Prevalence Of Traumatic Brain Injury Research Articles

An overview of preclinical models of traumatic brain injury (TBI): relevance to pathophysiological mechanisms.

Traumatic brain injury (TBI) is a major cause of morbidity and mortality, affecting millions annually worldwide. Although the majority of TBI patients return to premorbid baseline, a subset of patient can develop persistent and often debilitating neurocognitive and behavioral changes. The etiology of TBI within the clinical setting is inherently heterogenous, ranging from sport related injuries, fall related injuries and motor vehicle accidents in the civilian setting, to blast injuries in the military setting. Animal models of TBI, offer the distinct advantage of controlling for injury modality, duration and severity. Furthermore, preclinical models of TBI have provided the necessary temporal opportunity to study the chronic neuropathological sequelae of TBI, including neurodegenerative sequelae such as tauopathy and neuroinflammation within the finite experimental timeline. Despite the high prevalence of TBI, there are currently no disease modifying regimen for TBI, and the current clinical treatments remain largely symptom based. The preclinical models have provided the necessary biological substrate to examine the disease modifying effect of various pharmacological agents and have imperative translational value. The current review will include a comprehensive survey of well-established preclinical models, including classic preclinical models including weight drop, blast injury, fluid percussion injury, controlled cortical impact injury, as well as more novel injury models including closed-head impact model of engineered rotational acceleration (CHIMERA) models and closed-head projectile concussive impact model (PCI). In addition to rodent preclinical models, the review will include an overview of other species including large animal models and Drosophila. There are major neuropathological perturbations post TBI captured in various preclinical models, which include neuroinflammation, calcium dysregulation, tauopathy, mitochondrial dysfunction and oxidative stress, axonopathy, as well as glymphatic system disruption. The preclinical models of TBI continue to offer valuable translational insight, as well as essential neurobiological basis to examine specific disease modifying therapeutic regimen.

A Narrative Review on Financial Challenges and Health Care Costs Associated with Traumatic Brain Injury in the United States

Traumatic Brain Injury (TBI) is a highly prevalent and potentially severe medical condition. Challenges regarding TBI management are related to accurate diagnostics, defining its severity and establishing prompt interventions in order to impact outcomes. Among the healthcare components in TBI handling strategy is intracranial pressure (ICP) monitoring, which is fundamental to therapy decisions. However, ICP monitoring is an Aquiles tendon, imposing a significant financial burden on healthcare systems, particularly in middle and low-income communities. This review primarily investigates the economic burden of TBI and whether new technologies are suitable to reduce its healthcare costs without compromising the quality of care, according to the levels of evidence available MATERIAL AND METHODS: For this narrative review, the authors conducted a PUBMED search for articles discussing TBI healthcare costs, as well as monitoring technologies (tomography, magnetic resonance imaging, optic nerve sheath diameter, transcranial Doppler, pupillometry and noninvasive ICP waveform) and their application in managing TBI. Strategies were first evaluated from a medical noninferiority perspective before calculating the average savings of each selected strategy. All applicable papers were analyzed for quality using the Consolidated Health Economic Evaluation Reporting Standards 2022 Statement (CHEERS 2022)117 and the paper was written to conform as much as possible with it. The review included a total of 109 references and revealed a consistent potential in noninvasive technologies to reduce costs while maintaining or improving the quality of care. TBI prevalence has grown with an unproportionate healthcare burden in the last decades. Noninvasive monitoring techniques seem to be effective to reduce TBI healthcare costs, with no neglectable limitations, especially the need for more supporting scientific evidence. The clinical and financial undeniable potential of these techniques are compelling to further investigate their role in TBI management, as well as the creation of more comprehensive monitoring models to the understanding of complex phenomena occurring in the injured brain.

Refinement of a Preliminary Case Definition for Use in Traumatic Brain Injury Surveillance.

Current methods used to measure incidence of traumatic brain injury (TBI) underestimate its true public health burden. The use of self-report surveys may be an approach to improve these estimates. An important step in public health surveillance is to define a public health problem using a case definition. The purpose of this article is to outline the process that the Centers for Disease Control and Prevention undertook to refine a TBI case definition to be used in surveillance using a self-report survey. Survey. A total of 10 030 adults participated via a random digit-dial telephone survey from September 2018 to September 2019. Respondents were asked whether they had sustained a hit to the head in the preceding 12 months and whether they experienced a series of 12 signs and symptoms as a result of this injury. Head injuries with 1 or more signs/symptoms reported were initially categorized into a 3-tiered TBI case definition (probable TBI, possible TBI, and delayed possible TBI), corresponding to the level of certainty that a TBI occurred. Placement in a tier was compared with a range of severity measures (whether medical evaluation was sought, time to symptom resolution, self-rated social and work functioning); case definition tiers were then modified in a stepwise fashion to maximize differences in severity between tiers. There were statistically significant differences in the severity measure between cases in the probable and possible TBI tiers but not between other tiers. Timing of symptom onset did not meaningfully differentiate between cases on severity measures; therefore, the delayed possible tier was eliminated, resulting in 2 tiers: probable and possible TBI. The 2-tiered TBI case definition that was derived from this analysis can be used in future surveillance efforts to differentiate cases by certainty and from noncases for the purpose of reporting TBI prevalence and incidence estimates. The refined case definition can help researchers increase the confidence they have in reporting survey respondents' self-reported TBIs as well as provide them with the flexibility to report an expansive (probable + possible TBI) or more conservative (probable TBI only) estimate of TBI prevalence.

Assessing Prevalence of TBI in a Community Setting

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

Is lifetime traumatic brain injury a risk factor for mild cognitive impairment in veterans compared to non-veterans?

ABSTRACT Background: Traumatic brain injury (TBI) is prevalent in veterans and may occur at any stages of their life (before, during, or after military service). This is of particular concern, as previous evidence in the general population has identified TBI as a strong risk factor for mild cognitive impairment (MCI), a known precursor of dementia. Objectives: This study aimed to investigate whether exposure to at least one TBI across the lifetime was a risk factor for MCI in ageing UK veterans compared to non-veterans. Method: This cross-sectional study comprised of data from PROTECT, a cohort study comprising UK veterans and non-veterans aged ≥ 50 years at baseline. Veteran and TBI status were self-reported using the Military Service History Questionnaire (MSHQ) and the Brain Injury Screening Questionnaire (BISQ), respectively. MCI was the outcome of interest, and was defined as subjective cognitive impairment and objective cognitive impairment. Results: The sample population comprised of veterans (n = 701) and non-veterans (n = 12,389). TBI was a significant risk factor for MCI in the overall sample (OR = 1.21, 95% CI 1.11–1.31) compared to individuals without TBI. The prevalence of TBI was significantly higher in veterans compared to non-veterans (69.9% vs 59.5%, p < .001). There was no significant difference in the risk of MCI between veterans with TBI and non-veterans with TBI (OR = 1.19, 95% CI 0.98–1.45). Conclusion: TBI remains an important risk factor for MCI, irrespective of veteran status. The clinical implications indicate the need for early intervention for MCI prevention after TBI.

Epidemiology, Pathophysiology, and Treatment Strategies of Concussions: A Comprehensive Review.

A concussion is a particular manifestation of a traumatic brain injury, which is the leading cause of mortality and disabilities across the globe. The global prevalence of traumatic brain injury is estimated to be 939 instances per 100,000 individuals, with approximately 5.48 million people per year experiencing severe traumatic brain injury. Epidemiology varies amongst different countries by socioeconomic status with diverse clinical manifestations. Additionally, classifying concussions is an ambiguous process as clinical diagnoses are the only current classification method, and morbidity rates differ by demographic location as well as populations examined. In this article, we critically reviewed the pathophysiology of concussions, classification methods, treatment options available including both pharmacologic and nonpharmacologic intervention methods, etiologies as well as global etiologic differences associated with them, and clinical manifestations along with their associated morbidities. Furthermore, analysis of the current research regarding the incidence of concussion based traumatic brain injuries and future directions are discussed. Investigation on the efficacy of new therapeutic-related interventions such as exosome therapy and electromagnetic field stimulation are warranted to properly manage and treat concussion-induced traumatic brain injury.

The Bidirectional Association of TBI and Dementia/MCI among older US Veterans

AbstractBackgroundPrior studies have reported a link between traumatic brain injury (TBI) and risk of adverse neuropsychiatric outcomes including dementia. However it is unclear how prevalent these conditions are prior to TBI and if they are predisposing factors in addition to sequalae.MethodsWe studied older (age &gt;55 years) US veterans who were followed for care at Veterans Affairs Medical Centers across the nation from 2000 to 2019. We first identified all veterans with an incident TBI diagnoses defined as no prior TBI diagnosis, having been seen in an emergency department (ED), having a brain imaging scan (primarily CT) within one day of ED visit and with a subsequent new TBI diagnosis in the electronic medical record (EMR). We then determined 2‐year age‐adjusted prevalence rates (rate per 1000 person‐years and 95% confidence interval or CI) for dementia and mild cognitive impairment (MCI) prior to and post incident TBI. We also compared prior TBI prevalence to prevalence among 1:3 matched (on age and index date) veterans without TBI.ResultsThere were 13,709 primarily male veterans with incident TBI with mean age of 77.7 sd 9.1 years, 81% were non‐Hispanic White. Compared to the 41,127 veterans without TBI (mean age = 77.9, sd 9.1), veterans prior to having an incident TBI had almost a six‐fold greater pre‐TBI age‐adjusted prevalence of dementia (104.9; 95% CI 100.8‐109.0 vs 18.6; 95% CI 17.6‐19.7, p&lt;0.001) and MCI (48.0; 95% CI 45.2‐50.7 vs 8.1; 95% CI 7.4‐8.8, p&lt;0.001). After the incident TBI diagnosis, the age‐adjusted prevalence rates were even higher: dementia (193.5; 95% CI 187.7‐199.2) and MCI (59.3; 95% CI 56.0‐62.6).ConclusionsAmong older US veterans, there is a bidirectional association with dementia/ MCI and TBI with very high prevalence prior to TBI (compared to those without TBI) and even greater prevalence after TBI. These findings highlight the importance of prevention strategies for both pre‐ and post‐TBI cognitive impairment.

29 Predictors of Verbal Memory Performance Following Brain Injury Among Survivors of Intimate Partner Violence

Objective:Numerous survivors of Intimate Partner Violence (IPV) experience physical violence to the head and neck areas, placing them at high risk of sustaining a brain injury (BI). Studies report that the prevalence of traumatic BI among IPV survivors ranges from 35% to as much as 80%. IPV-related BIs can have debilitating long-term consequences on survivors’ quality of life and overall functioning. One important factor impacting quality of life following TBI is verbal memory abilities. Given the link between verbal memory abilities and functional status, identifying predictors of verbal memory performance has important implications for directing support and rehabilitative efforts for survivors of IPV-related BIs. The current aim of the study was to investigate predictors of verbal memory performance following TBI among survivors of IPV.Participants and Methods:A modified HELPS Brain Injury (BI) screener was administered to women receiving services for IPV through community organizations and shelters in two urban, Midwestern cities. Women who screened positive for IPV-related BI (n=32) were invited to complete a comprehensive neuropsychological evaluation including the Rey Auditory Verbal Learning Test. The delayed recall score of the RAVLT was used as a measure of verbal memory performance. BI history and characteristics were based on survivors’ responses to the modified HELPS screener. Multiple regression was used to determine significant predictors of verbal performance with RAVLT-Delayed Recall scores serving as the criterion, and education, age, number of reported injuries, number of injuries that left participants feeling dazed/confused, following provider recommendations, and childhood history of injury all entered as predictors.Results:The model indicated that a large percentage of the variability (R2 = .378) in delayed recall performance could be attributed to the combination of predictors in the model (F (6, 25) = 2.828, p = .047). Examination of the regression coefficients indicated that only following provider recommendations (ß = .420, p = .019), and number of injuries that induced disorientation/confusion (ß = -.592, p = .004) were significantly related to delayed recall after controlling for all other variables in the model.Conclusions:The results of this study suggest that injury severity and adhering to medical recommendations after IPV-related TBI play a significant role in predicting cognitive functioning. Consistent with existing literature, our findings show that injury characteristics of severity and repetition are closely associated with memory functioning. These findings have implications for guiding screening procedures that may be more sensitive to functional outcome in survivors of IPV who are at risk for BI. Furthermore, our findings highlight a need to increase awareness of IPV-related BI in medical professionals, and to support these front-line staff in providing medical care and psychoeducation about BI to IPV survivors.

Prevalence and characteristics of comorbid stroke and traumatic brain injury in a real-world population: findings from a nationally representative cross-sectional survey in China

BackgroundIn China, data on the prevalence and characteristics of comorbid stroke and traumatic brain injury (TBI) in real-world populations are still lacking but of paramount importance for the evidence-based prevention and control of the comorbidity of the two diseases. This study aimed to investigate the prevalence and characteristics of comorbid stroke and TBI in a real-world population.MethodsIn 2013, a nationally representative, door-to-door survey on stroke and TBI using a complex, multistage, probability sampling design was conducted among approximately 600,000 participants from 155 urban and rural areas in China (Ethic ID: KY2013-006-01). The weighted prevalence of comorbid stroke and TBI was estimated using individuals’ final weight. A Poisson regression analysis was used to compare the rate ratio of the comorbidity prevalence among different subgroups of the population, including age, sex, place of residence, and geographic location subgroups. For analyses of associations between the comorbidities and predictors of interest, all other variables were adjusted for in a multinomial logistic regression model.ResultsAmong the 596,536 people, 219 patients with comorbid stroke and TBI were identified. The point prevalence of comorbid stroke and TBI weighted to the China 2010 census population was 29.30 (95% CI: 22.69–37.84) per 100,000 population in China. The adjusted prevalence of post-TBI stroke in patients with previous TBI was significantly higher than that of post-stroke TBI in patients with previous stroke (6021.3 vs. 811.1 per 100,000 people; rate ratio: 11.001; 95% CI: 8.069–14.998). Patients with nonconcussion had significantly higher rates of both pre-stroke TBI (odds ratio: 4.694; 95% CI: 3.296–6.687) and post-stroke TBI (odds ratio: 6.735; 95% CI: 3.719–12.194) than patients with concussion. Compared to patients with ischaemic stroke, patients with subarachnoid haemorrhage (odds ratio: 2.044; 95% CI: 1.097–3.809) and intracerebral haemorrhage (odds ratio: 1.903; 95% CI: 1.296–2.795) had significantly higher rates of post-TBI stroke.ConclusionsThe high prevalence of stroke among TBI patients is becoming a new public health issue. TBI patients, especially those with nonconcussion TBI, are more likely to develop comorbid stroke and TBI than stroke patients, especially ischaemic stroke patients.

A - 158 The Effects of Migraine and Traumatic Brain Injury on Subjective Cognitive Functioning in Veterans in the Million Veteran Program.

The relationship between migraine and cognitive symptoms in Veterans is a complex issue, made more challenging by the high prevalence of traumatic brain injury (TBI) in this population. This study examined the relationship between migraine, TBI, and subjective cognitive function. Participants included 338,217 Veterans enrolled in the Million Veteran Program who completed the Medical Outcomes Study Cognitive Functioning Scale Revised (MOS-Cog-R), a self-report measure of cognitive functioning. Veterans were categorized into the following groups: (1) both migraine and TBI history (n = 7828), (2) migraine-only (n = 22,252), (3) TBI-only (n = 24,078), and (4) no history of migraine or TBI (n = 284,059). MOS-Cog-R scales were compared across groups using the Kruskal-Wallis Test for omnibus differences and Dunn's test and Cliff's Delta for effect size calculations of differences between groups. The migraine/TBI group reported the highest prevalence of cognitive symptoms across all domains (range: 76.1% for confusion to 90.5% for forgetfulness). In contrast, the no migraine/TBI group had the lowest prevalence of cognitive problems (range: 32.0% for confusion to 63.7% for forgetfulness). All omnibus group differences were statistically significant (p < 0.001), and nearly all pairwise comparisons were significant, except for some of the migraine-only vs. TBI-only group comparisons. Results showed a "dose-response" relationship between diagnostic group and subjective cognitive symptoms, such that the migraine/TBI group fared the worst, followed by the TBI-only and migraine-only groups, and finally the no migraine/TBI group. Findings set the stage for follow-up work to be conducted within MVP that will address the neurobiological underpinnings of cognitive distress in this population.

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

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

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

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

Dual diagnosis of TBI and SCI: an epidemiological study in the pediatric population.

Dual diagnosis (DD) with traumatic brain injury (TBI) and spinal cord injury (SCI) poses clinical and rehabilitation challenges. While comorbid TBI is common among adults with SCI, little is known about the epidemiology in the pediatric population. The primary objective of this study was to evaluate the prevalence of TBI among children in the United States hospitalized with SCI. Secondary objectives were to compare children hospitalized with DD with those with isolated SCI with regards to age, gender, race, hospital length of stay, and hospital charges. A retrospective analysis of hospital discharges among children aged 0-18 years occurring between 2016-2018 from U.S. hospitals participating in the Kids' Inpatient Database. ICD-10 codes were used to identify cases of SCI, which were then categorized by the presence or absence of comorbid TBI. 38.8% of children hospitalized with SCI had a co-occurring TBI. While DD disproportionately occurred among male children (67% of cases), when compared with children with isolated SCI, those with DD were not significantly more likely to be male. They were more likely to be Caucasian. The mean age of children with DD (13.2 ± 5.6 years) was significantly less than that of children with isolated SCI (14.4 ± 4.3 years). DD was associated with longer average lengths of stay (6 versus 4 days) and increased mean total hospital charges ($124,198 versus $98,089) when compared to isolated SCI. Comorbid TBI is prevalent among U.S. children hospitalized with SCI. Future research is needed to better delineate the impact of DD on mortality, quality of life, and functional outcomes.

Associations Between Traumatic Brain Injury and Severity of Tinnitus-Related Functional Impairment Among US Military Veterans: A National, Population-Based Study.

To describe associations between a history of traumatic brain injury (TBI) and the severity of tinnitus-related functional impairment among a national, stratified random sample of veterans diagnosed with tinnitus by the Department of Veterans Affairs (VA) healthcare system. A multimodal (mailed and internet) survey administered in 2018. Participants: VA healthcare-using veterans diagnosed with tinnitus; veterans with comorbid TBI diagnosis were oversampled. A population-based survey. TBI history was assessed using International Classification of Diseases (ICD) diagnosis codes in veterans' VA electronic health records. The severity of participants' overall tinnitus-related functional impairment was measured using the Tinnitus Functional Index. Population prevalence and 95% confidence intervals (CIs) were estimated using inverse probability weights accounting for sample stratification and survey nonresponse. Veterans' relative risk ratios of very severe or moderate/severe tinnitus-related functional impairment, versus none/mild impairment, were estimated by TBI history using bivariable and multivariable multinomial logistic regression. The population prevalence of TBI was 5.6% (95% CI: 4.8-6.4) among veterans diagnosed with tinnitus. Veterans with a TBI diagnosis, compared with those without a TBI diagnosis, had 3.6 times greater likelihood of rating their tinnitus-related impairment as very severe (95% CI: 2.1-6.3), and 1.5 times greater likelihood of rating their impairment as moderate/severe (95% CI: 1.0-2.4), versus none/mild. These findings suggest an important role of TBI in the severity of tinnitus-related functional impairment among veterans. This knowledge can help inform the integration of tinnitus management services into the care received by veterans with TBI.

Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review

Clinical practice guidelines (CPGs) predominantly prioritise treatment and cost-effectiveness, which encourages a universal approach that may not address the circumstances of disadvantaged groups. We aimed to advance equity and quality of care for individuals experiencing homelessness and traumatic brain injury (TBI) by assessing the extent to which homelessness and TBI are integrated in CPGs for TBI and CPGs for homelessness, respectively, and the extent to which equity, including consideration of disadvantaged populations and the PROGRESS-Plus framework, is considered in these CPGs. For this systematic review, CPGs for TBI or homelessness were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of eligible CPGs on November 16, 2021 and March 16, 2023. The proportion of CPGs that integrated evidence regarding TBI and homelessness was identified and qualitative content analysis was conducted to understand how homelessness is integrated in CPGs for TBI and vice versa. Equity assessment tools were utilised to understand the extent to which equity was considered in these CPGs. This review is registered with PROSPERO (CRD42021287696). Fifty-eight CPGs for TBI and two CPGs for homelessness met inclusion criteria. Only three CPGs for TBI integrated evidence regarding homelessness by recognizing the prevalence of TBI in individuals experiencing homelessness and identifying housing as a consideration in the assessment and management of TBI. The two CPGs for homelessness acknowledged TBI as prevalent and recognised individuals experiencing TBI and homelessness as a disadvantaged population that should be prioritised in guideline development. Equity was rarely considered in the content and development of CPGs for TBI. Considerations for equity in CPGs for homelessness and TBI are lacking. To ensure that CPGs reflect and address the needs of individuals experiencing homelessness and TBI, we have identified several guideline development priorities. Namely, there is a need to integrate evidence regarding homelessness and TBI in CPGs for TBI and CPGs for homelessness, respectively and engage disadvantaged populations in all stages of guideline development. Further, this review highlights an urgent need to conduct research focused on and with disadvantaged populations. Canada Research Chairs Program (2019-00019) and the Ontario Ministry of Health and Long-Term Care (Grant #725A).

Intentional Self-Harm Among US Veterans With Traumatic Brain Injury or Posttraumatic Stress Disorder: Retrospective Cohort Study From 2008 to 2017.

Veterans with a history of traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) may be at increased risk of suicide attempts and other forms of intentional self-harm as compared to veterans without TBI or PTSD. Using administrative data from the US Veterans Health Administration (VHA), we studied associations between TBI and PTSD diagnoses, and subsequent diagnoses of intentional self-harm among US veterans who used VHA health care between 2008 and 2017. All veterans with encounters or hospitalizations for intentional self-harm were assigned "index dates" corresponding to the date of the first related visit; among those without intentional self-harm, we randomly selected a date from among the veteran's health care encounters to match the distribution of case index dates over the 10-year period. We then examined the prevalence of TBI and PTSD diagnoses within the 5-year period prior to veterans' index dates. TBI, PTSD, and intentional self-harm were identified using International Classification of Diseases diagnosis and external cause of injury codes from inpatient and outpatient VHA encounters. We stratified analyses by veterans' average yearly VHA utilization in the 5-year period before their index date (low, medium, or high). Variations in prevalence and odds of intentional self-harm diagnoses were compared by veterans' prior TBI and PTSD diagnosis status (TBI only, PTSD only, and comorbid TBI/PTSD) for each VHA utilization stratum. Multivariable models adjusted for age, sex, race, ethnicity, marital status, Department of Veterans Affairs service-connection status, and Charlson Comorbidity Index scores. About 6.7 million veterans with at least two VHA visits in the 5-year period before their index dates were included in the analyses; 86,644 had at least one intentional self-harm diagnosis during the study period. During the periods prior to veterans' index dates, 93,866 were diagnosed with TBI only; 892,420 with PTSD only; and 102,549 with comorbid TBI/PTSD. Across all three VHA utilization strata, the prevalence of intentional self-harm diagnoses was higher among veterans diagnosed with TBI, PTSD, or TBI/PTSD than among veterans with neither diagnosis. The observed difference was most pronounced among veterans in the high VHA utilization stratum. The prevalence of intentional self-harm was six times higher among those with comorbid TBI/PTSD (6778/58,295, 11.63%) than among veterans with neither TBI nor PTSD (21,979/1,144,991, 1.92%). Adjusted odds ratios suggested that, after accounting for potential confounders, veterans with TBI, PTSD, or comorbid TBI/PTSD had higher odds of self-harm compared to veterans without these diagnoses. Among veterans with high VHA utilization, those with comorbid TBI/PTSD were 4.26 (95% CI 4.15-4.38) times more likely to receive diagnoses for intentional self-harm than veterans with neither diagnosis. This pattern was similar for veterans with low and medium VHA utilization. Veterans with TBI and/or PTSD diagnoses, compared to those with neither diagnosis, were substantially more likely to be subsequently diagnosed with intentional self-harm between 2008 and 2017. These associations were most pronounced among veterans who used VHA health care most frequently. These findings suggest a need for suicide prevention efforts targeted at veterans with these diagnoses.

Prevalence of comorbidities post mild traumatic brain injuries: a traumatic brain injury model systems study.

Traumatic brain injury (TBI) is associated with an increased risk of long-lasting health-related complications. Survivors of brain trauma often experience comorbidities which could further dampen functional recovery and severely interfere with their day-to-day functioning after injury. Of the three TBI severity types, mild TBI constitutes a significant proportion of total TBI cases, yet a comprehensive study on medical and psychiatric complications experienced by mild TBI subjects at a particular time point is missing in the field. In this study, we aim to quantify the prevalence of psychiatric and medical comorbidities post mild TBI and understand how these comorbidities are influenced by demographic factors (age, and sex) through secondary analysis of patient data from the TBI Model Systems (TBIMS) national database. Utilizing self-reported information from National Health and Nutrition Examination Survey (NHANES), we have performed this analysis on subjects who received inpatient rehabilitation at 5 years post mild TBI. Our analysis revealed that psychiatric comorbidities (anxiety, depression, and post-traumatic stress disorder (PTSD)), chronic pain, and cardiovascular comorbidities were common among survivors with mild TBI. Furthermore, depression exhibits an increased prevalence in the younger compared to an older cohort of subjects whereas the prevalence of rheumatologic, ophthalmological, and cardiovascular comorbidities was higher in the older cohort. Lastly, female survivors of mild TBI demonstrated increased odds of developing PTSD compared to male subjects. The findings of this study would motivate additional analysis and research in the field and could have broader implications for the management of comorbidities after mild TBI.

Traumatic Brain Injury among Patients Admitted in Neurosurgical Unit in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Traumatic brain injuries are one of the leading causes of mortality, morbidity, and economic burden in context to Nepal. Non-contrast computed tomography is used for rapid diagnosis and repeat computed tomography helps to detect the progression and complications of cerebral injury. The aim of this study was to find out the prevalence of traumatic brain injury among patients admitted in the neurosurgical unit in a tertiary care centre. This descriptive cross-sectional study was conducted among patients admitted to the neurosurgery unit in the tertiary care centre from 1 August 2019 to 29 August 2020. Ethical approval was taken from Institutional Review Committee (Reference number: CMC-IRC/075/076-156). Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 350 patients admitted in the neurosurgical unit, the prevalence of traumatic brain injury was 140 (40%) (34.87-45.13, 95% Confidence Interval). Change in management was required among 28 (20%) when computed tomography was done within 12-24 hours. Among them, 27 (19.29%) underwent surgical intervention after a repeat computed tomography scan. The prevalence of traumatic brain injury was found to be higher than similar studies done in similar settings. contusion; craniotomy; traumatic brain injury.

Using home monitoring technology to study the effects of traumatic brain injury on older multimorbid adults: protocol for a feasibility study

IntroductionThe prevalence of traumatic brain injury (TBI) among older adults is increasing exponentially. The sequelae can be severe in older adults and interact with age-related conditions such as multimorbidity. Despite...

Posttraumatic Stress Disorder and Mild Traumatic Brain Injury – Common Consequences of War: Issues of Pathogenesis and Differential Diagnosis (Review)

The article presents the modern views on the problem of wartime trauma, in particular, posttraumatic stress disorder (PTSD) and mild traumatic brain injury (TBI). Global epidemiological data on the prevalence of the above-mentioned conditions both among military personnel and among the civilian population are demonstrated. As for Ukraine, it is currently quite difficult to accurately determine the prevalence of PTSD and TBI in wartime conditions, but certain data are already available in the Ukrainian literature. Today, it can be assumed that a significant part of cases remains undiagnosed, especially in the case of PTSD. The situation is complicated by difficulties in accessing medical care in the war zones and in the occupied territory. The main pathogenetic mechanisms of the occurrence and relationship of PTSD and mild TBI were analyzed, in particular the development of oxidative stress, inflammatory response, neurotransmitter imbalance, activation of the hypothalamic-pituitary-adrenal system. Special attention is paid to the complex mechanisms of mine and explosive weapons impact on the human organism. The symptoms, criteria for diagnosis and differential diagnosis of the above pathological conditions are highlighted with reference to unified protocols. The main approaches to the management of such patients are considered, with an emphasis on a complex multidisciplinary approach with the involvement of related specialists, the necessity for constant dynamic monitoring by a family doctor. It is extremely important to involve the patient himself and his relatives in active participation in the treatment process in order to minimize the consequences of the trauma.