Brain Injury Research Articles

Epilepsy in children and anesthesia

Epilepsy, also called seizure disorder, is the most common childhood brain disorder in the United States. The aetiology of epilepsy in children is multifactorial with congenital, metabolic, infective, and problems associated with prematurity being common causes. Nearly 3 million Americans have epilepsy. About 450,000 of them are under 17 years old. About 1 in 200 children (0.5%) have epilepsy, a neurological condition where children have a predisposition to recurrent, unprovoked seizures. There are many different types of epilepsy, especially in infancy, childhood and adolescence. Epilepsy can be thought of in terms of either: the site of seizure origin in the brain (generalised or focal seizures), or the underlying cause. Genetic epilepsies (formerly called idiopathic or primary epilepsies) occur in an otherwise normal person and are due to a genetic predisposition to seizures. Some epilepsies are due to an underlying abnormality of the brain structure or chemistry (formerly called symptomatic or secondary epilepsies). Other epilepsies have no known cause. Epilepsy is commonly diagnosed in children and can be confused with other conditions. An accurate diagnosis is essential. A seizure is an excessive surge of electrical activity in the brain that can cause a variety of symptoms, depending on which parts of the brain are involved. Seizures can be provoked or unprovoked. Provoked seizures, caused by fever in a young child or severe hypoglycemia, are not considered to be forms of epilepsy. Unprovoked seizures have no clear cause but can be related to genetics or brain injury. When a child has two or more unprovoked seizures, epilepsy is often the diagnosis. Despite advances in antiepileptic medication therapy, a significant number of pediatric patients with epilepsy have seizures that are not well controlled. Antiepileptic medications interact with anesthetic agents, and common anesthetics can precipitate or suppress seizure activity. There are important pharmacokinetic and pharmacodynamic interactions between AEDs and drugs commonly used in anaesthesia. These affect both drug efficacy and the risk of seizure activity intraoperatively.

Racial and Socioeconomic Disparities in Traumatic Brain Injury Outcomes: Insights From a Nationwide Analysis

BACKGROUND AND OBJECTIVES: To examine the effects of racial and socioeconomic disparities on clinical outcomes: in-hospital mortality, discharge dispositions, and hospital length of stay (LOS) among patients with traumatic brain injury (TBI) stratified by race and socioeconomic status (SES). METHODS: We conducted a retrospective analysis by analyzing the 1995-2015 Nationwide Inpatient Sample database. Adjusted logistic regressions and multinomial logistic regression models with and without propensity score matching were applied to investigate the effects of disparities on clinical outcomes. RESULTS: African American and Hispanic patients with TBI had a lower risk of in-hospital mortality, longer hospital LOS, and lower likelihood of being discharged to rehabilitation compared with White patients. The TBI patients with poor SES (pSES) had lower in-hospital mortality and were more likely to leave against medical advice compared with non-pSES TBI patients. CONCLUSION: Racial and socioeconomic disparities had significant influences on in-hospital mortality, discharge dispositions, and hospital LOS among the TBI population. Our study observed pSES TBI patients had a lower likelihood of in-hospital mortality than non-pSES patients, which may be partially attributed to the fact that most of the pSES TBI patients were hospitalized in urban teaching hospitals and hospitals with large bed size. In effect, our data suggest that the Social Safety Net of the United States is effective in preventing mortality in patients with TBI.

Long-Term Cerebellar Consequences of Post-traumatic Brain Injury Assessed by MRI With Diffusion Tensor Imaging

BACKGROUND AND OBJECTIVES: Post-traumatic brain injury (TBI) lesions, which combine brain atrophy and white matter injuries, can lead to progressive post-traumatic encephalopathy. However, the specific involvement of the cerebellum, which participates in cognitive, executive, and sensory functions, has been little studied. The aim of this work was to explore the long-term cerebellar consequences of severe TBI. METHODS: In this retrospective study, patients included were hospitalized for a severe TBI and reassessed after discharge with a clinical examination and a MRI with diffusion tensor imaging. Patients were compared with a population of healthy volunteers. For a subgroup of this cohort, we analyzed the evolution of late post-TBI lesions on MRI up to 10 years after TBI. RESULTS: Ninety-seven patients reassessed 5 [3; 6] years after the TBI were included. Volume loss was revealed in the whole cerebellum (P = .01) and especially in the anterior lobe (P < .005) with a decrease in grey matter volume (P = 6.10−3). The mean diffusivity was increased in 4 cerebellar areas which are the right lower, right upper, left lower, and left upper cerebellar peduncles while the fractional anisotropy was decreased in all studied areas (P < 10−3). The longitudinal analysis (n = 17 patients) showed no progression of MRI lesions beyond the acute phase. CONCLUSION: This work shows that even if direct cerebellar damage is rare, long-term post-TBI cerebellar lesions can be observed. Therefore, clinical correlates of cerebellar lesions should be considered more systematically.

Road Traffic Injury Prevention: Bicycle

Abstract Purpose of review We describe recent trends in bicycle-related trauma, associated morbidity and mortality, the disparate effects on adult and pediatric populations, the effects of socioeconomic inequities on injury patterns, and milestones in preventative efforts. Recent findings National data demonstrates a lower incidence of unintentional injuries but a higher number of bicycle-related fatalities in the United States over the past decade. Traumatic brain injury remains the leading cause of mortality and chronic morbidity for bicyclists overall. Extremity and facial trauma predominate among older populations, while children are more susceptible to solid organ injuries and severe trauma with the use of electric bicycles. Factors that improve rider safety include changes in infrastructure, speed limits, and the implementation of dedicated bicycle lanes. Helmet usage is the most critical aspect for reducing bicyclist mortality, though rates of consistent usage in the US remain low, they can be improved with mandatory helmet laws. The lowest rates of helmet use are seen in areas of lower socioeconomic status, with these bicyclists subsequently subject to a greater burden of bicycle-related trauma. Summary Bicycle accidents are relatively common injuries in both adults and children. Road traffic accidents (RTAs), including those involving bicycles and electric bicycles (E-bikes), contributing significantly to morbidity and mortality across age groups. The focus in mitigating these injuries is on preventive measures, emphasizing the role of infrastructure improvements, public policies, and educational initiatives. The review discusses the trends in bicycle-related trauma, disparities affecting different age groups, socioeconomic influences on injury patterns, and recent advancements in injury prevention strategies.

TOXINA BOTULÍNICA ASSOCIADA À FISIOTERAPIA NEUROFUNCIONAL EM PACIENTES PEDIÁTRICOS ESPÁSTICOS: UMA REVISÃO INTEGRATIVA DA LITERATURA

Introduction: Cerebral palsy (CP) is the leading cause of motor disability in children, affecting movement and posture due to non-progressive brain injuries during development. Globally, the prevalence of CP is 2 to 3 cases per 1,000 live births, with prematurity being a significant risk factor. Methodology: This study conducted an Integrative Literature Review to evaluate physical therapy approaches in children with spastic CP following the use of botulinum toxin (BTX). Descriptors such as Cerebral Palsy, Physiotherapy, Botulinum Toxin, and Spasticity were used, with searches performed in databases like PubMed and Cochrane. From an initial 153 articles, after exclusion of duplicates and screening, seven studies were selected for analysis. Results and Discussion: The results indicate that the combination of BTX with physical therapy improves functionality and quality of life in children with CP. BTX reduces muscle spasticity, allowing physical therapy interventions such as stretching and strengthening to be more effective, potentially delaying surgical interventions. Studies have shown that this integrated strategy promotes motor rehabilitation and contributes to increased patient independence. Conclusion: The combination of BTX and physical therapy is a promising approach in managing spasticity in CP, standing out as an effective treatment for improving motor functionality and quality of life in these patients, as well as providing a foundation for future research.

Responding to the ongoing pandemic-related challenges of individuals with brain injury through the perspective of community-service in Canada: A qualitative study.

To investigate brain injury (BI) associations' perspectives regarding the impacts of the second year of the COVID-19 pandemic on individuals with BI and BI associations services across Canada. This qualitative descriptive study included 26 representatives of Canadian BI associations that participated in six online focus groups to discuss the effects of the second year of the pandemic on clients living with BI and on the provision of community services. Findings revealed three main themes: 1) ongoing pandemic-related challenges faced by clients living with BI, including worsening mental health and basic needs insecurities, difficulties faced by clients in adhering to safety measures, and ongoing technological issues; 2) ongoing adaptations to accommodate clients' needs, including offering tailored services, ensuring consistent and transparent safety measures, and providing hybrid services; and 3) developing a sustainable 'new normal' aligned with association mandates and resources by expanding networks and building resilience. The unfolding of the pandemic has brought increased challenges for people with BI and reinforced the need for adapted, clear, and accessible public health information to ensure the safety of vulnerable populations in times of crisis. It is essential to bolster community-based associations that provide direct care to people with BI.

Understanding 'quality' in adult traumatic brain injury rehabilitation from the perspectives of different stakeholders: a participatory mixed methods study.

The purpose of this study was to explore how 'quality' is understood for traumatic brain injury (TBI) rehabilitation from the perspectives of the rehabilitation recipients, their families and the providing clinicians. A participatory study using a mixed-methods, triangulation design. The study involved 1. a systematic literature search; 2. Individual semi-structured interviews with people with TBI and/or their caregivers and TBI rehabilitation clinicians, and 3. an online consensus process. 22 participants (7 people with TBI, 8 caregivers, 7 clinicians) participated in individual interviews. Their transcribed data were coded into broad categories via in-depth reflexive, thematic analysis; these categories were then mapped to 13 quality domains extracted from the literature. The emergent themes were then presented to the individuals, via an electronic consensus tool in two rounds. This resulted in 12 prioritized domains of quality that encompass service features, staff qualities and effectiveness. These evidence-informed and consensus-agreed indicators for quality may help guide both the provision and evaluation of TBI rehabilitation, that is valued and meaningful.

Numerical and experimental study of underwash effect and its role in blast-induced traumatic brain injury

Numerical and experimental study of underwash effect and its role in blast-induced traumatic brain injury

An Overview of Randomized Controlled Trials Examining Prescription and Nonprescription Pharmacological Interventions for Moderate to Severe Traumatic Brain Injury

Objective: To characterize randomized controlled trials (RCTs) of pharmacological interventions (prescription medications, nonprescription medications, and supplements) for the management of moderate to severe traumatic brain injury (MSTBI). Data sources: Systematic searches were conducted in MEDLINE, PubMed, Scopus, CINAHL, EMBASE, and PsycINFO for RCTs up to December 2022 inclusive in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection and data extraction: Inclusion criteria were RCT study design; participants’ mean age ≥ 18 years and ≥ 50% had MSTBI; examined ≥ 1 pharmacological intervention(s), either alone or in combination with other interventions. Two independent reviewers conducted Cochrane risk of bias assessment. Data synthesis: Three hundred thirteen RCTs (1978-2022) met inclusion criteria. A total of 146 unique pharmacotherapies and supplements were studied. The most frequently studied intervention was mannitol ( n = 20 RCTs). Mean sample size was 230.4 (4-12 737) and 195 studies (62.3%) were conducted in the acute phase post-MSTBI. Four hundred thirty-five unique outcome measures (OMs) were studied; the most common OMs used were Glasgow Outcome Scale (GOS) (29.4%), mortality (25.2%), and intracranial pressure (25.2%), Glasgow Coma Scale (GCS) (19.5%), and mean arterial pressure (17.3%), and heart rate (10%). Of the included studies, only 7% ( n = 22) had low risk of bias. Conclusion: The paucity of high-quality studies, variability in RCT methodology, sample sizes, and OMs utilization, as well as the low number of RCTs conducted in the subacute- and chronic-phase after injury pose a challenge for conducting meta-analyses to provide strong recommendations for informed decision-making in clinical practice.

Cardiovascular responses as predictors of mortality in children with acute brain injury.

Investigate the utility of cardiovascular responses such as heart rate (HR), blood pressure (BP), and heart rate variability (HRV) in the prognosis of children with acute acquired brain injury (ABI). Children under 18 years with severe acute acquired brain injury (ABI) who survived at least 12 h after PICU admission were included in a prospective observational cohort in a tertiary academic PICU. Physiological variables, neurological data, laboratory tests (chemistry and hematology), and medications were recorded within 12 h of admission. Linear and nonlinear HRV indices, CT scans, PICU scores, and survival rates were evaluated. Seventy-two children, median age 10.7 years (IQR 4.1-13.6), were eligible for the study; 28 (38.9%) were diagnosed with brain death (BD). Tachycardia, SBP and MBP < 5th percentile, and MBP and DBP> 99th percentile were significantly associated with mortality. Poincaré SD1/SD2 was significantly associated with mortality after adjusting for age, sex and ongoing medication. Tachycardia, systolic hypotension and median hypo and hypertension were associated to mortality in children with severe ABI. While further validation through larger, multicenter studies is necessary, the Poincaré SD1/SD2 ratio has shown promise as a prognostic tool for predicting mortality in children with severe ABI. This study explores cardiovascular changes, including heart rate and blood pressure, and linear/nonlinear HRV measures using ECG at 1000 Hz, and compare them with other prognostic factors like brain tomography and PICU scores. Tachycardia, hypo/hypertension in the early hours after admission are linked to early mortality in children with severe traumatic and non-traumatic brain injury. Linear/non-linear measures of HRV were also related to survival. Higher HRV values indicating better survival chances. We identified Poincaré SD1/SD2 ratio as a promising tool for predicting mortality in children with severe ABI.

Total Antioxidant Status in Critically Ill Patients with Traumatic Brain Injury and Secondary Organ Failure—A Systematic Review

Introduction: The available literature indicates that oxidant–antioxidant imbalance plays a significant role in the pathophysiology of traumatic brain injury and the subsequent secondary organ dysfunctions. However, there is a lack of studies summarizing the knowledge in this area, and no clear guidelines exist regarding the use of biomarkers of oxidative stress as diagnostics tools. Methods: The present work aims to provide a systematic review of the literature on the use of total antioxidant capacity (TAC) assays in predicting the outcomes of traumatic brain injury (TBI). A literature search was conducted up to 1 September 2024, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, using the PubMed and Scopus databases. Based on the inclusion criteria, 24 studies were used for the final review. Results: Promising data indicate that TAC assays are useful in predicting 30-day mortality and neurological outcomes. Moreover, they correlate with radiological findings on CT scans in brain injury and the clinical classifications of injuries, as well as the parameters of organ failure. Conclusions: Total antioxidant capacity assays can be used to assess the extent of brain damage and prognosticate general vital functions. Future experiments should include long-term randomized clinical trials on larger populations of TBI patients.

Pre-admission opioid use disorder as a new predictor of in-hospital mortality and six-month outcomes in traumatic brain injury patients: a retrospective longitudinal cohort study.

The present study aimed to investigate the effect of pre-admission Opioid Use Disorder (OUD) on in-hospital mortality and 6-month follow-up TBI outcomes. This study included 2804 patients with TBI admitted to the Intensive Care Unit of Emtiaz (Rajaee) Hospital, a referral trauma center in Shiraz, Iran. Finally, 1087 eligible participants were selected from included patients. Then, 872 discharged patients were followed for six months. Subsequently, unfavorable neurological outcomes (Glasgow Outcome Scale-Extended ≤ 4) and the mortality rate were compared among the patients with and without OUD. The mean age of the patients was 38.0 ± 18.9 years old (84.7% men). About 9.2% of patients had OUD. Opioid users had a slightly lower risk of in-hospital mortality (OR = 0.62, 95% CI = [0.328, 1.183], P-value = 0.148). In contrast, 6-month follow-up mortality significantly increased in the survived patients with a history of pre-admission OUD (OR = 2.49, 95%CI= [1.29, 2.80], P-value = 0.007). Moreover, 6-month unfavorable outcomes were raised in OUD, though it was not significant (OR = 1.59, 95%CI= [0.89, 2.84], P-value = 0.121). Our results revealed that patients with OUD are at increased risk of 6-month follow-up complications and also death following moderate to severe TBI. Although OUD decreased in-hospital mortality, 6-month follow-up indicated that mortality and unfavorable outcomes were increased in the OUD group. Based on the existing evidence, this effect is probably not only due to the destructive impact of pre-admission OUD on brain physiology. However, it may also be due to an increase in opioid consumption to alleviate pain and withdrawal symptoms after hospital discharge.

Efficacy and Safety of Tranexamic Acid in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Efficacy and Safety of Tranexamic Acid in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Changes in cognitive functional performance and basic activities of daily living in patients with traumatic brain injury after two methods of cognitive retraining

Introduction: Evidence supports a bottom-up approach to assist in addressing functional cognitive deficits in patients with traumatic brain injury (TBI). There is however, little evidence supporting the use of online programmes for this purpose. The aim of this research was to describe the outcomes for cognitive functional performance and basic activities of daily living (bADL) or self-care functioning after cognitive retraining using an online programme versus task-oriented intervention for patients with acute mild and moderate traumatic brain injury (TBIs). Methods: A quantitative, quasi experimental, longitudinal research design was used for determining within-group and between-groups changes for cognitive functional performance and bADL functioning in two sample groups with mild to moderate TBI. Intervention using an online programme (n=7) or task-oriented activities (n=15) was evaluated at three assessment intervals: on recruitment into the study (Assessment 1), on completion of inpatient hospital intervention (Assessment 2) and after four weeks of home programme intervention and fortnightly outpatient intervention (Assessment 3). Results: Results for both groups showed a statistically significant change for cognitive functional performance assessed on the Bay Area Functional Performance Evaluation (BaFPE) while the task-oriented cognitive training group also achieved a statistically significant change in bADL scores during the first inpatient assessment period. Only the online programme group had statistically significant improvement during the home programme in the third assessment period. Conclusion: Cognitive retraining using an online programme or task-oriented activities resulted in positive change in a therapist directed inpatient programme but a structured, graded, online programme was more effective in supporting significant improvement in cognitive functional performance when used with an outpatient home programme. Implications for practice Cognitive retraining using an online programme or task orientated activities have a positive outcome for cognitive functional performance in patients with mild or moderate TBI in a therapist directed inpatient intervention. A task orientated approach for cognitive retraining appears to have positive effect on bADL outcomes. Cognitive retraining using an online programme intervention should be considered as a home programme to improve cognitive functional performance in patients with mild or moderate TBI.

Plant derived bioactive compounds for the treatment of neurodegeneration and neuroimmune disorders associated with the complement system

The complement system is a key component of the innate immune system that mediates the clearance of pathogens, apoptotic cells, and cellular debris. However, the complement system also has diverse roles in the central nervous system (CNS), where it regulates synaptic pruning, neural plasticity, and neuroinflammation. Dysregulation of the complement system has been implicated in various neurodegenerative disorders such as Alzheimer’s disease, multiple sclerosis, epilepsy, stroke, and traumatic brain injury. In these conditions, excessive or chronic activation of the complement system may lead to synaptic loss, neuronal damage, immune dysregulation, and inflammation, which leads to exacerbating the disease’s progression and severity. Moreover, the complement system may interact with infectious agents that invade the CNS, such as bacteria, viruses, fungi, and parasites, and modulate their pathogenicity and host response. Therefore, understanding the complex interplay between the complement system and the CNS is crucial for developing novel therapeutic strategies to prevent or treat neurodegenerative and neuroimmune disorders. Natural compounds, such as plant extracts, phytochemicals, and nutraceuticals, have emerged as promising candidates for modulating the complement system and its effects on the CNS. These compounds may exert anti-inflammatory, antioxidant, neuroprotective, and immunomodulatory effects by regulating the expression of various complement components and pathways. In this review, we summarized the current knowledge on the roles of the complement system in human neurodegenerative disorders and the benefits of natural compounds for complement-targeted therapy.

C1-inhibitor to prevent intracerebral hemorrhage-related secondary brain injury.

Preclinical studies indicate that the systemic application of C1-inhibitor, clinically used to treat hereditary angioedema, reduces secondary brain injury after ischemic stroke. This study assessed the effect of C1-inhibitor on secondary brain injury after hemorrhagic stroke. We used an established striatal whole-blood injection mouse model to mimic intracerebral hemorrhage-related secondary brain injury. Based on the spatiotemporal dynamics in our model, we calculated the necessary sample size (n = 24) and determined the most sensitive time point to detect potential group differences (48h) prior to the experiments. The experimental setup, tissue processing and image analysis adhered to our published protocol. We randomized mice into three groups: C1-inhibitor treatment, placebo, and sham. Histology was standardized by taking eight anatomically predefined slices across the entire lesion. Lesion size, vascular leakage, and inflammatory responses were assessed using automated thresholding and dextran/ICAM1/CD45 intensity mapping. Investigators were blinded to group allocation during the experiment, tissue processing, and image analysis. Whole blood injection resulted in significantly larger lesion size and more pronounced vascular leakage and cellular inflammation compared to the sham group. However, there was no difference in lesion size or inflammatory markers between the C1-inhibitor and placebo groups. In addition, there was no difference in the inflammatory response of the choroid plexus, which has been identified as a central organ orchestrating inflammation after intracerebral hemorrhage. The protective effect of C1-inhibitor might be isolated to pathophysiological processes with a predominant thromboinflammatory component, as in ischemia-reperfusion, but less so in permanent ischemia or intracerebral hemorrhage.

Co-use of cannabis and alcohol among adults and the burden of traumatic brain injury from fall-related events

ABSTRACT Background Co-use of cannabis and alcohol is an emerging trend that can exacerbate injury outcomes. While research has focused on younger age groups, there is a need to examine consequences associated with co-use among adults populations. Falls represent a leading cause of injury among older adults. Coupled with substance use, injuries associated with falls may be more severe. Objectives To examine the burden of fall-related head injury among adults who co-use cannabis and alcohol. Methods Emergency department data from the 2019–2022 National Electronic Injury Surveillance System were analyzed for fall-related head injuries associated with co-use of cannabis and alcohol among middle-aged and older adults aged 55–75. Results An annualized estimate of 545,276 fall-related injuries occurred. Patients who presented with co-use of cannabis and alcohol had the highest prevalence of TBI (PR 1.75; 95% CI 1.25–2.25) and CMF injuries (PR 1.70; 95% CI 1.38–2.03) when contrasted to the alcohol-only or cannabis-only groups. Conclusions Results highlight the burden of co-use of cannabis and alcohol on fall-related head injuries. Healthcare providers, policymakers, patients, and caregivers should be aware of these risks and prioritize targeted interventions to mitigate the impact on the health and safety of older individuals.

Cisternostomy associated with decompressive craniectomy for traumatic brain injury: a systematic review and meta-analysis.

Decompressive craniectomy (DC) has been the main surgical treatment of refractory high intracranial pressure (ICP) in traumatic brain injury (TBI) for decades. Basal cisternostomy emerged as a novel option in brain trauma, with results still unclear. We performed a systematic review and meta-analysis comparing cisternostomy added to conventional DC versus DC alone for the treatment of TBI. This study was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Three databases were systematically searched for studies comparing cisternostomy + DC versus DC alone. Primary outcomes were overall mortality, length of stay in ICU care, duration of mechanical ventilation. Review Manager was used for statistical analysis and I2 measured heterogeneity. A total of seven studies and 980 patients were included in this meta-analysis, 473 in the cisternostomy + DC group and 507 in the DC group. Age ranged from 14 to 69 years old, with 76% male patients. Overall mortality was significantly lower in the cisternostomy + DC group (OR 0.70; 95% CI 0.53-0.92; p = 0.01; I2 = 31%). Length of stay in ICU care was significantly reduced in the patients submitted to cisternostomy + DC (OR -4.58; CI -6.78, -2.37); p < 0.0001; I2 = 35%). The mean duration in mechanical ventilation was significantly lower in the group submitted to cisternostomy + DC (-3.49; 95% CI-6.79, -0.20; p = 0.04; I2 = 86%). Regarding functional outcomes, the scarce and heterogeneous data were not sufficient to make any conclusion about the effect of cisternostomy on functional outcomes, but tends to favor patients who underwent cisternostomy combined with DC. In this meta-analysis, the implementation of cisternostomy added to conventional DC was associated with lower mortality, days in mechanical ventilation and length of stay in ICU care. Larger prospective and randomized cohorts are necessary to recommend this procedure on a large scale.

Emergency neurosurgery for traumatic brain injury by general surgeons at local hospitals in Sweden: a viable option when time is brain.

Timing of surgical evacuation of mass lesions in traumatic brain injury (TBI) is crucial. However, due to geographical variations, transportation time to the nearest neurosurgical department may be long. To save time, general surgeons at a local hospital may perform the operation, despite more limited experience in neurosurgical techniques. This study aimed to determine whether patient outcomes differed between those who had undergone emergency neurosurgery at local hospitals by general surgeons vs. at university hospitals by neurosurgeons. A nationwide observational study was performed using data from the Swedish Trauma Registry (SweTrau) between 2018 and 2022. A total of 565 TBI patients (local hospitals, n = 21; university hospitals, n = 544) who underwent intracranial hematoma evacuation within 8h after arrival at the hospital were included. Data on demography, admission variables, traumatic injuries, and outcome (Glasgow Outcome Scale [GOS]) at discharge were evaluated. Favourable vs. unfavourable outcomes were defined as GOS scores of 4-5 vs. 1-3. Compared with those treated at university hospitals, patients treated with intracranial hematoma evacuation at local hospitals had lower median Glasgow Coma Scale (GCS) scores (8 vs. 12, p < 0.001), higher rate of acute subdural hematomas (86% vs. 77%, p < 0.001), and lower rate of contusions (14% vs. 53%, p = 0.01). Being operated on at a local hospital was independently associated with higher mortality (p = 0.03) but with a similar rate of favourable outcome (p = 0.74) in multiple logistic regressions after adjustment for demographic and injury-related variables. Although a slightly greater proportion of patients who underwent emergency neurosurgery at local hospitals died, there was no difference in the rate of favourable outcome. Thus, in patients with impending brain herniation, when time is of the essence, evacuation of traumatic intracranial bleeding by general surgeons at local hospitals remains a highly viable option.

Soluble Urokinase-Type Plasminogen Activator Receptor and Inflammatory Biomarker Response with Prognostic Significance after Acute Neuronal Injury - a Prospective Cohort Study.

Aneurysmal subarachnoid hemorrhage (aSAH), ischemic stroke (IS), and traumatic brain injury (TBI) are severe conditions impacting individuals and society. Identifying reliable prognostic biomarkers for predicting survival or recovery remains a challenge. Soluble urokinase type plasminogen activator receptor (suPAR) has gained attention as a potential prognostic biomarker in acute sepsis. This study evaluates suPAR and related neuroinflammatory biomarkers in serum for brain injury prognosis. This prospective study included 31 aSAH, 30 IS, 13 TBI, and three healthy controls (n = 77). Serum samples were collected on average 5.9days post-injury, analyzing suPAR, IL-1β, cyclophilin A, and TNFα levels using ELISA. Outcomes were assessed 90days post-injury with the modified Rankin Scale (mRS), categorized as favorable (mRS 0-2) or unfavorable (mRS 3-6). Statistical analyses included 2-tailed t-tests, Pearson's correlations, and machine learning linear discriminant analysis (LDA) for biomarker combinations. Elevated suPAR levels were found in brain injury patients compared to controls (p = 0.017). Increased suPAR correlated with unfavorable outcomes (p = 0.0018) and showed prognostic value (AUC = 0.66, p = 0.03). IL-1β levels were higher in the unfavorable group (p = 0.0015). LDA combinatory analysis resulted a fair prognostic accuracy with canonical equation = 0.775[suPAR] + 0.667[IL1-β] (AUC = 0.77, OR 0.296, sensitivity 93.1%, specificity 53.1%, p = 0.0007). No correlation was found between suPAR and CRP or infection status. Elevated suPAR levels in acute brain injury patients were associated with poorer outcomes, highlighting suPAR's potential as a prognostic biomarker across different brain injury types. Combining IL-1β with suPAR improved prognostic accuracy, supporting a multimodal biomarker approach for predicting outcomes.