Diagnosis Of mTBI Research Articles

Therapeutic Relationship in mTBI Rehabilitation: The Disparity Between the Illness Experience and Clinical Definitions.

A positive therapeutic relationship is characterized by trust and mutually perceived genuineness. It is positively associated with patients' adherence to treatment, satisfaction, and health outcomes. When service members with a history of mild traumatic brain injury (mTBI) present to rehabilitation clinics with nonspecific symptoms, a disparity between their experience of disability and clinical expectations of mTBI may disrupt the establishment of a positive therapeutic relationship between patients and providers. The objectives of this study are to (1) explore disparities between military service members and rehabilitation clinicians about the clinical diagnosis and illness experience of mTBI and (2) identify barriers to the establishment of a positive therapeutic relationship. This is a qualitative descriptive study of military service members with prior mTBI (n = 18) and clinicians (n = 16) who participated in interviews and focus groups. Data were analyzed thematically using Kleinman's framing of illness experience and clinical diagnosis. Three themes reflected the potential breakdowns in the therapeutic relationship. The first theme, clinical expectations for post-injury recovery versus patients' experience of ongoing disability, reflects the inconsistency between clinicians' expectations of symptom resolution within 90 days following mTBI and service members' experiences of symptoms that worsened over several months or years. The second theme, symptom attribution to mental health conditions versus tissue injury, describes the difficulty in attributing symptoms to the physical impact of the mTBI or mental health diagnoses that may also stem from the injury event. The third theme, suspected malingering versus valid disability, describes clinicians' reports of frustration with cases in which they suspected malingering for secondary gains in contrast with service members' feelings that their problems were not taken seriously by clinicians. This study extended previous research on therapeutic relationships by examining the situation of mTBI rehabilitation services for military service members. The findings reinforce the best practice recommendations of acknowledging patients' experiences, addressing the presenting symptoms and problems, and encouraging progressive return to activity following mTBI. Acknowledgment of and attention to patients' illness experience by rehabilitation clinicians is necessary and important for supporting a positive therapeutic relationship and ultimately to optimize patients' health outcomes and reduce disability.

Non-invasive fluid biomarkers in the diagnosis of mild traumatic brain injury (mTBI): a systematic review

BackgroundDespite approximately 55.9 million annual mild traumatic brain injuries (mTBIs) worldwide, the accurate diagnosis of mTBI continues to challenge clinicians due to symptom ambiguity, reliance on subjective report and presentation...

Research on the Potential Biomarkers of Mild Traumatic Brain Injury: a Systematic Review and Bibliometric Analysis.

Reliable diagnostic methods for mild traumatic brain injury (mTBI) are lacking, and many researchers continue to search for objective biomarkers that can both define and detect mTBI. Although much research has been conducted in this field, there have not been many bibliometric studies. In this study, we aim to analyze the development over the last two decades in scientific output relating to the diagnosis of mTBI. To do this, we extracted documents from Web of Science, PubMed, and Embase and performed descriptive analysis (number of publications, primary journals, authors, and countries/regions), trend topics analysis, and citation analysis for papers across the globe, with a particular focus on molecular markers. One thousand twenty-three publications spanning 390 journals were identified on Web of Science, PubMed, and Embase for the period from 2000 to 2022. The number of publications increased every year (from 2 in 2000 to 137 in 2022). Of all the publications we analyzed, 58.7% had authors from the USA. Our analysis shows that molecular markers are the most studied markers in the field of mTBI diagnostics, accounting for 28.4% of all publications, and that the number of studies focused on this specific aspect has increased sharply in the past 5years, indicating that molecular markers may become a research trend in the future.

Racial and Ethnic Differences in Deaths by Suicide, Drug Overdose, and Opioid-Related Overdose in a National Sample of Military Members With Mild Traumatic Brain Injury, 1999-2019.

To examine racial and ethnic differences in suicide and drug and opioid-related overdose deaths among a population-based cohort of military service members who were diagnosed with a mild traumatic brain injury (mTBI) during military service. Retrospective cohort. Military personnel receiving care within the Military Health System between 1999 and 2019. In total, 356 514 military members aged 18 to 64 years, who received an mTBI diagnosis as their index TBI between 1999 and 2019, while on active duty or activated. Death by suicide, death by drug overdose, and death by opioid overdose were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes within the National Death Index. Race and ethnicity were captured from the Military Health System Data Repository. Overall crude rates were 38.67 per 100 000 person-years for suicide; 31.01 per 100 000 person-years for drug overdose death; and 20.82 per 100 000 person-years for opioid overdose death. Crude and age-specific rates for military members who self-identified as Other were higher than all other racial/ethnic groups for all 3 mortality outcomes. Adjusting for age, suicide rates for those classified as Other were up to 5 times that of other racial/ethnic groups for suicide, and up to 11 and 3.5 times that of other race/ethnicity groups for drug and opioid overdose death, respectively. Findings extend previous knowledge regarding risk for suicide and deaths by drug overdose among those with mTBI and highlight new important areas for understanding the impact of race and ethnicity on mortality. Methodological limitations regarding classification of race and ethnicity must be addressed to ensure that future research provides a better understanding of racial and ethnic disparities in suicide and drug overdose mortality among military members with TBI.

Changes in Outpatient Healthcare Utilization and Costs Following Mild Traumatic Brain Injury Among Service Members in the Military Health System by Preexisting Behavioral Health Condition Status.

To evaluate changes in healthcare utilization and cost following an index mild traumatic brain injury (mTBI) diagnosis among service members (SMs). We hypothesized that differences in utilization and cost will be observed by preexisting behavioral health (BH) diagnosis status. Direct care outpatient healthcare facilities within the Military Health System. A total of 21 984 active-duty SMs diagnosed with an index mTBI diagnosis between 2017 and 2018. This retrospective study analyzed changes in healthcare utilization and cost in military treatment facilities among SMs with an index mTBI diagnosis. Encounter records 1 year before and after mTBI were assessed; preexisting BH conditions were identified in the year before mTBI. Ordinary least squares regressions evaluated difference in the average change of total outpatient encounters and costs among SMs with and with no preexisting BH conditions (eg, posttraumatic stress disorder, adjustment disorder). Additional regressions explored changes in utilization and cost within clinic types (eg, mental health, physical rehabilitation). There was a 39.5% increase in overall healthcare utilization during the following year, representing a 34.8% increase in total expenditures. Those with preexisting BH conditions exhibited smaller changes in overall utilization (β, -4.9; [95% confidence interval (CI), -6.1 to -3.8]) and cost (β, $-1873; [95% CI, $-2722 to $-1024]), compared with those with no BH condition. The greatest differences were observed in primary care clinics, in which those with prior BH conditions exhibited an average decreased change of 3.2 encounters (95% CI, -3.5 to -3) and reduced cost of $544 (95% CI, $-599 to $-490) compared with those with no prior BH conditions. Despite being higher utilizers of healthcare services both pre- and post-mTBI diagnosis, those with preexisting BH conditions exhibited smaller changes in overall cost and utilization. This highlights the importance of considering prior utilization and cost when evaluating the impact of mTBI and other injury events on the Military Health System.

Early Diagnosis of Cognitive Impairment in Mild TBI

Background: Traumatic brain injury (TBI) is the first cause of death and disability in the young and active population. In the context of TBI, Mild Traumatic brain Injury (m-TBI) is frequent and it is often associated with transient cognitive disorders. Aim: The aim of this study was to promote the early diagnosis of cognitive and behavioral disorders in patients with m-TBI and to prevent under-diagnosed and long-term symptoms, reducing the risk of a decline in patient’s quality life. Design: A Longitudinal observational study was conducted on subjects who received diagnosis of mTBI in emergency department along a period of time between October 2018 and June 2021. Setting: Patients were primarily evaluated in Emergency Department of the Buccheri La Ferla Hospital in Palermo. Rehabilitation and follow-ups were conducted in Rehabilitation Medicine Complex Operative Unit of the same medical center. Population: 520 patients were registered with a diagnosis of Head Trauma in Emergency Rooms during the observational period. 65 patients (12, 5%) had a diagnosis of non-commotional head injury and therefore the possibility of being part of the study. 49 patients were included, 9 patients were excluded, 4 patients refused to be part of the study. The average age was 46, 7 years. Methods: a first neuro-psychological evaluation of the patient with m-TBI was conducted within 48 hours of the event. Anamnestic data were collected and standardized neuro-psychological screening tests were administered. Patients were followed up by a team of doctors and neuro-psychologists for a period of 12 months in order to monitor cognitive and behavioral condition. Patients with a cognitive deficit underwent to neuro-psychological rehabilitation. Results: 41% of the patients showed cognitive deficits, especially in executive functions. Patients who underwent to neuro-psychological rehabilitation obtained a normal profile at subsequent follow-up evaluations. Conclusion: m-TBI can cause different clinical manifestations. Therefore, a multidisciplinary intervention is important in order to recognize the patients most at risk of developing long-term cognitive symptoms that can compromise social and occupational functioning. Clinical Rehabilitative Impact: Post-trauma neuropsychological evaluation allows for early recognition of cognitive disorders. Neuro-psychological rehabilitation improves the quality of life of patients and reduces healthcare cost.

Missed Emergency Department Diagnosis of Mild Traumatic Brain Injury in Patients with Chronic Pain After Motor Vehicle Collision

BACKGROUND: Mild traumatic brain injury (mTBI), or concussion, is the most common presentation of TBI in the emergency department (ED), but a diagnosis of mTBI may be missed in patients presenting with other acute injuries after a motor vehicle collision (MVC). OBJECTIVE: To estimate the frequency of missed diagnoses of mTBI in patients seen in the ED after MVC who later developed chronic pain syndromes. STUDY DESIGN: Retrospective cohort study. SETTING: An interventional pain management clinic. METHODS: Data were drawn from information collected during standardized intake assessments completed by 33 patients involved in an MVC referred to a community-based clinic for chronic pain management. The prevalence of missed mTBI and postconcussion syndrome (PCS) were estimated based on the clinical diagnosis, which included reviewing acute care medical records, the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) scores, and patient-reported injury history. RESULTS: There was a high prevalence of presumed mTBI in this sample (69.7%) of patients involved in an MVC, but an acute care diagnosis was made in only 39.1% of cases. Patients diagnosed with mTBI at acute care had significantly lower PCS symptom scores than patients whose diagnosis was missed (P < 0.05). Diagnostic brain imaging (magnetic resonance imaging [MRI] or computed tomography [CT]) was more frequently ordered (P < 0.05) in patients diagnosed with mTBI. Using a modified RPQ developed for use with chronic pain patients, 54.5% of the sample met criteria for PCS. Loss of consciousness, meeting established criteria for mTBI, postinjury headache, and meeting criteria for posttraumatic stress disorder were significantly correlated with the development of PCS. LIMITATIONS: Data may be subject to recall and selection bias. Additional research with a larger study sample is needed to investigate correlations between individual symptoms and the development of PCS following an MVC. CONCLUSION: Patients presenting to the ED following an MVC have a high prevalence of mTBI. Patients whose diagnosis of mTBI is missed end up with significantly more severe postconcussion symptoms. While all patients included in this study were either referred or being treated for chronic pain after an MVC, they all also went on to develop PCS and disability following their accident, suggesting that better screening for mTBI after an MVC might identify those who may require more follow-up or rehabilitation therapy. In particular, those presenting with loss of consciousness, an altered mental state, posttraumatic amnesia, or postinjury headache are at increased risk of PCS. KEY WORDS: Motor vehicle collision, postconcussion syndrome, chronic pain, posttraumatic stress disorder, concussion, mild traumatic brain injury, emergency department

White Matter Microstructure Is Associated with Serum Neuroactive Steroids and Psychological Functioning.

Military service members are at increased risk for mental health issues, and comorbidity with mild traumatic brain injury (mTBI) is common. Largely overlapping symptoms between conditions suggest a shared pathophysiology. The present work investigates the associations among white matter microstructure, psychological functioning, and serum neuroactive steroids that are part of the stress-response system. Diffusion-weighted brain imaging was acquired from 163 participants (with and without military affiliation) and free-water-corrected fractional anisotropy (FAT) was extracted. Associations between serum neurosteroid levels of allopregnanolone (ALLO) and pregnenolone (PREGNE), psychological functioning, and whole-brain white matter microstructure were assessed using regression models. Moderation models tested the effect of mTBI and comorbid post-traumatic stress disorder (PTSD) and mTBI on these associations. ALLO is associated with whole-brain white matter FAT (β = 0.24, t = 3.05, p = 0.006). This association is significantly modulated by PTSD+mTBI comorbidity (β = 0.00, t = 2.50, p = 0.027), although an mTBI diagnosis alone did not significantly impact this association (p = 0.088). There was no significant association between PREGNE and FAT (p = 0.380). Importantly, lower FAT is associated with poor psychological functioning (β = -0.19, t = -2.35, p = 0.020). This study provides novel insight into a potential common pathophysiological mechanism of neurosteroid dysregulation underlying the high risk for mental health issues in military service members. Further, comorbidity of PTSD and mTBI may bring the compensatory effects of the brain's stress response to their limit. Future research is needed to investigate whether neurosteroid regulation may be a promising tool for restoring brain health and improving psychological functioning.

A novel point-of-care diagnostic prototype system for the simultaneous electrochemiluminescent sensing of multiple traumatic brain injury biomarkers.

Traumatic brain injuries (TBI) are typically acquired when a sudden violent event causes damage to the brain tissue. A high percentage (70-85%) of all TBI patients are suffering from mild TBI (mTBI), which is often difficult to detect and diagnose with standard imaging tools (MRI, CT scan) due to the absence of significant lesions and specific symptoms. Recent studies suggest that a screening test based on the measurement of a protein biomarker panel directly from a patient's blood can facilitate mTBI diagnosis. Herein, we report a novel prototype system designed as a precursor of a future hand-held point-of-care (POC) diagnostic device for the simultaneous multi-biomarker sensing, employing a microarray-type spatially resolved electrochemiluminescence immunoassay (SR-ECLIA). The small tabletop prototype consists of a screen-printed electrode compartment to conduct multi-analyte ECL sandwich assays, a potentiostat module and a light collection module, all integrated into a compact 3D-printed housing (18.2 × 16.5 × 5.0 cm), as well as an sCMOS detector. Based on this design concept, further miniaturization, system integration, performance optimization and clinical evaluation shall pave the way towards the development of a portable instrument for use at the site of accident and healthcare. To demonstrate the system's feasibility, current performance and efficiency, the simultaneous detection of three mTBI biomarkers (GFAP, h-FABP, S100β) in 50% serum was achieved in the upper pg mL-1 range. The proposed device is amenable to the detection of other biomarker panels and thus could open new medical diagnostic avenues for sensitive multi-analyte measurements with low-volume biological sample requirements.

Discriminating Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Using Latent Neuroimaging and Neuropsychological Profiles in Active-Duty Military Service Members.

Mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) commonly occur among military Service Members and Veterans and have heterogenous, but also overlapping symptom presentations, which often complicate the diagnoses of underlying impairments and development of effective treatment plans. Thus, we sought to examine whether the combination of whole brain gray matter (GM) and white matter (WM) structural measures with neuropsychological performance can aid in the classification of military personnel with mTBI and PTSD. Active-Duty US Service Members ( n = 156; 87.8% male) with a history of mTBI, PTSD, combined mTBI+PTSD, or orthopedic injury completed a neuropsychological battery and T1- and diffusion-weighted structural neuroimaging. Cortical, subcortical, ventricular, and WM volumes and whole brain fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated. Latent profile analyses were performed to determine how the GM and WM indicators, together with neuropsychological indicators, classified individuals. For both GM and WM, respectively, a 4-profile model was the best fit. The GM model identified greater ventricular volumes in Service Members with cognitive symptoms, including those with a diagnosis of mTBI, either alone or with PTSD. The WM model identified reduced FA and elevated RD in those with psychological symptoms, including those with PTSD or mTBI and comorbid PTSD. However, contrary to expectation, a global neural signature unique to those with comorbid mTBI and PTSD was not identified. The findings demonstrate that neuropsychological performance alone is more robust in differentiating Active-Duty Service Members with mTBI and PTSD, whereas global neuroimaging measures do not reliably differentiate between these groups.

Neurobehavioral Symptom Inventory Item-Level Change Complements the Reliable Change Method.

To determine correspondence between the statistically derived 8-point reliable change index for the Neurobehavioral Symptom Inventory (NSI) against clinically significant item-level change in symptom severity from intake to discharge for mild traumatic brain injury (mTBI). Brain Injury Rehabilitation Service at Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas. In total, 655 active-duty service members with a diagnosis of mTBI who received treatment and completed self-report measures between 2007 and 2020. Observational retrospective analysis of outpatient clinical outcomes data. NSI total score change was used to divide patients into responder and nonresponders based on whether they met an 8-point decrease between intake and discharge. In addition, patients who had at least one NSI item that changed from a rating of 3 (severe) or 4 (very severe) at intake to a rating of 0 (none) or 1 (mild) at discharge were coded as an individual with significant item-level change. Forty-five percent of the sample had significant item-level change and were classified as responders according to the reliable change method. Eight percent of the sample had significant item-level change but did not meet the 8-point reliable change threshold. Fifteen percent of the sample did not experience significant item-level change but were classified as responders according to reliable change. Thirty-one percent did not meet either method's criterion for change. Classification agreement between the reliable change and item-level change methods was 76%, which was statistically significant ( = 181.32, P < .001). There is good correspondence between reliable change and item-level change on the NSI in this population. Reliable change is easily calculated and thus much more accessible than the item-level change method. There may be some situations where calculating item-level change may be helpful.

Mild Traumatic Brain Injury: What We Can Learn from a Qualitative Study of Patient Perceptions Following Emergency Department Discharge

Aims: This study investigated the experiences of patients with mild traumatic brain injury (mTBI) to identify barriers and suggest clinically relevant areas for improvement in the current system of care.&#x0D; Methods: 16 patients with a clinical diagnosis of mTBI were recruited from the Cork University Hospital Emergency Department (ED) for participation in this study. Semi-structured phone interviews were conducted at approximately 2.5-3 months post-discharge. Reflexive thematic analysis with an inductive and realist approach was used to code and inductively analyse the data. The most frequently occurring themes and their relationship to subthemes are reported.&#x0D; Results: A total of 16 mTBI adult patients were interviewed (mean age: 50.5 (18-85)). Major themes identified in the experience of mTBI patients were: lack of clarity in diagnosis and treatment, poor access to information, and ongoing symptoms. Notably, 87.5% of participants reported being uncertain about their diagnosis of mTBI and 93.8% of participants did not seek further information regarding their head injury. Nearly half (43.8%) of the participants reported prolonged recovery with two participants (12.5%) reporting ongoing symptoms. Headache, photophobia, and difficulty with thinking and memory were the predominant symptoms reported.&#x0D; Conclusion: Several overarching themes were identified in the qualitative self-reported experiences of mTBI patients following ED discharge. Participants reported persistent symptoms, lack of clarity, and a lack of access to information regarding their mTBI diagnosis and treatment. Suggested recommendations for future practice include adding psychoeducational resources and increasing awareness and training among staff to provide timely patient education.

MTBI-DSANet: A deep self-attention model for diagnosing mild traumatic brain injury using multi-level functional connectivity networks

The main approach for analyzing resting-state functional magnetic resonance imaging (rs-fMRI) is the low-order functional connectivity network (LoFCN) based on the correlation between two brain regions. Based on LoFCN, researchers recently proposed the topographical high-order FCN (tHoFCN) and the associated high-order FCN (aHoFCN) to explore the high-order interactions among brain regions. In this work, we designed a Deep Self-Attention (DSA) framework called mTBI-DSANet to diagnose mild traumatic brain injury (mTBI) using multi-level FCNs, including LoFCN, tHoFCN, and aHoFCN. The multilayer perceptron and self-attention mechanism in mTBI-DSANet were designed to capture important features for the mTBI diagnosis. We evaluated the mTBI-DSANet’s performance on the real rs-fMRI dataset, which was collected by Third Xiangya Hospital of Central South University from April 2014 to February 2021. We compared the performance of mTBI-DSANet with distinct FCNs and their combinations under 10-fold cross-validation. Based on the LoFCN+aHoFCN combination, the average performance of mTBI-DSANet achieved the best accuracy of 0.834, which is significantly better than peer methods. The experiments demonstrated the potential of the mTBI-DSANet in assisting mTBI diagnosis.

The Potential Role of Neurofilament Light in Mild Traumatic Brain Injury Diagnosis: A Systematic Review.

Mild traumatic brain injury (mTBI) is an insult to the CNS often overlooked at the time of presentation due to variable symptomatology and undetectable nature on CT/MRI. Increased exposure to repetitive head injuries results in a high prevalence of mTBI among athletes and military personnel. While most patients fully recover with rest, some are at risk for long-lasting neurocognitivedysfunction, leading to a high morbidity and cost burden on the healthcare system. Currently, there are no unified symptom-based criteria or gold standard objective measurement for mTBI. Neurofilament light (Nf-L) is a highly sensitive biomarker for axonal injury with the potential to serve as an objective serum measurement for mTBI. This systematic review investigates the ability of Nf-L to accurately diagnose acute mTBI in athletes and military personnel. A comprehensive literature search of PubMed, Scopus, and Google Scholar from 2010 to 2021 using keywords neurofilament light chain, mTBI, concussion, athletes, and military identified 239 articles for eligibility screening. Ten articles met the inclusion criteria for qualitative analysis, with extracted data including Nf-L levels, recovery characteristics, and neuroimaging results. Of the 10 studies meeting inclusion criteria, one was military-related, five were sports-related, and four were mixed-focus. Six studies investigated the association between mTBI and Nf-L levels within 24 hours of injury. Four of these studies involved athletes, with three showing evidence of acute Nf-L elevations. No evidence of acute Nf-L elevations was reported among military personnel or emergency department patients. Nf-L elevations were recorded at various time points greater than 24 hours post-injury in athletes (two studies) and emergency department patients (one study). Positive associations were found between Nf-L levels and loss of consciousness/post-traumatic amnesia (one study), positive neuroimaging findings (three studies), and prolonged recovery times (three studies). We are unable to conclude whether Nf-L has the capacity for acute diagnosis of mTBI or the optimal time for serum measurement. Nf-L does, however, shows promise as a prognostic factor for mTBI complications, neuroimaging findings, and recovery. Additional studies are warranted, as the use of Nf-L in early diagnosis of mTBI in the future would improve clinical management while decreasing complications and healthcare costs.

A diagnostic, test-accuracy study to evaluate the ability of the Eye Guide Visual Tracking System and the Post-Concussion Symptom Scale to diagnose mild TBI and predict protracted recovery

Abstract Mild traumatic brain injury (mTBI) is the most common type of traumatic brain injury (TBI), and 100–300 individuals per every 100 000 seek medical care for mTBI annually. The Eye Guide is a portable device that evaluates oculomotor function. This device has promising potential to detect trauma-related neurological deficits that are otherwise undetected by a non-contrast computed tomography scan, the current gold standard. However, to our knowledge, a study has yet to be conducted that evaluates its ability to detect mTBIs specifically. By contrast, the Post-Concussion Symptom Scale (PCSS) is a 22-item, self-reported symptom survey that has become one of the most trusted tools in evaluating mTBI-related sequelae. Although this scale has been well validated in adolescent athletes, there is a notable lack of studies defining its clinical utility in adults with non-sports-related trauma. Patients with mTBI are expected to have detectable alterations in the PCSS score and the Eye Guide visual tracing. Thus, this study aims to determine each tool’s diagnostic accuracy in detecting mTBI and prognostic accuracy in predicting a protracted recovery in our patient population. Additionally, for both tools, we seek to establish cut-off values for future clinical decision-making in non-athlete, adult populations. A prospective, observational cohort test-accuracy study will be conducted in two clinics that form part of the ValleSalud Clinic Network in Cali, Colombia. Both are Level III referral trauma centers. The sensitivity, specificity and positive predictive value of both the Eye Guide and PCSS tests in diagnosing mTBI and predicting protracted recovery will serve as primary outcomes of the study. Additionally, the area under the curve analyses will be undertaken to determine the optimal sensitivity and specificity cut-offs for each test. The ground truth labels will be the diagnosis of mTBI by neurological examination as evaluated by an experienced neurosurgeon and recovery at 1 month post-injury according to the Extended Glasgow Outcome Scale. This study will follow the principles set forth by the Declaration of Helsinki.

Healthcare pathways for mild traumatic brain injury patients in New Zealand, determined from Accident Compensation Corporation data.

To describe healthcare pathways for mild traumatic brain injury (mTBI) patients in New Zealand and identify areas for improvement. A data science methodology was applied to mTBI ACC claims (children and adults) between 1 September 2016 and 1 September 2018, and payment and purchase order data until 1 September 2020. Frequency, median and interquartile ranges were used to describe the pathway. Of the 55,494 claims and 63,642 referrals, >99% were accepted by ACC. Claim processing took more than a week for 7% (3,647) of claims and referral processing took more than three days for 33% (21,139) of referrals. One in four (25%) cases referred to a concussion clinic took >2 months to receive the service due to administrative delays. Of all patients, 36% (20,413) received more than the initial appointment, and their median time in the pathway was 49 days (IQR, 12-185). TBI diagnostic codes were not added at initial appointment in 6% (3,382) of cases. Administrative claim and referral processes resulted in minimal delays in the pathway for most patients. However, the volume of claims meant delays affected thousands of New Zealanders every year. Pathways could be improved by facilitating mTBI diagnosis, improving follow-up rates and reducing unnecessary administrative processes.

Identifying mild traumatic brain injury using measures of frequency-specified networks

Objective. Early diagnosis of mild traumatic brain injury (mTBI) is challenging, yet crucial for providing patients with timely treatments and minimizing the risks of developing injury-related disorders. To tackle this problem, this paper presents a framework based on measures of frequency-specified brain functional networks identifying mTBI. Approach. Cortical activity of 15 control and 15 injury Thy1-GCaMP6s mice are recorded, using widefield calcium imaging, prior to and 20 minutes after inducing injury. Power spectral distribution (PSD) of the recorded cortical activities is examined, and the frequency bands with significant difference in PSD between the injury and control groups are identified. Frequency-specified functional networks are then constructed. Employing graph theoretical analysis, various network measures from the constructed frequency-specified functional networks are extracted and used as features. Several classifiers are utilized to evaluate the performance of the computed network measures, either individually or collectively as features, to classify mTBI from control. Main results. Spectral analysis reveals the presence of two dominant frequency bands (low: Hz) and high: [1–8] Hz) in the cortical activities recorded via calcium imaging. Comparison of the brain networks of control and injury groups shows significant reduction (p < 0.05) in global functional connectivity following injury, specially for the high frequency band network. Interestingly, graph measures of the high frequency band network provided higher classification accuracy results, compared to those computed from the low frequency band network, suggesting that mTBI network-based features are frequency dependent. Using all network measures collectively as a multi-measure feature vector and a convolutional neural networks classifier, a model for identifying mTBI is developed, offering an average classification accuracy of 97.28%. Significance. Results signifies the importance of considering frequency-specific analysis in functional networks for mTBI identification, and demonstrate the possibility of using network measures for early mTBI diagnosis.

Determining the Agreement Between Common Measures Related to Vestibulo-ocular Reflex Function After a Mild Traumatic Brain Injury in Children and Adolescents

ObjectiveTo (1) determine the level of agreement between symptom provocation and performance-based tests of vestibulo-ocular reflex (VOR) function after pediatric mild traumatic brain injury (mTBI) and (2) describe the level of symptom provocation induced by a VOR task in individuals with and without cervical findings. DesignCross-sectional. SettingThis study was conducted at a tertiary care pediatric hospital. ParticipantsA total of 101 participants (N=101) aged 6-18 years within 3 weeks of mTBI diagnosis were included (54.5% female; mean age, 13.92±2.63 years; mean time since injury at assessment, 18.26±6.16 days). InterventionsNone. Main Outcome MeasuresSymptom provocation (Vestibular/Ocular Motor Screening tool), performance (clinician-observed VOR performance, head thrust test [HTT], computerized dynamic visual acuity test, video head impulse test), and cervical impairment (cervical flexion-rotation test, range of motion test, self-reported neck pain). Agreement was evaluated using Cohen's κ statistic. ResultsNo outcomes demonstrated agreement with symptom provocation (κ=−0.15 to 0.14). Fair agreement demonstrated between clinician-observed VOR performance and HTT (κ=0.32), with little to no agreement demonstrated between other measures. Proportions reporting test-induced dizziness and headache were greater among individuals with cervical findings (29.1%-41.8%) than without (2.3%-6.8%). ConclusionsFindings support that symptom provocation and performance-based tests measure different constructs and thus have distinct roles when assessing VOR function. Findings suggest results from measures of symptom provocation may be influenced by coexisting cervical impairments, underlining the value of assessing for cervical injury after pediatric mTBI.

Neuropathological Mechanisms of Mild Traumatic Brain Injury: A Perspective From Multimodal Magnetic Resonance Imaging

Mild traumatic brain injury (mTBI) accounts for more than 80% of the total number of TBI cases. The mechanism of injury for patients with mTBI has a variety of neuropathological processes. However, the underlying neurophysiological mechanism of the mTBI is unclear, which affects the early diagnosis, treatment decision-making, and prognosis evaluation. More and more multimodal magnetic resonance imaging (MRI) techniques have been applied for the diagnosis of mTBI, such as functional magnetic resonance imaging (fMRI), arterial spin labeling (ASL) perfusion imaging, susceptibility-weighted imaging (SWI), and diffusion MRI (dMRI). Various imaging techniques require to be used in combination with neuroimaging examinations for patients with mTBI. The understanding of the neuropathological mechanism of mTBI has been improved based on different angles. In this review, we have summarized the application of these aforementioned multimodal MRI techniques in mTBI and evaluated its benefits and drawbacks.

Advocacy for Change: An Osteopathic Review of Traumatic Brain Injury Among Combat Veterans.

As a "signature injury" of the Iraq and Afghanistan wars, traumatic brain injury (TBI) remains a major health concern among military service members. Traumatic brain injury is associated with a wide range of symptoms which may be cognitive, emotional, psychological, biochemical, and social in nature. Mild TBI (mTBI) ranks as the most common traumatic brain injury among veterans. Due to the absence of specific symptoms, mTBI diagnosis may be challenging in acute settings. Repetitive traumatic brain injury during combat deployments can lead to devastating chronic neurodegenerative diseases and other major life disruptions. Many cases of TBI remain undetected in veterans and may lead to long-term adverse comorbidities such as post-traumatic stress disorder (PTSD), suicide, alcohol disorders, psychiatric diagnoses, and service-related somatic dysfunctions. Veterans with TBI are almost twice as likely to die from suicide in comparison to veterans without a history of TBI. Veterans diagnosed with TBI experience significant comorbid conditions and thus advocacy for improved care is justified and necessary. Given the complexity and variation in the symptomatology of TBI, a personalized, multimodal approach is warranted in the evaluation and treatment of veterans with TBI and other associated conditions. As such, this review provides a broad overview of treatment options, with an emphasis on advocacy and osteopathic integration in the standard of care for veterans.