Definition Of Traumatic Brain Injury Research Articles

Comparison of different definitions of traumatic brain injury: implications for cohort characteristics and survival in women, Philadelphia, USA

BackgroundTraumatic brain injury (TBI) is an acute injury that is understudied in civilian cohorts, especially among women, as TBI has historically been considered to be largely a condition of athletes...

Incidence of Traumatic Brain Injury in a Longitudinal Cohort of Older Adults

Traumatic brain injury (TBI) occurs at the highest rate in older adulthood and increases risk for cognitive impairment and dementia. To update existing TBI surveillance data to capture nonhospital settings and to explore how social determinants of health (SDOH) are associated with TBI incidence among older adults. This nationally representative longitudinal cohort study assessed participants for 18 years, from August 2000 through December 2018, using data from the Health and Retirement Study (HRS) and linked Medicare claims dates. Analyses were completed August 9 through December 12, 2022. Participants were 65 years of age or older in the HRS with survey data linked to Medicare without a TBI prior to HRS enrollment. They were community dwelling at enrollment but were retained in HRS if they were later institutionalized. Baseline demographic, cognitive, medical, and SDOH information from HRS. Incident TBI was defined using inpatient and outpatient International Classification of Diseases, Ninth or Tenth Revision, diagnosis codes received the same day or within 1 day as the emergency department (ED) visit code and the computed tomography (CT) or magnetic resonance imaging (MRI) code, after baseline HRS interview. A cohort with TBI codes but no ED visit or CT or MRI scan was derived to capture diagnoses in nonhospital settings. Descriptive statistics and bivariate associations of TBI with demographic and SDOH characteristics used sample weights. Fine-Gray regression models estimated associations between covariates and TBI, with death as a competing risk. Imputation considering outcome and complex survey design was performed by race and ethnicity, sex, education level, and Area Deprivation Index percentiles 1, 50, and 100. Other exposure variables were fixed at their weighted means. Among 9239 eligible respondents, 5258 (57.7%) were female and 1210 (9.1%) were Black, 574 (4.7%) were Hispanic, and 7297 (84.4%) were White. Mean (SD) baseline age was 75.2 (8.0) years. During follow-up (18 years), 797 (8.9%) of respondents received an incident TBI diagnosis with an ED visit and a CT code within 1 day, 964 (10.2%) received an incident TBI diagnosis and an ED code, and 1148 (12.9%) received a TBI code with or without an ED visit and CT scan code. Compared with respondents without incident TBI, respondents with TBI were more likely to be female (absolute difference, 7.0 [95% CI, 3.3-10.8]; P < .001) and White (absolute difference, 5.1 [95% CI, 2.8-7.4]; P < .001), have normal cognition (vs cognitive impairment or dementia; absolute difference, 6.1 [95% CI, 2.8-9.3]; P = .001), higher education (absolute difference, 3.8 [95% CI, 0.9-6.7]; P < .001), and wealth (absolute difference, 6.5 [95% CI, 2.3-10.7]; P = .01), and be without baseline lung disease (absolute difference, 5.1 [95% CI, 3.0-7.2]; P < .001) or functional impairment (absolute difference, 3.3 [95% CI, 0.4-6.1]; P = .03). In adjusted multivariate models, lower education (subdistribution hazard ratio [SHR], 0.73 [95% CI, 0.57-0.94]; P = .01), Black race (SHR, 0.61 [95% CI, 0.46-0.80]; P < .001), area deprivation index national rank (SHR 1.00 [95% CI 0.99-1.00]; P = .009), and male sex (SHR, 0.73 [95% CI, 0.56-0.94]; P = .02) were associated with membership in the group without TBI. Sensitivity analyses using a broader definition of TBI yielded similar results. In this longitudinal cohort study of older adults, almost 13% experienced incident TBI during the 18-year study period. For older adults who seek care for TBI, race and ethnicity, sex, and SDOH factors may be associated with incidence of TBI, seeking medical attention for TBI in older adulthood, or both.

Patterns of concomitant traumatic brain injury and ocular trauma in US service members

BackgroundConcomitant traumatic brain injury (TBI) and ocular trauma (OT) are caused by the same physical mechanisms, which may complicate therapeutic intervention if screening and evaluation of each condition are not...

Assessing Prevalence of TBI in a Community Setting

Background: Traumatic brain injury (TBI) is often under-reported and thus under-recognized by clinicians. Reports of TBI prevalence have been widely variable based on the methods of data collection and definition of TBI. This study investigates the prevalence of TBI using the Ohio State University TBI Identification Method (OSU TBI-ID), a reliable and valid structured interview designed to elicit lifetime history of TBI. We also assessed relationships between TBI and psychiatric illnesses. Identifying prevalence and effects of TBI on mental health is critical to providing personalized, higher-quality care for psychiatric patients in community settings. &#x0D; &#x0D; Methods: Patients receiving mental health care at the IUSM Psychiatry Residency Clinic in Vincennes, Indiana were asked to participate in a research study assessing history of head or neck injuries. Patients attended their regularly scheduled appointments with resident physicians, and 2–5-minute TBI screenings were conducted during or immediately after their appointment. Following the interview, patient charts were reviewed for documentation of prior TBI and all current psychiatric diagnoses. &#x0D; &#x0D; Results: Prevalence of TBI was reported at 62.3% among patients receiving psychiatric care. 87 total TBI events were recorded, including repetitive TBI events, after 77 patient interviews. The most common cause of acute TBI was vehicular accident. The most common cause of repetitive TBI was sports injury. Of the 87 TBIs, only 5 TBI events were recorded in patient charts. History of TBI was more likely in patients with PTSD as well as substance use disorders, and this was especially evident in patients with repetitive TBI. &#x0D; &#x0D; Conclusion and Potential Impact: This study shows that TBI is quite common among psychiatric patients and is vastly under-reported in patient charts. Increasing clinician awareness of TBI history in their patients is critical to providing high-quality care, and the OSU TBI-ID provides an efficient way to screen patients for TBI.

H - 30 California Surveillance of Mental Health Disparities in Survivors of Traumatic Brain Injury (TBI): a Randomized & Representative Sample.

Traumatic Brain Injury (TBI) is a silent public health epidemic that begins as a medical condition ("neurometabolic cascade") that may develop into significant psychiatric symptoms that negatively impact community reintegration for survivors following injury ("neuropsychosocial cascade"). However, survivors may not seek medical attention for a variety of reasons (e.g., anosognosia, fear of retaliation, no insurance). Therefore, medical incidence does not necessarily reflect the community prevalence of TBI. The California Department of Rehabilitation, the Department of Public Health, and the State Survey Panel collected data from a randomized and representative sample of Californians (N = 1057) using three probability-based techniques, such that every Californian registered with the United States postal service had a non-zero chance of being selected. Respondents were evaluated using psychometrically established methods for screening history and symptoms of TBI. California rates of community prevalence ranged between 15% (estimated 4.2 million Californians) and 42%, depending on the definition of TBI used, highlighting significant disparities in operationalization. These rates were compared to the annual medical rates (< 1%) derived from the California Department of Public Health (2016-2020). This study revealed significantly higher rates of depression, anxiety, and neurocognitive disorders over three decades, on average, relative to the general California population: illustrating a disease process. Neuropsychiatric disparities were associated with dysfunctional community reintegration (e.g., home insecurity, justice system involvements, employment instability).

The prevalence of traumatic brain injury (TBI) among people impacted by the criminal legal system: An updated meta-analysis and subgroup analyses.

Traumatic brain injury (TBI) is a significant public health concern and has implications for people directly impacted by the criminal legal system during arrest, conviction, incarceration, and community supervision. This meta-analysis estimated the lifetime prevalence of TBI among people supervised by the criminal legal system across settings. Building on previous research, we hypothesized that prevalence estimates would be impacted by methodological, clinical, and demographic factors. Eligible studies included those with adult participants supervised by the criminal legal system (i.e., prison, jail, probation, parole, inpatient/forensic hospital) and that provided sample TBI prevalence and method of ascertaining TBI history. We employed subgroup analyses and metaregression to investigate the effects of setting, TBI definition and method of detection, lifetime history of mental illness and substance use disorders, and gender. The sample ultimately included 64 studies totaling 52,540 participants. Using a random-effects model and logit transformation, we found that the overall estimate of TBI prevalence was 45.8% (95% confidence interval, CI [37.8, 54.1], 95% prediction interval, PI [5.5, 92.5]) across all studies and 32.0% (95% CI [25.0, 39.8], 95% PI [11.2, 63.6]) for moderate-to-severe TBI. Significant effects were found for TBI definition and method of detection on the pooled estimate. The prevalence of TBI among people impacted by the criminal legal system may be larger than in the general population. However, despite recent and ongoing progress in this area of study, the reliability of prevalence estimates remains limited by methodological factors related to TBI definitions and detection methods. Implications for TBI research and clinical service provision are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Traumatic Brain Injury and Abnormal Moral Judgment

This article explains the underlying mechanism of utilitarian decisions in Traumatic Brain Injury (TBI) patients when pondering trolley-type moral dilemmas. In the first section of the literature review, definitions of TBI, utilitarianism and abnormal moral judgment have been provided. The ventromedial prefrontal cortex (vmPFC) has been identified to be undoubtedly prominent based on a discussion of the previous contradictory evidences about the brain areas involved in causing abnormal moral judgment. Subsequently, the function of vmPFC as an emotional integration station is introduced, substantiated by functional magnetic resonance imaging studies and the dual-system theory of moral decision-making. The inability or the diminished ability to feel morally-related emotions following TBI has also been considered a causal factor of endorsement to the act of harming someone directly. Finally, the author advises a few future directions to fill the gap within current knowledge and points out the limitations of thought experiments. Overall, the paper highlighted that the atypical response pattern of moral judgment in TBI patients is attributed to the failure to generate appropriate emotions in the face of moral stimuli.

Management and Treatment of Traumatic Brain Injuries.

Traumatic brain injuries (TBI) are one of the main reasons for death in recent years worldwide or globally. They are the number one cause of death for both civilians and military members. It affects how the brain functions and is currently one of the crucial concerns ofglobal public health issues. TBIis increasing worldwide because of the increasing dependency on motorized vehicles and machinery. One of the reasons for TBIis the expanding human population. It is the major cause of death and disability in the world. In young adults around the world, it is the main cause of mortality and morbidity. Its complicated etiology and pathogenesis include primarily primary and secondary injury types. Neuroinflammation is also focused on TBItobe cured. The neuroprotection of the injured brain has received tremendous attention during TBI treatment. In this review, we will first discuss the definition of traumatic brain injury, its causes, and the symptoms experienced by patients of various age groups. Finally, treatment methods and advances in treatment will be discussed. In this review, the aftereffects of traumatic brain damage are also covered. Ferroptosis and choline phospholipids are also emphasized as important components of the treatment of traumatic brain damage in this review.

Neuroimaging Correlates of Post-Traumatic Stress Disorder in Traumatic Brain Injury: A Systematic Review of the Literature

IntroductionNeuroimaging has been a highly utilized technique for studying traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) independently of one another, however, neuroimaging has increasingly been identified as a useful tool in better understanding TBI-related psychiatric conditions, such as PTSD.ObjectivesTo complete a systematic review of the literature examining neuroimaging findings in TBI-related PTSD and to highlight the current literature’s limitations in order to strengthen future research.MethodsA PRISMA compliant literature search was conducted in PubMed (MEDLINE), PsychINFO, EMBASE, and Scopus databases prior to May of 2019. The initial database query yielded 4388 unique articles, which were narrowed down based on specified inclusion criteria (e.g., clear TBI definition, clinician-diagnosed PTSD, statistically analyzed relationship between neuroimaging and PTSD, quantified time interval between TBI and neuroimaging).ResultsA final cohort of 10 articles met inclusion criteria, comprising the findings of 482 participants with TBI. Key neuroanatomical findings among the included articles suggest that PTSD is associated with significant changes in whole-brain networks of resting state connectivity and disruptions in bilateral frontal and temporal white matter tracts, fronto-limbic pathways, the internal capsule, and the uncinate fasciculus (Figure 1). Figure 1a:Neuroimaging Findings in TBI-related PTSD.Figure 1b.Replicated Neuroimaging Findings in TBI-related PTSD in the Right Uncinate Fasciculus.ConclusionsAdditional inquiry with attention to specified imaging timing post-injury, consistent TBI definitions, clinician-diagnosed TBI and PTSD, and control groups is crucial to extrapolating discrepancies between primary and TBI-related PTSD. Prospective studies could further differentiate predisposing factors from sequelae of TBI-related PTSD.DisclosureNo significant relationships.

Mind the Gap: Missing Links in the Understanding of Traumatic Brain Injury and Mental Health

Traumatic brain injury (TBI) is a leading cause of disability worldwide, with an increasing incidence and an estimated 55 million people living with TBI-related disability (1). Disability after TBI appears to be driven largely by the diverse neurobehavioral—or mental health–related—consequences of the injury (2,3). The reviews in this special issue of Biological Psychiatry discuss the current state of knowledge on TBI and mental health, but we cannot introduce them without acknowledging that the definitions of TBI and mental health are continually evolving.

Учение о последствиях черепно-мозговой травмы Часть I. Дефиниции, классификация, клиническая и количественно-томографическая синдромология

The paper presents the experience of assessment and treatment of 5000 cases of various traumatic brain injury (TBI) effects using brain imaging methods, minimally invasive and reconstructive neurosurgery. Definitions of TBI “effects” and “complications” have been proposed for the first time. Clinical and morphological classification of those has been developed, which identifies tissue effects, effects on cerebrospinal fluid system dynamics, and vascular effects of TBI. The major clinical symptoms of TBI effects have been described: neurologic deficit, mental dysfunctions, disturbances of vegetative function, epilepsy. Focal and diffuse alterations in brain tissue, intrathecal space and ventricular system resulting from TBI, identified by x-ray computed tomography, have been systematized. This has become the basis for investigation of pathogenesis and sanogenesis of brain disorders resulting from TBI, as well as for developing theory about the TBI effects.

Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

BackgroundThe transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017.ResultsThe monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97).ConclusionThe reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

Emotional Traumatic Brain Injury.

The definition of traumatic brain injury (TBI) has expanded to include mild TBI and postconcussive syndrome. This evolution has resulted in difficulty disentangling the physical trauma of mild TBI from the emotional trauma of posttraumatic stress disorder (PTSD). Advances in stress neurobiology and knowledge of brain injury at the macroscopic, microscopic, biochemical, and molecular levels call for a redefinition of TBI that encompasses both physical and emotional TBI. Conceptualizing a spectrum of TBI with both physical and emotional causation resolves the irreconcilable tangle between diagnostic categories and acknowledges overlapping forms of brain injury and shared systemic effects due to hormonal and inflammatory mediators. Recognizing emotional TBI shifts the interpretation of emotional trauma from a confound to a comorbid, related cause of brain injury. The mechanism of emotional TBI includes the intricate actions of stress hormones on diverse brain functions due to changes in synaptic plasticity, where chronically elevated hormone levels reduce neurogenesis, resulting in dendritic atrophy and impaired cognition. The overlapping effects of physical and emotional trauma are seen in neuropathology (ie, reduction of hippocampal volume in TBI and PTSD); fMRI (similar regional activations in physical and emotional pain); and systemic sequelae, including changes in proinflammatory cytokine levels and immune cell function. Accumulating evidence favors a change in the definition of TBI to encompass emotional TBI. The definition of TBI will be strengthened by the inclusion of both physical and emotional trauma that result in diverse and overlapping forms of brain injury with sequelae for physical and mental health.

Expert Panel Survey to Update the American Congress of Rehabilitation Medicine Definition of Mild Traumatic Brain Injury

ObjectiveAs part of an initiative led by the Brain Injury Special Interest Group Mild Traumatic Brain Injury (TBI) Task Force of the American Congress of Rehabilitation Medicine (ACRM) to update the 1993 ACRM definition of mild TBI, the present study aimed to characterize current expert opinion on diagnostic considerations. DesignCross-sectional web-based survey. SettingNot applicable. ParticipantsAn international, interdisciplinary group of clinician-scientists (N=31) with expertise in mild TBI completed the survey by invitation between May and July 2019 (100% completion rate). InterventionsNot applicable. Main Outcome MeasuresRatings of agreement with statements related to the diagnosis of mild TBI and ratings of the importance of various clinical signs, symptoms, test findings, and contextual factors for increasing the likelihood that the individual sustained a mild TBI, on a scale ranging from 1 (“not at all important”) to 10 (“extremely important”). ResultsMen (n=25; 81%) and Americans (n=21; 68%) were over-represented in the sample. The survey revealed areas of expert agreement (eg, acute symptoms are diagnostically useful) and disagreement (eg, whether mild TBI with abnormal structural neuroimaging should be considered the same diagnostic entity as “concussion”). Observable signs were generally rated as more diagnostically important than subjective symptoms (Wilcoxon signed ranks test, Z=3.77; P<.001; r=0.68). Diagnostic importance ratings for individual symptoms varied widely, with some common postconcussion symptoms (eg, fatigue) rated as unhelpful (<75% of respondents indicated at least 5 out of 10 importance). Certain acute test findings (eg, cognitive and balance impairments) and contextual factors (eg, absence of confounds) were consistently rated as highly important for increasing the likelihood of a mild TBI diagnosis (≥75% of respondents indicated at least 7 out of 10). ConclusionsThe expert survey findings identified several potential revisions to consider when updating the ACRM mild TBI definition, including preferentially weighing observable signs in a probabilistic framework, incorporating symptoms and test findings, and adding differential diagnosis considerations.

The long journey towards uniform epidemiological monitoring of TBI around the globe

Reliable epidemiological data and improved awareness of traumatic brain injury (TBI) are both essential to fully understand the scale and socioeconomic burden of this condition, including our ability to plan and implement prevention measures, and to allocate health-care resources. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (1061) Google Scholar Although accomplishing these tasks, at first glance, might be considered straightforward, reality has proven the contrary. To date, all attempts to harmonise data collection and analyses across Europe and USA still confirm wide variation and discrepancies in reported incidence and mortality. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (1061) Google Scholar , 2 Li M Zhao Z Yu G Zhang J Epidemiology of traumatic brain injury over the world: a systematic review. Austin Neurol & Neurosci. 2016; 1: 1007 Google Scholar , 3 Majdan M Plancikova D Brazinova A et al. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016; 1: e76-e83 Summary Full Text Full Text PDF PubMed Scopus (228) Google Scholar These differences are mostly attributable to methodological diversity, including differences in case ascertainment, non-standardised definitions of TBI, and variations in hospital admission policies. 1 Maas AIR Menon DK Adelson PD et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16: 987-1048 Summary Full Text Full Text PDF PubMed Scopus (1061) Google Scholar , 2 Li M Zhao Z Yu G Zhang J Epidemiology of traumatic brain injury over the world: a systematic review. Austin Neurol & Neurosci. 2016; 1: 1007 Google Scholar , 3 Majdan M Plancikova D Brazinova A et al. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016; 1: e76-e83 Summary Full Text Full Text PDF PubMed Scopus (228) Google Scholar Moreover, robust data for many parts of the world, particularly for low-to-middle-income countries (LMICs) where TBI is likely to occur much more frequently, are almost entirely absent. Traumatic brain injury in ChinaChina has more patients with traumatic brain injury (TBI) than most other countries in the world, making this condition a major public health concern. Population-based mortality of TBI in China is estimated to be approximately 13 cases per 100 000 people, which is similar to the rates reported in other countries. The implementation of various measures, such as safety legislation for road traffic, establishment of specialised neurosurgical intensive care units, and the development of evidence-based guidelines, have contributed to advancing prevention and care of patients with TBI in China. Full-Text PDF

Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review.

This systematic review provides a comprehensive, up-to-date summary of traumatic brain injury (TBI) epidemiology in Europe, describing incidence, mortality, age, and sex distribution, plus severity, mechanism of injury, and time trends. PubMed, CINAHL, EMBASE, and Web of Science were searched in January 2015 for observational, descriptive, English language studies reporting incidence, mortality, or case fatality of TBI in Europe. There were no limitations according to date, age, or TBI severity. Methodological quality was assessed using the Methodological Evaluation of Observational Research checklist. Data were presented narratively. Sixty-six studies were included in the review. Country-level data were provided in 22 studies, regional population or treatment center catchment area data were reported by 44 studies. Crude incidence rates varied widely. For all ages and TBI severities, crude incidence rates ranged from 47.3 per 100,000, to 694 per 100,000 population per year (country-level studies) and 83.3 per 100,000, to 849 per 100,000 population per year (regional-level studies). Crude mortality rates ranged from 9 to 28.10 per 100,000 population per year (country-level studies), and 3.3 to 24.4 per 100,000 population per year (regional-level studies.) The most common mechanisms of injury were traffic accidents and falls. Over time, the contribution of traffic accidents to total TBI events may be reducing. Case ascertainment and definitions of TBI are variable. Improved standardization would enable more accurate comparisons.

Early, specialist vocational rehabilitation to facilitate return to work after traumatic brain injury: the FRESH feasibility RCT.

Up to 160,000 people incur traumatic brain injury (TBI) each year in the UK. TBI can have profound effects on many areas of human functioning, including participation in work. There is limited evidence of the clinical effectiveness and cost-effectiveness of vocational rehabilitation (VR) after injury to promote early return to work (RTW) following TBI. To assess the feasibility of a definitive, multicentre, randomised controlled trial (RCT) of the clinical effectiveness and cost-effectiveness of early, specialist VR plus usual care (UC) compared with UC alone on work retention 12 months post TBI. A multicentre, feasibility, parallel-group RCT with a feasibility economic evaluation and an embedded mixed-methods process evaluation. Randomisation was by remote computer-generated allocation. Three NHS major trauma centres (MTCs) in England. Adults with TBI admitted for > 48 hours and working or studying prior to injury. Early specialist TBI VR delivered by occupational therapists (OTs) in the community using a case co-ordination model. Self-reported RTW 12 months post randomisation, mood, functional ability, participation, work self-efficacy, quality of life and work ability. Feasibility outcomes included recruitment and retention rates. Follow-up was by postal questionnaires in two centres and face to face in one centre. Those collecting data were blind to treatment allocation. Out of 102 target participants, 78 were recruited (39 randomised to each arm), representing 39% of those eligible and 5% of those screened. Approximately 2.2 patients were recruited per site per month. Of those, 56% had mild injuries, 18% had moderate injuries and 26% had severe injuries. A total of 32 out of 45 nominated carers were recruited. A total of 52 out of 78 (67%) TBI participants responded at 12 months (UC, n = 23; intervention, n = 29), completing 90% of the work questions; 21 out of 23 (91%) UC respondents and 20 out of 29 (69%) intervention participants returned to work at 12 months. Two participants disengaged from the intervention. Face-to-face follow-up was no more effective than postal follow-up. RTW was most strongly related to social participation and work self-efficacy. It is feasible to assess the cost-effectiveness of VR. Intervention was delivered as intended and valued by participants. Factors likely to affect a definitive trial include deploying experienced OTs, no clear TBI definition or TBI registers, and repatriation of more severe TBI from MTCs, affecting recruitment of those most likely to benefit/least likely to drop out. Target recruitment was not reached, but mechanisms to achieve this in future studies were identified. Retention was lower than expected, particularly in UC, potentially biasing estimates of the 12-month RTW rate. This study met most feasibility objectives. The intervention was delivered with high fidelity. When objectives were not met, strategies to ensure feasibility of a full trial were identified. Future work should test two-stage recruitment and include resources to recruit from 'spokes'. A broader measure covering work ability, self-efficacy and participation may be a more sensitive outcome. Current Controlled Trials ISRCTN38581822. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 33. See the NIHR Journals Library website for further project information.

Definition of Traumatic Brain Injury, Neurosurgery, Trauma Orthopedics, Neuroimaging, Psychology, and Psychiatry in Mild Traumatic Brain Injury.

Traumatic brain injury (TBI) disrupts the normal function of the brain. This condition can adversely affect a person's quality of life with cognitive, behavioral, emotional, and physical symptoms that limit interpersonal, social, and occupational functioning. Although many systems exist, the simplest classification includes mild, moderate, and severe TBI depending on the nature of injury and the impact on the patient's clinical status. Patients with TBI require prompt evaluation and multidisciplinary management. Aside from the type and severity of the TBI, recovery is influenced by individual patient characteristics, social and environmental factors, and access to medical and rehabilitation services.

Computed tomography findings in young children with minor head injury presenting to the emergency department greater than 24 h post injury

BackgroundLarge studies which developed decision rules for the use of Computed tomography (CT) in children with minor head trauma excluded children with late presentation (more than 24h). ObjectiveTo assess the prevalence of significant traumatic brain injury (TBI) on CT in infants with head trauma presenting to the emergency department (ED) more than 24h from the injury. MethodsA retrospective chart review of infants less than 24 months old referred for head CT because of traumatic brain injury from January 2004 to December 2014 in Assaf-Harofeh medical center was conducted. We used the PECARN definitions of TBI on CT to define significant CT findings. Results344 cases were analyzed, 68 with late presentation.There was no significant difference in the age between children with late and early presentation (mean 11.4 (SD 5.6) month vs 10. 5 (SD 7.0) month, P=0.27). There was no significant difference between the groups in the incidence of significant TBI (22% vs 19%, p=0.61). Any TBI on CT (e.g. fracture) was found in 43 (63%) patients with late presentation compared with 116 (42%) patients with early presentation (p=0.002, OR 2.37, 95% CI 1.37–4.1). ConclusionA similar rate of CT-identified traumatic brain injury was detected in both groups.‏ There was no significant difference in the incidence of significant TBI on CT between the groups.‏ Young children presenting to the ED more than 24 hours after the injury may have abnormal findings on CT.

Incidence, Demographics, and Outcome of Traumatic Brain Injury in The Middle East: ASystematic Review.

Traumatic brain injury (TBI) is a serious global public health challenge. We aimed to assess the pattern of TBI in the Middle East, as reported in the last decade. Literature searches were conducted on PubMed, MEDLINE, and Google scholar electronic databases. The search terms used in different combinations were epidemiology, incidence, case fatality, mortality, intracranial injury, brain injury, head injury, and the country names. Additional searches were conducted using reference lists of studies and review articles for selection of relevant articles. The search yielded 1082 articles; of which 701 duplicates and 346 articles were excluded. Thirty-five original studies met the inclusion criteria. Data were extracted using standardized Excel form and pilot tested. Median with interquartile range (IQR) was used to estimate the incidence rate and mortality of TBI. In the Middle East region, the median TBI incidence rate per capita was 45 (IQR, 38.5-367) per 100,000. The overall median emergency department-based TBI mortality, which included all age groups and all injury severities, was 10% (IQR, 7.75-15.75). We estimated the overall median mortality for head trauma studies based on emergency department admissions as 6% (IQR, 3-18) among all age groups and all injury severities. The overall TBI-related median mortality in the intensive care unit-based studies was 25% (IQR, 15.5-47). The epidemiology of TBI in the Middle East remains understudied. The use of a globally recognized definition of TBI will contribute greatly to improve its reporting, analysis, and interpretation and to establish appropriate injury prevention programs.