Speed performance and long-term functional and vocational outcome in a group of young patients with moderate or severe traumatic brain injury

We studied specific aspects of speed performance in neuropsychological tests and functional and vocational long-term outcome among moderate or severe traumatic brain injury (TBI) patients admitted to a rehabilitation programme. A group of 140 patients with mild, moderate or severe TBI was followed up for a minimum of 5 years in a rehabilitation programme. Severity of TBI was estimated using the Glasgow Coma Scale (GCS) scores on emergency hospital admission. The patients, grouped by age at injury into the categories: 7 or younger, 8-16 and 17 years of age or older, were tested five or more years post-injury with comprehensive neuropsychological tests, including a speed performance test with the Stroop material, the Purdue Pegboard (PB) test and simple visual and auditive reaction times. The outcome variables were functional outcome, as measured by the Glasgow Outcome Scale (GOS) score, and capacity for employment at the end of follow-up, i.e. on average 12 years post-injury. The patients with mild TBI were excluded from further analysis of outcome. The study was carried out at the Kauniala outpatient neurological clinic. In the Stroop test, patients with a GOS score of 3 and patients who were incapable of employment were slower (P = 0.0046 and P = 0.0015, respectively) than those with a GOS score of 1 or 2 and those capable of independent or subsidized employment, respectively. The PB test also differentiated significantly between the patients with a GOS score of 3 and those with a GOS score of 1 or 2 at the end of follow-up (P = 0.0413), and predicted incapacity for employment (P = 0.032), those with worse outcome being slower. Simple reaction times did not differ significantly between the GOS scores at the end of follow-up, and neither did they predict capacity or incapacity for employment. Our data suggest that the Stroop and PB tests can help estimate functional outcome, as measured by the GOS, among patients with initially moderate or severe TBI and who were referred to a rehabilitation programme. The same tests could also be useful in predicting long-term vocational outcome.     

Academic Achievement and Academic Placement Following Traumatic Brain Injury in Children and Adolescents: A Two-Year Longitudinal Study

Prospective, longitudinal follow-up of academic status following pediatric traumatic brain injury (TBI) identified that patients with severe TBI (n = 33) obtained significantly lower reading recognition, spelling, and arithmetic scores than those with mild to moderate TBI (n = 28). Independent of injury severity, adolescents scored lower than children on computational arithmetic and reading comprehension subtests. Although all achievement scores increased significantly from the baseline evaluation to 6 months after the injury, no further change was noted from 6 months to 2 years. Despite average achievement test scores by 2 years after TBI, 79% of the severely injured patients had either failed a grade or received special educational assistance. Traditional achievement tests may be insensitive to posttraumatic academic deficits.     

Academic achievement and academic placement following traumatic brain injury in children and adolescents: a two-year longitudinal study.

Prospective, longitudinal follow-up of academic status following pediatric traumatic brain injury (TBI) identified that patients with severe TBI (n = 33) obtained significantly lower reading recognition, spelling, and arithmetic scores than those with mild to moderate TBI (n = 28). Independent of injury severity, adolescents scored lower than children on computational arithmetic and reading comprehension subtests. Although all achievement scores increased significantly from the baseline evaluation to 6 months after the injury, no further change was noted from 6 months to 2 years. Despite average achievement test scores by 2 years after TBI, 79% of the severely injured patients had either failed a grade or received special educational assistance. Traditional achievement tests may be insensitive to posttraumatic academic deficits.     

颅脑损伤患者血清脑源性神经营养因子动态变化及其与预后关系的研究

目的探讨不同程度颅脑损伤（TBI）患者在不同时间点血清脑源性神经营养因子（BDNF）浓度变化规律以及血清BDNF浓度与预后的关系。 方法选择自2016年10月至2018年10月青海省人民医院神经外科收治的149例TBI患者为研究对象，根据患者入院时的GCS评分将其分为轻型组（13~15分）52例、中型组（9~12分）49例、重型组（3~8分）48例。对照组为35例健康体检者。分析不同伤情组在不同时间点BDNF动态变化关系及其与对照组BDNF之间的关系。TBI患者伤后3个月采用GOS评分对患者预后进行评定，分为预后良好组（4~5分）98例、预后不良组（1~3分）51例，对比2组不同时间点血清BDNF浓度的差异，并对不同时间点血清BDNF值与患者入院时GCS评分及伤后3个月GOS评分进行相关性分析。 结果（1）轻、中、重型组患者1、7、14 d血清BDNF浓度与对照组比较，第1天轻型组与对照组比较，差异无统计学意义（P>0.05），其余各组及不同时间点均明显低于对照组，差异具有统计学意义（P=0.001）；（2）中、重型组患者血清BDNF浓度于1、7、14 d均低于轻型组（P=0.001），重型组患者血清BDNF浓度于1、7、14 d低于中型组，差异具有统计学意义（P=0.001）；（3）随访3个月，预后不良组与预后良好组各时间点BDNF浓度比较，差异具有统计学意义（P=0.001）；（4）TBI患者伤后1、7、14 d血清BDNF浓度水平与GCS评分呈正相关，与伤后3个月GOS评分亦呈正相关。 结论TBI患者血清BDNF浓度变化与不同伤情及预后有相关性，可作为临床早期判断TBI伤情和预后的指标之一。     

颅脑损伤患者血清GFAP和NSE的变化与神经功能缺损程度的相关性研究

目的探讨颅脑损伤患者血清胶质纤维酸性蛋白（GFAP）和神经元特异性烯醇化酶（NSE）的水平变化,并根据预后美国国立卫生院神经功能缺损评估量表（NIHSS）进行相关性分析。 方法选取北京市红十字会急诊抢救中心神经外科自2017年4月至2018年3月收治的颅脑损伤患者140例,根据NIHSS评分将患者分为对照组（20例,NIHSS 0~1分）、轻度组（40例,NIHSS 2~15分）、中度组（40例,NIHSS 16~20分）及重度组（40例,NIHSS 21~42分）,对症治疗并通过酶联免疫吸附法进行GFAP和NSE不同时间点的动态检测。比较不同损伤水平患者两个指标的变化趋势,分析两个指标与NIHSS水平的相关性。 结果轻、中、重度组患者血清GFAP和NSE水平显著高于对照组,差异具有统计学意义（P<0.05）。轻、中、重度组间不同时间段GFAP及NSE水平变化比较,差异有统计学意义（P<0.05）,且重度组GFAP、NSE浓度显著增高。患者血清GFAP和NSE水平与NHISS评分均呈正相关（r=0.484,0.447,P<0.05）。 结论颅脑损伤患者血清GFAP和NSE水平和神经功能缺损程度密切相关,动态监测有助于评估患者病情演变和神经功能缺损的严重程度。     

Interpreting the trail making test following traumatic brain injury: comparison of traditional time scores and derived indices

The purpose of this study was to examine the clinical application of traditional time scores and various derived indices from the Trail Making Test (TMT) in a sample of 571 patients with acute traumatic brain injury (TBI). Participants were classified into four injury severity groups. A clear linear relation between injury severity and TMT performance was demonstrated, with the more severely brain injured patients performing more poorly on most measures. Hierarchical logistic regression analysis of TMT time scores across binary extreme groups based on injury severity resulted in high classification rates for patients with very mild TBI (93.0% correctly classified) and low classification rates for patients with moderate to severe TBI (50.0% correctly classified). However, TMT derived indices did not provide a unique contribution to test interpretation beyond what is already available from Part A and B separately.     

D-二聚体、P-选择素、CNP在创伤性颅脑损伤患者中的表达水平及临床意义

目的探讨创伤性颅脑损伤（TBI）患者血清D-二聚体（D-D）、P-选择素（P-selectin）、C型利钠多肽（CNP）浓度的水平变化与TBI临床症状相关性及临床意义，为进一步研究TBI发病机制及治疗提供具有临床价值的信息。 方法回顾性分析自2015年3月至2019年5月蚌埠市第一人民医院神经外科收治的80例TBI患者的病例资料，根据病情严重程度分为轻度组（n=27）、中度组（n=33）、重度组（n=20），并随机选取同时期内非外伤颅脑疾病患者30例作为对照组，比较各组患者D-D、P-selectin、CNP水平并分析各指标间相关性；从入院治疗后对患者随访1年，根据随访期间生存情况分为存活组（n=71）与死亡组（n=9），比较2组患者D-D、P-selectin、CNP水平，采用Spearman相关系数分析D-D、P-selectin、CNP与TBI临床症状的相关性，多因素Logistic回归分析患者短期死亡危险因素，构建ROC曲线分析比较D-D、P-selectin、CNP对TBI的诊断价值。 结果轻度组、中度组、重度组的D-D、P-selectin水平高于对照组，中度组、重度组的CNP水平低于轻度组，差异有统计学意义（P<0.05）。D-D、P-selectin与TBI严重程度呈显著正相关（P<0.05），CNP与TBI严重程度呈显著负相关（P<0.05）；1年随访期间，死亡患者共9例（11.25%）；死亡组D-D、P-selectin高于生存组，CNP低于生存组，差异均具有统计学意义（P<0.05）；D-D、P-selectin、CNP是TBI死亡的独立危险因素（P<0.05）；D-D与P-selectin、CNP均呈显著相关关系（P<0.05）；D-D、P-selectin、CNP联合检测对TBI的诊断价值高于单独检测（P<0.05）。 结论D-D、P-selectin、CNP水平与TBI发生和发展密切相关，在诊断和治疗过程中应关注其水平变化；且D-D、P-selectin、CNP联合检测可进一步提高对该病的诊断和预测价值。     

Responsiveness and discriminant validity of the Child and Adolescent Scale of Participation across three years for children and youth with traumatic brain injury

ABSTRACT

Purpose: To examine responsiveness and discriminant validity of the Child and Adolescent Scale of Participation (CASP) across three years. Methods: Examined longitudinal data on 515 children and youth with TBI and arm injuries. Repeated measures analyses of variance were used to examine CASP scores (pre-injury; 3, 12, 24, 36 months post-injury). Results: Scores decreased from pre-injury to 3 months, but significantly only for moderate and severe TBI groups. Scores gradually increased post-injury for all groups except severe TBI. Scores were consistently lowest for severe TBI, followed by moderate TBI, mild TBI, and arm injury across time. Severe TBI scores were significantly lower than scores for mild TBI and arm injury, but not moderate TBI. Conclusions: CASP scores were responsive to change over time at most measurements and differentiated between groups, particularly severe TBI. Further research is needed with a larger sample of children with moderate/severe TBI as they were underrepresented in this study.     

The King's Outcome Scale for Childhood Head Injury and injury severity and outcome measures in children with traumatic brain injury

The aim of this study was to relate discharge King's Outcome Scale for Childhood Head Injury (KOSCHI) category to injury severity and detailed outcome measures obtained in the first year post-traumatic brain injury (TBI). We used a prospective cohort study. Eighty-one children with TBI were studied: 29 had severe, 15 moderate, and 37 mild TBI. The male:female ratio was 1.8:1. The mean age was 11 years 10 months (SD 3.6, range 5-16y). Discharge KOSCHI categories were good (n=34), moderate (n=39), severe (n=6), and unclassifiable (n=2). KOSCHI category correlated strongly with admission Glasgow Coma Score, length of hospital stay, and post-traumatic amnesia. It also correlated significantly with Verbal IQ and Performance IQ (Wechsler); measures of attention; health status (Health Utilities Index [HUI]); health-related quality of life (Pediatric Quality of Life Inventory [PedsQL]); depressive symptoms (Birleson Depression Scale) assessed within 3 months postTBI; and with Verbal IQ, selective attention (map mission), and HUI and PedsQL domains assessed at least 6 months post-TBI discharge. KOSCHI did not correlate with behaviour or executive function. We conclude that the KOSCHI scored at hospital discharge correlates with severity of injury and some cognitive, health status, and HRQL outcomes early after TBI. It is not helpful at predicting later difficulties, or behavioural and emotional problems.     

Functional memory skills following traumatic brain injury in young children

Traumatic brain injury (TBI) may have a profound impact on a child's ongoing development. Various risk factors have been found to predict outcome, but considerable variability remains unexplained. This study used a prospective, longitudinal design to examine recovery of memory function following TBI within the pre-school period. Forty-four children with TBI were divided according to injury severity (mild, moderate, severe), and compared to age and SES matched healthy controls (n = 26). Children were evaluated acutely and at 12 months post-injury using the Rivermead Behavioural Memory Test for Children. Results failed to show a clear dose-response relationship between injury severity and memory function during the acute phase of recovery. However, this relationship developed over time, with greater memory impairments evident for children with more severe TBI by 12 months post-injury. Children with mild TBI exhibited few memory problems.     

Validation and clinical utility of the executive function performance test in persons with traumatic brain injury

ABSTRACT

This study examined the relationships between the Executive Function Performance Test (EFPT), the NIH Toolbox Cognitive Function tests, and neuropsychological executive function measures in 182 persons with traumatic brain injury (TBI) and 46 controls to evaluate construct, discriminant, and predictive validity. Construct validity: There were moderate correlations between the EFPT and the NIH Toolbox Crystallized (r?=??.479), Fluid Tests (r?=??.420), and Total Composite Scores (r?=??.496). Discriminant validity: Significant differences were found in the EFPT total and sequence scores across control, complicated mild/moderate, and severe TBI groups. We found differences in the organisation score between control and severe, and between mild and severe TBI groups. Both TBI groups had significantly lower scores in safety and judgement than controls. Compared to the controls, the severe TBI group demonstrated significantly lower performance on all instrumental activities of daily living (IADL) tasks. Compared to the mild TBI group, the controls performed better on the medication task, the severe TBI group performed worse in the cooking and telephone tasks. Predictive validity: The EFPT predicted the self-perception of independence measured by the TBI-QOL (beta = ?0.49, p?<?.001) for the severe TBI group. Overall, these data support the validity of the EFPT for use in individuals with TBI.     

颅脑创伤患者记忆障碍比较研究

目的探讨不同类型颅脑创伤患者记忆障碍的特征。方法根据患者入院时GCS评分,按创伤严重程度将42例颅脑创伤患者分为轻度创伤组(GCS13～15分,16例)、中度创伤组(GCS9～12分,14例)和重度创伤组(GCS3～8分,12例)。采用临床记忆量表进行短时记忆测量并与42名健康受试者(对照组)进行比较,观察冲击点伤、对冲伤、混合伤及加速伤、减速伤、混合伤、切线伤对颅脑创伤患者记忆力的影响。结果与对照组相比,不同程度颅脑创伤患者的记忆商(MQ)均显著下降,其中轻度创伤组与中、重度创伤组相比,差异具有显著性意义(P<0.05);冲击点伤、对冲伤以及混合伤患者之间MQ相比,差异具有显著性意义(P<0.01),冲击点伤患者的MQ值最高(P<0.05);加速伤、减速伤、混合伤和切线伤患者之间MQ相比,差异亦有显著性意义(P<0.01)。结论颅脑创伤后混合伤和切线伤对患者记忆的影响最为明显。     

An Examination of the Wechsler Adult Intelligence Scales,Fourth Edition (WAIS-IV) in Individuals with Complicated Mild,Moderate and Severe Traumatic Brain Injury (TBI)

This study examined the clinical utility of the Wechsler Adult Intelligence Scales-Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate or severe TBI. One hundred individuals with TBI (n = 35 complicated mild or moderate TBI; n = 65 severe TBI) and 100 control participants matched on key demographic variables from the WAIS-IV normative dataset completed the WAIS-IV. Univariate analyses indicated that participants with severe TBI had poorer performance than matched controls on all index scores and subtests (except Matrix Reasoning). Individuals with complicated mild/moderate TBI performed more poorly than controls on the Working Memory Index (WMI), Processing Speed Index (PSI), and Full Scale IQ (FSIQ), and on four subtests: the two processing speed subtests (SS, CD), two working memory subtests (AR, LN), and a perceptual reasoning subtest (BD). Participants with severe TBI had significantly lower scores than the complicated mild/moderate TBI on PSI, and on three subtests: the two processing speed subtests (SS and CD), and the new visual puzzles test. Effect sizes for index and subtest scores were generally small-to-moderate for the group with complicated mild/moderate and moderate-to-large for the group with severe TBI. PSI also showed good sensitivity and specificity for classifying individuals with severe TBI versus controls. Findings provide support for the clinical utility of the WAIS-IV in individuals with complicated mild, moderate, and severe TBI.     

Using the Wechsler Memory Scale-III to detect malingering in mild traumatic brain injury

This study examined the classification accuracy of the WMS-III primary indices in the detection of Malingered Neurocognitive Dysfunction (MND) in Traumatic Brain Injury (TBI) using a known-groups design. Sensitivity, specificity, and positive predictive power are presented for a range of index scores comparing mild TBI non-malingering (n = 34) and mild TBI malingering (n = 31) groups. A moderate/severe TBI non-malingering (n = 28) and general clinical group (n = 93) are presented to examine specificity in these samples. In mild TBI, sensitivities for the primary indices ranged from 26% to 68% at 97% specificity. Three systems used to combine all eight index scores were also examined and all achieved at least 58% sensitivity at 97% specificity in mild TBI. Specificity was generally lower in the moderate/severe TBI and clinical comparison groups. This study indicates that the WMS-III primary indices can accurately identify malingered neurocognitive dysfunction in mild TBI when used as part of a comprehensive classification system.     

Malingering detection with the Wisconsin Card Sorting Test in mild traumatic brain injury

This study evaluates the ability of several Wisconsin Card Sorting Test (WCST; Psychological Assessment Resources, 1990) variables to detect malingering in mild traumatic brain injury (TBI). The sample consisted of 373 TBI patients and 766 general clinical patients. Classification accuracy for seven indicators is reported across a range of injury severity and scores levels. Overall, most WCST scores were ineffective in discriminating malingering from non-malingering mild TBI patients. Failure-to-Maintain-Set, the Suhr & Boyer formula, and the King et al. formula detected about 30% of malingerers at cutoffs associated with a false positive error rate of < or =11%. The clinical interpretation and use of these indicators are discussed.     

A quantitative review of the effects of traumatic brain injury on cognitive functioning

Changes in cognitive functioning often result from traumatic brain injury (TBI) and predict other important aspects of psychosocial recovery. Despite this pivotal role, no quantitative review of cognitive functioning across the spectrum of TBI severity has been reported. We therefore conducted a meta-analysis of 39 mostly cross-sectional studies of the cognitive effects of mild head injury (MHI) and moderate–severe TBI from the acute phase through long-term follow-up. The studies reported 48 comparisons of patients (n = 1716) and control subjects (n = 1164). Averaged across all follow-up periods, the effect of moderate–severe TBI (weighted mean Cohen‘s d = ?0.74) was more than three times the effect of MHI (weighted mean d = ?0.24) on overall cognitive functioning. Further, the natural logarithm of the follow-up interval correlated very strongly with estimates of d among patients with MHI, but less so among those with moderate–severe TBI. In short, findings from published research suggest that overall cognitive functioning recovers most rapidly during the first few weeks following MHI, and essentially returns to baseline within 1–3 months. Cognitive functioning also improves during the first two years after moderate–severe TBI, but remains markedly impaired even among patients tested >?2 years post-injury.     

Memory Dysfunctions after Mild and Moderate Traumatic Brain Injury : Comparison between Patients with and without Frontal Lobe Injury

Objective

The purpose of this study was to assess memory dysfunction in patients with mild and moderate traumatic brain injury (TBI) with and without frontal lobe injury (FLI).

Methods

The subjects were 110 TBI patients, who had recovered from the acute clinical phase, and comprised 20 (18.2%) mild TBI (MTBI) patients with FLI, 16 (14.5%) MTBI patients without FLI, 51 (46.4%) moderate TBI (MOTBI) patients with FLI and 23 (20.9%) MTBI patients without FLI. All patients were administrated the Korean version of the Memory Assessment Scale (K-MAS).

Results

Almost all the Summary Scale scores on the K-MAS failed to show any differences between TBI patients with and without FLI, but differences did emerge by types at severities. TBI patients with FLI showed higher Global Memory ability than TBI patients without FLI if their TBI was only mild, but when their TBI was more severe, this finding was reversed, and TBI patients with FLI showed lower Verbal and Global Memory abilities than TBI patients without FLI.

Conclusion

Different kinds of assessment tools are needed for the measurement of memory abilities in TBI patients with FLI, and that the selection of the appropriate tool depends on the severity of the TBI.     

Psychosocial status after pediatric traumatic brain injury: a subtype analysis using the Child Behavior Checklist.

This study identified subtypes of psychosocial functioning in children who had sustained traumatic brain injury (TBI). Child Behavior Checklist (CBCL) profiles for 92 participants, aged 12 to 18 years, who had sustained a mild, moderate, or severe TBI were subjected to Q-Factor analysis. Sixty-four of the participants (75%) were classified into a four-category psychosocial typology labelled Normal (n = 32), Attention (n = 14), Delinquent (n = 10), and Withdrawn-Somatic (n = 8). This typology was found to overlap in part with previous TBI psychosocial typology (Butler et al., 1997), and with three of the clinical profile types derived by Achenbach (1993) for the CBCL. The majority of participants, including those who sustained severe TBI, were assigned to the Normal subtype and the overall level of psychosocial deviance was relatively mild in the other three subtypes. The results of this study support previous typology efforts and confirm the heterogeneous presentation of social and emotional functioning following TBI.     

Cardiac-cerebral-renal associations in pediatric traumatic brain injury: Preliminary findings

ObjectiveThe clinical epidemiology of organ outcomes in pediatric traumatic brain injury (TBI) has not been examined. We describe associated markers of cerebral, cardiac and renal injury after pediatric TBI.DesignProspective observational study.PatientsChildren 0–18 years who were hospitalized with TBI.MeasurementsMeasures of myocardial (at least one elevated plasma troponin [cTnI] ≥ 0.4 ng/ml) and multiorgan (hemodynamic variables, cerebral perfusion, and renal) function were examined within the first ten days of hospital admission and within 24 h of each other.Main ResultsData from 28 children who were 11[IQR 10.3] years, male (64.3%), with isolated TBI (67.9%), injury severity score (ISS) 25[10], and admission Glasgow coma score (GCS) 11[9] were examined. Overall, 50% (14 children) had elevated cTnI, including those with isolated TBI (57.9%; 11/19), polytrauma (33.3%; 3/9), mild TBI (57.1% 8/14), and severe TBI (42.9%; 6/11). Elevated cTnI occurred within the first six days of admission and across all age groups, in both sexes, and regardless of TBI lesion type, GCS, and ISS. Age-adjusted admission tachycardia was associated with cTnI elevation (AUC 0.82; p < 0.001). Reduced urine output occurred more commonly in patients with isolated TBI (27.3% elevated cTnI vs. 0% normal cTnI).ConclusionsMyocardial injury commonly occurs during the first six days after pediatric TBI irrespective of injury severity, age, sex, TBI lesion type, or polytrauma. Age-adjusted tachycardia may be a clinical indicator of myocardial injury, and elevated troponin may be associated with cardio-cerebro-renal dysfunction.     

Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury

Fifty-one patients with mild(n = 14),moderate(n = 10) and severe traumatic brain injury(n = 27) received early rehabilitation.Level of consciousness was evaluated using the Glasgow Coma Score.Functional level was determined using the Glasgow Outcome Score,whilst mobility was evaluated using the Mobility Scale for Acute Stroke.Activities of daily living were assessed using the Barthel Index.Following Bobath neurodevelopmental therapy,the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury,but was not greatly influenced in patients with mild traumatic brain injury.Mobility and functional level were significantly improved in patients with mild,moderate and severe traumatic brain injury.Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury.Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury.Nevertheless,complete recovery was not acquired at discharge.Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.