Severe Brain Injury Research Articles

A Comparative Study on the Trends of Blood Glucose, Serum Triglycerides, and CRP-Based Levels in Correlation with GCS among Patients with Traumatic Head Injury

AbstractTraumatic head injury, which has a high mortality rate, can present as mild contusions, hemorrhages (subdural, extradural, intraparenchymal), diffuse axonal injuries, or direct penetrating injuries. Glasgow Coma Scale (GCS) is used to assess the severity of head injury. Stress-induced hyperglycemia associated with traumatic brain injury has high mortality compared with hyperglycemia in diabetic patients. Stress-induced hyperglycemia not only occurs due to head injury but also serves as a predictor of its outcome. C-reactive protein (CRP) levels are also associated with severity of head injury. Triglyceride levels are said to correlate with neuroinflammation and apoptosis, thus pivotal with severity of traumatic brain injury. With this background, this study aims to compare the levels of blood glucose, CRP, and serum triglycerides in patients with traumatic head injury according to their level of consciousness.This article compares the levels of blood glucose, CRP, and serum triglyceride in traumatic head injury patients according to their GCS and assesses their trends.Patients were divided into two groups (patients with GCS ≤ 8 as group 1 and patients with GCS > 8 as group 2). Blood was collected in these patients at admission, 24 hours after admission, and 48 hours after admission. Glucose was estimated at admission, 24 hours, and 48 hours after admission. CRP and triglycerides were estimated after 24 and 48 hours after admission. The levels were compared between groups and also their trends were assessed.Mean and standard deviation were calculated for the above parameters using Excel. Statistical analysis was done using SPSS software version 26. Statistical significance was assessed using “t-test” and “analysis of variance.” A p-value of < 0.05 was considered statistically significant.Group 1 showed increased levels of glucose after 24 and 48 hours compared with group 2. CRP showed increased levels in group 1 compared with group 2. There was no significant difference in triglyceride levels between the two groups. Levels of blood glucose showed decreasing trends in group 2. CRP showed increasing trend in group 1. Triglyceride levels showed increasing trend in both the groups.The decreasing trend in glucose levels in group 2 and increasing trend in CRP levels in group 1 are due to the same pathogenesis, which is associated with the severity of head injury. Increased trends in triglyceride levels were seen in both the groups. Since the association of levels of these parameters and their trends with severity of head injury, regular and serial monitoring of these analytes may be used as prognostic marker.

The development and face validity of the music therapy sensory instrument for cognition, consciousness, and awareness (MuSICCA)

Severe brain injuries in children and young people can result in disorders of consciousness. This can pose significant challenges for the brain injury survivor as they may struggle to show awareness; for their family, who want to help their child to recover consciousness; and for the team providing treatment and care for them, who need an assessment that will inform optimal treatment and care planning. Currently, there is a paucity of fully validated behavioral tools to assess consciousness in 2–18-year-olds. Assessing awareness across this age range is challenging and complex due to neurodevelopmental changes that occur during maturation. This study evaluated the face validity of a music-based behavioral assessment for children and young people with disorders of consciousness. This is known as the Music therapy Sensory Instrument for Cognition, Consciousness and Awareness (MuSICCA). The study recruited 20 participants to compose a mixed cohort of music therapists, non-music therapy healthcare professionals and family members with lived experience of caring for a child or young person with a disorder of consciousness. These participants reviewed the MuSICCA and evaluated its suitability as an assessment of consciousness for use with children and young people. They provided feedback by rating their level of agreement with two statements and they also described the perceived strengths and limitations of the MuSICCA. The results showed substantial agreement among raters that the MuSICCA appears to be an assessment of consciousness and awareness, and that the MuSICCA appears to be suitable for use with children and young people. Its strengths include being rigorous, comprehensive, providing guidance and opportunity for caregiver involvement, its use of salience in stimulation, and its utility in supporting the wider clinical and care teams. The findings suggest that the MuSICCA may be a valuable assessment tool in providing treatment and care for children and young people with disorders of consciousness and their families.

The role of cardiovascular response as a predictor of neurologic disability in children with brain injury - a pilot study.

The role of cardiovascular response as a predictor of neurologic disability in children with brain injury - a pilot study.

Epidemiology and impact of traumatic brain injuries from motorbike accidents

Background: Head injuries are a major cause of trauma-related deaths worldwide, significantly impacting both healthcare systems and socioeconomic structures. Despite the availability of safety measures, their inconsistent enforcement has led to persistently high injury rates. Motorbike accidents, in particular, have emerged as a leading cause of traumatic brain injuries (TBI), especially in regions with high motorbike usage. In Kerbala, the rise in motorbike accidents has placed a substantial burden on emergency and neurosurgical services. Many of these injuries result in severe head trauma, leading to increased mortality, long-term disability, and significant healthcare costs. Understanding the epidemiological trends and clinical outcomes associated with these accidents is crucial for implementing effective prevention and management strategies. This study aims to provide a comprehensive analysis of motorbike-related TBIs and their impact compared to other mechanisms of head trauma. Conclusion: Motorbike-related traumatic brain injuries are a critical public health issue in Kerbala, leading to significant morbidity and mortality. Objective: This study examines the frequency, severity, and consequences of motorbike-related traumatic brain injuries in Kerbala and compares them with other causes of head trauma.

Real-Time Evaluation of Brain Injury Severity in Septic Mice Using a Novel Scoring System.

The difficulty in translating findings from basic research on sepsis associated encephalopathy (SAE) into clinical practice may be attributed to the suboptimal assessment methods currently in use. The objective was to develop an assessment index to dynamically evaluate brain injury severity in the septic acute phase, making the experimental data more representative of clinical SAE patients. We independently developed the Sepsis-Associated Brain Injury Score (SABIS) based on qSOFA, FOUR, and CAM-ICU methodologies. Under blind conditions, we validated SABIS's effectiveness and accuracy by assessing its correlation with brain tissue pathology and its ability to predict mortality, and compared the variance of SABIS and classical scoring system from different evaluators in the same batch of models to verify its standardization and generalizability. We used condition-matched male and female mice to establish cecal ligation and puncture, feces intraperitoneal injection, and endotoxemia models, monitoring SABIS changes to investigate gender and modeling method effects. At the same time point and detection region, the Spearman correlation analysis between SABIS and three brain injury pathological indicators showed positive results. SABIS predicts short-term and long-term mortality as well as the classical Modified Murine Sepsis Score, and its operator-derived heterogeneity index is significantly lower. Evaluating SABIS can reveal the impact of gender and modeling method on sepsis-related brain injury characteristics. Our novel Sepsis-associated Brain Injury Score (SABIS) can robustly and accurately assess brain injury severity in various sepsis animal models. The scoring system demonstrates good generalizability and high consistency with pathological indicators, enhancing the translational potential of sepsis research.

Association of patient characteristics with recovery in adults with disorders of consciousness.

Association of patient characteristics with recovery in adults with disorders of consciousness.

Effects of rapid chest compression technique on intracranial and cerebral perfusion pressures in acute neurocritical patients: a randomized controlled trial

BackgroundSome studies refer to the increase in intracranial pressure (ICP) with chest physiotherapy techniques but without any randomized controlled trials that evaluate the safety of the manual rapid chest compression technique in patients with severe acute brain injuries on invasive mechanical ventilation. Our research question examines whether intracranial and cerebral perfusion pressures significantly change during rapid chest compression technique.MethodsA prospective, randomized, single-blinded controlled trial of acute neurocritical patients under mechanical ventilation was performed. The intervention group was subjected to rapid chest compression, and the control group received mechanical passive inferior limbs mobilization. The outcomes were intracranial pressure, cerebral perfusion pressure, blood partial pressure of oxygen and carbon dioxide, and inspiratory and expiratory peak flows.ResultsBetween May 2021 and December 2023, 50 patients (aged 56.3 years), 66% females, were randomized into two groups (25 controls and 25 interventions). The ICP and cerebral perfusion pressure (CPP) did not significantly differ between the groups at any of the studied times. Intragroup analysis revealed significant decreases in the ICP and CPP in the intervention group, with posterior recovery in both groups. The CPP significantly decreased in the control group but did not reach the preintervention values at the last measurement time. PaCO2 was significantly lower in the intervention group than in the control group at the end of the study.ConclusionThe rapid chest compression technique did not increase the ICP during its application or even 30 min after it. The ICP showed a slight significant decrease during the application of the rapid chest compression technique but reached the previous values in the posterior 30 min. CPP had a similar behavior but did not completely recover in both groups.Trial registration: NCT03609866. Registered on 08/01/2018.

The assessment of mood in people with severe cognitive and communication impairments following brain injury: a survey of UK-based professionals

ABSTRACT Aim Assessing mood via standardized measures and clinical interviews is challenging in people with ongoing cognitive and receptive communication impairments after a severe brain injury. This study examined how healthcare professionals in the United Kingdom assess this population via two online surveys, one of clinical psychologists (CPs) and one of medical professionals (MPs). Method Recruitment was completed via social media and invitational e-mails to identified services, professional bodies and special interest groups. Survey responses were via multiple choice and free text. Responses were analyzed using descriptive statistics and content analysis. Results 55 CPs and 29 MPs responded. All respondents reported asking others about the patient’s mood, and the majority of both groups interview and observe the patient. 86% of CPs and 45% of MPs use standardized measures. Most of the CPs made adaptations to the measures, as did more than a third of MPs. The majority of both groups made adaptations to the scores. Conclusions Most clinicians assessing mood in this population ask others about the person. Mood measures are used, but the administration and score interpretation are frequently adapted, bringing the validity of the use of measures in this population into question. Although there was overlap regarding methods used by surveyed clinicians, there was no clear consensus on how mood should be assessed in this population.

Motor Coordination Disorders in Patients with Chronic Kidney Disease

Background: The number of senior chronic kidney disease (CKD) patients is steadily increasing worldwide. Falls are more frequent in this group than in the general population, and they are associated with a variety of complications ranging from minor (bruises) to severe (fracture, brain injury, or death). The significant burden of comorbidities, particularly cardiovascular disorders, impacts coordination. The aim of the study was to assess coordination disorders in CKD patients in the context of cardiovascular complications and vascular status. Methods: In this prospective study, 132 patients with CKD 2–5, including 40 (30%) hemodialysis patients, were enrolled. The short form physiological profile assessment (S-PPA) was used to assess coordination. Results: During a 2-year follow-up period, 49 individuals experienced 84 falls. The median S-PPA score (Z score) was 3.36. Based on this, we divided our cohort into two groups: a Z score of <3.36 and a Z score of ≥3.36. The groups with high scores (≥3.36) characterized by higher parameters of vessel stiffness, including AIx@75, augmentation pressure, and PWV, experienced considerably greater numbers of falls (41 vs. 8, p < 0.001), CV events (10 vs. 2, p < 0.05), and deaths (14 vs. 0, p < 0.001). Conclusions: Coordination impairments and the associated risk of falls in CKD patients are directly related to cardiovascular diseases and vascular conditions. Lower arterial compliance has been linked with the largest coordination disorder. Visual impairments, especially contrast sensitivity, are an independent risk factor for falls.

Communicating with Families after Severe Acute Brain Injury.

Communicating with patients and families after severe acute brain injury (SABI) is often considered an art, but the science of communication in SABI is advancing. Recent research demonstrates how surrogates perceive various styles of prognostic language in SABI, provides insight on factors that influence prognostic discordance between surrogate decision-makers and clinicians, and identifies sources of bias in prognostic communication and shared decision-making. In this article for Neurocritical Care's topical collection on palliative care, we review this latest research, offer strategies to approach difficult communication tasks with insufficient evidence to guide practice, and discuss ethical issues relevant to decision-making for this patient population.

Contribution of Extracranial Injuries to GOSE Scores after Traumatic Brain Injury TBI: A TRACK-Traumatic Brain Injury Study.

The Glasgow Outcome Scale Extended (GOSE) is the most widely used outcome measure for hospital-based studies of traumatic brain injury (TBI). The GOSE may be administered several ways, the choice depending on the purpose of the research. In this investigation, we evaluated the effect of administering the GOSE to collect functional disability attributed to all injuries sustained (GOSE-All) or excluding the impact of extracranial injuries (GOSE-TBI). We examined the differences in reported disability between the two administration methods at 2 weeks, 3 months, 6 months, and 12 months after injury. Data are summarized from 2288 individuals who were enrolled in the prospective observational Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) cohort study. The distribution of scores is summarized by time after injury, brain injury severity, and extracranial injury severity. Dichotomizing the GOSE varying ways, differences in the prevalence of unfavorable outcomes for GOSE-All versus GOSE-TBI range from none to 42 percentage points. Discrepancies in disability captured by GOSE-All and GOSE-TBI decrease with greater TBI severity, no serious extracranial injuries, and longer time post-injury. It is important for researchers, given the aims of their studies, to decide in advance whether GOSE classification should be based on the effects of all injuries sustained or excluding the effects of extracranial injuries so as to emphasize the effects of the brain injury, as well as how disability due to emotional consequences of injury and other circumstances will be scored. Instructions to the respondent and outcomes examiner need to be clear about what causes of disability are to be included. The TBI Common Data Elements should include information that reflects the method that was used to collect the GOSE data and data repositories should disclose which data collection method was used for a given study.

A Multimodal Analysis of Visual Impairments, Visual Evoked Potentials, and Cerebral Metabolism in Patients with Severe Brain Injury (P12-7.006)

A Multimodal Analysis of Visual Impairments, Visual Evoked Potentials, and Cerebral Metabolism in Patients with Severe Brain Injury (P12-7.006)

Optimising neonatal services for very preterm births between 27+0 and 31+6 weeks gestation in England: the OPTI-PREM mixed-methods study.

To investigate, for preterm babies born between 27+0 and 31+6 weeks gestation in England, optimal place of birth and early care. Mixed methods. National Health Service neonatal care, England. To investigate whether birth and early care in neonatal intensive care units (tertiary units) compared to local neonatal units (non-tertiary units) influenced gestation-specific survival and other major outcomes, we analysed data from the National Neonatal Research Database, for 29,842 babies born between 27+0 and 31+6 weeks gestation and discharged from neonatal care between 1 January 2014 and 31 December 2018. We utilised an instrumental variable (maternal excess travel time between local neonatal units and neonatal intensive care units) to control for unmeasured differences. Sensitivity analyses excluded postnatal transfers within 72 hours of birth and multiple births. Outcome measures were death in neonatal care, infant mortality, necrotising enterocolitis, retinopathy of prematurity, severe brain injury, bronchopulmonary dysplasia, and receipt of breast milk at discharge. We also analysed outcomes by volume of neonatal intensive care activity. We undertook a health economic analysis using a cost-effectiveness evaluation from a National Health Service perspective and using additional lives saved as a measure of benefit, explored differences in quality of care in high compared with low-performing units and performed ethnographic qualitative research. The safe gestational age cut-off for babies to be born between 27+0 and 31+6 weeks and early care at either location was 28 weeks. We found no effect on mortality in neonatal care (mean difference -0.001; 99% confidence interval -0.011 to 0.010; p = 0.842) or in infancy (mean difference -0.002; 99% confidence interval -0.014 to 0.009; p = 0.579) (n = 18,847), including after sensitivity analyses. A significantly greater proportion of babies in local neonatal units had severe brain injury (mean difference -0.011; 99% confidence interval -0.022 to -0.001; p = 0.007) with the highest mean difference in babies born at 27 weeks (-0.040). Those transferred in the first 72 hours were more likely to have severe brain injury. For 27 weeks gestation, birth in centres with neonatal intensive care units reduced the risk of severe brain injury by 4.2% from 11.9% to 7.7%. The number needed to treat was 25 (99% confidence interval 10 to 59) indicating that 25 babies at 27 weeks would have to be delivered in a neonatal intensive care unit to prevent one severe brain injury. For babies born at 27 weeks gestation, birth in a high-volume unit (> 1600 intensive care days/year) reduced the risk of severe brain injury from 0.242 to 0.028 [99% confidence interval 0.035 to 0.542; p = 0.003; number needed to treat = 4 (99% confidence interval 2 to 29)]. Estimated annual total costs of neonatal care were £262 million. The mean (standard deviation) cost per baby varied from £75,594 (£34,874) at 27 weeks to £27,401 (£14,947) at 31 weeks. Costs were similar between neonatal intensive care units and local neonatal units for births at 27+0 to 29+6 weeks gestation, but higher for local neonatal units for those born at 30+0 to 31+6 weeks. No difference in additional lives saved were observed between the settings. These results suggested that neonatal intensive care units are likely to represent value for money for the National Health Service. However, careful interpretation of this results should be exercised due to the ethical and practical concerns around the reorganisation of neonatal care for very preterm babies from local neonatal units to neonatal intensive care units purely on the grounds of cost savings. We identified a mean reduction in length of stay (1 day; 95% confidence interval 1.029 to 1.081; p < 0.001) in higher-performing units, based on adherence to evidence- and consensus-based measures. Staff reported that decision-making to optimise capacity for babies was an important part of their work. Parents reported valuing their baby's development, homecoming, continuity of care, inclusion in decision-making, and support for their emotional and physical well-being. Birth and early care for babies ≥28 weeks is safe in both neonatal intensive care units and local neonatal units in England. For anticipated births at 27 weeks, antenatal transfer of mothers to centres colocated with neonatal intensive care units should be supported. When these inadvertently occur in centres with local neonatal units, clinicians should risk assess decisions for postnatal transfer, taking patient care requirements, staff skills and healthcare resources into consideration and counselling parents regarding the increased risk of severe brain injury associated with transfer. This study is registered as Current Controlled Trials NCT02994849 and ISRCTN74230187. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/70/104) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 12. See the NIHR Funding and Awards website for further award information.

Diagnosis for Neonatal Sepsis-Associated Encephalopathy: Don't Forget Neuropathological Biomarkers.

Diagnosis for Neonatal Sepsis-Associated Encephalopathy: Don't Forget Neuropathological Biomarkers.

LncRNA ENSSSCG00000035331 Alleviates Hippocampal Neuronal Ferroptosis and Brain Injury Following Porcine Cardiopulmonary Resuscitation by Regulating the miR-let7a/GPX4 Axis.

Following successful cardiopulmonary resuscitation, those survivors of cardiac arrest (CA) often suffer from severe brain injury, and the latter can result in significant mortality and morbidity. Emerging evidence implicates that ferroptosis is involved in the pathogenesis of post-resuscitation brain injury, and its regulatory mechanisms remain to be investigated. Recently, some studies manifested that long noncoding RNAs could be critical regulators of cell ferroptosis in diverse ischemia-reperfusion injuries of vital organs. This study was designed to explore the role and mechanism of a newly screened long noncoding RNA ENSSSCG00000035331 in alleviating post-resuscitation hippocampal neuronal ferroptosis and further investigate its potential regulation by a novel antioxidant sulforaphane. Healthy male pigs and mice were used to establish the models of CA and resuscitation invivo. A hypoxia/reoxygenation (H/R) model using primary porcine hippocampal neurons was constructed to replicate post-resuscitation brain injury invitro. We found that the expression of ENSSSCG00000035331 was significantly decreased in the post-resuscitation impaired hippocampus using RNA sequencing analysis and verification. Subsequently, ENSSSCG00000035331 overexpression significantly reduced ferroptosis-related ferrous iron and reactive oxygen species production while markedly increased glutathione and further alleviated post-resuscitation brain injury. Mechanistically, ENSSSCG00000035331 interacted with miR-let7a, then inhibited its binding with glutathione peroxidase 4 (GPX4) mRNA and finally promoted the recovery of the latter's translation after H/R stimulation. In addition, sulforaphane treatment significantly increased ENSSSCG00000035331 and GPX4 expression while markedly decreased miR-let7a expression and hippocampal neuronal ferroptosis and finally alleviated post-resuscitation brain injury. Our findings highlighted that ENSSSCG00000035331 was a critical regulator of hippocampal neuronal ferroptosis after CA and resuscitation by targeting the miR-let7a/GPX4 axis, and additionally, sulforaphane might be a promising therapeutic agent for alleviating post-resuscitation brain injury by regulating the signaling axis mentioned above.

Surgical versus conservative management for traumatic brain injury in elderly patients: A propensity-matched cohort study.

The management of traumatic brain injury in elderly patients remains a topic of conflicting evidence in the literature. While some studies suggest that surgical intervention is beneficial, others indicate increased mortality and morbidity. Therefore, we conducted this retrospective matched cohort study to further investigate the role of surgical and conservative management for traumatic brain injury in elderly individuals. The authors conducted a retrospective review comparing patients with traumatic brain injury who underwent nonoperative management (NOM) versus those who underwent operative management (OM). Case matching was employed to create an artificial control group matched for age, sex, noncontrast computed tomography (NCCT) findings, and symptoms at a 1:1 ratio of treatment to control. The inclusion criteria included patients aged 60 years and above who presented to the emergency medicine department with head injuries resulting from various causes, such as road traffic accidents, falls, or assault, whereas the exclusion criteria included polytrauma, severe hypovolemic shock, and referrals to other institutions. The outcomes of interest included all-cause mortality and Glasgow Outcome Scale (GOS) scores, with statistical significance set at P < 0.05. Optimal case matching was achieved for 52 out of 96 patients who underwent surgical management. There was no statistically significant difference in all-cause mortality between patients who underwent surgical management (32.69%) and those who did not (28.82%). Similarly, there was no statistically significant difference in the GOS score at 1 month between the two groups. A subgroup analysis based on the severity of traumatic brain injury and radiological diagnosis of intracranial injury revealed no difference between the OM and NOM groups, except for patients who underwent midline shift surgery. There was no difference in all-cause mortality among elderly patients with traumatic brain injury regardless of whether they received conservative or surgical management, except for patients who underwent midline shift surgery.

Chronic, Shunt-Dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage: Incidence, Risk Factors, Clinical Phenotypes, and Outcome.

Chronic, Shunt-Dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage: Incidence, Risk Factors, Clinical Phenotypes, and Outcome.

Nonconvulsive status epilepticus in patients under intensive care: Should we view epilepsy as a sleep disorder?

Nonconvulsive status epilepticus (NCSE) was initially described in patients with typical and atypical absence status epilepticus (ASE) characterized by states of confusion varying in severity and in focal epilepsies with or without alteration of consciousness. Continuous EEG monitoring of critically ill patients has further refined the classification of NCSE into two main categories: with coma and without coma. Hypnotic, soporific or somniferous epileptic seizures do not exist. On the contrary, patients usually awaken when seizures occur during sleep, and their eyes remain open during ASE. Excessive sleepiness and coma alone are not ictal signs but are observed in the postictal phase of convulsive seizures. On the other hand, excessive sleepiness evolving into coma is a cardinal sign of metabolic/toxic encephalopathies with triphasic waves evolving to burst suppression patterns and ultimately to cerebral inactivity and death. NCSE alone does not directly cause coma. Comas are related to the underlying etiology, patient age and comorbidities, as well as the administration of intravenous sedative drugs to control epileptic seizures. In cases of severe brain injury, NCSE can explain the failure to awaken after the withdrawal of anesthetics and is only an aggravating factor of the neurological condition. In typical ASE, which is characterized by sustained, rhythmic, bilateral, synchronous and unreactive discharges with evolving spatiotemporal patterns (the best example of NCSE), there is no vigilance impairment. This contrasts with metabolic/toxic encephalopathies, which exhibit monomorphic generalized periodic discharges in which patients may become comatose and die. The extended concept of NCSE in comatose patients may lead to an inflated assessment of NCSE, implying a potentially worse prognosis compared to convulsive status epilepticus.

Increased Traumatic Brain Injury Severity and Mortality in Undocumented Immigrants.

Health disparities related to traumatic brain injury (TBI) have focused on socioeconomic status, race, and ethnicity. We sought to characterize TBI patterns and outcomes based on undocumented status. Patients who presented to University of California, San Diego Health Trauma Center with a TBI between 2019 and 2022 were identified and stratified based on undocumented status. Undocumented immigrants were identified using validated methods of absent or invalid social security number and key terms through chart review. Demographic information, injury characteristics, and neurosurgical interventions were recorded. Univariable and multivariable analyses were performed to determine the impact of patient factors on outcomes. Of 1654 patients with TBI, 76 (4.6%) were undocumented. Undocumented immigrants were younger (50 vs 60 years; P < .001) and had higher Injury Severity Score (17 vs 13; P < .001). They presented from farther distances (12.8 vs 5.3 miles, P < .001) with greater midline shift (1.49 vs 0.91 mm; P = .003). A greater proportion had basal cistern compression/effacement (14% vs 4.6%; P = .001) and required neurosurgical intervention (18% vs 9.6%; P = .012). Undocumented immigrants had higher hospital charges ($208 403 vs $128 948; P < .001), length of stay (5 vs 4 days; P = .002), and were discharged to a health facility at a lower rate (18% vs 32%; P = .012). They had nearly double the mortality rate (14% vs 7.3%; P = .021), with undocumented status trending as a predictor on multivariable regression (odds ratio = 2.87; P = .052). Undocumented immigrants presented from farther distances with increased TBI severity, likely from both more severe trauma and delayed presentation, requiring more neurosurgical intervention. They also had greater length of stay, charges, and nearly double the mortality rate. Importantly, undocumented status was a strong predictor for mortality. Despite worse outcomes, they were discharged to a health care facility at a lower rate. Advocacy efforts should be directed at increasing health care coverage and migrant community engagement and education.

1260 Neuroworsening in the Emergency Department: An Early and Important Indicator of Traumatic Brain Injury Severity and Neurosurgical Intervention

1260 Neuroworsening in the Emergency Department: An Early and Important Indicator of Traumatic Brain Injury Severity and Neurosurgical Intervention