Levels Of Traumatic Brain Injury Research Articles

Blast injury risks to humans within a military trench

In land warfare, trenches serve as vital defensive fortifications, offering protection to soldiers while engaging in combat. However, despite their protective function, soldiers often sustain injuries within these trenches. The lack of corresponding blast data alongside empirical injury reports presents a significant knowledge gap, particularly concerning the blast pressures propagating within trench spaces following nearby explosions. This absence hinders the correlation between blast parameters, trench geometry, and reported injury cases, limiting our understanding of blast-related risks within trenches.This paper addresses the critical aspect of blast propagation within trench systems, essential for evaluating potential blast injury risks to individuals within these structures. Through advanced computational fluid dynamics (CFD) simulations, the study comprehensively investigates blast injury risks resulting from explosions near military trenches. Employing a sophisticated computational model, the research analyzes the dynamic blast effects within trenches, considering both geometrical parameters and blast characteristics influenced by explosive weight and scaled distance.The numerical simulations yield valuable insights into the impact of these parameters on blast injury risks, particularly focusing on eardrum rupture, lung injury, and traumatic brain injury levels within the trench. The findings elucidate distinct patterns of high-risk zones, highlighting unique characteristics of internal explosions due to confinement and venting dynamics along the trench. This study underscores the significance of detailed numerical modeling in assessing blast injury risks and provides a novel knowledge base for understanding risks associated with explosives detonating near military trenches. The insights gained contribute to enhancing safety measures in both military and civilian contexts exposed to blast events near trench structures.

Statistical Analysis of Survival of Brain Injury Patients

Background: Developing countries are facing a number of health issues and spend a huge amount of money on them. Out of the health issues, Traumatic Brain Injury (TBI) is a major global public health problem causing substantial mortality and disability among adults as well as young people. Also, people spend a lot of money to take care of TBI patients. So, this study aims at identifying how in-hospital survival differs with age of TBI patients. Objective: To study the survival of different age groups at different levels of Traumatic Brain Injury(TBI). Methodology: The patients having brain injury and admitted to the Intensive Care Unit (ICU) ward with an age between 18 and 55 years are included in the study. Every patient will be followed up to death or discharge or up to the 21st day after admission to the ICU. We used Kaplan Meier (KM) survival plots to compare survival rates in different age groups and different levels of brain injury. Results: We found that 77% are male and 33% are female patients. About 85% of brain injuries are due to the Road Traffic Accidents (RTA) and 10% due to violations of traffic rules. Mild, Moderate, and severely injured patients are 46%, 25%, and 29% respectively. Conclusion: As age increases, the in-hospital survival rate of TBI patients increases. In-hospital survival rate of TBI patients in the age groups 18–30 and 44–55 increases as the level of injury increases.

What is next in African neuroscience?

Working in Africa provides neuroscientists with opportunities that are not available in other continents. Populations in this region exhibit the greatest genetic diversity; they live in ecosystems with diverse flora and fauna; and they face unique stresses to brain health, including child brain health and development, due to high levels of traumatic brain injury and diseases endemic to the region. However, the neuroscience community in Africa has yet to reach its full potential. In this article we report the outcomes from a series of meetings at which the African neuroscience community came together to identify barriers and opportunities, and to discuss ways forward. This exercise resulted in the identification of six domains of distinction in African neuroscience: the diverse DNA of African populations; diverse flora, fauna and ecosystems for comparative research; child brain health and development; the impact of climate change on mental and neurological health; access to clinical populations with important conditions less prevalent in the global North; and resourcefulness in the reuse and adaption of existing technologies and resources to answer new questions. The article also outlines plans to advance the field of neuroscience in Africa in order to unlock the potential of African neuroscientists to address regional and global mental health and neurological problems.

The effects of marijuana use prior to traumatic brain injury on survival

BackgroundLegalization of recreational marijuana throughout the United States has been associated with increased emergency department visits involving marijuana and its metabolites, tetrahydrocannabinol (THC) and cannabinoids. We investigated the relationship between marijuana use and outcomes after all levels of traumatic brain injury (TBI) from a large multi-center regional dataset. MethodsA retrospective review of de-identified patient data from twenty-six regional hospitals, was performed to identify adult patients with mild, moderate, and severe TBI between January 2012 and December 2018, a toxicology screen, and drug screen results. Included patients were divided into four subgroups: 1) No Drugs, 2) THC, 3) Other drugs (one or more drugs not including THC), and 4) THC + Other drugs. The primary outcome was mortality at discharge, while secondary outcomes included days in intensive care unit (ICU), length of hospital stay (LOS), and days on a ventilator. ResultsA total of 3,237 patients (median age 46 years [range: 18–97 years]; 31.9% female [1029/3,227]) met the inclusion criteria. Patients in the No Drugs group had significantly higher mortality rates at discharge than the THC (p = 0.0046), Other Drugs (p = 0.0307), and THC + Other Drugs groups (p = 0.0441). On multiple logistic regression, drug status was found not to be an independent predictor of mortality at discharge, while age, Glasgow Coma Scale (GCS), days in the ICU, Injury Severity Score (ISS), LOS, and days on a ventilator were independent predictors. ConclusionsPatients positive for one or more drugs, including marijuana, had significantly lower mortality at discharge than those with no drugs; however, after controlling for confounding variables, drug status was not found to be an independent predictor of mortality at discharge. Therefore, our results indicate no survival benefit for any level of TBI with concomitant drug use, including marijuana, in contrast to recent studies. Level of Evidence[Level III Prognostic and Epidemiological Study] - Prognostic.

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.

Understanding concussion knowledge and behavior among mixed martial arts, boxing, kickboxing, and Muay Thai athletes and coaches

ABSTRACT Objectives: In combat sports, strikes to the head are not just incidental but a deliberate and clear determinant of success. Concussion is a complex injury that is poorly understood and inappropriate practices are often observed among athletes and coaches. The purpose of this study was to investigate concussion knowledge and behavior as well as address recommendations for combat sports athletes and coaches. Methods: 70 athletes and 35 coaches from combat sports disciplines completed an online-validated survey and a personal questionnaire about concussion knowledge, training experience, and knowledge translation. Athletes were divided into subgroups for analysis according to sex (male n = 55, female n = 15), skill level (amateur n = 52, professional n = 18), and weight classes (<66.2 kg: n = 25, 66.6 to 77.5 kg: n = 30, and >78 kg: n = 15). Results: The likely absence of health-care professionals during training was confirmed by 68.5% of coaches, and athletes declared that self-diagnosis (79%) and coaches’ diagnosis (43.3%) were the most used method of suspected concussion assessment. Merely 5.7% of coaches properly recognized the level of traumatic brain injury a concussion represents, 68.8% were unfamiliar with any sideline assessment tools, and only 14.3% often seek out concussion knowledge. Athletes who were aware of the level of brain injury a concussion represents performed fewer sparring sessions per week (mild: 1.27 ± 1.1; severe: 3.17 ± 2.81; p = .05, d = .89) and had a greater likelihood of reporting concussive episodes. Most professional (55.5%), female (54.5%), and under 66.2 kg (50%) athletes returned to full practice within 1 week following a concussion diagnosis. Conclusions: Relevant key gaps of knowledge and behavior were verified in combat sports athletes and coaches. The awareness of basic concepts may improve injury reporting and safer behavior in athletes. Knowledge translation strategies with accessible language are recommended for coaches, in particular on how to identify acute symptoms and perform basic assessment.

Factors affecting functional outcome in patients with traumatic brain injury sequelae: Our single-center experiences on brain injury rehabilitation.

This study aims to investigate the effect of rehabilitation on functional level of traumatic brain injury (TBI) patients and to examine the associated factors on functional gain in this patient population. Between October 2010 and November 2015, a total of 71 patients (63 males, 8 females; mean age 26.6±8.1 years; range, 18 to 56 years) who were admitted to our rehabilitation clinic with moderate-to-severe TBI were retrospectively analyzed. Functional recovery was assessed using the Functional Independence Measure (FIM) and Functional Ambulation Classification (FAC) scales. The patients were divided into two groups according to time from TBI to the initiation of rehabilitation: early (<6 months) and late (≥6 months). Possible predictive factors associated with FIM gain were evaluated. There was a significant improvement in the FIM scores from admission to discharge (p<0.001). There was a statistically significant difference in the FIM gain and FIM efficiency between the patient groups according to the initiation of rehabilitation (p<0.001). The FAC scores increased from admission to discharge, showing statistical significance (p<0.001). Duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis were found to be significant factors associated with FIM gain (p<0.001). Our study results suggest that rehabilitation is effective for functional gain, particularly in the early period in patients with moderate- to-severe TBI and duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis are also predictors of functional improvement.

Impacts of cognitive impairment for different levels and causes of traumatic brain injury, and education status in TBI patients.

ABSTRACTTraumatic brain injury (TBI) is one of main causes of death and disability among many young and old populations in different countries.Objective:The aim of this study were to consider and predict the cognitive impairments according to different levels and causes of TBI, and education status.Methods:The study was performed using the Mini-Mental State Examination (MMSE) to estimate cognitive impairment in patients at a trauma center in Zahedan city. Individuals were considered eligible if 18 years of age or older. This investigation assessed a subset of patients from a 6-month pilot study.Results:The study participants comprised 66% males and 34% females. Patient mean age was 32.5 years and SD was 12.924 years. One-way analysis of variance between groups indicated cognitive impairment related to different levels and causes of TBI, and education status in patients. There was a significant difference in the dimensions of cognitive impairments for different levels and causes of TBI, and education status. A regression test showed that levels of traumatic brain injury (b=.615, p=.001) and education status (b=.426, p=.001) predicted cognitive impairment.Conclusion:Different levels of TBI and education status were useful for predicting cognitive impairment in patients. Severe TBI and no education were associated with worse cognitive performance and higher disability. These data are essential in terms of helping patients understand their needs. Therefore, the factors identified can help plan effective rehabilitation programs.

Quality of the Development of Traumatic Brain Injury Clinical Practice Guidelines: A Systematic Review.

Traumatic brain injury (TBI) is a leading cause of death worldwide and is increasing exponentially particularly in low and middle income countries (LMIC). To inform the development of a standard Clinical Practice Guideline (CPG) for the acute management of TBI that can be implemented specifically for limited resource settings, we conducted a systematic review to identify and assess the quality of all currently available CPGs on acute TBI using the AGREE II instrument. In accordance with PRISMA guidelines, from April 2013 to December 2015 we searched MEDLINE, EMBASE, Google Scholar and the Duke University Medical Center Library Guidelines for peer-reviewed published Clinical Practice Guidelines on the acute management of TBI (less than 24 hours), for any level of traumatic brain injury in both high and low income settings. A comprehensive reference and citation analysis was performed. CPGs found were assessed using the AGREE II instrument by five independent reviewers and scores were aggregated and reported in percentage of total possible score. An initial 2742 articles were evaluated with an additional 98 articles from the citation and reference analysis, yielding 273 full texts examined. A total of 24 final CPGs were included, of which 23 were from high income countries (HIC) and 1 from LMIC. Based on the AGREE II instrument, the best score on overall assessment was 100.0 for the CPG from the National Institute for Health and Clinical Excellence (NIHCE, 2007), followed by the New Zealand Guidelines Group (NZ, 2006) and the National Clinical Guideline (SIGN, 2009) both with a score of 96.7. The CPG from a LMIC had lower scores than CPGs from higher income settings. Our study identified and evaluated 24 CPGs with the highest scores in clarity and presentation, scope and purpose, and rigor of development. Most of these CPGs were developed in HICs, with limited applicability or utility for resource limited settings. Stakeholder involvement, Applicability, and Editorial independence remain weak and insufficiently described specifically with piloting, addressing potential costs and implementation barriers, and auditing for quality improvement.

A miscarriage of justice: why is policy not implemented for young offenders?

In her recent State Opening of Parliament statement (May 2016), Her Majesty the Queen announced that action will be taken to ensure better mental health provision for individuals in the criminal justice system. We are optimistic that this welcome initiative means that all offenders, including those under 18 years old, will soon benefit from much needed and improved mental health services. Young offenders are known to have high levels of unmet and untreated mental health needs; they have frequently been in care and often come from violent and neglected backgrounds. This year's legislative programme is the opportunity to implement prevention, early intervention and treatment that suits young offenders and will improve young people's life outcomes.BACKGROUNDIn many countries, young offenders have some of the worst health of any group of young people. Deaths of young offenders are 10 times higher than in other adolescents due to drug overdose, suicide, accidental injury and homicide.1 In England, there are widespread concerns about organisational fragmentation and poor care in secure services for young people. This came to light on film at the private sector Medway centre.2 In relation to custody across all ages, the policymakers responsible for mental health have 'taken their eye off the ball': in Parliament, recently, Luciana Berger3 (Shadow Cabinet) requested information on the number of people with diagnosed mental health conditions receiving a custodial sentencing in the last five years. Jeremy Hunt (Secretary of State for Health) was unable to give an answer.Young people with mental health disorders are especially vulnerable while in custody. The board responsible for monitoring their care since 2000 (Youth Justice Board) has failed to implement good mental health practices.4Research funded by the Wellcome Trust shows there has been a gulf between well-intentioned policies on mental health in prisons and their implementation for over a century.5 Deaths of young people in custody demands effective implementation6 - this year, the whole system of youth justice is currently under review.7 In addition, young people have given their priorities through the Association for Young People's Health (AYPH). AYPH8 underlines two measures from the Public Health Outcomes Framework: reducing first time entrants to the youth justice system and reducing the suicide rate.WISHFUL THINKING?Under the Health and Social Care Act 2012,9 NHS England has the overall responsibility for health including mental health in prisons and immigration detention centres. This year, the government introduced a Five year Forward view on Mental Health.10 There is acknowledgement that half of all mental health problems are established by the age of 14 and this rises to three quarters by the age of 24. The risk factors for a mental illness are similar to the risk factors for becoming a young offender. In 2016, the National Audit Office estimates 90% of prisoners have mental health, drug and/or alcohol problems.11 The limited evidence we have from youth justice suggests this could be true for young offenders,12 who may have similar levels of unmet mental health needs. This could be aggravated by high levels of traumatic brain injury, recently estimated to be between 49% and 72% in young offenders.13 A risk factor for childhood traumatic brain injury is violence in the home and having come from a violent home is a risk factor for later offending. Longitudinal and inter-generational studies have shown that the more adverse events a growing child experiences, the more likely they are to develop mental disorders and antisocial behaviours. Of the sons of male prisoners, 60% are eventually imprisoned.There is insufficient provision for prevention, early intervention or continuing treatment of mental illness in young offenders. In this population, government fails to meet the UN's Sustainable Development Goals. Goal 3 is to ensure healthy lives and to promote wellbeing for all at all ages. …

Dopamine Release Impairment in Striatum After Different Levels of Cerebral Cortical Fluid Percussion Injury.

To investigate the role of dopamine release in cognitive impairment and motor learning deficits after brain injury, different levels of traumatic brain injury (TBI) were made in rats by using fluid percussion at two different atmospheres (2 Psi and 6 Psi). Tonic and phasic bursting dopamine release and behavior tests followed at several time points. We used in vitro fast-scan cyclic voltammetry to survey dopamine release in the striatum and analyzed the rats' behavior using novel object recognition (NOR) and rotarod tests. Both tonic and bursting dopamine release were greatly depressed in the severely (6 Psi) injured group, which persisted up to 8 weeks later. However, in the 2 Psi-injured group, the suppression of bursting dopamine release occurred at 1∼2 weeks after injury, but there were no significant differences after 4 weeks. Tonic dopamine release was also diminished significantly at 1∼2 weeks after the injury; partial recovery could then be seen 4 weeks after injury. A significant deficiency in the fixed speed rotarod test and NOR test were noted in both 2 Psi and 6 Psi groups initially; however, the changes recovered in the 2 Psi group 2 weeks after injury while persisting in the 6 Psi group. In conclusion, striatal evoked dopamine release was affected by fluid percussion injury, with behavioral deficits showing differences as a function of injury severity. The severe fluid percussion injury (6 Psi) group showed more dopamine release defects, as well as cognitive and motor deficiencies. Recovery of dopamine release and improvement in behavioral impairment were better in the mild TBI group.

Psychological state and needs of family member caregivers for victims of traumatic brain injury: A cross-sectional descriptive study

ObjectiveHere we evaluated the impact of varying severity of traumatic brain injury on the psychological state and demands of family caregivers. Further, we determined the most significant and least significant daily needs among family caregivers. MethodsWe performed a cross-sectional descriptive study in three public hospitals in Tai'an, China. Three hundred caregivers related to traumatic brain injury victims were randomly selected. Patients had varying degrees of injuries (mild to severe). The Symptom Checklist-90 (SCL-90) was used to assess family caregivers' psychological statuses. The Critical Care Family Needs Inventory (CCFNI) was used to determine family caregivers' needs. Finally, the Glasgow Coma Scale (GCS) was employed to define patients' level of traumatic brain injury. ResultsSCL-90 scores for each psychological dimension were significantly higher with increasing TBI severity (p < 0.05). Similarly, CCFNI scores were significantly higher with increasing TBI severity (p < 0.05) for information, reassurance, and accessibility. These same dimensions were found to be the most important needs for family members of TBI injury victims, while support and comfort were the least important dimensions. ConclusionsThe more severe pathogenic condition of the patient, the heavier the psychological pressure is on their family member caregivers. Medical staff should therefore pay close attention to the psychological health of family caregivers of TBI patients, especially family caregivers of critical cases. Interventions should be accordingly designed and conducted to meet the needs of family caregivers.

Traumatic pediatric white matter injury

White matter (WM) injury is increasingly recognized as central to the impact on the quality of life of patients with all severity levels of traumatic brain injury. It can be the determinant of death or persistent disability. This article reviews the characteristics of the developing brain in relation to trauma, the primary and secondary phases of WM injury, and advanced magnetic resonance techniques in the evaluation of brain trauma. Special emphasis is placed on non-accidental trauma and sports-related WM injury, respectively.

Readability Levels of Traumatic Brain Injury Websites in Australia, New Zealand, the United Kingdom, and the United States

Abstract Date Presented 4/17/2015 This study investigated the readability of international traumatic brain injury (TBI) websites. Results show that they are written at grade levels that exceed the literacy of many of those with TBI and a large portion of the general population. Suggestions to enhance readability of website and nonwebsite sources are described.

The Effect of Traumatic Brain Injury to the Emotional Intelligence

In this study, the effect of traumatic brain injury to the emotional intelligence was examined. It was identified by testing the difference of emotional intelligence among (1) types of injury (traumatic brain injury-non traumatic brain injury), (2) injured area of brain, (3) level of traumatic brain injury, and (4) injured area and level of brain injury. The participants in this study were twenty. They were asked to fill the emotional intelligence scale designed by the researcher. The data obtained was analyzed using non-parametric approach. The results showed there was significant effect of traumatic brain injury to the emotional intelligence (Z=-2.546; p<0.05). Meanwhile, there was no significant effect found to the emotional intelligence among the injured area of brain (chi-square=1.107; p>0.05), level of brain injury (Z=-1.226; p>0.05), and both; the injured area and the level of brain injury (F=0.302; p>0.05).

Update on Mild Traumatic Brain Injury: Neuropathology and Structural Imaging

In this installment of the Windows to the Brain series, the authors present detailed, graphic representation of neuronal injury for all levels of traumatic brain injury (TBI), including mild. We see representation of the swollen axon profiles characteristic of the “diffuse axonal injury” that produces transient focal deformations resulting from applied forces such as angular acceleration, pressure, and ballistic trauma, and, over time, the localized swelling that can become sufficient to rupture the axon. A challenge for the clinical follow-up of mild TBI is the presence of considerable differences across patients in the anatomic distribution of affected areas.

Training communication partners of people with severe traumatic brain injury improves everyday conversations: A multicenter single blind clinical trial

To determine effectiveness of communication training for partners of people with severe traumatic brain injury. Three arm non-randomized controlled trial comparing communication partner training (JOINT) with individual treatment (TBI SOLO) and a waitlist control group with 6 month follow-up. Forty-four outpatients with severe chronic traumatic brain injuries were recruited. Ten-week conversational skills treatment program encompassing weekly group and individual sessions for both treatment groups. The JOINT condition focused on both the partner and the person with traumatic brain injury while the TBI SOLO condition focused on the individual with TBI only. Primary outcomes were blind ratings of the person with traumatic brain injury's level of participation during conversation on the Measure of Participation in Communication Adapted Kagan scales. Communication partner training improved conversational performance relative to training the person with traumatic brain injury alone and a waitlist control group on the primary outcome measures. Results were maintained at six months post-training. Training communication partners of people with chronic severe traumatic brain injury was more efficacious than training the person with traumatic brain injury alone. The Adapted Kagan scales proved to be a robust and sensitive outcome measure for a conversational skills training program.

The Toronto traumatic brain injury study

To assess the relationship between regional brain volume changes and traumatic brain injury (TBI) severity in patients with and without focal lesions. Sixty-nine chronic-phase TBI patients spanning the full range of severity were recruited from consecutive hospital admissions. Patients received high-resolution structural MRI a minimum of 1 year after injury. Multivariate statistical analyses assessed covariance patterns between volumes of gray matter, white matter, and sulcal/subdural and ventricular CSF across 38 brain regions and TBI severity as assessed by depth of coma at the time of injury. Patients with diffuse and diffuse plus focal injury were analyzed both separately and together. There was a stepwise, dose-response relationship between parenchymal volume loss and TBI severity. Patients with moderate and severe TBI were differentiated from those with mild TBI, who were in turn differentiated from noninjured control subjects. A spatially extensive pattern of volume loss covaried with TBI severity, with particularly widespread effects in white matter volume and sulcal/subdural CSF. The most reliable effects were observed in the frontal, temporal, and cingulate regions, although effects were observed to varying degrees in nearly every brain region. Focal lesions were associated with greater volume loss in frontal and temporal regions, but volume loss remained marked even when analyses were restricted to patients with diffuse injury. Patterns of parenchymal volumetric changes can differentiate among levels of traumatic brain injury (TBI) severity, even in mild TBI. TBI causes a spatially extensive pattern of volume loss that reflects independent but overlapping contributions of focal and diffuse injury.

Modelling 5-year functional outcome in a major traumatic injury survivor cohort

Aim. To estimate associations between possible predictors of functional disability outcome at 5 years in a working adult population cohort of survivors of major traumatic injury and to develop a prognostic model of outcome.Design. Population based retrospective cohort study.Population. Persons who had experienced major traumatic injury (Injury Seventy Score >15) in the area of the former Yorkshire Regional Health Authority during the period 30 September 1988 to 1 October 1989 and who survived for 5 years (average 5.3 years).Methods. The same interviewer saw each survivor at their home and used the OPCS Adult Disability Schedule to ascertain levels of functional disability. Disability scores for each survivor were then combined in accordance with the OPCS guidance to calculate a level of disability between 0 (no disability) to 10 (maximum disability). The OPCS level was then dichotomised with a cut-point at 4/5. Possible predictor and confounding variables from pre-injury, injury and post-injury periods were modelled in a logistic regression to identify those that predicted outcome level. Two reduced models were developed to allow early prognosis of late outcome.Results. The full model correctly classified 91% of observed outcomes. Inpatient length of stay OR 1.031 (95% CI 1.014,1.048) per day predicted poorer 5-year outcome; Glasgow Coma Score OR 0.790(0.629,0.992) per 1 point increase; stay in Intensive Care Unit OR 0.931 (0.877,0.987) per day; attainment of degree-level education OR 0.014 (0.000,0.707); single civil status OR 0.110 (0.013,0.908); being taken initially to a hospital with a neurosurgical facility OR 0.064(0.010,0.420); being in paid work during the 2 weeks before index injury OR 0.093(0.009,0.969) predicted better 5-year disability outcome. Two reduced models were constructed that included a simple set of variables, one of these models excluded any rehabilitation variables but still correctly classified 85% of the observed outcomes.Conclusion. As well as level of traumatic brain injury (TBI) and total inpatient stay, Pre-injury educational attainment and employment, civil status, immediate care in a hospital with a neurosurgical facility and stay in an Intensive Care Unit determined 5-year outcome. It is possible to efficiently predict outcome at an early stage. Previous work on predictors of disablement have suffered from large selection and attrition biases.

The effect of age on outcome following traumatic brain injury in rats

Age of the patient is one of the most important predictors of outcome following human traumatic brain injury. This study employs the fluid-percussion model to investigate the effects of aging on outcome following traumatic brain injury in rats. The results revealed that there was an age-associated increase in mortality rate following both low (1.7 to 1.8 atm) and moderate (2.00 to 2.25 atm) levels of traumatic brain injury. Age-related changes in systemic physiological, neurological, and histopathological indexes of brain injury were also examined following a low level of traumatic brain injury. Traumatic brain injury produced equivalent acute hypertension and increased plasma glucose levels in both young adult and aging rats. Injury produced an acute increase in heart rate in the young adult rat group, while the heart rate decreased in the aged rats. At low levels of brain injury, no significant gross histopathological alterations were produced in either age group. Neurological outcome was assessed by measuring the duration of suppression of a number of nonpostural and postural reflexes and more complex somatomotor functions (righting, escape, head support). Except for head support, there was a significant age-related increase in the duration of the suppression of these reflexes following brain injury. These data demonstrate that aging is associated with an increased mortality rate and greater acute neurological deficits following traumatic brain injury. These data also demonstrate the usefulness of the fluid-percussion model for studying the mechanisms responsible for the age-related increase in vulnerability to brain injury.