Length Of Coma Research Articles

Identifying biomarkers for epilepsy after cerebral malaria in Zambian children: rationale and design of a prospective observational study

IntroductionMalaria affecting the central nervous system (CM) is a major contributor to paediatric epilepsy in resource-poor settings, with 10%–16% of survivors developing epilepsy within 2 years of infection. Despite high...

Memory functioning 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l'Enfant study.

To explore memory functioning 7 years after severe paediatric traumatic brain injury (TBI), associated factors, and relationships with other outcomes. Children aged 0-15 years (n = 65), consecutively admitted over a 3-year period in a single trauma centre, who survived after severe non-inflicted TBI, were included in a prospective longitudinal study. Memory assessments were performed 7 years post-injury using the Children's Memory Scale or the Wechsler Memory Scale (WMS IV), according to age. The General Memory Score (GMS-7) was the primary outcome. Thirty-seven patients were available for assessment at 7 years post-injury. Mean GMS-7 was in the low average range (M = 84.9, SD = 12.1). Lower GMS-7 was significantly associated with markers of higher injury severity, such as length of coma. One year post-injury functional and disability outcomes explained 74% of the variance of GMS-7. Concurrent intellectual ability and type of ongoing education correlated strongly with GMS-7. Age at injury and parental education were not associated with memory outcome. Memory functioning is variable but often strongly impaired several years after severe paediatric TBI, and is mostly related to injury severity, functional outcomes measured 1 year post-injury, and concomitant cognitive and educational outcomes. GMS-7 was lower at 7 years than one year post-injury, supporting the importance of long term follow-up.

A-131 Clinical Utility of the Child & Adolescent Memory Profile in Children with TBI

Abstract Objective To evaluate the sensitivity of The Child and Adolescent Memory Profile (ChAMP), a relatively new test of learning and memory, to traumatic brain injury (TBI). Method The ChAMP was administered to 61 6–16 year-old children with TBI within 1–12 months post injury. The sample was 64% male and 75% Caucasian, with a median parental level of education of 13 years. Twenty-nine children had uncomplicated mild TBI whereas 32 children had either intracranial lesions on neuroimaging or coma of at least 24 hrs, or both. The findings from the complete TBI group were compared to those from a demographically matched control group, obtained from the ChAMP standardization sample. Results Within the TBI group, the Visual Memory, Immediate Memory, Total Memory and Screening Index scores all demonstrated statistically significant correlations with length of coma. After applying a Benjamini-Hochberg adjustment to correct for the effect of multiple comparisons, the performance of the matched control group was still statistically significantly better than that of the children with TBI on all of the ChAMP Index scores. Effect sizes ranged from small to medium. At the subtest level, Places and Places Delayed showed the greatest group differences. Conclusion These findings supported the clinical utility of the ChAMP in the evaluation of learning and memory in children with TBI.

Executive functions and attention 7years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l'Enfant (TGE) cohort.

Severe childhood traumatic brain injury (TBI) leads to long-standing executive function and attention deficits, with negative consequences for participation, academic outcome and independence. This study aimed to assess executive function and attention 7years after severe childhood TBI in comparison with a matched control group and to investigate associated factors. Children (<15years) with severe accidental TBI consecutively admitted in a single trauma center over 3years were included in the Traumatisme Grave de l'Enfant (TGE) prospective longitudinal study. Of the 81children initially included, 65survived. At 7years post-TBI, executive functions and attention were assessed in 27participants (42% of the 65survivors) by using a combination of computerized tasks from the Test of Attentional Performance (TAP) and the Behavioral Rating of Executive Functions (BRIEF) questionnaire. Patients were compared to a group of 27typically developing controls who were matched for sex, age and parental education level. Among the 27participants, mean (SD) age at injury was 7.7 (4.6)years, and mean length of coma 5.6 (4.6) days. Regarding the TAP, the number of errors was significantly higher (P=0.003) and reaction time marginally slower (P=0.08) in the TBI than control group. The BRIEF questionnaire completed by parents indicated significantly more executive difficulties in the TBI than control group (Behavior Regulation Index, P=0.005; Metacognitive index, P=0.02; Global Executive Composite, P=0.012). Correlations between BRIEF and TAP scores did not reach statistical significance. BRIEF total score was correlated moderately with length of coma (r=0.40, P=0.037), and TAP scores were correlated with the Full-Scale Intellectual Quotient (total number of errors: r=-0.48; P=0.01; mean reaction time: r=-0.51; P=0.009). Executive and attention deficits were evident 7years after severe childhood TBI. Computerized tasks and questionnaires provide complementary and non-redundant information. Systematic long-term follow-up should be provided until the transition to adulthood, to assess ongoing development and to implement timely tailored interventions.

Sluggish cognitive tempo in children with traumatic brain injuries

This exploratory study is the first to investigate whether the construct of sluggish-cognitive tempo (SCT) is related to slowed processing speed in children with traumatic brain injury (TBI), while also considering pre-morbid and injury variables. The study evaluated SCT, as measured by the Child Behavior Checklist (CBCL), and processing speed, as assessed with the Wechsler Intelligence Scale for Children—Fourth Edition (WISC–IV Processing Speed Index), in children who sustained TBI with a wide range of injury severity. Injury variables examined included the length of coma, presence of neuroimaging findings, and time between injury and assessment. Children’s cognitive reserve, as estimated by parental level of education, was a non-injury variable. The participants included 50 children, ages 6–16 years, without co-morbid neurological or psychiatric conditions who underwent a neuropsychological evaluation within 1–12 months after injury. Results indicated no significant correlations between SCT and any of the WISC–IV index scores. Children with a moderate-severe TBI did not differ from those with uncomplicated mild TBI on SCT but they had statistically significant lower WISC–IV Processing Speed. Although parents of children with uncomplicated mild TBI had higher levels of education as compared to parents of children with moderate-severe TBI, there was no statistically significant relationship between the level of parental education and either SCT or Processing Speed. This study suggests that SCT, as measured by the CBCL, is not a sensitive measure of sequelae of pediatric TBI.

Participation seven years after severe childhood traumatic brain injury

Purpose: Participation in home, school and community activities is considered as the ultimate aim of rehabilitation. The aims of this study were to examine participation seven years post-severe childhood traumatic brain injury and factors associated with participation.Materials and methods: Participants were enrolled in the Traumatisme Grave de l’Enfant (Severe Childhood Injury) cohort study following severe accidental childhood traumatic brain injury. Participation seven years post-injury, was examined using parent- and self-report forms of the Child and Adolescent Scale of Participation among 37 patients [62% males, mean age 15.4 years (SD = 4.4), mean length of coma 6.68 days (SD = 4.96)] and 33 matched controls.Results: Parent reports indicated significantly lower participation among patients compared to controls, but the self-reports did not. In the traumatic brain injury group, parent-reported participation was variable, with 22% of the patients clearly showing greater restrictions than controls. Participation restrictions were significantly associated with injury severity, poor functional outcome one-year post-injury, executive and behavioral difficulties and higher fatigue levels seven years post-injury, but not with pre-injury nor family factors.Conclusions: Several years after severe childhood traumatic brain injury, participation appears to depend more on injury-related factors than on environmental factors. In self-reports assessments of participation, it could be difficult for children and adolescents to distinguish capacity from performance.Implications for rehabilitationParticipation outcomes were highly variable in a sample of patients who sustained severe childhood traumatic brain injury.Participation should be assessed systematically following severe traumatic brain injury, both initially but also in the long-term, ideally using a combination of self- and proxy-report measures.Among patients with severe injuries, the influence of initial brain injury severity markers on participation seems much stronger than that of social/family environment factors.Children’s and adolescents’ self-reported participation assessed with the Child and Adolescent Scale of Participation may be difficult to interpret.

Memory functioning following severe traumatic brain injury in children: Results of the TGE (Traumatisme crânien grave de l’enfant) Cohort

Severe Traumatic Brain Injury (TBI) is the main cause of children mortality and disability in developed countries. Among cognitive sequelae, memory impairment is frequent and impacts everyday functioning and academic achievement. The aims of this study were: (1) to measure memory functioning in children who sustained a severe TBI, and performance's evolution over time; (2) to assess factors associated to memory function and recovery. In the TGE (Traumatisme crânien grave de l’enfant) cohort, a prospective longitudinal study, 65 children aged 0 to 15 years old who sustained a severe TBI were included. Memory function was assessed using the Children's Memory Scale (CMS) at 3, 12 and 24 months post-injury. Memory was assessed in 46 children aged 5–15 years. Significant memory impairment was found at 3months post-injury (mean general memory (GENM) score = 89.1, SD = 20.5). Significant improvement was found at 24 months, but less so for verbal, learning and attention/concentration abilities. At 3 and 24 months post-injury, GENM score was significantly correlated to TBI severity indices (length of coma, Pediatric Traumatic Scale and Injury Severity Score). It was strongly correlated to full-scale intellectual quotient at each time point. Female gender was associated with worse memory impairment, whereas age at injury and socio-economic status were not. Furthermore, presence of motor impairment (MI) was correlated with worse memory recovery, probably as a marker of injury severity. Finally, the GENM score was significantly correlated with less favorable educational outcome. Memory functioning is significantly impaired following severe TBI; it is mostly influenced by initial TBI severity and strongly impacts educational outcome. Those patients should benefit from long-term follow-up post injury.

Criterion validity of the D-KEFS color–word and verbal fluency switching paradigms following traumatic brain injury

ABSTRACTThe present study was composed of two parts examining the clinical utility of the Delis–Kaplan Executive Function System (D-KEFS) Verbal Fluency and Color–Word subtests in traumatic brain injury (TBI). In the first part, the performance of 128 outpatients with mild to severe TBI on the Verbal Fluency and Color–Word subtests was examined in relation to two primary indicators of TBI severity: length of coma and the presence of intracranial lesions on neuroimaging through regression analysis. After controlling for education, ethnicity, and complicating premorbid and comorbid factors, length of coma predicted performance on the Color–Word Inhibition/Switching subtest, whereas the presence of diffuse lesions was related to Verbal Fluency Category Switching performance. In the second part of this study, performance on the Category Switching and Inhibition/Switching subtests was compared between a group of 28 participants with moderate-to-severe TBI and demographically matched groups with mild-uncomplicated TBI (n = 28) and neurologically healthy control participants (n = 56). The moderate-to-severe TBI group performed significantly worse on both subtests than the mild-uncomplicated TBI and control groups, and the latter groups did not differ from each other on these subtests. Logistic regression analysis showed that the combined group classification accuracy of these subtests was 66.07%, with an area under the curve (AUC) of .70 and a likelihood ratio of 1.93. The findings provide modest support for the clinical utility of the Color–Word Inhibition/Switching subtest in the cognitive assessment of TBI, while also replicating prior research suggesting clinical utility of the Category Switching subtest in this population.

Intellectual outcome following childhood severe traumatic brain injury: Results of a prospective longitudinal study: The seven-year follow-up of the TGE cohort

Childhood traumatic brain injury (TBI) is a leading cause of death and lifelong acquired disability. The aim of this study was to prospectively study intellectual ability following childhood severe TBI over 7–8 years post-injury, and factors influencing outcome and change over time. Children (0–15 years) consecutively admitted in a single trauma center for severe non-inflicted TBI over a 3-year period were included in a prospective longitudinal study. Assessment was conducted at 3, 12 and 24 months, and at 7–8 years using age appropriate Wechsler Intelligence Scales. For the 7–8-year follow-up, one third of the group was aged 18 years or more, and a group of matched controls was included. SES was assessed by parents’ education. Sixty-five of the 81 included children survived (66% boys). After a mean delay post-injury of 7.6 years (SD = 1.5), 39 patients (60%) participated in the study [mean age at injury 7.6 years (SD = 4.72; < 6 years, n = 15; ≥ 6 years, n = 23); median initial Glasgow Coma Scale (GCS) score: 6; mean coma duration: 6 days (SD = 4.8)]. Participants and non-participants did not differ in terms of demographic and severity factors, or initial full scale IQ (FSIQ). For 36% of the sample, at least one parent had graduated from high school. At the 7–8 year follow-up, mean FSIQ in the TBI group was significantly lower than in the control group (86.4; SD = 18 versus 97.2; SD = 11.2; P = 0.016), with no significant change over time when compared with initial FSIQ (3 months post-injury; 85.2; SD = 18). In multivariate analysis, FSIQ was predicted mainly by parental SES ( P = 0.031), with a marginal effect of length of coma ( P = 0.079) and no effect of age at injury, initial GCS or intracranial hypertension. Severe childhood TBI leads to severe and long-standing cognitive impairments, without significant improvement over time. Parental education appears to be the main predictor of cognitive outcome several years post-injury, consistent with previous studies in the literature.

Presentations to an urban emergency department in Switzerland due to acute γ-hydroxybutyrate toxicity.

Backgroundγ-Hydroxybutyrate (GHB) is a drug of abuse with dose-dependent sedative effects. Systematic data on the acute toxicity of GHB from emergency department (ED) presentations over a long period of time are currently missing from the literature. The present study described the clinical features of GHB toxicity.MethodsRetrospective case series of GHB intoxications seen in an urban ED.ResultsFrom January 2002 to September 2015, 78 GHB-related intoxication cases were recorded (71 % male patients). The mean ± SD age was 29 ± 8 years. The co-use of alcohol and/or other illicit drugs was reported in 65 % of the cases. Neurological symptoms other than central nervous system depression included agitation (40 %) and clonus (21 %). The most frequent reasons for admission were coma (64 %) and agitation (23 %). The median time to regain consciousness was 90 min (range, 3–400 min). Sudden recovery was reported in 25 cases (32 %). Coma was not significantly associated with polyintoxication. Coma occurred in 77 % of the alcohol co-users and in 62 % ofthe non-alcohol users (p=0.052). The mean recovery time in comatose patients was 142 min in patients with co-use of alcohol compared with 89 min in patients without alcohol co-use (p=0.07). Alcohol co-use was not significantly associated with nausea/vomiting (p=0.07). The co-use of stimulants was not significantly associated with non-responsive coma (Glasgow Coma Scale = 3) or mean recovery time. Analytical confirmation of GHB was available in 37 cases (47 %), with additional quantitative analysis in 20 cases. The median GHB concentration was 240 mg/L (range, 8.3–373 mg/L). Intoxication was severe in 72 % of the cases. No fatalities occurred, and 72 % of the patients were discharged directly home from the ED.DiscussionThere were trend associations between alcohol co-use and frequency and length of coma and nausea/vomiting which did not reach the significance level (all p=0.05-0.07) but may nevertheless be clinically relevant. As the exact time of use is not always known, and co-use of other substances can affect the severity of poisoning, no definitive conclusions can be drawn regarding the association between GHB concentration and severity.ConclusionImpaired consciousness and agitation were typical findings of GHB intoxication. The co-use of alcohol and/or other illicit substances is common but was not significantly associated with the severity of the intoxications in our study.

Executive function after severe childhood traumatic brain injury – Age-at-injury vulnerability periods: The TGE prospective longitudinal study

BackgroundExecutive function (EF) impairment is a major predictor of overall outcome after traumatic brain injury (TBI). TBI severity is a factor of poor outcome, but most studies include a majority of children with mild and moderate TBI. The aims of this study were to estimate EF impairment after severe childhood TBI and to explore factors predicting EF outcome. The secondary aim was to compare recovery trajectories by age-at-injury groups. MethodsThis was a prospective longitudinal study of children with severe TBI who were tested for EFs by performance-based tests and questionnaires at 3, 12 and 24 months. ResultsChildren with TBI (n=65) showed significant impairment in working memory, inhibition, attention and global EF, with little or no recovery at 24 months. For flexibility and performance-based EF score, children were impaired at 3 months only and showed normal scores by 12 months. No impairment was found in planning. At 3 and 24 months, Glasgow Coma Scale score and parental education predicted global EF. Coma length was not a significant predictor of outcome. Age at injury predicted progress in EF, but the relationship was not linear; children 10–12 years old at injury showed better outcome than older and younger children. ConclusionsEFs are impaired after severe TBI in childhood. The relationship between age at injury and outcome is not linear. Relying on only performance-based EF tests can underestimate EF impairment.

Serum Total Cholinesterase Activity on Admission Is Associated with Disease Severity and Outcome in Patients with Traumatic Brain Injury.

BackgroundTraumatic brain injury (TBI) is one of the leading causes of neurological disability. In this retrospective study, serum total cholinesterase (ChE) activities were analyzed in 188 patients for diagnostic as well as predictive values for mortality.Methods and FindingsWithin 72 hours after injury, serum ChE activities including both acetylcholinesterase and butyrylcholinesterase were measured. Disease severity was evaluated with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Glasgow Coma Score, length of coma, post-traumatic amnesia and injury feature. Neurocognitive and functional scores were assessed using clinical records. Of 188 patients, 146 (77.7%) survived and 42 (22.3%) died within 90 days. Lower ChE activities were noted in the non-survivors vs. survivors (5.94±2.19 vs. 7.04±2.16 kU/L, p=0.023), in septic vs. non-infected patients (5.93±1.89 vs. 7.31±2.45 kU/L, p=0.0005) and in patients with extremely severe injury vs. mild injury (6.3±1.98 vs. 7.57±2.48 kU/L, p=0.049). The trajectories of serum ChE levels were also different between non-survivors and survivors, septic and non-infected patients, mild and severely injured patients, respectively. Admission ChE activities were closely correlated with blood cell counts, neurocognitive and functional scores both on admission and at discharge. Receiver operating characteristic analysis showed that the area under the curve for ChE was inferior to that for either APACHE II or white blood cell (WBC) count. However, at the optimal cutoff value of 5 kU/L, the sensitivity of ChE for correct prediction of 90-day mortality was 65.5% and the specificity was 86.4%. Kaplan-Meier analysis showed that lower ChE activity (<5 kU/L) was more closely correlated with poor survival than higher ChE activity (>5 kU/L) (p=0.04). After adjusting for other variables, ChE was identified as a borderline independent predictor for mortality as analyzed by Binary logistic regression (P=0.078).ConclusionsLowered ChE activity measured on admission appears to be associated with disease severity and outcome for TBI patients.

Outcome and prognosis of hypoxic brain damage patients undergoing neurological early rehabilitation.

BackgroundThe prevalence of patients suffering from hypoxic brain damage is increasing. Long-term outcome data and prognostic factors for either poor or good outcome are lacking.MethodsThis retrospective study included 93 patients with hypoxic brain damage undergoing neurological early rehabilitation [length of stay: 108.5 (81.9) days]. Clinical data, validated outcome scales (e.g. Barthel Index—BI, Early Rehabilitation Index—ERI, Glasgow Coma Scale—GCS, Coma Remission Scale—CRS), neuroimaging data, electroencephalography (EEG) and evoked potentials were analyzed.Results75.3% had a poor outcome (defined as BI <50). 38 (40.9%) patients were discharged to a nursing care facility, 21 (22.6%) to subsequent rehabilitation, 17 (18.3%) returned home, 9 (9.7%) needed further acute-care hospital treatment and 8 (8.6%) died. Barthel Index on admission as well as coma length were strong predictors of outcome from hypoxic brain damage. In addition, duration of vegetative instability, prolongation of wave III in visual evoked potentials (flash VEP), theta and delta rhythm in EEG, ERI, GCS and CRS on admission were related to poor outcome. All patients with bilateral hypodensities of the basal ganglia belonged to the poor outcome group. Age had no independent influence on functional status at discharge.ConclusionsAs with other studies on neurological rehabilitation, functional status on admission turned out to be a strong predictor of outcome from hypoxic brain damage.

Falls and fallers in traumatic brain injury (TBI) rehabilitation settings: an integrative review

Purpose: To critically appraise the research literature on the nature of falls and fallers in traumatic brain injury (TBI) rehabilitation settings. Method: An integrative review of the literature using thematic analysis was undertaken. Papers identified via a systematic search strategy were independently appraised by two reviewers. A data extraction instrument was developed to record results and to aid identification of themes in the literature. Critical Appraisal Skills Programme instruments were utilised to conduct a methodological critique of the papers included. Results: Thirteen studies were identified as having between 4% and 100% TBI patients in their study cohorts. From these papers, up to 71% of falls took place in a patient’s bedroom occurring in peaks and troughs over a 24-h period. With some divergent results, nine themes were identified describing faller characteristics including: (1) functional mobility impairments; (2) dizziness; (3) bladder and bowel dysfunction; (4) certain medications and number of medications prescribed; (5) executive functioning; (6) patient age; (7) fear of falling; (8) coma length following TBI; and (9) Functional Independence Measure (FIM™) total score, subscale scores and particular individual items. Conclusions: Being a multifactorial phenomenon, falls are a complex clinical issue. Despite the heterogeneity of diagnosis related groups (DRGs) in the included studies, TBI patients were identified as a high falls risk patient population in several studies.Implications for RehabilitationDue to multisystem impairments, falls in the traumatic brain injury (TBI) rehabilitation context are a multifactorial and significant clinical issue.When interpreting and generalising results from research into falls, clinicians need to be mindful that falls and faller characteristics may be dependent on study setting and patient population.There is need for context specific research into faller characteristics following a TBI; particularly in relation to post-traumatic amnesia.

Relevance of cognition to health-related quality of life in good-outcome survivors of out-of-hospital cardiac arrest.

For survivors of out-of-hospital cardiac arrest (OHCA) with good outcomes, it is not known whether and how health-related quality of life is affected by the cognitive impairments frequently observed in these patients. This study explores how neuropsychological tests of memory, exe-cutive and psychomotor functioning relate to the physical and mental aspects of health-related quality of life in functionally independent and community dwelling OHCA survivors discharged early from hospital. The study included 42 adult survivors (mean age 62 years, 38 males). Health-related quality of life was measured approximately 3 months post-OHCA with the Medical Outcome Study Short Form 36 (SF-36). Cognition was measured with established neuropsychological tests. Regression analyses were used to examine associations between neuropsychological domains and physical and mental health-related quality of life, respectively, when controlling for age, education and length of coma. The physical, but not the mental, component of the SF-36 was significantly worse than Norwegian population data. Neuropsychological tests showed frequent impairments most often in the memory domain. Worse psychomotor functioning was associated with worse physical health-related quality of life, whereas worse memory performance was associated with worse mental health-related quality of life. The cognitive impairments frequently reported in OHCA survivors with good outcomes may compromise health-related quality of life. Cognitive functioning should be addressed even in survivors with rapid recovery.

Accuracy of Self-reported Length of Coma and Posttraumatic Amnesia in Persons With Medically Verified Traumatic Brain Injury

ObjectiveTo determine the accuracy of self-reported length of coma and posttraumatic amnesia (PTA) in persons with medically verified traumatic brain injury (TBI) and to investigate factors that affect self-report of length of coma and PTA duration. DesignProspective cohort study. SettingSpecialized rehabilitation center with inpatient and outpatient programs. ParticipantsPersons (N=242) with medically verified TBI who were identified from a registry of persons who had previously participated in TBI-related research. InterventionNot applicable. Main Outcome MeasuresSelf-reported length of coma and self-reported PTA duration. ResultsReview of medical records revealed that the mean medically documented length of coma and PTA duration was 6.9±12 and 19.2±22 days, respectively, and the mean self-reported length of coma and PTA duration was 16.7±22 and 106±194 days, respectively. The average discrepancy between self-report and medical record for length of coma and PTA duration was 8.2±21 and 64±176 days, respectively. Multivariable regression models revealed that time since injury, performance on cognitive tests, and medical record values were associated with self-reported values for both length of coma and PTA duration. ConclusionsIn this investigation, persons with medically verified TBI showed poor accuracy in their self-report of length of coma and PTA duration. Discrepancies were large enough to affect injury severity classification. Caution should be exercised when considering self-report of length of coma and PTA duration.

Prognostic factors of long-term outcome in cases of severe traumatic brain injury

IntroductionThe purpose of this monocentric study was to assess the long-term outcome of a group of severe traumatic brain-injured patients and explore the prognostic values of some clinical and paraclinical parameters available at the initial stage. MethodologyThe patients included were victims of severe traumatic brain injuries in 2007 or 2008. A standardized assessment was performed for each patient including clinical, radiological, and electrophysiological data collected at the initial stage, The outcomes were assessed at least 2 years after injury. Depending on the patients’ availability and ability to communicate, the assessments included measures of dependency for activities of daily living (ADL), cognitive functions, behaviour, mood, and quality of life. ResultsEighteen patients were included, of whom ten were autonomous for ADL at the time of assessment. Memory complaints, attentional deficits, anxiety, and irritability were the main long-term impairments observed. A correlation analysis showed significant correlations between the dependency level (as rated by the Functional Independence Measure) and each of length of coma, length of the post-traumatic amnesia, and the N100 auditory evoked potentials. DiscussionThese results confirm the uniqueness of each patient regarding the long-term consequences of a traumatic brain injury and the multi-determined nature of each prognosis.

Cognitive and adaptive functioning after severe TBI in school-aged children

Objective: Persistent cognitive and behavioural deficits have been documented in children suffering severe TBI. The aim of the present study was to examine the cognitive and adaptive profile of children of school age with severe TBI.Methods: This study selected 118 patients and divided them into three groups according to the severity of their clinical-functional picture. All the patients received a functional assessment using the Wee-FIM. Subjects with reduced responsiveness were evaluated by LOCFAS. Last, the cognitive profile children with a better recovery were described with WISC-III and Leiter-R and their adaptive behaviour with VABS.Results: Group 1 (n = 77) showed a borderline cognitive level with a disharmonious profile between VIQ and PIQ, significant deficits in the Processing Speed and Perceptual Organization Indices, lastly specific adaptive behavioural deficits. Length of coma correlated with their cognitive and adaptive profile. Group 2 (n = 14) included subjects with severe language and/or motor disabilities presenting with a partial cognitive functioning level moderately impaired. Group 3 (n = 27) included patients with reduced responsiveness (LOCFAS ≤ 3).Conclusions: In the first 12 months following severe TBI, 22.9% children stayed in minimal responsiveness, 11.9% showed debilitating language and motor deficits and 65.2% showed a more favourable cognitive recovery and could be assessed by WISC-III.

Use of the Tower of London – Drexel University, Second Edition (TOLDX) in Adults With Traumatic Brain Injury

The Tower of London – Drexel University, Second Edition (TOLDX) was investigated in order to determine the efficacy of using this instrument in evaluating the impact of traumatic brain injury on cognitive functioning in adults. Performance on the TOLDX was compared among 56 individuals with complicated mild to severe traumatic brain injury (“sTBI”), 68 individuals with uncomplicated, mild traumatic brain injury (“mTBI”), and 124 demographically matched, healthy controls. Both TBI groups performed worse than controls on TOLDX measures of executive time (ET) and number of moves used (TMS), but only patients with sTBI were more likely to be impaired on TMS (i.e., performing at least 1.5 SD below the mean). Poorer performance on TMS was associated with increasing length of coma. Although poor sensitivity of this measure limits its use in isolation, the TOLDX may provide a complementary measurement of aspects of problem-solving deficit in TBI that may not be captured by other tests.

Value of clinical manifestations in predication of prognosis of patients with diffuse axonal injury

Objective To investigate the relationship of clinical manifestations with prognosis of patients with diffuse axonal injury (DAI) and select the indices that can accurately evaluate the prognosis so as to create a predictive model of outcome of DAI patients. Methods Clinical data of 98 DAI patients were retrospectively analyzed to identify the relationship between the indices and outcomes through Cochran-Mantel-Haenszel x2 test or Student-Newman-Keuls one way variance test via SAS 8.1.Then,the indices was analyzed through multivariant cumulative stepwise way so as to establish the Logistic regression model. Results (1)The indices including Glasgow Coma Score (GCS) on admission,combined with other type of cerebral injuries,unstable vital signs,abnormal pupil size and reactivity,decerebrate rigidity,imaging with characteristic DAI signs,paralysis of the limbs and length of coma were correlated with the outcome,while the indices including gender,age,injury mechanism,pathologic signs and decorticate rigidity were insignificantly associated with the outcome.(2) The logistic regression model showed that GCS on admission,paralysis degree of the limbs,abnormal pupil size and reactivity,and combined with cerebral injuries were the optimum predictors of outcome of the DAI patients. Conclusions The logistic regression model in the study is a reliable tool in predicting the prognosis of DAI patients.The patients wit higher GCS on admission may have better outcome.The patients with light degree of paralysis,normal pupil size and reaction,and combined with none cerebral injuries may have sound prognosis. Key words: Diffuse axonal injury; Prognosis; Regression analysis