Traumatic Brain Injury Cases Research Articles

Estimated incidence and case fatality rate of traumatic brain injury among children (0-18 years) in Sub-Saharan Africa. A systematic review and meta-analysis.

Studies from Sub-Saharan Africa (SSA) countries have reported on the incidence and case fatality rate of children with Traumatic Brain Injury (TBI). However, there is lack of a general epidemiologic description of the phenomenon in this sub-region underpinning the need for an accurate and reliable estimate of incidence and outcome of children (0-18 years) with TBI. This study therefore, extensively reviewed data to reliably estimate incidence, case fatality rate of children with TBI and its mechanism of injury in SSA. Electronic databases were systematically searched in English via Medline (PubMed), Google Scholar, and Africa Journal Online (AJOL). Two independent authors performed an initial screening of studies based on the details found in their titles and abstracts. Studies were assessed for quality/risk of bias using the modified Newcastle-Ottawa Scale (NOS). The pooled case fatality rate and incidence were estimated using DerSimonian and Laird random-effects model (REM). A sub-group and sensitivity analyses were performed. Publication bias was checked by the funnel plot and Egger's test. Furthermore, trim and fill analysis was used to adjust for publication bias using Duval and Tweedie's method. Thirteen (13) hospital-based articles involving a total of 40685 participants met the inclusion criteria. The pooled case fatality rate for all the included studies in SSA was 8.0%; [95% CI: 3.0%-13.0%], and the approximate case fatality rate was adjusted to 8.2%, [95% CI:3.4%-13.0%], after the trim-and-fill analysis was used to correct for publication bias. A sub-group analysis of sub-region revealed that case fatality rate was 8% [95% CI: 2.0%-13.0%] in East Africa, 1.0% [95% CI: 0.1% -3.0%] in Southern Africa and 18.0% [95% CI: 6.0%-29.0%] in west Africa. The pooled incidence proportion of TBI was 18% [95% CI: 2.0%-33.0%]. The current review showed that Road Traffic Accident (RTA) was the predominant cause of children's TBI in SSA. It ranged from 19.1% in South Africa to 79.1% in Togo. TBI affects 18% of children aged 0 to 18 years, with almost one-tenth dying in SSA. The most common causes of TBI among this population in SSA were RTA and falls. TBI incidence and case fatality rate of people aged 0-18 years could be significantly reduced if novel policies focusing on reducing RTA and falls are introduced and implemented in SSA.

Traumatic Brain Injury Cases Through Emergency Department During Covid-19 Pandemic Era 2020 In Adam Malik General Hospital Medan

Abstract
 Introduction: Coronavirus disease 2019 (COVID-19) has been infecting nearly 800.000 individuals of all ages in 31 March 2020. Based on Harvard Medical school experience, almost over 80% of patients have switched to telemedicine services. In Indonesia, there are almost 1,22 million cases with recovery of 1 million case and the death of 33.183 cases. In North Sumatera, the COVID-19 cases occurred in 22.999 cases and the recovery of 19.758 cases with death of 786 cases. Here, we report the trend of traumatic brain injury (TBI) cases in pandemic era 2020 in our institution in Adam Malik General Hospital, Medan, North Sumatera.
 Method: This retrospective observational study reported 343 TBI cases from January 2020 to December 2020. January 2020 to March 2020 regarded as pre pandemic and April 2020 to December 2020 as the pandemic era.
 Results: There is significant decrease of traumatic brain injury patients from March 2020 to April 2020. It was 61% decrease in patients admission to our Emergency Department (ED). Demographically, male patients in productive age group and mild TBI has the most common presentation to our ED.
 Discussion: There is significant decrease of patients with TBI in our institution. The number of cases was declining from 55 patients on January to 21 patients on April. This also occurred concurrently with the start of social distancing in Indonesia on April 2020 and the civilian suggested to stay at home during this period. This decline was also found in other countries, like Massachusetts, USA and India.
 Conclusion: We reported significant decrease in traumatic brain injury cases in Adam Malik General Hospital during COVID-19 pandemic era in 2020. Neurosurgeons and Residents of Neurosurgery have to be cautious in assessing the TBI patients to limit the spread of COVID-19 in ED.

Widespread Cortical Demyelination in Geriatric Cases of Mild Traumatic Brain Injury and in Alzheimer’s Disease

Dynapenia, the age-related loss of skeletal muscle strength without the loss of muscle mass, significantly impacts the activities and quality of life of the aging population. Studies have shown that dynapenia occurs earlier in females than males in both human and rodent studies. Moreover, in females, estrogen deficiency has been shown to contribute to the loss of skeletal muscle strength as well as blunted recovery of strength after injury. The maintenance of skeletal muscle contractile function is vital to the overall health of women, especially as women live 1/3 of their life in an estrogen deficient state. Reversible protein phosphorylation is an indispensable post-translational modification, playing a key role in signal transduction pathways. Phosphorylation of skeletal muscle proteins have been shown to regulate sarcomeric function, excitation-contraction coupling, energy metabolism, and fiber-type composition. To define the physiological changes in the skeletal muscle phosphoproteome associated with estrogen deficiency, we used an ovariectomy model coupled with mass spectrometry. We identified, in total, 5,424 unique phosphorylation sites and 1,177 phosphoproteins in the tibialis anterior muscle. Ingenuity Pathway Analysis show decreased phosphorylation of contractile proteins and significant predicted inhibition of the upstream kinase, CDK6 (z-score -2.0) in ovariectomized compared to control muscles. Our results suggest that estrogen deficiency remodels the skeletal muscle phosphoproteome which may alter phosphorylation signaling that might contribute to the loss of strength in females.

Widespread Cortical Demyelination in Geriatric Cases of Mild Traumatic Brain Injury and in Alzheimer’s Disease

Extreme adverse events such as natural disasters can accelerate disease progression and promote chronic inflammation. These phenotypes also increase in prevalence with age, suggesting that experiencing adversity might accelerate aging of the immune system. Adversity can induce persistent gene regulatory changes which may mechanistically explain the immune similarities between aging and adversity. To test how immune system aging is accelerated following a natural disaster, we measured the impact of Hurricane Maria on peripheral blood immune cell gene expression in a population of free-ranging rhesus macaques (Macaca mulatta) from before (n=435) versus after (n=108) Hurricane Maria. Experiencing Hurricane Maria altered the expression of 260 genes (FDR<10%), which were primarily involved in the inflammatory response. There was significant overlap in these hurricane-affected and age-associated genes with 40% (n=104) being associated with both the hurricane and aging, more than double the expected amount (Fisher’s Exact Test OR=3.7, p=4.06 x 10–21). The effects of the hurricane and aging on gene expression were also significantly correlated (rho=0.23, p=1.33 x 10-84), suggesting that they alter similar molecular pathways in the immune system. Further, we found that animals that experienced the hurricane had a gene expression profile that was, on average, 1.6 years older than animals that did not experience the hurricane (the equivalent of 6–7 years in a human lifespan, p=0.003). Together, our results provide some of the first evidence that extreme natural disasters mechanistically accelerates aging in the immune system.

Pediatric Minor Head Injury and Concussion

Head injury is one of the most common reasons children present to the emergency department (ED) and the leading cause of pediatric death and disability. Head injuries can range from having no neurologic deficits to death. Management in the ED centers on determining if there is a serious brain injury and preventing secondary brain injury. In most cases of mild traumatic brain injury, serious injuries can be ruled out based on the history of the injury, associated symptoms, and clinical assessment. Concussion is a common presentation of head injury and encompasses a wide range of symptoms. Computed tomography should be used judiciously, and extensive research has led to algorithms to aid in this decision. Prior to discharge from the ED, parents will often have questions about when their child may resume normal activity. This is a decision that most often will involve the patient’s primary care provider or a concussion specialist as the ED provider is unable to follow progression or resolution of symptoms. However, the ED provider should be able to provide anticipatory guidance. This review contains 5 figures, 7 tables, and 48 references. Keywords: computed tomography, concussion, head injury, mild traumatic brain injury, traumatic brain injury

Pediatric Minor Head Injury and Concussion

Head injury is one of the most common reasons children present to the emergency department (ED) and the leading cause of pediatric death and disability. Head injuries can range from having no neurologic deficits to death. Management in the ED centers on determining if there is a serious brain injury and preventing secondary brain injury. In most cases of mild traumatic brain injury, serious injuries can be ruled out based on the history of the injury, associated symptoms, and clinical assessment. Concussion is a common presentation of head injury and encompasses a wide range of symptoms. Computed tomography should be used judiciously, and extensive research has led to algorithms to aid in this decision. Prior to discharge from the ED, parents will often have questions about when their child may resume normal activity. This is a decision that most often will involve the patient’s primary care provider or a concussion specialist as the ED provider is unable to follow progression or resolution of symptoms. However, the ED provider should be able to provide anticipatory guidance. This review contains 5 figures, 7 tables, and 48 references. Keywords: computed tomography, concussion, head injury, mild traumatic brain injury, traumatic brain injury

Pediatric Minor Head Injury and Concussion

Head injury is one of the most common reasons children present to the emergency department (ED) and the leading cause of pediatric death and disability. Head injuries can range from having no neurologic deficits to death. Management in the ED centers on determining if there is a serious brain injury and preventing secondary brain injury. In most cases of mild traumatic brain injury, serious injuries can be ruled out based on the history of the injury, associated symptoms, and clinical assessment. Concussion is a common presentation of head injury and encompasses a wide range of symptoms. Computed tomography should be used judiciously, and extensive research has led to algorithms to aid in this decision. Prior to discharge from the ED, parents will often have questions about when their child may resume normal activity. This is a decision that most often will involve the patient’s primary care provider or a concussion specialist as the ED provider is unable to follow progression or resolution of symptoms. However, the ED provider should be able to provide anticipatory guidance. This review contains 5 figures, 7 tables, and 48 references. Keywords: computed tomography, concussion, head injury, mild traumatic brain injury, traumatic brain injury

Traumatic brain injury of childhood

Traumatic brain injury of childhood

Risk factors of mortality due to traumatic brain injury in Marsidi Judono general hospital, Belitung, Indonesia

Introduction: Traumatic brain injury (TBI) is a global problem and the biggest cause of mortality and disability of all trauma cases. This study aimed to determine the characteristics and relationship between risk factors for TBI and its impact on mortality and also to provide epidemiological data related to TBI in Belitung regency.Methods: A retrospective study was conducted using secondary data from the medical records of participants who met the inclusion and exclusion criteria at dr. H. Marsidi Judono General Hospital Belitung from January to December 2019. Data were analyzed as univariate, bivariate, and multivariate using binary logistic regression.Results: Two hundred and seventy patients were included in this study. Men were more likely to have a TBI than women in all categories (65.9%). The adolescent age group (33.7%) followed by adults (31.5%) were the largest contributors to TBI. Road traffic accident cases (86.7%) dominated the incidence of TBI. The use of headgear was still lacking (36.7%) while cases of road traffic accidents were high. The use of ambulances was lacking (10.4%) compared to other vehicles. A total of 119 patients (44%) were hospitalized in either the general ward or ICU with an average length of hospitalization was 3 days. Of all TBI cases, the mortality rate was 11.9%. People with older age have a higher mortality rate compared to other age categories (OR 1.052; 95% CI: 1.001 – 1.106).Conclusion: The mortality rate due to TBI reaches 11.9% in this region, with age as a statistically significant predictor of mortality due to TBI. Older patients tend to have a higher likelihood of death due to TBI. The data obtained can be used by general practitioners, disease preventative planners, and policymakers to reduce mortality due to TBI in Belitung regency.Keywords: Belitung, risk factors of mortality, road traffic injury, traumatic brain injury

A fatal case of traumatic brain injury with severe coagulopathy due to Rhabdophis tigrinus (yamakagashi) bites: a case report

BackgroundYamakagashi venom is a prothrombin activator, leading to disseminated intravascular coagulation. We report a fatal case of severe coagulopathy from head trauma assumed to be caused by a yamakagashi bite.Case presentationAn 80-year-old man fell and developed systemic tonic–clonic convulsions. Head computed tomography revealed brain contusion and acute subdural hematoma. Physical examination revealed two bite marks with persistent bleeding on the right lower leg. The patient stated that he had been bitten by some creature 3 days prior, but the bite was left untreated. Laboratory tests showed fibrinogen levels below the detection limit. Although eighteen units of fresh frozen plasma were administered for coagulopathy, fibrinogen levels did not improve. He died about 18 h after a head injury.ConclusionIn this case of a yamakagashi bite with active bleeding due to trauma, early administration of yamakagashi antivenom should be considered to control coagulopathy.

Spatial patterns of cortical demyelination in geriatric cases of traumatic brain injury and in Alzheimer's disease.

Traumatic brain injury (TBI) causes demyelination and cortical neurodegeneration patterns similar to those of Alzheimer's disease (AD, Irimia et al. 2020). The ratio of T1 - to T2 -weighted magnetic resonance imaging (MRI) intensities is a measure of myelin content (Glasser & Van Essen, 2011). By mapping changes in this ratio, we report on the spatial and extent of demyelination after mild TBI (mTBI) relative to typical aging and AD. At two time points ∼6 months apart, T1 - and T2 -weighted MRIs were acquired from age- and sex-matched healthy control (HC) participants (N = 68; age (years): μ = 76.162, σ = 4.145), mTBI volunteers (N = 19; age: μ = 69.579. σ = 5.143), and AD patients (N = 33; age: μ = 77.420, σ = 5.545). After MRI coregistration, segmentation and bias field correction, the ratio R = T1 /T2 and its time change ΔR were computed at each cortical location. The null hypotheses that the means of ΔR were equal in (a) HCs vs. mTBI, (b) HCs and AD, and (c) mTBI vs. AD were tested (α = 0.05). Age effects were accounted for in statistical analyses. In the mTBI and AD groups, ∼10% and ∼23% of the cortex, respectively, exhibited significant decreases in R compared to HCs (p < 0.05); ∼7% of the cortex exhibited significantly larger myelin decreases in mTBI than in AD. mTBI subjects were found to have significantly less myelin than HCs in anterior limbic areas, the longitudinal frontal gyrus, left supplementary motor areas, and ventrolateral temporal regions. Compared to HCs, AD patients exhibited more demyelination across all lobes. mTBI subjects exhibited more demyelination than AD patients in temporal, supplementary motor, superior frontal, and orbitofrontal areas. Compared to mTBI, AD patients had significantly less myelin in parietal regions. Whereas demyelination occurs in both AD and geriatric mTBI, mTBI effect sizes are comparable to, or even greater than, those observed in AD. Future research should attempt to understand the long-term demyelination trajectories of mTBI relative to AD and leverage this information to forecast AD risk after geriatric TBI.

Ultrasound measurement of the optic nerve sheath diameter in traumatic brain injury: a narrative review

Background : Raised intracranial pressure (ICP) needs to be investigated in various situations, especially in traumatic brain injury (TBI). Ultra-sonographic (US) measurement of the optic nerve sheath diameter (ONSD) is a promising noninvasive tool for assessing elevated ICP. Objectives : This narrative review aimed to explain the history of and indications forUS measurement of ONSD. We focused on the detection of elevated ICP after TBI and discussed the possible improvements in detection methods. Conclusions : US measurement of ONSD in TBI cases provides a qualitative but no quantitative assessment of ICP. Current studies usually calculate their own optimum cutoff value for detecting raised ICP based on the balance between sensitivity and specificity of the method when compared with invasive methods. There is no universally accepted threshold. We did not find any paper focusing on the prognosis of patients benefiting from it when compared with usual care. Another limitation is the lack of standardization. US measurement of ONSD cannot be used as the sole technique to detect elevated ICP and monitor its evolution, but it can be a useful tool in a multimodal protocol and it might help to determine the prognosis of patients in various situations.

To determine the effectiveness of antiepileptic drugs in treatment of acute traumatic brain injury for preventing seizure.

Objectives: To determine the effectiveness of antiepileptic drugs in treatment of acute traumatic brain injury for preventing seizure. Study Design: Cross Sectional Study. Setting: Ziauddin Hospital, North Campus, Karachi. Period: 2014 to 2016. Material &amp; Methods: Eighty diagnosed cases of traumatic brain injury were included in this study. Patients were examined physically and neurological assessment, with mental status was assessed by Glasgow Coma scoring. A blood sample was taken and Computed tomography was performed. Antiepileptic therapy was given for a period of one week minimally or 10 days maximally and patients were assessed clinically for seizures. All information was collected in the predesign proforma. Results: The patients median age was 25[16-43]. There were 70% male and 30% female. Rate of seizure was 6.3% (5/80) cases mortality was observed 5% (4/80) cases. Rate of seizure was significantly high in patients who had moderate TBI as compare to mild TBI (p=0.016). It was also significantly high in those cases who had diabetes and IHD. Rate of mortality was significantly high in seizure cases (p=0.0005). Conclusion: Prophylactic antiepileptic drugs are effective in decreasing the risk of early post-traumatic seizures in acute traumatic brain injury.These drug may provide an important and alternative treatment option for seizure prevention in acute TBI patients and prevent further brain damage.

Investigation of Machine Learning and Deep Learning Approaches for Detection of Mild Traumatic Brain Injury from Human Sleep Electroencephalogram.

Traumatic Brain Injury (TBI) is a highly prevalent and serious public health concern. Most cases of TBI are mild in nature, yet some individuals may develop following-up persistent disability. The pathophysiologic causes for those with persistent postconcussive symptoms are most likely multifactorial and the underlying mechanism is not well understood, although it is clear that sleep disturbances feature prominently in those with persistent disability. The sleep electroencephalogram (EEG) provides a direct window into neuronal activity during an otherwise highly stereotyped behavioral state, and represents a promising quantitative measure for TBI diagnosis and prognosis. With the ever-evolving domain of machine learning, deep convolutional neural networks, and the development of better architectures, these approaches hold promise to solve some of the long entrenched challenges of personalized medicine for uses in recommendation systems and/or in health monitoring systems. In particular, advanced EEG analysis to identify putative EEG biomarkers of neurological disease could be highly relevant in the prognostication of mild TBI, an otherwise heterogeneous disorder with a wide range of affected phenotypes and disability levels. In this work, we investigate the use of various machine learning techniques and deep neural network architectures on a cohort of human subjects with sleep EEG recordings from overnight, in-lab, diagnostic polysomnography (PSG). An optimal scheme is explored for the classification of TBI versus non-TBI control subjects. The results were promising with an accuracy of ∼95% in random sampling arrangement and ∼70% in independent validation arrangement when appropriate parameters were used using a small number of subjects (10 mTBI subjects and 9 age- and sex-matched controls). We are thus confident that, with additional data and further studies, we would be able to build a generalized model to detect TBI accurately, not only via attended, in-lab PSG recordings, but also in practical scenarios such as EEG data obtained from simple wearables in daily life.

Assessing Protein Biomarkers to Detect Lethal Acute Traumatic Brain Injuries in Cerebrospinal Fluid.

Diagnosing traumatic brain injury (TBI) from body fluids in cases where there are no obvious external signs of impact would be useful for emergency physicians and forensic pathologists alike. None of the previous attempts has so far succeeded in establishing a single biomarker to reliably detect TBI with regards to the sensitivity: specificity ratio in a post mortem setting. This study investigated a combination of body fluid biomarkers (obtained post mortem), which may be a step towards increasing the accuracy of biochemical TBI detection. In this study, serum and cerebrospinal fluid (CSF) samples from 30 acute lethal TBI cases and 70 controls without a TBI-related cause of death were evaluated for the following eight TBI-related biomarkers: brain-derived neurotrophic factor (BDNF), ferritin, glial fibrillary acidic protein (GFAP), interleukin 6 (IL-6), lactate dehydrogenase, neutrophil gelatinase-associated lipocalin (NGAL), neuron-specific enolase and S100 calcium-binding protein B. Correlations among the individual TBI biomarkers were assessed, and a specificity-accentuated threshold value analysis was conducted for all biomarkers. Based on these values, a decision tree modelling approach was performed to assess the most accurate biomarker combination to detect acute lethal TBIs. The results showed that 92.45% of acute lethal TBIs were able to be diagnosed using a combination of IL-6 and GFAP in CSF. The probability of detecting an acute lethal TBI was moderately increased by GFAP alone and considerably increased by the remaining biomarkers. BDNF and NGAL were almost perfectly correlated (p = 0.002; R2 = 0.944). This study provides evidence that acute lethal TBIs can be detected to a high degree of statistical accuracy using forensic biochemistry. The high inter-individual correlations of biomarkers may help to estimate the CSF concentration of an unknown biomarker, using extrapolation techniques.

244 Traumatic Brain Injury Related Paediatric Mortality and Morbidity in Low- And Middle-Income Countries: A Systematic Review and Meta-Analysis

Abstract Aim Three million cases of paediatric traumatic brain injury (pTBI) occur annually, the majority of which occur in low-and-middle-income countries (LMICs). However, there is a paucity of data on the outcomes of pTBI available. We aimed to systematically review and synthesise the reported morbidity and mortality from pTBI in the published literature about LMICs. Method A systematic review and meta-analysis were conducted. MEDLINE, EMBASE, Global Health, and Global Index Medicus were searched for relevant articles from January 2000 to May 2020. Observational or experimental studies on pTBI (individuals between the ages of 0 to 16 years) in LMICs were included. Morbidity data were descriptively analysed, and a random-effects model was used to pool mortality rates. PROSPERO ID: CRD42020171276. Results We included 145 studies from 38 countries representing 174073 patients with pTBI. Males were twice (95% CI: 1.6 – 2.4) as likely to have a pTBI than females. Where available, mild TBI represented ≥ 60% of all pTBI cases in most reports (n = 24/43, 56%). The commonest cited cause of pTBI was road traffic accidents (n = 16643/43083, 39%), followed by falls (n = 10927/43083, 25%). 4385 patients (n = 4385/18092, 24%) had a reduction from normal function on discharge. On average, there were 6.7 deaths per 100 cases of pTBI. Conclusions Only 38 LMICs have published data on the volume and burden of pTBI in their country. Limited data available suggests that young male children are at a high-risk of pTBIs in LMICs, particularly from road traffic accidents.

Delayed-Onset Neuropathological Complications From a Foramen Magnum and Occipital Crest Focused TBI of the Vietnam War and Other Conflicts: Part III, Critique of Existing TBI Criteria and Their Operational Controversies.

In this report, we discuss the controversy of the diverse traumatic brain injury (TBI) categorization and taxonomy and the need to develop a new multidimensional and multidisciplinary categorization system that can be an aid in improved diagnostic and prognostic outcomes. Of interest, the heterogeneity of TBI marks the major obstacle to develop effective therapeutic interventions. Currently, the Glasgow Coma Scale has been utilized to guide in the prognosis and clinical management of TBI; it does not encompass the pathophysiological mechanisms leading to neurological deficits that can impede therapeutic interventions and consequently the failure of clinical trials. An unfortunate gap exists between advances in TBI research and existing U.S. Department of Defense (DoD) definitions, categorization, and management. Part I illustrates a unique posterior-focused TBI case report that does not fit any existing TBI definitions. Part II summarizes new animal-based TBI research that supports the case report as a legitimate TBI category. Part III critiques existing TBI criteria and their controversies. Current DoD definitions and decision-making protocols based on concussion time alone are reviewed and compared to the myriad of additional TBI definitions that further illustrate the marked differences in definitions, especially in mild TBIs. The DoD definitions are not consistent with what academic research and science bring to the debate. With increasing world conflicts and wars, evaluators are not prepared to accept, evaluate, and properly manage those TBIs that are not associated with immediate levels of unconsciousness alone as the prime determinant of diagnosis and long-term severity. Despite comprehensive research, current understanding among decision-makers of progressive pathology of non-hemispheric TBIs remains limited, inconsistent, and confusing. This dilemma requires a multidisciplinary, science/medicine-led panel to actively reassess TBI criteria that take into consideration the latest research including non-cerebral hemispheric injuries. We recommend that DoD/Veterans Affairs establish a commission to regularly review the academic-related scientific evidence and incorporate these findings in a timely fashion into their operational definitions. This would guarantee that recognition, diagnosis, and follow-up of all TBIs are properly understood, managed, and documented.

Reliability and Validity of a Virtual Reality-based Cognitive Assessment Tool (VR-CAT) for Children with TBI

<h3>Research Objectives</h3> An estimated 700,000 pediatric traumatic brain injury (TBI) cases are reported each year in the U.S. The long-term goal of this project is to address the need to identify and treat those patients with persistent executive function problems. Virtual reality (VR) has the potential to provide an immersive environment for measuring EFs. This presentation aimed to examine the reliability and validity of the VR-based Cognitive Assessment Tool (VR-CAT) for inhibitory control [IC], working memory [WM], cognitive flexibility [CF]). <h3>Design</h3> Cross-sectional design with comparison. <h3>Setting</h3> Level 1 trauma center. <h3>Participants</h3> A total of 24 patients 7-17 years with mild complicated/moderate/severe TBI and 30 patients with orthopedic injury (OI) participated. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Test-retest reliability was measured by correlating VR scores between two assessments among TBI/OI patients. Concurrent validity, ecological validity, and diagnostic validity was measured among TBI and OI patients using NIH Toolbox Cognitive Battery and BRIEF2. <h3>Results</h3> VR-CAT demonstrated adequate test-retest reliability on IC, WM, and CF. Adequate concurrent validity on IC and WM but not CF tasks was established by significant correlation with respective age-corrected NIH Toolbox scores. VR-CAT demonstrated adequate ecological validity with BRIEF2 only on WM but not IC or CF. Finally, VR-based WM (but not IC or CF) task showed fair diagnostic validity between TBI and OI groups. <h3>Conclusions</h3> VR-CAT demonstrated high temporal reliability inhibitory control, working memory, and cognitive flexibility. It also showed adequate concurrent, ecological, and diagnostic validity on working memory. <h3>Author(s) Disclosures</h3> None.

Effects of Prescription Opioid Use on Traumatic Brain Injury Risk in Older Adults.

The objective of this study was to estimate the risk of traumatic brain injury (TBI) associated with opioid use among older adult Medicare beneficiaries. Five percent sample of Medicare administrative claims obtained for years 2011-2015. A total of 50 873 community-dwelling beneficiaries 65 years and older who sustained TBI. Case-crossover study comparing opioid use in the 7 days prior to TBI with the control periods of 3, 6, and 9 months prior to TBI. TBI cases were identified using ICD-9 (International Classification of Diseases, Ninth Revision) and ICD-10 (International Classification of Diseases, Tenth Revision) codes. Prescription opioid exposure and concomitant nonopioid fall risk-increasing drug (FRID) use were determined by examining the prescription drug event file. The 8257 opioid users (16.2%) were significantly younger (mean age 79.0 vs 80.8 years, P < .001). Relative to nonusers, opioid users were more likely to be women (77.0% vs 70.0%, P < .001) with a Charlson Comorbidity Index of 2 or more (43.7% vs 30.9%, P < .001) and higher concomitant FRID use (94.0% vs 82.7%, P < .001). Prescription opioid use independently increased the risk of TBI compared with nonusers (OR = 1.34; 95% CI, 1.28-1.40). In direct comparisons, we did not observe evidence of a significant difference in adjusted TBI risk between high- (≥90 morphine milligram equivalents) and standard-dose opioid prescriptions (OR = 1.01; 95% CI, 0.90-1.14) or between acute and chronic (≥90 days) opioid prescriptions (OR = 0.93; 95% CI, 0.84-1.02). Among older adult Medicare beneficiaries, prescription opioid use independently increased risk for TBI compared with nonusers after adjusting for concomitant FRID use. We found no significant difference in adjusted TBI risk between high-dose and standard-dose opioid use, nor did we find a significant difference in adjusted TBI risk between acute and chronic opioid use. This analysis can inform prescribing of opioids to community-dwelling older adults for pain management.

A-114 Neurocognitive Correlates of Persistent Post-Concussion Syndrome in Youth

Abstract Objective In the U.S., youths account for most annual mild traumatic brain injury (mTBI) cases. Often mTBI patients experience impairing symptoms that affect several domains of functioning, typically these symptoms remit within a month though many patients will experience impairing symptoms that persist for greater than three months. Due to the current difficulties in diagnosing this condition in a standardized way, the current study aims to clarify the cognitive profiles of persistent post-concussion syndrome (PPCS) in youth patients. Method 30 youths between the ages of 8 and 18 years participated. 15 youths with mTBI symptoms for greater than three months were recruited from a mTBI treatment clinic. An additional 15 youths without a mTBI history were recruited as a control group. All participants underwent cognitive testing using the standard Woodcock-Johnson Tests of Cognitive Abilities battery. Logistic regression analyses explored the importance of cognitive processing speed and working memory for identifying youth patients with PPCS. Further exploratory analyses were conducted to clarify additional cognitive domains that may be impacted by PPCS. Results Findings suggest processing speed and working memory abilities alone are not adequate for identifying patients with PPCS and measures of processing speed, fluid reasoning, working memory, and long-term retrieval may be important to consider when differentially diagnosing PPCS. Conclusions More research is needed to appropriately identify and validate diagnostic practices for PPCS in youth. Our findings provide a basis for future work and suggests neuropsychological batteries that include measures for these four cognitive domains may be valuable for identifying PPCS in youth patients.