Information needs of the traumatic brain injury patient's family members regarding the consequences of the injury and associated perception of physical, cognitive, emotional and quality of life changes

We studied physical cognitive emotional and quality of life changes noted by relatives in a sample of 65 severely traumatic brain injured TBI patients several years after injury The purpose of the present study was to evaluate the families perception of these changes and their need for information con cerning the consequences of TBI Our results indicated that the perceived changes in behavioural and affective symptoms and in the patient s quality of life were most closely associated with the need expressed by family members for information concerning TBI We also found that family relationships were especially affected by problems in the behavioural and affective domain and the decrease in patient quality of life as reported by relatives These findings underline the importance of providing the relatives of TBI patients with information about the consequences of the injury with particular emphasis on behavioural and emotional disturbances in order that they might cope better with these problems     

Health-related quality of life and psychosocial consequences after mild traumatic brain injury in children and adolescents

BACKGROUND: Little is known about the course of health-related quality of life (HRQOL) and functional outcome parameters in children and adolescents with TBI. In addition, a neuropsychological screening instrument would be useful for routine clinical care. OBJECTIVE: To describe health-related quality of life and psychosocial consequences following mild traumatic brain injury (TBI). METHODS: One chose a prospective, longitudinal design (two measurement time points). Methods included a telephone interview and a questionnaire, which was mailed to the parents whose children (older than 4 years of age) were admitted (with TBI) to a collaborating hospital. In addition, a feasibility study for screening children for cognitive side effects, attention and memory tasks was conducted. A group of 59 parents filled out questionnaires assessing health-related quality of life (KINDL), behavioural problems (SDQ) and health status (FS-II-R). Ten families participated in the feasibility study. RESULTS: Results indicated that HRQOL, behavioural problems and health status remained stable over time. Compared to the reference groups, no significant differences in HRQOL were noted. Thirty per cent of the children screened were classified as being cognitively impaired. CONCLUSION: Mild TBI resulted in no decline in the children's health outcome after injury. The cognitive screening approach proved itself to be a useful instrument for routine clinical care.     

Factors associated with insomnia among post-acute traumatic brain injury survivors

This study investigated the relationships between insomnia and select demographic, injury and psychosocial variables in post-acute, traumatic brain injury. Clinical assessment of sleep and mood was undertaken via objective measures and a diagnostic interview among 91 consecutive brain injury admissions to an outpatient neurorehabilitation clinic. No associations between insomnia and gender, education, age, and time since injury were found. A logistic regression model of insomnia prediction based upon the Beck Depression Inventory (BDI), self-reported pain disturbance, litigation and Glasgow Coma Score (GCS) correctly classified 87% of the sample with respect to the presence or absence of insomnia; however, depression and injury severity were the only variables that made a significant unique contribution to the prediction of insomnia. It is concluded that among post-acute traumatic brain injury patients, insomnia is linked with both the presence of depression and a history of milder brain injuries. This suggests that the determinants of insomnia may differ from the acute to the post-acute phase, with neurological factors playing a primary role early in the recovery process and psychosocial factors ascending later. Therefore, assessment and treatment of insomnia must give careful attention to the larger psychosocial context in which the sleep disorder emerges, particularly to role of emotional disturbance.     

Traumatic brain injury in childhood: intellectual, behavioural and social outcome into adulthood

In order to obtain indicative data regarding intellectual, behavioural and social outcome into adulthood of subjects with a history of childhood head injury (CHI) , twenty adults were selected who had been referred to the Neuropsychology Unit at the University of Parma at the time of a traumatic brain injury (TBI) at an age between 8 and 14 years. The level of intellectual and behavioural impairment was determined and rated by WISC and WAIS IQa and by the frequency of maladjustive behaviour. GOS score and Barthel index were used to detect the level of disability. Social adjustment and community integration were determined by the Social Adjustment Scale SAS and the Community Integration Questionnaire (CIQ) respectively. Results indicate that (1) subjects who suffer a severe CHI present a higher pre injury incidence of character disturbances than the normal population and injury related difficulties to socialize which persist long term and add to other problems; (2) even though intellectual and functional sequelae are frequent in these children in adulthood and do not improve in their correlation to age, these do not appear to be the prevailing problems and (3) the prevailing problems seem to be social maladjustment and poor quality of life, which are still present several years post injury and seem to be related to behavioural and psychosocial disorders in spite of an increased ADL functioning. This has already been clearly demonstrated in the case of adulthood trauma.     

227例颅脑创伤患者凝血功能的动态变化及其临床意义

目的：观察和研究各类颅脑创伤患者凝血功能异常的发生率及其临床意义。方法对本院2013年收治的227例单纯性颅脑创伤患者按损伤的性质和类型进行分组并分别检测凝血酶原时间（PT）、部分凝血活酶时间（APTT）、凝血酶时间（TT）和纤维蛋白原（FIB）等凝血功能指标的动态变化。结果227例患者中,颅脑外伤后24小时内凝血功能指标PT、APTT、TT和FIB检测值异常的发生率分别为11%、71.4%、34.4%和21.2%;颅脑外伤后72小时PT、APTT、TT和FIB检测值异常的发生率明显降至2.6%、33.9%、5.7%和17.6%。在各类颅脑创伤中,急性硬膜下血肿患者24小时、48小时、72小时和7天时间段凝血功能指标PT、APTT、TT和FIB检测值异常的发生率均明显高于其他颅脑外伤患者,差异有统计学意义（P＜0.05）。结论颅脑创伤患者伤后24小时内即可出现凝血功能异常,72小时后凝血功能异常的发生率明显降低;颅脑创伤患者凝血功能异常的发生率和持续时间可能与颅脑创伤的性质和类型有关。     

Competence in discourse as a measure of social integration and quality of life in persons with traumatic brain injury

Persisting difficulties in communication are a serious handicap faced by many after traumatic brain injury (TBI) and a major barrier to community reintegration. Conventional approaches to the study of communication problems after TBI have focused on the form of language production and expression, usually in terms of phonological, semantic and syntactical features. Most TBI patients, however, perform overall within normal ranges on these conventional indicators. More recently, attention has focused on language in its naturally occurring form, that is, discourse, which is heavily influenced by linguistic, cognitive and social skills. Because most TBI patients are left with residual deficits in these areas, study of discourse abilities seem to be particularly suited to understanding their problems in communication and facilitating eventual reintegration into the community. This study was designed to determine if and how the conversational discourse of TBI patients differs from a matched non TBI group and whether any identified variables are related to measures of outcome as measured by community integration and quality of life. Additionally, the study was designed to explore the relationship between TBI and features of discourse across conversational, narrative, procedural genres. TBI patients (n=30) from an out patient brain injury programme were compared to matched controls (n=10) in the three discourse genres. Bivariate and multivariate analyses evaluated 23 measures of discourse efficiency, complexity, topic management, information and pragmatic behaviours in each genre as well as measures of psychosocial adjustment, particularly social integration and quality of life. Results indicated that TBIs were significantly different from controls on several measures of discourse and psychosocial adjustment. A number of other features of discourse were found to correlate significantly with social integration and quality of life. Interestingly, discourse variables appeared to correlate with social integration more strongly than age, gender, education, and other conventional psychosocial factors. Contrary to prediction, features of conversational discourse did not correlate more strongly than other types of discourse with social integration and quality of life. Discussion centred on the apparent comorbidity of features in everyday discourse and psychosocial deteriminants that were associated with quality of life and social integration.     

Long-term life quality and family needs after traumatic brain injury.

OBJECTIVES: This investigation assessed the life quality and long-term family needs of caregivers of persons with brain injury. DESIGN: Respondents completed the Virginia Traumatic Brain Injury Family Needs Assessment Survey. SETTING: Community-based sample. PARTICIPANTS: Respondents included 57 caregivers of persons with traumatic brain injury who were at least 4 years after injury and who resided in Virginia. Respondents ranged in age from 19 to 82 years and were primarily women and Caucasian. OUTCOME MEASURES: The Family Needs Questionnaire (FNQ) and quality of life questions. RESULTS: Results indicate diminished life quality after injury. With regard to family needs, Health Information (51.43%) and Involvement with Care (47.93%) needs were most often rated as met. Instrumental Support (31.52%) and Professional Support (28.38%) needs were most often rated as not met. CONCLUSIONS: Family needs and support systems for those needs change over time. This investigation provides evidence that unmet family needs extend well beyond the acute setting and that caregiver life quality diminishes over time. The importance of appreciating long-term family needs and other life quality issues should not be underestimated.     

Psychosocial functioning during the year following severe traumatic brain injury

The psychosocial functioning of a group of 65 adults with severe traumatic brain injury was assessed at 6 months and 1 year post-injury. Aspects of emotional, behavioural, and social functioning were investigated. The prevalence of depression remained constant (24%) over time, although there was some individual variation in the reporting of symptoms. Impatience was the most frequently reported behavioural problem at both assessments. Whilst there was a slight increase in the number of behavioural problems and level of distress reported over time, the most obvious change was in the type of behavioural problems that caused distress. At 1 year post-injury, problems with emotional control were found to be most distressing for the patients. A comparison with pre-morbid social functioning showed the loss of employment to be 70%, 30% returned to live with their parents, and relationship breakdown occurred for 38%. There was also a significant and ongoing decrease in all five aspects of social and leisure activities.     

Frühe Prognosefaktoren der Lebensqualität nach Schädel-Hirn-Trauma

Despite major advances in medical treatment, head injury (HI) still contributes to morbidity and mortality. However, there is not much known about the prediction of long-term outcome after HI. In a study of 111 patients we evaluated clinical and radiological variables as predictors for the health-related quality of life after HI. The physical aspect of quality of life after HI could be reliably predicted by the initial neurological status, by the age of the patient, and by the severity of the traumatic subarachnoid hemorrhage. The presence of a brain stem contusion was also associated with a worse long-term outcome. The prognostic power, however, was limited. Therefore, new variables have to be studied for a more reliable prediction, especially of the psychosocial aspects of the health-related quality of life.     

Spinal cord injury outcomes in a population-based sample

Outcomes and follow-up data from a population-based sample of 358 persons with spinal cord injuries are described. The case fatality rate during hospitalization was less than 4%. Among those who survived, over half exhibited neurologic preservation below the level of vertebral injury at onset. Twenty-four percent of those with thoracolumbar injuries and 36% with cervical injuries experienced additional later neurologic recovery. Ninety-five percent of all survivors were discharged home, and at 2 years post-injury, 48% reported no significant medical or psychosocial problems. Of a subgroup, surveyed, 63% rated their adjustment and 60% rated their quality of life as good or excellent. Overall, the favorable outcome findings of this study support a relatively positive outlook following traumatic spinal cord injury.     

Correlates of functional status 3-5 years after traumatic brain injury with CT abnormalities

The Functional Status Examination (FSE) is a relatively new measure of functional outcome after traumatic brain injury (TBI). This study examines functional status limitations and what contributes to them to further enhance interpretability of the FSE and to continue its development as an outcome measure. The measure was given to 209 adults sustaining TBI with CT abnormalities who were followed prospectively until three to five years after injury. Relationships between functional status change as assessed by the FSE and characteristics of the injury and pre-injury characteristics of the person injured were evaluated as were relationships with concurrent measures of neuropsychological, emotional, and psychosocial functioning, health status, quality of life, and other functional status measures. Groups based on degree of functional status limitations due to the injury differ significantly on injury severity, especially length of impaired consciousness. They do not differ on most pre-injury characteristics of the person injured, although pre-existing conditions, primarily alcohol abuse, are more common in those with more negative functional changes after injury. All concurrent measures examined differ significantly among FSE groups with strongest relationships with measures of quality of life, psychosocial functioning, and other measures of health status and functional status (each p < 0.001). The Functional Status Examination shows promise as a measure reflecting a broad range of functional limitations. The FSE is an excellent tool combining clinical relevance, face validity, strong relationships to other measures of relevant constructs (criterion-related validity), and reasonable sensitivity to TBI severity even long after the injury and in a mostly moderately injured group.     

Anticoagulation therapy in patients with traumatic brain injury: An Eastern Association for the Surgery of Trauma multicenter prospective study

BackgroundTrauma care providers often face a dilemma regarding anticoagulation therapy initiation in patients with traumatic brain injury owing to the associated risks of traumatic brain injury progression. The aims of this study were the following: (1) to describe the current practice of anticoagulation therapy in traumatic brain injury patients and their outcomes and (2) to identify factors associated with the progression of traumatic brain injury after anticoagulation therapy.MethodsIn this multicenter prospective observational study, we included computed tomography–proven traumatic brain injury patients who received anticoagulation therapy within 30 days of hospital admission. Our primary outcome was the incidence of clinically significant progression of traumatic brain injury after anticoagulation therapy initiation.ResultsA total of 168 patients were enrolled more than 22 months. Atrial fibrillation and venous thromboembolism were the most common pre-injury and postinjury anticoagulation therapy indications, respectively. Overall, 16 patients (9.6%) experienced clinically significant traumatic brain injury progression after anticoagulation therapy, out of which 9 (5.4%) patients subsequently required neurosurgical interventions. Between patients with clinical progression of traumatic brain injury and patients who showed no such progression, there were no significant differences in the baseline demographics and severity of traumatic brain injury. However, anticoagulation therapy was initiated significantly earlier in patients of the deterioration group than those of the no-deterioration group (4.5 days vs 11 days, P = .015). In a multiple logistic regression model, patients who received anticoagulation therapy later after injury had significantly lower risk of clinically significant traumatic brain injury progression (odds ratio: 0.915 for each day, 95% confidence interval: 0.841–0.995, P = .037).ConclusionOur results suggest that early anticoagulation therapy is associated with higher risk of traumatic brain injury progression, thus a balance between bleeding and thromboembolic risks should be carefully evaluated in each case before initiating anticoagulation therapy.     

Management of traumatic brain injury: a narrative review of current evidence

Globally, approximately 70 million people sustain traumatic brain injury each year and this can have significant physical, psychosocial and economic consequences for patients, their families and society. The aim of this review is to provide clinicians with a summary of recent studies of direct relevance to the management of traumatic brain injury in order to promote best clinical practice. The use of tranexamic acid in the management of traumatic brain injury has been the focus of several studies, with one large randomised controlled trial suggesting a reduction in all-cause mortality within 24 h of injury. The use of therapeutic hypothermia does not improve neurological outcomes and maintenance of normothermia remains the optimal management strategy. For seizure management, levetiracetam appears to be as effective as phenytoin, but the optimal dose remains unclear. There has been a lack of clear outcome benefit for any individual osmotherapy agent, with no difference in mortality or neurological recovery. Early tracheostomy (< 7 days from injury) for patients with traumatic brain injury is associated with a reduction in the incidence of ventilator-associated pneumonia and duration of mechanical ventilation, critical care and hospital stay. Further research is needed in order to determine the optimal package of care and interventions. There is a need for research studies to focus on patient-centred outcome measures such as long-term neurological recovery and quality of life.     

Psychosocial outcome risk indicator: predicting psychosocial outcome following traumatic brain injury

This study examines the outcome of 29 individuals with traumatic brain injury (TBI) and 23 of their respective significant others, 12 months after discharge from inpatient rehabilitation services, as a means of determining the validity of a measure developed to predict psychosocial outcome. This measure consists of 18 questions that examine 12 factors and requires the rater to make a judgement about the likely impact each factor would have on the individual with TBI and significant other. Results indicate that the social work raters accurately predicted outcome according to the factors contained in the measure. Scores on the measure at discharge were also found to be associated with general psychological distress, anxiety and insomnia, depression, family functioning, and the problems related to emotion and behaviour. Although the sample size was small, there is an indication that the devised measure is useful in predicting outcome and so has clinical value in identifying adults at greatest risk of poor psychosocial outcome after a traumatic brain injury.     

Spinal cord injuries. Clinical, functional, and emotional status

Ninety-eight patients with traumatic spinal cord injury, at a median age of 33.5 years (range, 16-72 years), with nonremarkable distributions of neurologic characteristics were investigated at a median of 2.3 years (range, 0.1-23 years) after injury. Functioning, mood disturbances, and overall quality of life were recorded with established self-assessment instruments. Physical dysfunction levels were moderate, being proportionate to neurologic impairment. Psychosocial functions, mood states, and quality-of-life perceptions did not differ from those of a control population sample. Psychosocial function and mood disturbances varied greatly during the first 4 years after injury, but patients' later recordings expressed predominantly a balanced emotional state and a rewarding social life. Progress in this direction consisted of clearly lessened physical dysfunction 1 year after injury and better psychosocial function and well-being after 2 years, whereas patterns of social activities and contacts became gradually less inhibited during a 4-year period after injury. Analysis of complications in patients' histories that affected function and mood showed severe pain to be the only complication that related to lower quality-of-life scores. Urinary incontinence and infection and autonomous dysreflexia related to inhibited self-care performance; spasticity related to impaired ambulation and feeding skills. Gainful employment was the only demographic factor linked to high quality-of-life scores.     

Recent advance and current status of management of head trauma in China

It is estimated that more than 1 million Chinese people sustain traumatic brain injury （TBI） annually, nearly 10% of whom are dead and 30% are compli-cated with physical, cognitive, behavioral and/or psychosocial impairments in China. A lot of experimental researches and clinical trials of head trauma have been made in China recently, which improves the understanding of pathological mechanisms and prognosis of severe traumatic brain injury.     

Neurobehavioral outcome in persons with violent or nonviolent traumatic brain injury

OBJECTIVE: To broaden the investigation of those injured violently by examining neuropsychological and psychosocial outcomes in relation to circumstances of traumatic brain injury and preinjury factors. DESIGN: A prospective, longitudinal study. PARTICIPANTS: A total of 752 adults with traumatic brain injury was grouped into those injured by violent or nonviolent circumstances and followed to 1-year post injury. MAIN OUTCOME MEASURES: Circumstance groups were compared on demographics, preexisting conditions, brain injury severity, and neuropsychological and psychosocial outcomes. RESULTS: The results indicate significant differences between the groups on demographics, preexisting conditions, and head injury severity. Neuropsychological and psychosocial outcome did not differ between the circumstance groups when all other factors were taken into account. CONCLUSIONS: Injury severity and characteristics of the person that predate the injury were important to outcome rather than the circumstances of the injury itself.     

Sustained attention in children and adolescents after traumatic brain injury: relation to severity of injury, adaptive functioning, ADHD and social background

Primary objective: To examine the relationship of child and family psychosocial variables and traumatic brain injury (TBI) severity as it relates to sustained attention (the Paediatric Assessment of Cognitive Efficiency, PACE).

Research design: Forty-two children and adolescents were recruited and participated in a 2 year longitudinal study to evaluate sustained attention using the computerized testing metric, PACE. More specifically, errors of omission (inattention) and commission (impulsiveness) were measured.

Main outcomes and results: Significant improvement on inattention and impulsiveness were observed over time. High pre-injury psychosocial adversity and low pre-injury adaptive functioning significantly predicted a greater number of inattention errors. Severity of injury predicted the reduction of impulsiveness. Moreover, omission errors immediately after TBI predicted later secondary attention-deficit/hyperactivity disorder (SADHD, ADHD that emerges after TBI).

Conclusions: Based on these findings, it is important to consider pre-injury child and family psychosocial characteristics in addition to severity of injury when predicting outcome of TBI in children.     

综合康复护理对颅脑损伤患者神经恢复及生活质量影响的研究

目的：探讨综合康复护理对颅脑损伤患者神经恢复及生活质量的影响。方法选取2011年10月~2013年10月来我院治疗的443例颅脑损伤患者,按照入院的先后顺序分为两组,观察组222例,对照组221例,对照组实施常规康复功能锻炼,观察组实施综合康复护理,即在常规康复功能锻炼的基础上实施促醒护理。比较两组患者清醒时间、并发症发生率、NDF评分、生活质量评分。结果观察组清醒时间、并发症发生率、出院时观察组的NDF评分与对照组比较明显较低,差异有统计学意义（P＜0.05）。观察组干预后生活质量量表的躯体功能、心理功能、社会功能及物质生活状态评分与对照组比较均显著升高,差异有统计学意义（P＜0.05）。结论颅脑损伤患者实施常规康复功能锻炼及促醒护理在内的综合康复护理能降低并发症的发生率,缩短清醒时间,降低NDF评分,提高患者生活质量,临床效果显著。     

脑外伤后进展性出血性损伤的发生率及其危险因素分析

目的调查脑外伤后进展性出血性损伤的发生率,分析其发生的危险因素。方法回顾性分析2009年6月至2011年6月本院收治的168例脑外伤患者。收集年龄、性别、入院时间、入院时GCS评分、蛛网膜下腔出血、中线移位、环池形态、瞳孔散大、急诊手术、首次CT时间、创伤严重程度评分和APACHEⅡ评分等资料。计算脑外伤后进展性出血性损伤的发生率,采用非条件多因素Logistic回归分析确定脑外伤后进展性出血性损伤发生的危险因素。结果 63例(37.5%)脑外伤患者发生进展性出血性损伤。多因素Logistic回归分析显示,蛛网膜下腔出血(OR=12.421,95%CI=1.263～42.715,P=0.001)和首次CT时间(OR=0.421,95%CI=0.263～0.715,P=0.002)是脑外伤后进展性出血性损伤发生的独立危险因素。结论脑外伤后进展性出血性损伤发生率较高,外伤性蛛网膜下腔出血和短时间内完成首次CT检查是脑外伤后进展性出血性损伤的独立危险因素。