Degrees Of Traumatic Brain Injury Research Articles

The Secondary Impact of Mild Traumatic Brain Injury: An Interpretative Phenomenological Analysis of the Experiences of Family Members

Mild traumatic brain injury (mTBI), with symptoms beyond 3 months, may be more common than previously believed, but is poorly understood. This has resulted in contradictory and confused information for service users, which has had an impact on those with mTBI and their families. This qualitative study aimed to improve understanding of the lived experiences of families of people with mTBI, with symptoms beyond 3 months. It extends a previous study, which focussed on all degrees of traumatic brain injury (TBI) (mild, moderate, and severe). Four individuals participated in semi-structured, virtual interviews. Following an interpretative phenomenological analysis (IPA), three superordinate themes were identified: (1) Going round in circles, (2) The second secondary impact, and (3) Dialogue with myself. Findings indicate that families of people with mTBI, with symptoms beyond 3 months, may experience many of the same challenges as families of people with moderate or severe TBI, albeit at a lesser intensity. This includes difficulty making sense of TBI and challenges to their identity, both of which mirror the comparator TBI study findings. However, findings also indicated that this group may experience different challenges to families of people with moderate or severe TBI, aspects of which have not previously been reported. Feelings of ambiguous loss may be increased by incongruity between information provided and families’ experiences, and by the varied availability and content of information. Implications for service providers are that consistent, transparent, and realistic information and education may aid adjustment and assist families to support people with mTBI.

Amide Proton Transfer-Weighted Magnetic Resonance Imaging for Detecting Severity and Predicting Outcome after Traumatic Brain Injury in Rats.

After traumatic brain injury (TBI), early assessment of secondary injury severity is critically important for estimating prognosis and treatment stratification. Currently, secondary injury severity is difficult to estimate. The objective of this study was to investigate the capacity of non-invasive amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI) techniques to assess TBI injury in different brain regions and predict long-term neurobehavior outcomes. Fifty-five male and female rats were subjected to a controlled cortical impact with one of three different impactor depths to produce different degrees of TBI. Multi-parameter MRI data were acquired on a 4.7-Tesla scanner at 1 h, 1 day, and 3 days. Immunofluorescence staining was used to detect activated microglia at 3 days, and neurobehavioral tests were performed to assess long-term outcomes after 28 days. The APTw signal in the injury core at 1 day correlated with deficits in sensorimotor function, the sucrose preference test (a test for anhedonia), and spatial memory function on the Barnes maze. The APTw signal in the perilesion ipsilateral cortex gradually increased after TBI, and the value at 3 days correlated with microglia density at 3 days and with spatial memory decline and anhedonia at 28 days. The correlation between APTw and activated microglia was also observed in the ipsilateral thalamus, and its correlation to memory deficit and depression was evident in other ipsilateral sites. These results suggest that APTw imaging can be used for detecting secondary injury and as a potential predictor of long-term outcomes from TBI.

Characteristics of Epileptiform Spike-wave Discharges and Chronic Histopathology in Controlled Cortical Impact Model of Sprague-Dawley Rats.

Post-traumatic epilepsy (PTE) is a serious complication that can occur following traumatic brain injury (TBI). Sustained secondary changes after TBI promote the process of PTE. Here, we aim to evaluate changes in behavior, electrocorticogram, and histomorphology in rats following chronic TBI models. We observed intensive 7-8Hz spike-wave-discharges (SWDs) at frontal recording sites and quantified them in SD rats with different degrees of TBI and compared them with age-matched sham rats to evaluate the association between SWDs and injury severity. Notably, although SWDs were even presented in the sham group, the number and duration of events were much lower than those in the TBI groups. SWDs have numerous similarities to absence seizures, such as abrupt onset, termination, and lack of postictal suppression, which may be the nonconvulsive characteristics of PTE. Retigabine, a novel antiepileptic drug, is ineffective in reducing SWDs. In addition, we examined chronic histopathological changes in TBI rats. Rats subjected to moderate and severe TBI exhibited significantly impaired neurological function, which was accompanied by marked cortical injury, hippocampus deformation, reactive gliosis, and mossy fiber sprouting. Long-term progressive structural changes in the brain are one of the characteristics of epileptogenesis after TBI. Our study provided the potential value of epileptiform SWDs in reflecting the nonconvulsive characteristic of PTE and highlighted the vital role of chronic pathological changes, such as reactive gliosis, in promoting the epileptogenesis following TBI.

Gastrointestinal failure score in children with traumatic brain injury

BackgroundTo review the value of the gastrointestinal failure (GIF) score in children with different degrees of traumatic brain injury (TBI) by analyzing the correlation between outcome and gastrointestinal function.MethodsA total of 165 children with TBI who were diagnosed and treated in the surgical intensive care unit (SICU) for longer than 72 h between August 2017 and September 2019 were analyzed. Admission parameters included sex, age, Glasgow Coma Scale (GCS) score, body mass index (BMI), leukocyte count, C-reactive protein (CRP), hemoglobin (Hb), hematocrit (Hct), blood glucose, lactic acid, procalcitonin (PCT), albumin, plasma osmotic pressure, prothrombin time (PT) and activated partial thromboplastin time (APTT). To predict outcomes, the Pediatric Sequential Organ Failure Assessment (SOFA) score, Pediatric Clinical Illness Score (PCIS), and mean GIF score for the first three days were combined.ResultsThe percentage of patients with gastrointestinal dysfunction on the first day was 78.8 %. Food intolerance (FI) and intra-abdominal hypertension (IAH) developed in 36.4 and 21.8 % of the patients, respectively. The GIF score and mean GIF score for the first three days were significantly different between children with different degrees of TBI (P < 0.05); these scores were also significantly different between patients who died and those who survived (P < 0.05). The mean GIF score for the first three days was identified as an independent risk factor for mortality (odds ratio > 1, 95 % confidence interval = 1.457 to 16.016, P < 0.01), as was the PCIS. Receiver operating characteristic (ROC) curve analysis suggested that the mean GIF score for the first three days had the same calibrating power as the PCIS in discriminating the risk of death of children.ConclusionsThe incidence of gastrointestinal dysfunction in children with TBI is high. The GIF score has the ability to reflect the status of the gastrointestinal system. The mean GIF score for the first three days has high prognostic value for ICU mortality in the SICU.

Serum Substance P Concentration in Children With Traumatic Brain Injury: A First Report

To review the clinic value and severity assessment of serum substance P (SP) concentration in children with different degrees of traumatic brain injury (TBI) through analyzing correlations with outcomes. One hundred thirty-nine children with TBI who were diagnosed and treated at Nanjing Medical University for longer than 72 hours between June 2017 and 2019 were analyzed. Blood samples were obtained within 24 hours after TBI to measure SP concentration. The endpoint was discharge mortality. Thirty healthy children composed the control group. Comparative analyses of differences in SP concentration were conducted for the different groups. Both the Sequential Organ Failure Assessment (SOFA) scores and Pediatric Clinical Illness Score (PCIS) were measured on admission and used in univariate and multivariate analyses. The serum SP (89.10 ± 64.32) pmol/L) level in the case group was significantly higher than that in the control group (21.84 ± 2.09) pmol/L (t= 5.71, P < 0.05). The serum SP (182.81 ± 58.39) pmol/L) level in the deceased group was significantly higher than that in the survival group (59.93 ± 27.90) pmol/L (t= 16.52, P < 0.05). A negative correlation existed between serum SP concentration and Glasgow Coma Scale score in the severe, moderate, and mild groups (r=-0.72, P < 0.05). Serum SP concentration was identified as an independent risk factor for mortality (odds ratio >1, 95% confidence interval= 1.04-1.28, P < 0.01). Receiver operating characteristic curve analysis suggested that serum SP concentration had the same calibrating power as SOFA and PCIS in discriminating the risk of death of children. Serum SP concentration was associated with severity in children with TBI, and extremely high levels indicated a poor prognosis.

Traumatic brain injury (TBI): exploring degrees and causes of TBI in mental health impairment by comprising gender differences

ABSTRACT Objective: To exploring differences between degrees and causes of TBI in mental health impairment with comprising gender differences. Methods: The study was a cross-sectional observational study of TBI patients who bedded within 24 hours of presentation to the emergency department (ED), Khatam Hospital, located in Zahedan, Iran. Participants were randomized by a simple randomization technique. Information had been collected twice, first time screening patients by Glasgow Coma Scale score (GCS) and the second time was two months after discharging patients from the ED to estimate mental health impairment by using two separate clinical diagnostic tests. Results: The research considered 80 patients, with 66% being male and 34% female. The median age for both genders estimated 23.5 years. There was a statistically significant difference between degrees and causes of TBI on the total score of hospital anxiety and depression. In particular, degree and cause of TBI with depression in males (M = 14.54, SD = .22), and degrees of TBI on post-traumatic stress disorder in females (M = 87, SD = .7) were significant difference. Conclusion: The current investigation highlights the incidence of depression in male patients with severe levels of traumatic brain injury who injured by car accident multiple trauma; furthermore, this research found the remarkable rate of post-traumatic stress disorder in female patients with a mild degree of TBI. The researcher in traumatic brain injury should seriously deliberate and explore gender differences with the degree and cause of TBI in detail.

Diagnostic properties of a portable near-infrared spectroscopy to detect intracranial hematoma in traumatic brain injury patients

Traumatic brain injury (TBI) is a major public health issue worldwide. A portable near-infrared spectroscopy (NIRS) is a non-invasive device to detect intracranial hematoma. The advantages of the NIRS include real time results and non-radiation exposure. However, sensitivity and specificity of the NIRS for intracranial hematoma are varied. This study aimed to evaluate the diagnostic properties of the NIRS in TBI patients to detect intracranial hematoma. This study was a diagnostic and prospective study conducted at the Emergency Department. The inclusion criteria were adult patients (age of 18 years or over) with moderate to high risk of all degrees of traumatic brain injury within 24 h after the injury. The primary endpoint of the study was a description of diagnostic properties of the NIRS compared with the CT brain. There were 47 patients enrolled in the study. Most of patients had Glasgow Coma Scale of 15 (44 patients; 93.62 %). Of those, 11 patients (23.40 %) had intracranial hematoma: subdural hematoma (n = 9), epidural hematoma (n = 1), intracerebral hematoma (n = 1), and subarachnoid hemorrhage (n = 3). One patient had subdural hematoma, epidural hematoma, intracerebral hematoma and subarachnoid hemorrhage. There were 31 patients had abnormal findings by the NIRS but only 11 patients had bleeding detected by the CT brain. There were 16 patients had negative results on both the NIRS and the CT brain. The sensitivity and specificity of the NIRS compared with the CT brain was 100 % and 44.4 %, respectively. The area under the ROC curve of the NIRS was 0.722. The median time to complete the NIRS examination was 3 min. In conclusion, the NIRS has high sensitivity and negative predictive value for intracranial hematoma detection in mild TBI patients with extra-axial hematomas.

Expression profile of plasma microRNAs and their roles in diagnosis of mild to severe traumatic brain injury.

Traumatic brain injury (TBI) is associated with trauma-related death. In this study, we evaluated differences in the expression of plasma microRNAs (miRNAs) in patients with different degrees of TBI, and explored the potential of miRNAs for use as diagnostic TBI biomarkers. The miRNA microarray results showed upregulation of 65, 33, and 16 miRNAs and downregulation of 29, 27, and 6 miRNAs in patients with mild, moderate, and severe TBI, respectively, compared with healthy controls. Thirteen miRNAs (seven upregulated and six downregulated) were found to be present in all TBI groups. Seven upregulated miRNAs were selected for validation in an enlarged cohort of samples and showed good diagnostic accuracy. The expression levels of miR-3195 and miR-328-5p were higher in the severe TBI group than in the mild and moderate TBI groups. In summary, our study demonstrates different expression profiles in plasma miRNAs among patients with mild to severe TBI. A subset of seven miRNAs can be used for diagnosis of TBI. Moreover, miR-3195 and miR-328-5p may be utilized during diagnosis to distinguish mild and moderate TBI from severe TBI.

High-sensitivity terahertz imaging of traumatic brain injury in a rat model

We demonstrated that different degrees of experimental traumatic brain injury (TBI) can be differentiated clearly in fresh slices of rat brain tissues using transmission-type terahertz (THz) imaging system. The high absorption region in THz images corresponded well with the injured area in visible images and magnetic resonance imaging results. The THz image and absorption characteristics of dehydrated paraffin-embedded brain slices and the hematoxylin and eosin (H&E)-stained microscopic images were investigated to account for the intrinsic differences in the THz images for the brain tissues suffered from different degrees of TBI and normal tissue aside from water. The THz absorption coefficients of rat brain tissues showed an increase in the aggravation of brain damage, particularly in the high-frequency range, whereas the cell density decreased as the order of mild, moderate, and severe TBI tissues compared with the normal tissue. Our results indicated that the different degrees of TBI were distinguishable owing to the different water contents and probable hematoma components distribution rather than intrinsic cell intensity. These promising results suggest that THz imaging has great potential as an alternative method for the fast diagnosis of TBI.

Automatic evaluation of traumatic brain injury based on terahertz imaging with machine learning.

The imaging diagnosis and prognostication of different degrees of traumatic brain injury (TBI) is very important for early care and clinical treatment. Especially, the exact recognition of mild TBI is the bottleneck for current label-free imaging technologies in neurosurgery. Here, we report an automatic evaluation method for TBI recognition with terahertz (THz) continuous-wave (CW) transmission imaging based on machine learning (ML). We propose a new feature extraction method for biological THz images combined with the transmittance distribution features in spatial domain and statistical distribution features in normalized gray histogram. Based on the extracted feature database, ML algorithms are performed for the classification of different degrees of TBI by feature selection and parameter optimization. The highest classification accuracy is up to 87.5%. The area under the curve (AUC) scores of the receiver operating characteristics (ROC) curve are all higher than 0.9, which shows this evaluation method has a good generalization ability. Furthermore, the excellent performance of the proposed system in the recognition of mild TBI is analyzed by different methodological parameters and diagnostic criteria. The system can be extensible to various diseases and will be a powerful tool in automatic biomedical diagnostics.

The assessment of balance and dizziness in the TBI patient

All degrees of traumatic brain injury (TBI) are associated with balance dysfunction and/or dizziness. The clinician assessing and managing patients with TBI should become familiar with vestibular and non-vestibular causes of dizziness and imbalance, and be able to perform screening tests to determine when referral to a vestibular specialist is warranted. This chapter outlines the clinical pathways to be followed in history-taking, physical examination, and assessment. Dizziness, vertigo, balance dysfunction and gait ataxia can have their origin in the vestibular system, elsewhere, or be multifactorial. The complex anatomy and physiology of the balance canals, otolithic organs, and vestibular nerves peripherally, and the vestibular nuclei centrally, as well as the neural connections between vestibular, oculomotor, and proprioceptive systems will be covered in clinically pertinent detail. A majority of diagnosis of dizziness/vertigo can be made after a proper history has been obtained. This can be challenging in all dizzy patients, and more so in the TBI patient in whom memory and recall may be impaired. The reader will learn how to use tools such as dizziness questionnaires as well as targeted history taking to elicit the information. Similarly, the addition of a programmatic, targeted physical examination of the dizzy patient will allow the clinician to fine-tune the diagnosis between peripheral and central causes. Once history and examination have narrowed the diagnostic possibilities, appropriate testing--in the vestibular laboratory and radiologic testing--is indicated. The reader will learn when these tests should be considered, and what the findings will show. Treatment can then be targeted for maximal outcome. Managing TBI is challenging; the addition of dizziness or balance complaints in these individuals makes it even more so. This paper seeks to provide a useful roadmap clinical pathway for assessment of these patients with appropriate and timely referral for treatment.

Impact of pre-injury factors on outcome after severe traumatic brain injury: Does post-traumatic personality change represent an exacerbation of premorbid traits?

Although personality change is a frequent and disabling consequence of severe degrees of traumatic brain injury (TBI), little information is available beyond descriptive statements. The present paper presents a brief overview of the literature on the effects of pre-injury variables on post-trauma psychosocial functioning, and makes specific examination of the effect of premorbid personality structure on the post-trauma personality in people with TBI. A close relative of 28 people undergoing rehabilitation after TBI completed the Eysenck Personality Questionnaire Revised (EPQ-R) and Current Behaviour Scale (CBS) regarding the injured person's personality and character. Data were collected on three occasions: Ratings about premorbid status were taken as soon as feasible after admission, and follow-up ratings regarding current status were made at 6and 12 months post-trauma. As a group, premorbid ratings indicated an unremarkable profile on the EPQ-R. Significant changes had occurred by 6months post-trauma, which were sustained at 12 months post-trauma for both the EPQ-R and CBS. Yet none of the specific hypotheses regarding premorbid personality structure on the EPQ-R and post-trauma characterological deficits on the two CBS factors, Loss of Emotional Control (LEC) and Loss of Motivation (LM), was supported: There were no significant differences between subgroups with high or low premorbid levels of Extraversion, Neuroticism, Psychoticism, Addiction and Criminality and post-trauma CBS factors, LEC, and LM. These findings suggest that although personality changes occur as a result of traumatic brain injury, they are largely independent of the premorbid personality structure.

Psychosocial adjustment after traumatic brain injury: what are the important variables?

The common legacy of severe degrees of traumatic brain injury is varying degrees and types of impairments, which impact significantly upon the individual's resumption of pre-morbid psychosocial roles. Yet there are few data to indicate the relative contribution of these and other non-injury related variables. Seventy individuals with varying levels of disability after severe traumatic brain injury were examined neurologically and neuropsychologically, on average at 6 years post-trauma. A range of biographical, injury, impairment and psychological variables were examined with multiple regression analyses to identify those that contributed to successful psychosocial reintegration. Severity of injury and impairments, along with chronicity and level of self-esteem were significant predictors of psychosocial adjustment. Further analyses revealed that within the neuropsychological domain, the variable measuring behavioural regulation of abilities was the most significant. Examination of specific domains of psychosocial functioning (occupational activities, interpersonal relationships and independent living skills) revealed different patterns of significant predictor variables, in addition to indices of the severity of initial injury: neurophysical impairments and memory functioning predicted successful occupational activities; chronicity, cognitive speed and behavioural regulation predicted success in interpersonal relationships; and neurophysical impairments, behavioural regulation and memory functioning predicted independent living skills. These results reinforce the overriding importance of injury severity and neurological factors (both neurophysical as well as neuropsychological) in predicting psychosocial adjustment after traumatic brain injury. Support for the contribution of non-neurological factors was also found.