Risk Of Traumatic Brain Injury Research Articles

Traumatic brain injury associated with dementia risk among people with type 1 diabetes.

To examine the association between traumatic brain injury (TBI) and dementia risk among a cohort of middle-aged and elderly individuals with type 1 diabetes (T1D). We evaluated 4,049 members of an integrated health care system with T1D ≥50 years old between January 1, 1996, and September 30, 2015. Dementia and TBI diagnoses throughout the study period were abstracted from medical records. Cox proportional hazards models estimated associations between time-dependent TBI and dementia adjusting for demographics, HbA1c, nephropathy, neuropathy, stroke, peripheral artery disease, depression, and dysglycemic events. Fine and Gray regression models evaluated the association between baseline TBI and dementia risk accounting for competing risk of death. A total of 178 individuals (4.4%) experienced a TBI and 212 (5.2%) developed dementia. In fully adjusted models, TBI was associated with 3.6 times the dementia risk (hazard ratio [HR] 3.64; 95% confidence interval [CI] 2.34, 5.68). When accounting for the competing risk of death, TBI was associated with almost 3 times the risk of dementia (HR 2.91; 95% CI 1.29, 5.68). This study demonstrates a marked increase in risk of dementia associated with TBI among middle-aged and elderly people with T1D. Given the complexity of self-care for individuals with T1D, and the comorbidities that predispose them to trauma and falls, future work is needed on interventions protecting brain health in this vulnerable population, which is now living to old age.

Tranexamic acid for significant traumatic brain injury (The CRASH-3 trial): Statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial.

Background: Worldwide, traumatic brain injury (TBI) kills or hospitalises over 10 million people each year. Early intracranial bleeding is common after TBI, increasing the risk of death and disability. Tranexamic acid reduces blood loss in surgery and death due to bleeding in trauma patients with extra-cranial injury. Early administration of tranexamic acid in TBI patients might limit intracranial bleeding, reducing death and disability. The CRASH-3 trial aims to provide evidence on the effect of tranexamic acid on death and disability in TBI patients. We will randomly allocate about 13,000 TBI patients (approximately 10,000 within 3 hours of injury) to an intravenous infusion of tranexamic acid or matching placebo in addition to usual care. This paper presents a protocol update (version 2.1) and statistical analysis plan for the CRASH-3 trial. Results: The primary outcome is head injury death in hospital within 28 days of injury for patients treated within 3 hours of injury (deaths in patients treated after 3 hours will also be reported). Because there are reasons to expect that tranexamic acid will be most effective in patients treated immediately after injury and less effective with increasing delay, the effect in patients treated within one hour of injury is of particular interest. Secondary outcomes are all-cause and cause-specific mortality, vascular occlusive events, disability based on the Disability Rating Scale and measures suggested by patient representatives, seizures, neurosurgical intervention, neurosurgical blood loss, days in intensive care and adverse events. Sub-group analyses will examine the effect of tranexamic acid on head injury death stratified by time to treatment, severity of TBI and baseline risk. Conclusion: The CRASH-3 trial will provide reliable evidence of the effectiveness and safety of tranexamic acid in patients with acute TBI. Registration: International Standard Randomised Controlled Trials registry ( ISRCTN15088122) 19/07/2011, and ClinicalTrials.gov ( NCT01402882) 25/07/2011.

Tranexamic acid for significant traumatic brain injury (The CRASH-3 trial): Statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial.

Background: Worldwide, traumatic brain injury (TBI) kills or hospitalises over 10 million people each year. Early intracranial bleeding is common after TBI, increasing the risk of death and disability. Tranexamic acid reduces blood loss in surgery and death due to bleeding in trauma patients with extra-cranial injury. Early administration of tranexamic acid in TBI patients might limit intracranial bleeding, reducing death and disability. The CRASH-3 trial aims to provide reliable evidence on the effect of tranexamic acid on death and disability in TBI patients. We will randomly allocate about 13,000 TBI patients to an intravenous infusion of tranexamic acid or matching placebo in addition to usual care. This paper presents a protocol update (version 2.1) and statistical analysis plan for the CRASH-3 trial. Results: The primary outcome is head injury death in hospital within 28 days of injury for patients treated within 3 hours of injury (deaths in patients treated after 3 hours will also be reported). Because there are strong scientific reasons to expect that tranexamic acid will be most effective in patients treated immediately after injury and less effective with increasing delay, the effect in patients treated within one hour of injury is of particular interest. Secondary outcomes are all-cause and cause-specific mortality, vascular occlusive events (myocardial infarction, pulmonary embolism, deep vein thrombosis, stroke), disability based on the Disability Rating Scale and measures suggested by patient representatives, seizures, neurosurgical intervention, neurosurgical blood loss, days in intensive care and adverse events. Sub-group analyses will examine the effect of tranexamic acid on head injury death stratified by time to treatment, severity of TBI and baseline risk. Conclusion: The CRASH-3 trial will provide reliable evidence of the effectiveness and safety of tranexamic acid in patients with acute TBI. Registration: International Standard Randomised Controlled Trials registry ( ISRCTN15088122) 19/07/2011, and ClinicalTrials.gov ( NCT01402882) 25/07/2011.

Risk of Traumatic Brain Injury Among Children, Adolescents, and Young Adults With Attention-Deficit Hyperactivity Disorder in Taiwan

PurposePrevious studies suggested that patients with attention-deficit hyperactivity disorder (ADHD) were prone to health-risk behaviors and accidents. However, the relationship of ADHD with the risk of traumatic brain injury (TBI) remained uncertain. MethodsUsing the Taiwan National Health Insurance Research Database, 72,181 children (aged 3–11 years), adolescents (12–17 years), and young adults (18–29 years) with ADHD and 72,181 age-/sex-matched controls were enrolled between 2001 and 2009, and followed up to the end of 2011 in our study. Those who developed any TBI during the follow-up period were identified. ResultsChildren, adolescents, and young adults with ADHD had a higher incidence of developing any TBI (9.8% vs. 2.2%, p < .001), such as skull fracture (.2% vs. .1%, p < .001) and concussion (4.3% vs. 1.0%, p < .001), than the controls did. Cox regression analysis with the adjustment of demographic data, psychiatric comorbidities, and ADHD medications showed that ADHD was related to an increased risk of subsequent TBI (hazard ratio: 4.57, 95% confidence interval: 4.31–4.85), and indicated that long-term use of ADHD medication was associated with a reduced likelihood of subsequent TBI (hazard ratio: .93, 95% confidence interval: .87–.99). ConclusionsPatients with ADHD had an increased risk of developing any TBI compared with the controls. Long-term use of ADHD medications would reduce this risk. Our findings suggested that the public health government and clinicians should pay more attention to the TBI risk among patients with ADHD, and further indicated the importance of the optimal treatment for ADHD.

Comparative Analysis on Traumatic Brain Injury Risk Due to Primary and Secondary Impacts in a Pedestrian Sideswipe Accident

A series of pedestrian sideswipe impacts were computationally reconstructed; a fast-walking pedestrian was collided laterally with the side of a moving vehicle at 25 km/h or 40 km/h, which resulted in rotating the pedestrian's body axially. Potential severity of traumatic brain injury (TBI) was assessed using linear and rotational acceleration pulses applied to the head and by measuring intracranial brain tissue deformation. We found that TBI risk due to secondary head strike with the ground can be much greater than that due to primary head strike with the vehicle. Further, an “effective” head mass, meff, was computed based upon the impulse and vertical velocity change involved in the secondary head strike, which mostly exceeded the mass of the adult head-form impactor (4.5 kg) commonly used for a current regulatory impact test for pedestrian safety assessment. Our results demonstrated that a sport utility vehicle (SUV) is more aggressive than a sedan due to the differences in frontal shape. Additionally, it was highlighted that a striking vehicle velocity should be lower than 25 km/h at the moment of impact to exclude the potential risk of sustaining TBI, which would be mitigated by actively controlling meff, because meff is closely associated with a rotational acceleration pulse applied to the head involved in the final event of ground contact.

CORRECTION OF DISTURBED NEUROIMMUNE INTERACTIONS IN EXPERIMENTAL TRAUMATIC BRAIN INJURY BY MEANS OF RECOMBINANT INTERLEUKIN 2

Traumatic brain injury (TBI) commonly proceeds as a severe disease with high morbidity that can lead to neurological disorders in some of these patients. TBI is associated by multidirectional abnormalities of immune system, which affect quantity and functions of T-, B-, and NK-lymphocytes leading to infectious complications or autosensibilization. Restoration of the disturbances in neuroimmune interactions after TBI may be achieved by means of immunomodulators that have neuroprotective properties and may potentially initiate regenerative CNS activity. IL-2 is a cytokine that possesses neurooperative and neuroprotective properties. In immune system, IL-2 is produced by T-cells in response to antigen stimuli; in CNS, by brain cells. Lack of IL-2 production by both T-lymphocytes and brain cells increases a possibility of autoimmune and inflammatory pathologies. The objective of present study was to evaluate possible effects of human recombinant IL-2 (rIL-2, Roncoleukin®, Biothech Ltd., Russia) upon state and correction of immune and neuro-endocrine TBI consequences. The study was performed in adult Wistar rats. Mechanical TBI was produced by the dropping load model. 72 hours after inflicting the TBI, r-IL-2, at dose 30 mg/kg was injected once a day for three times. The animals from control group received 0.15M NaCl solution over the same period. The results have shown that, within first hours and days after TBI, corticosterone levels showed a sharp increase, whereas testosterone concentrations were decreased.In parallel, an increase in cytotoxic and proliferative activity of splenocytes was revealed, as well as increased number of splenocytes at their late apoptotic stage. Three daily injections of rIL-2 resulted into a significant increase in corticosterone and testosterone levels in injured animals on the day 7 after TBI. The animals treated with rIL-2 have exhibited more rapid normalization of cytotoxic and proliferative activity of splenocytes and return to normal ratio of proliferating splenocytes vs. apoptotic cells. Therefore, usage of rIL-2 may correct neuro-endocrine and immune interaction disturbances after TBI and decrease risk of chronic neurological disorders in TBI patients.

Pharmacologic Treatment for Depression at Injury Is Associated With Fewer Clinician Visits for Persistent Symptoms After Mild Traumatic Brain Injury: A Medical Record Review Study

BackgroundDepression and traumatic brain injury (TBI) substantially contribute to the U.S. health care burden. Depression is a known risk factor for prolonged recovery after TBI. However, the effect of depression treatment on health care utilization has yet to be studied. ObjectiveTo examine whether an association exists between pharmacologic treatment of depression at the time of mild or concussive TBI and the number of subsequent clinician visits for persistent injury-related symptoms. DesignRetrospective medical record review. SettingTertiary care medical center. ParticipantsA total of 120 patients (mean age 45.6 years) with a history of depression who subsequently experienced a mild or concussive TBI were included. MethodsIndividuals were identified with co-occurring diagnoses of depression and mild or concussive TBI by retrospective electronic medical record review. The diagnosis of depression must have preceded the diagnosis of TBI. Main OutcomeThe number of clinician visits for postinjury symptoms were counted at 3, 6, and 12 months postinjury. ResultsClinician visits for persistent injury-related symptoms were significantly fewer at all 3 time points for the group treated for depression at time of injury. ConclusionsDepressed individuals who were pharmacologically treated for depression at the time of TBI had significantly fewer clinician visits for persistent postinjury symptoms than those not pharmacologically treated for depression at the time of injury. Routine depression screening in patients with a high risk for TBI may identify a mood disorder that could contribute to persistent symptoms if left untreated, with its effective management potentially reducing health-related costs. Level of EvidenceIII

The Risk of Traumatic Brain Injury Occurring Among Patients with Parkinson Disease: A 14-Year Population-Based Study.

Previous studies have implicated traumatic brain injury (TBI) as a risk factor for Parkinson disease (PD). However, the incidence risk of new-onset TBI among patients with PD is not well established. This study investigated the contribution of PD to new-onset TBI associations. The study selected 6076 patients with PD and using 1:2 propensity score matching 12,152 general population cohorts in a longitudinal population database in Taiwan. The Cox proportional hazard regression model was used to estimate the hazard ratio of TBI adjusted with the potential confounding factors. The incidence of TBI in patients with PD (2.57%) and compared cohorts (1.81%) was significantly different (P= 0.0007). Patients with PD had a higher risk of TBI (hazard ratio, 1.63; 95% confidence interval, 1.32-2.01) compared with the general population. Patients with PD with TBI incidence had a higher Charlson Comorbidity Index than did the general population with TBI (P < 0.0001). Fall is the major cause of TBI in patients with PD. This study shows that patients with PD have a high risk of TBI, and the major cause of TBI in patients with PD is fall.

Effect of Helmet Use on Traumatic Brain Injuries and Other Head Injuries in Alpine Sport

Sport helmet effectiveness in preventing traumatic brain injury (TBI) has been repeatedly questioned. This study assesses the effect of helmet use on risk of TBI and other types of head injury (OTHI) in alpine sports. From 2012 to 2014, data on the injured population were collected by physicians in on-mountain clinics in 30 French ski resorts, and interviews were conducted on the slope to sample a noninjured control population. Two sets of cases (1425 participants with TBI and 1386 with OTHI) were compared with 2 sets of controls (2145 participants without injury and 40,288 with an injury to a body part other than the head). The effect of helmet use on the risk of TBI and OTHI was evaluated with a multivariate logistic regression adjusted for age, sex, sport, skill level, crash type, and crash location. Using participants without injury as control, we found that helmet wearers were less likely to sustain any head injury (odds ratio [OR]TBI = 0.65; OROTHI = 0.42). When considering participants with an injury to another body part as control, the risk of OTHI was lower among helmet wearers (OROTHI: 0.61). However, no significant effect was found for the risk of TBI. Participants with low skill levels, those aged <26 and >50 years, snowboarders, and those involved in collision and in snowpark accidents were at higher risk of head injury. This study confirms the effectiveness of helmets in protecting users from head injuries but questions their effects on TBI, especially concussion.

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions.

This review of the literature on traumatic brain injury (TBI) in older adults focuses on incident TBI sustained in older adulthood ("geriatric TBI") rather than on the separate, but related, topic of older adults with a history of earlier-life TBI. We describe the epidemiology of geriatric TBI, the impact of comorbidities and pre-injury function on TBI risk and outcomes, diagnostic testing, management issues, outcomes, and critical directions for future research. The highest incidence of TBI-related emergency department visits, hospitalizations, and deaths occur in older adults. Higher morbidity and mortality rates among older versus younger individuals with TBI may contribute to an assumption of futility about aggressive management of geriatric TBI. However, many older adults with TBI respond well to aggressive management and rehabilitation, suggesting that chronological age and TBI severity alone are inadequate prognostic markers. Yet there are few geriatric-specific TBI guidelines to assist with complex management decisions, and TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include under-representation of older adults in TBI research, lack of systematic measurement of pre-injury health that may be a better predictor of outcome and response to treatment than age and TBI severity alone, and lack of geriatric-specific TBI common data elements (CDEs). This review highlights the urgent need to develop more age-inclusive TBI research protocols, geriatric TBI CDEs, geriatric TBI prognostic models, and evidence-based geriatric TBI consensus management guidelines aimed at improving short- and long-term outcomes for the large and growing geriatric TBI population.

Traumatic brain injury in the prodromal period of Parkinson's disease: A large epidemiological study using medicare data.

Studies suggest a greater risk of Parkinson's disease (PD) after traumatic brain injury (TBI), but it is possible that the risk of TBI is greater in the prodromal period of PD. We aimed to examine the time-to-TBI in PD patients in their prodromal period compared to population-based controls. We identified 89,790 incident PD cases and 118,095 comparable controls aged > 65 years in 2009 using Medicare claims data. Using data from the preceding 5 years, we compared time-to-TBI in PD patients in their prodromal period to controls. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for TBI in a Cox regression, while adjusting for age, sex, race/ethnicity, modified Charlson comorbidity index, smoking, and alcohol use. Risk of TBI was greater in PD patients in their prodromal period across all age and sex groups, with HRs consistently increasing with proximity to PD diagnosis. HRs ranged from 1.64 (95% CI, 1.52, 1.77) 5 years preceding diagnosis to 3.93 (95% CI, 3.74, 4.13) in the year before. The interaction between PD, TBI, and time was primarily observed for TBI attributed to falls. Motor dysfunction and cognitive impairment, suggested by corresponding International Classification of Diseases, Ninth Revision codes, partially mediated the PD-TBI association. There is a strong association between PD and a recent TBI in the prodromal period of PD. This association strengthens as PD diagnosis approaches and may be a result of undetected nonmotor and motor symptoms, but confirmation will be required. Ann Neurol 2017;82:744-754.

Systematic Review of Traumatic Brain Injuries in Baseball and Softball: A Framework for Prevention.

Traumatic brain injuries (TBIs) are an important public health challenge. The classification of baseball and softball as low contact sports and their association with extremity injuries cause individuals to overlook the risk of TBI in baseball and softball. To summarize our knowledge of the epidemiology and risk factors of TBIs associated with baseball and softball with an aim to better design and implement preventive strategies. A search algorithm containing keywords that were synonymous to the terms "TBI," "baseball" was applied to the following nine databases: MEDLINE, Scopus, PubMed, EMBASE, CINAHL, Healthstar, PsychINFO, AMED, Cochrane library. Cited reference lists of identified articles were also consulted yielding a total of eighty-eight articles for full review. The search was concluded on November 14, 2016. The level of evidence was evaluated according to the guidelines from Strengthening the Reporting of Observational Studies in Epidemiology statement. Twenty-nine articles published between 2000 and 2016 met the criteria for analysis. Collectively, they examined the years 1982-2015 and identified 242,731 baseball-and softball-related TBIs. The most explored outcome of TBI was concussion. The average injury rate per 1,000 athletic exposures was 0.13 (range 0.03-0.46). The most common mechanism of injury was being struck by bat for younger players and being struck by ball for older athletes (adolescent and beyond). Rates of TBI were on average 4.17 times greater in games compared to practices. Females were on average 2.04 times more likely to sustain a TBI than males. Severity of TBIs varied considerably from mild and returning to the field on the same day, to immediate death. Generally, there is poor compliance with helmet use and return-to-play post-concussion guidelines. An increase TBI rates was observed over time. Multifaceted preventive strategies must be implemented to reduce the frequency and burden of these injuries. It is difficult to compare the epidemiologic trends of TBI in baseball and softball due critical differences in the methods employed across the studies. Additional research is needed to provide a greater understanding of baseball- and softball-related TBI and to aid in the development of prevention and management modules.

Bypassing nearest hospital for more distant neuroscience care in head-injured adults with suspected traumatic brain injury: findings of the head injury transportation straight to neurosurgery (HITS-NS) pilot cluster randomised trial

ObjectiveReconfiguration of trauma services, with direct transport of patients with traumatic brain injury (TBI) to specialist neuroscience centres (SNCs)—bypassing non-specialist acute hospitals (NSAHs), could improve outcomes. However, delays in stabilisation...

Clinical observation: A safe alternative to radiology in infants with mild traumatic brain injury

Abstract Objective The protocol for the management of mild cranioencephalic trauma in the emergency department was changed in July 2013. The principal innovation was the replacement of systematic skull X -ray in infants with clinical observation. The aims of this study were to determine whether there was (1) a reduction in the ability to detect traumatic brain injury (TBI) in the initial visit to Emergency, and (2) a change in the number of requests for imaging tests and hospital admissions. Methodology This was a retrospective, descriptive, observational study. Two periods were established for the study: Period 1 (1/11/2011–30/10/2012), prior to the implementing of the new protocol, and Period 2 (1/11/2013–30/10/2014), following its implementation. The study included visits to the emergency department by children ≤2 years old for mild cranioencephalic trauma (Glasgow Scale modified for infants ≥14) of ≤24 h onset. Results A total of 1,543 cases were included, of which 807 were from Period 1 and 736 from Period 2. No significant differences were observed as regards sex, age, mechanism, or risk of TBI. More cranial fractures were detected in Period 1 than in Period 2 (4.3% vs 0.5%; P X -rays (49.7% vs 2.7%; P Conclusions The use of clinical observation as an alternative to cranial radiography leads to a reduction in the number of imaging tests and hospital admissions of infants with mild cranioencephalic trauma, without any reduction in the reliability of detecting TBI. This option helps to lower the exposure to radiation by the patient, and is also a more rational use of hospital resources.

Dosage of methylphenidate and traumatic brain injury in ADHD: a population-based study in Taiwan.

Preventive effect of stimulants on the risk of brain injuries had been reported. The aim of this study is to determine the extent to which methylphenidate (MPH) prescription moderates the risk of traumatic brain injuries (TBI) in individuals with attention-deficit/hyperactivity disorder (ADHD). Individuals with a recent diagnosis of ADHD between January 1997 and December 2013 (n=163,618) were identified from Taiwan's National Health Insurance Research Database. A total of 124,438 adolescents and children with ADHD and without prior TBI diagnoses were included and evaluated for subsequent TBI. Methylphenidate prescription duration was subgrouped by the annual average cumulative defined daily dose (DDD): 0,>0 to≤28,>28 to≤84, and>84. We identified 11,463 diagnoses of TBI among 124,438 adolescents and children with ADHD. A Cox regression model was used to investigate whether MPH prescription influenced the risk for TBI after adjusting for sex, age, level of urbanization, seizure, autism and sedative-anxiolytics use. A reduced TBI incidence was observed with MPH prescription DDDs>84. The protective effect of MPH against TBI persisted after adjusting for confounding factors [hazard ratio (HR)=0.49; 95% confidence interval (CI): 0.47-0.51]. There was also statistically significant difference in risk for TBI in subjects receiving>0 to ≤28 or>28 to ≤84 DDDs of MPH treatment (HR=0.88, 95% CI=0.83-0.92; HR=0.76, 95% CI=0.72-0.80, respectively) when compared with subjects not receiving treatment with MPH. Treatment with MPH for greater than 84 DDDs reduced the risk for TBI among children with ADHD.

Effect of neck flexor muscle activation on impact velocity of the head during backward falls in young adults

Falls are a common cause of traumatic brain injuries (TBI) across the lifespan. A proposed but untested hypothesis is that neck muscle activation influences impact severity and risk for TBI during a fall. We conducted backward falling experiments to test whether activation of the neck flexor muscles facilitates the avoidance of head impact, and reduces impact velocity if the head contacts the ground. Young adults (n=8) fell from standing onto a 30cm thick gymnastics mat while wearing a helmet. Participants were instructed to fall backward and (a) prevent their head from impacting the mat (“no head impact” trials); (b) allow their head to impact the mat, but with minimal impact severity (“soft impact” trials); and (c) allow their head to impact the mat, while inhibiting efforts to reduce impact severity (“hard impact” trials).Trial type associated with peak magnitude of electromyographic activity of the sternocleidomastoid (SCM) muscles (p<0.017), and with the vertical and horizontal velocity of the head at impact (p<0.001). Peak SCM activations, expressed as percent maximal voluntary isometric contraction (%MVIC), averaged 75.3, 67.5, and 44.5%MVIC in “no head impact”, “soft impact”, and “hard impact” trials, respectively. When compared to “soft impact” trials, vertical impact velocities in “hard impact” trials averaged 87% greater (3.23 versus 1.73m/s) and horizontal velocities averaged 83% greater (2.74 versus 1.50m/s). For every 10% increase in SCM %MVIC, vertical impact velocity decreased 0.24m/s and horizontal velocity decreased 0.22m/s.We conclude that SCM activation contributes to the prevention and modulation of head impact severity during backward falls.

Developing new brain injury criteria for predicting the intracranial response by calculating von Mises stress, coup pressure and contrecoup pressure

Animal and anatomic research has shown that head impact direction is an influential parameter in the risk of traumatic brain injury (TBI). In this field, however, not much research has been done on human subjects. The aim of this study is to assess influences of head impact direction on the intracranial responses. Furthermore, brain injury criteria have been developed to predict the influences of impact direction on probability of head injury and brain responses. For this purpose, 150 head impacts were simulated for three magnitudes and 50 directions of translational impact using finite element head model. Simulations were performed to evaluate pressure and stress responses by brain tissues due to changing the impact direction. Next, statistical analysis was used to develop new head injury criteria. The results indicate that TBI risk in simulations with sagittal and frontal planes are higher than those with transverse plane impacts. Furthermore, it has been shown that impact direction is as important as the impact magnitude and duration to develop head injury index. Moreover, new head injury indices have been proposed for predicting von Mises stress, coup pressure, and contrecoup pressure in the brain which have correlation coefficients 0.86, 0.92 and 0.89 with FEM responses, respectively. However, the results of this study show the influence of impact direction on TBI risk. It also indicates that impact direction and brain responses are necessary for developing head injury index.

Incidence and Associated Risk Factors of Traumatic Brain Injury in a Cohort of Homeless and Vulnerably Housed Adults in 3 Canadian Cities

To examine the factors associated with incident traumatic brain injury (TBI) among homeless and vulnerably housed persons over a 3-year follow-up period. Data were obtained from the Health and Housing in Transition study, which tracked the health and housing status of 1190 homeless or vulnerably housed individuals in 3 Canadian cities for 3 years. Main measure was self-reported incident TBI during the follow-up period. Factors associated with TBI were ascertained using mixed-effects logistic regression. During first, second, and third years of follow-up, 187 (19.4%), 166 (17.1%), and 172 (17.9%) participants reported a minimum of 1 incident TBI, respectively. Among 825 participants with available data for all 3 years of follow-up, 307 (37.2%) reported at least 1 incident TBI during the 3-year follow-up period. Lifetime prevalence of TBI, endorsing a history of mental health diagnoses at baseline, problematic alcohol and drug use, younger age, poorer mental health, and residential instability were associated with increased risk of incident TBI during follow-up period. Mental health support and addressing residential instability and problematic substance use may reduce further risk of TBI and its associated poor health and social outcomes in this population.

乳児頭部外傷における外傷性脳損傷と頭蓋骨骨折の危険因子の比較検討(Comparison of risk factors between traumatic brain injury and skull fracture in infant head injury)

要旨【目的】小児頭部外傷に対する大規模CT適応基準は，外傷性脳損傷（TBI）の発見を目的としており，頭蓋骨単独骨折（ISF）は見落とされる可能性がある。このため，本研究では2歳未満児のTBIとISFの危険因子を比較するため検討を行った。【対象】2013–2015年の3年間に頭部外傷で救急受診し，CTが施行された2歳未満児416例を後方視的に検討した。対象症例をTBI群：25例，ISF群：30例，異常所見なし群（以下NAF群）：361例の3群に分け特徴を比較した。また多変量解析でTBIとISFの危険因子を検討した。【結果】年齢は，TBI群は0–3か月で，ISF群は6–12か月で，NAF群は12か月以降で多かった。受傷機転は，ISF群で墜落が多く，TBI群では抱っこでの転倒・受傷機転不明が多かった。TBI群・ISF群ともに前頭部以外の皮下血腫がNAF群より多く，径も大きかった。多変量解析では，TBIと関連する因子は低年齢，受傷機転不明，2回以上の嘔吐，痙攣，前頭部以外の皮下血腫であったが，ISFと関連する因子は，経過時間（24時間以降または不明），前頭部以外の皮下血腫，5cm以上の皮下血腫であった。【結語】乳児頭部外傷におけるTBIとISFの危険因子は異なり，大規模基準で低リスクであってもISFを疑う場合は，経過観察もしくはCTが必要である。

Still Making Music: How Students with Traumatic Brain Injury Can Continue with Musical Activities

Traumatic brain injury (TBI) is common in the United States. All age groups are at risk for TBI, but there is a larger occurrence among school-age children and young adults. No matter the severity of a student’s injury, he or she can benefit from music education, whether listening to music, singing, or performing on an instrument. Students can engage in music listening assignments that include selected pieces of music or music that an ensemble is currently rehearsing. For students with mild TBI who are able, performing music has also been shown to be beneficial.