MRI) findings after traumatic brain injury (TBI) aiming to improve the grading of traumatic axonal injury (TAI) to better reflect the outcome.MethodsFour-hundred sixty-three patients (8–70 years) with mild (n = 158), moderate (n = 129), or severe (n = 176) TBI and early MRI were prospectively included. TAI presence, numbers, and volumes at predefined locations were registered on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging, and presence and numbers on T2*GRE/SWI. Presence and volumes of contusions were registered on FLAIR. We assessed the outcome with the Glasgow Outcome Scale Extended. Multivariable logistic and elastic-net regression analyses were performed.ResultsThe presence of TAI differed between mild (6%), moderate (70%), and severe TBI (95%). In severe TBI, bilateral TAI in mesencephalon or thalami and bilateral TAI in pons predicted worse outcomes and were defined as the worst grades (4 and 5, respectively) in the Trondheim TAI-MRI grading. The Trondheim TAI-MRI grading performed better than the standard TAI grading in severe TBI (pseudo-R2 0.19 vs. 0.16). In moderate-severe TBI, quantitative models including both FLAIR volume of TAI and contusions performed best (pseudo-R2 0.19–0.21). In patients with mild TBI or Glasgow Coma Scale (GCS) score 13, models with the volume of contusions performed best (pseudo-R2 0.25–0.26).ConclusionsWe propose the Trondheim TAI-MRI grading (grades 1–5) with bilateral TAI in mesencephalon or thalami, and bilateral TAI in pons as the worst grades. The predictive value was highest for the quantitative models including FLAIR volume of TAI and contusions (GCS score <13) or FLAIR volume of contusions (GCS score ≥ 13), which emphasise artificial intelligence as a potentially important future tool.Clinical relevance statementThe Trondheim TAI-MRI grading reflects patient outcomes better in severe TBI than today’s standard TAI grading and can be implemented after external validation. The prognostic importance of volumetric models is promising for future use of artificial intelligence technologies.Key PointsTraumatic axonal injury (TAI) is an important injury type in all TBI severities. Studies demonstrating which MRI findings that can serve as future biomarkers are highly warranted.This study proposes the most optimal MRI models for predicting patient outcome at 6 months after TBI; one updated pragmatic model and a volumetric model.The Trondheim TAI-MRI grading, in severe TBI, reflects patient outcome better than today’s standard grading of TAI and the prognostic importance of volumetric models in all severities of TBI is promising for future use of AI.

Traumatic Brain Injury (TBI) is a major problem in military and civilian medicine. Yet, there are no simple non-invasive diagnostics for TBI. Our goal is to develop and clinically validate blood-based biomarker assays for the diagnosis, prognosis and management of mild, moderate and severe TBI patients. These assays will ultimately be suitable for deployment to far-forward combat environments. Using a proteomic and systems biology approach, we identified over 20 candidate biomarkers for TBI and developed robust ELISAs for at least 6 candidate biomarkers, including Ubiquitin C-terminal hydrolase- L1 (UCH-L1), Glial Fibrillary Acidic Protein (GFAP) and a 145 kDa breakdown products of &#945;II-spectrin (SBDP 145) generated by calpain proteolysis. In a multi-center feasibility study (Biomarker Assessment For Neurotrauma Diagnosis And Improved Triage System (BANDITS), we analyzed CSF and blood samples from 101 adult patients with severe TBI [Glasgow Coma Scale (GCS) &le; 8] at 6 sites and analyzed 27 mild TBI patients and 5 moderate TBI patients [GCS 9-15] from 2 sites in a pilot study. We identified that serum levels of UCH-L1, GFAP and SBDP145 have strong diagnostic and prognostic properties for severe TBI over controls. Similarly initial post-TBI serum levels (&lt; 6 h) of UCH-L1 and GFAP have diagnostic characteristics for moderate and mild TBI. We are now furthering assay production, refining assay platforms (both benchtop and point-ofcare/ handheld) and planning a pivotal clinical study to seek FDA approval of these TBI diagnostic assays.

You have accessThe ASHA LeaderFeature1 Jul 2009Improving Inpatient and Follow-Up TBI Services Carlee W. Jones andMS, CCC-SLP Carolyn FoleyRN Carlee W. Jones Google Scholar More articles by this author , MS, CCC-SLP and Carolyn Foley Google Scholar More articles by this author , RN https://doi.org/10.1044/leader.FTR3.14092009.18 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Even though up to 2 million people sustain traumatic brain injury (TBI) each year, their long-term physical, behavioral and/or cognitive impairments may remain under-diagnosed and untreated (NIH, 1999). The resulting disorders frequently result in functional limitations (Cicerone et al., 2005; Coelho, DeRuyter, & Stein, 1996). As a level-one trauma center, Duke University Hospital routinely admits patients with TBI to the Adult Trauma Service. The Division of Speech Pathology and Audiology provides speech-language, cognitive, and swallowing services to all patients at Duke, including those with TBI. In the past, referral to speech pathology for cognitive-communicative TBI assessment was limited to those patients whose physicians specifically asked for the assessment. However, the attending physician’s focus in treating these multi-injured trauma patients was frequently on resuscitation, stabilization, and treatment to maintain life. Confounding factors—such as baseline substance abuse/withdrawal, psychiatric issues, and hospital sedation—coupled with brief, generic, and informal physician- or nurse-administered cognitive examinations resulted in under-identification of mild and even moderate TBI. As a consequence, referral for speech pathology evaluation and treatment of the resulting cognitive-communicative disorders was inconsistent and underutilized. In an attempt to improve service provision, the speech pathology and trauma service coordinators joined forces to conduct a performance improvement project. Their goal was to identify the scope, need, and utilization of services to determine if the identification of and intervention with patients with TBI could be improved. This project, conducted in five phases, led to an alternative model of service delivery that improved and enhanced services to this population. Phase One: Identification of Need The first step was to identify the use of existing services through a retrospective review of all speech pathology consults for inpatients with TBI admitted to the adult trauma service during a 60-day time period. Results showed that physicians ordered speech pathology consults for cognitive-communicative evaluation for less than 10% of patients that met TBI criteria. These criteria included Glasgow Coma Scale (GCS) < 15; positive brain CT; loss of consciousness; report of amnesia; altered mental status; and/or a traumatic mechanism of injury such as ejection from a motor vehicle (Kay et al., 1993). Based on this retrospective review, the speech pathology and trauma coordinators developed a two-pronged approach to improve service provision to TBI patients that includes: Educating care providers, patients, and patients’ families about TBI. Improving service delivery to patients with TBI. Phase Two: Improved Clinical Education and Service Delivery The clinical education focus for the Division of Speech Pathology and Audiology was to enhance knowledge and skills in TBI management, implement new practice patterns, and improve service delivery. An intensive TBI education program was developed and provided to all clinicians. In addition, a speech-language pathologist was identified to coordinate all services to inpatients in the Adult Trauma Service. This SLP addressed all consults, attended all trauma rounds to advocate for necessary cognitive-communicative services, participated in discharge planning, and served as a consistent physical reminder of the services provided by speech pathology. The multidisciplinary team embraced all of these changes. Another SLP also began to attend the weekly Outpatient Trauma Clinic that provides medical follow-up to all trauma patients after discharge. This SLP re-evaluated the cognitive-communicative status of all patients identified as having TBI during their inpatient stay, determined if recommended services were being received, and provided education to patients and their families. Simultaneously, the Adult Trauma Service spearheaded a similar initiative. The speech pathology and trauma coordinators formed a “TBI Advocacy Team” comprising medical professionals from different disciplines (e.g., physical therapy, occupational therapy, social work, patient resources). Meeting regularly, the team identified enhancements related to TBI services specific to their respective disciplines, identified individual and multidisciplinary goals, developed data collection strategies, and accumulated and analyzed data. The team also focused on increasing TBI awareness and education for staff and patients. Additional TBI education (lectures, in-services, etc.) was provided to nurses, physicians, and medical students. Speech pathology staff—with multidisciplinary input—developed a comprehensive patient and family TBI education book that is provided to all inpatients with TBI and their families. Phase Three: Pilot Project The follow-up data collected by the TBI Advocacy Team during Phase Two revealed that the newly implemented educational and service-delivery measures had increased the provision of cognitive-communicative services to 50% of inpatients who met the TBI criteria. Although this statistic represented an improvement, it also indicated that not all patients were receiving necessary services under the existing physician-requested consultation model. After reviewing the data, the Trauma Service medical director initiated a three-month pilot project that revised the existing physician-ordered consultation model to a “standing order” model of screening and evaluation driven by the Division of Speech Pathology and Audiology. During the pilot study, all TBI patients admitted with blunt force injuries above the neck automatically received a TBI screening (using the criteria previously defined) by Speech Pathology within 24 hours of admission. Both “pass” and “fail” results were documented in the medical record. If any of the TBI criteria was met (“fail”), a cognitive-communicative evaluation was automatically conducted. Pilot-study results showed that 100% of adult trauma service admissions meeting TBI criteria received a TBI screening and, when warranted, subsequent cognitive-communicative evaluation. Our unpublished data reveal that approximately one-third of the patients passed the screening and did not require a full cognitive-communicative evaluation. The remaining two-thirds required a full assessment; of those, approximately half needed immediate cognitive-communicative treatment and half were determined to have signs or symptoms of mild TBI that necessitated follow-up services to reevaluate their cognitive-communicative abilities after discharge. Because of the success of the pilot and demonstration of improved services to patients with TBI, the “standing order” model was permanently implemented. Although data on patient outcomes are not available for this pilot project, care of patients with TBI improved as we shifted from providing few or no services to being actively involved with their evaluation and treatment. Phase Four: Improved Re-evaluation As more individuals with TBI were being identified and more cognitive-communicative deficits were being diagnosed, a coordinated discharge follow-up plan was needed. Before the study, most patients with moderate or severe TBI would receive post-discharge TBI follow-up, including cognitive-communicative treatment, either at inpatient rehabilitation facilities or through outpatient services. However, those with mild TBI often did not receive TBI follow-up services, especially high-functioning patients with mild TBI who may have been assessed as “within normal limits” but still had mild impairments. To address this issue, a follow-up plan has been implemented to ensure that all inpatients identified with mild TBI receive adequate post-discharge treatment. This plan attempted to address functional issues likely to surface when the patient with mild TBI is discharged and attempts to resume daily life at home or work—just as more subtle, but equally serious, signs and symptoms of TBI are likely to emerge. Under the new plan, all inpatients who fail the TBI screening receive a re-evaluation four weeks after discharge—even if they functioned at a high level during their hospital stay. By building on the existing Outpatient Trauma Clinic (described in Phase Two), the speech and trauma coordinators implemented a re-evaluation program for discharged inpatients with TBI. Program patients with TBI who receive a medical follow-up are also re-evaluated for recovery of physical, behavioral, and cognitive aspects of TBI. Based on re-evaluation findings, referrals are then made for more comprehensive TBI services (e.g., speech-language treatment, neurology, neuropsychology). Phase Five: Continual Improvements The desire to improve TBI services grew from a small performance improvement project into a full-scale, multidisciplinary service-delivery model change that continues to evolve almost two years later. The TBI Advocacy Team continues to address process improvements and identify new challenges. These new challenges include creating a Multidisciplinary Outpatient TBI Clinic with the appropriate disciplines in one location to further enhance comprehensive follow-up services for TBI patients. The clinic facilitates patient safety, customer satisfaction, and resource utilization efficacy, and has encouraged the expansion of the inpatient screening process and outpatient follow-up to other hospital services (e.g., neurology, neurosurgery, and orthopedics) and to the pediatric population. Expectations remain high for this evolving project, which may serve as a best practice model for hospitals and medical centers across the nation. References Cicerone K.D., Dahlberg C., Malec J.F., Langenbahn D.M., Felicetti T., Kneipp S., et al. (2005). Evidence-based cognitive rehabilitation: Updated review of the literature from 1998 through 2002.Archives of Physical Medicine and Rehabilitation, 861681–1692. CrossrefGoogle Scholar Coelho C., DeRuyter F., & Stein M. (1996). Treatment efficacy: Cognitive-communicative disorders resulting from traumatic brain injury in adults.Journal of Speech and Hearing Research, 39, S5–S17. AbstractGoogle Scholar Kay T., Adams R., Anderson T., Berrol S., Cicerone K., Dahlberg C., et al. (1993). Definition of mild traumatic brain injury.Journal of Head Trauma Rehabilitation, 8, 86–87. Google Scholar NIH Consensus Development Panel on Rehabilitation of Persons with Traumatic Brain Injury (1999). Rehabilitation of persons with traumatic brain injury.Journal of the American Medical Association, 282, 974–983. Google Scholar Author Notes Carlee W. Jones, MS, CCC-SLP, is a clinical coordinator for the Division of Speech Pathology and Audiology at Duke University Hospital. Her professional interests include the evaluation and treatment of adult neurogenic communication and swallowing disorders, especially with the TBI population, and program development. Contact her at [email protected]. Carolyn Foley, RN, is the trauma nurse coordinator at Duke University Hospital. Her clinical interests include participation in and monitoring of trauma patient care and developing performance improvement initiatives. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetailsCited ByAmerican Journal of Speech-Language Pathology30:3 (1074-1089)18 May 2021The Cognitive-Communication Checklist for Acquired Brain Injury: A Means of Identifying, Recording, and Tracking Communication ImpairmentsSheila MacDonald Volume 14Issue 9July 2009 Get Permissions Add to your Mendeley library History Published in print: Jul 1, 2009 Metrics Downloaded 287 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2009 American Speech-Language-Hearing AssociationLoading ...

Background : The objective of this study was to describe the functional level during the first year after moderate and severe traumatic brain injury (TBI), and to evaluate the predictive impact of pre-injury and injury-related factors. Methods : A cohort of 65 patients with moderate (N = 21) or severe (N = 44) TBI were examined with FIM (Functional Independence Measure) at admission and discharge from the rehabilitation clinic (on average two months after injury) and at 12 months, and with GOSE (Glasgow Outcome Scale Extended) at 12 months after injury. Possible predictors were analyzed in a regression model using FIM total score at 12 months as outcome. Results : All mean FIM scores improved significantly from injury to discharge from sub-acute rehabilitation. In the later period from discharge to 12 months after injury, the mean FIM motor score improved in severe TBI but not in moderate TBI patients. The mean FIM cognitive scores did not improve in any of the groups. At 12 months, 95% with moderate TBI had a FIM score from 109 - 126 (functionally independent) compared to 74% with severe TBI. Functional global outcome as assessed by GOSE was “good recovery” in 52% with moderate TBI versus 33% in severe TBI, “moderate disability” in 33% with moderate TBI versus 31% in severe TBI, and “severe disability” in 14% with moderate TBI versus 36% in severe TBI. Predictors such as PTA duration (B = -0.209), GCS admission rehabilitation (B = 5.058) and LOS rehabilitation (B = 0.458) explained 47% of the FIM variance 12 months post injury. Conclusions : The greatest improvement after moderate and severe TBI was in the sub-acute phase during the stay in a specialized rehabilitation unit. Residual disability was reported in 47% of moderate TBI patients as measured by GOSE at 12 months post injury indicating the importance of post-acute rehabilitation for these patients. Longer stays at the rehabilitation unit, a short PTA period and a high GCS score at admission to rehabilitation were positive predictors of functional level (FIM) at 12 months follow-up demonstrating that these factors are common predictors of early and late TBI phases. doi:10.4021/jnr20w

Background : The objective of this study was to describe the functional level during the first year after moderate and severe traumatic brain injury (TBI), and to evaluate the predictive impact of pre-injury and injury-related factors. Methods : A cohort of 65 patients with moderate (N = 21) or severe (N = 44) TBI were examined with FIM (Functional Independence Measure) at admission and discharge from the rehabilitation clinic (on average two months after injury) and at 12 months, and with GOSE (Glasgow Outcome Scale Extended) at 12 months after injury. Possible predictors were analyzed in a regression model using FIM total score at 12 months as outcome. Results : All mean FIM scores improved significantly from injury to discharge from sub-acute rehabilitation. In the later period from discharge to 12 months after injury, the mean FIM motor score improved in severe TBI but not in moderate TBI patients. The mean FIM cognitive scores did not improve in any of the groups. At 12 months, 95% with moderate TBI had a FIM score from 109 - 126 (functionally independent) compared to 74% with severe TBI. Functional global outcome as assessed by GOSE was “good recovery” in 52% with moderate TBI versus 33% in severe TBI, “moderate disability” in 33% with moderate TBI versus 31% in severe TBI, and “severe disability” in 14% with moderate TBI versus 36% in severe TBI. Predictors such as PTA duration (B = -0.209), GCS admission rehabilitation (B = 5.058) and LOS rehabilitation (B = 0.458) explained 47% of the FIM variance 12 months post injury. Conclusions : The greatest improvement after moderate and severe TBI was in the sub-acute phase during the stay in a specialized rehabilitation unit. Residual disability was reported in 47% of moderate TBI patients as measured by GOSE at 12 months post injury indicating the importance of post-acute rehabilitation for these patients. Longer stays at the rehabilitation unit, a short PTA period and a high GCS score at admission to rehabilitation were positive predictors of functional level (FIM) at 12 months follow-up demonstrating that these factors are common predictors of early and late TBI phases. J Neurol Res. 2011;1(2):48-58 doi: https://doi.org/10.4021/jnr20w

Traumatic brain injury (TBI) is the leading cause of mortality and disabilities among all trauma cases. Following TBI, damage to axons results in τ protein hyperphosphorylation leading to microtubule instability and τ-mediated neurodegeneration. In addition, τ protein is proteolytically cleaved and is able to access the cerebrospinal fluid (CSF) and serum; thus, this protein may serve as a potential biomarker in the diagnosis of injury severity and outcome prediction. Although a limited number of studies have investigated the CSF τ protein levels after TBI, the data are divergent and conflicting, and investigations into the serum τ protein levels have yet to be conducted. Therefore, the present study aimed to examine the serum τ protein levels in the full spectrum of TBI patients on days 0-14 after TBI, using an enzyme-linked immunosorbent assay. The protein levels were compared to the initial Glasgow Coma Score (GCS) and the Extended Glasgow Outcome Scale (GOS-E), which are used to represent the injury severity and patient outcome, respectively. In total, 56 patients, including 20 patients with mild TBI (GCS, 13-15), 19 patients with moderate TBI (GCS, 9-12) and 17 patients with severe TBI (GCS, 3-8), were included in the current study. The outcome was assessed 1 year after the injury and patients were classified into the good outcome (40 cases; GOS-E, 5-8) and poor outcome groups (16 cases; GOS-E, 1-4). The results indicated that serum τ protein levels increased soon after TBI and reached a peak value at ~2 days after the injury. The serum τ protein levels were significantly higher in the severe TBI group compared with those in the mild and moderate TBI groups (P<0.0001). Univariate analysis indicated that poor outcome was significantly associated with higher serum τ protein levels on day 2 (P<0.0001). A receiver operating characteristic curve demonstrated that a τ protein level of >116.04 pg/ml on day 2 resulted in a 93.75% sensitivity and 92.50% specificity for predicting a poor outcome. Furthermore, a τ protein level of >372.1 pg/ml on day 2 yielded 100% sensitivity and 83.33% specificity for 1 year mortality in the severe TBI group. In conclusion, the present study suggests that serum τ protein may serve as a potential biomarker for evaluating the injury severity and predicting the outcome of TBI patients.

The burden of traumatic brain injury in children